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Psychological Disorders
Chapter 16
1
Psychological Disorders
Perspectives on Psychological
Disorders
 Defining Psychological Disorders
 Understanding Psychological
Disorders
 Classifying Psychological Disorders
 Labeling Psychological Disorders
2
Psychological Disorders
Anxiety Disorders
 Generalized Anxiety Disorder and
Panic Disorder
 Phobias
 Obsessive-Compulsive Disorders
 Post-Traumatic Stress Disorders
 Anxiety Disorder Explanation
3
Psychological Disorders
Mood Disorders
 Major Depressive Disorders
 Bipolar Disorder
 Mood Disorder Explanation
Schizophrenia
 Symptoms of Schizophrenia
 Subtypes of Schizophrenia
4
Psychological Disorders
Schizophrenia
 Understanding Schizophrenia
Personality Disorders
Rates of Psychological
Disorders
5
Psychological Disorders
I felt the need to clean my room … spent four to five
hour at it … At the time I loved it but then didn't want
to do it any more, but could not 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)
6
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.
7
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.
8
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).
9
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.
10
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)
11
Medical Perspective
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.
12
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. Etiology: Cause and development of the
disorder.
2. Diagnosis: Identifying (symptoms) and
distinguishing one disease from
another.
3. Treatment: Treating a disorder in a
psychiatric hospital.
13
Biopsychosocial Perspective
Assumes that biological, socio-cultural, and
psychological factors combine and interact to
produce psychological disorders.
14
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.
15
Multiaxial Classification
Axis I
Axis II
Axis III
Axis IV
Axis V
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,
hypertension or arthritis etc) also
present?
Are Psychosocial
or Environmental
Problems (school or housing issues) also
present?
What is the Global
Assessment of the
person’s functioning?
16
Multiaxial Classification
Note 16 syndromes in Axis I
17
Multiaxial Classification
Note Global Assessment for Axis V
18
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.”
19
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)
20
Labeling Psychological Disorders
2. Labels may be helpful for healthcare
professionals when communicating with
one another and establishing therapy.
21
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)
22
Anxiety Disorders
Feelings of excessive apprehension and anxiety.
1. Generalized anxiety disorders
2. Phobias
3. Panic disorders
4. Obsessive-compulsive disorders
23
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.
24
Panic Disorder
Symptoms
Minute-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.
25
Phobia
Marked by a persistent and irrational fear of an
object or situation that disrupts behavior.
26
Kinds of Phobias
Agoraphobia
Acrophobia
Claustrophobia
Hemophobia
Phobia of open places.
Phobia of heights.
Phobia of closed spaces.
Phobia of blood.
27
Obsessive-Compulsive Disorder
Persistence of unwanted thoughts (obsessions)
and urges to engage in senseless rituals
(compulsions) that cause distress.
28
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
29
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
30
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.
31
Explaining Anxiety Disorders
Freud suggested that we repress our painful
and intolerable ideas, feelings, and thoughts,
resulting in anxiety.
32
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.
33
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.
34
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.
35
The Biological Perspective
Anterior Cingulate Cortex
of an OCD patient.
36
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.
Dissociative Disorder
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.
37
Dissociative Identity Disorder (DID)
Is 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)
38
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.
39
Mood Disorders
Emotional extremes of mood disorders come in
two principal forms.
1. Major depressive disorder
2. Bipolar disorder
40
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
Gasping for air after a
hard run
Major Depressive
Disorder
Chronic shortness of
breath
41
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.
Signs include:
1. Lethargy and fatigue
2. Feelings of worthlessness
3. Loss of interest in family &
friends
4. Loss of interest in activities
42
Dysthymic Disorder
Dysthymic disorder lies between a blue mood
and major depressive disorder. It is a disorder
characterized by daily depression lasting two
years or more.
Blue
Mood
Dysthymic
Disorder
Major Depressive
Disorder
43
Bipolar Disorder
Formerly called manic-depressive disorder. An
alternation between depression and mania
signals bipolar disorder.
Depressive Symptoms
Manic Symptoms
Gloomy
Withdrawn
Inability to make
decisions
Tired
Slowness of thought
Elation
Euphoria
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.
Clemens
Hemingway
45
Earl Theissen/ Hulton Getty Pictures Library
The Granger Collection
Wolfe
George C. Beresford/ Hulton Getty Pictures Library
Bettmann/ Corbis
Whitman
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, 1995) 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. 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.
Suicide Statistics
1. National differences
2. Racial differences
3. Gender differences
4. Age differences
5. 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
Neurotransmitters & Depression
A reduction of
norepinephrine and
serotonin has been
found in depression.
Pre-synaptic
Neuron
Norepinephrine
Drugs that alleviate
mania reduce
norepinephrine.
Serotonin
Post-synaptic
Neuron
51
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
52
Social-Cognitive Perspective
The social-cognitive perspective suggests that
depression arises partly from self-defeating
beliefs and negative explanatory styles.
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
Example
Explanatory style plays a major role in becoming
55
depressed.
Schizophrenia
If depression is the common cold of
psychological disorders, schizophrenia is the
cancer.
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.
56
Symptoms of Schizophrenia
The literal translation is “split mind.” A group
of severe disorders characterized by the
following:
1. Disorganized and delusional
thinking.
2. Disturbed perceptions.
3. Inappropriate emotions and
actions.
57
Disorganized & Delusional Thinking
This morning when I was at Hillside [Hospital],
I was making a movie. I was surrounded by
movie stars … I’m Marry 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”).
58
Disorganized & Delusional Thinking
Many psychologists believe disorganized
thoughts occur because of selective attention
failure (fragmented and bizarre thoughts).
59
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.
Photos of paintings by Krannert Museum, University of Illinois at Urbana-Champaign
August Natter, Witches Head. The Prinzhorn Collection, University of Heidelberg
L. Berthold, Untitled. The Prinzhorn Collection, University of Heidelberg
60
Inappropriate Emotions & Actions
A schizophrenic person may laugh at the news
of someone dying or show no emotion at all
(apathy).
Patients with schizophrenia may continually
rub an arm, rock a chair, or remain motionless
for hours (catatonia).
61
Subtypes of Schizophrenia
Schizophrenia is a cluster of disorders. These
subtypes share some features, but there are
other symptoms that differentiate these
subtypes.
62
Positive and Negative Symptoms
Schizophrenics have inappropriate symptoms
(hallucinations, disorganized thinking, deluded
ways) that are not present in normal
individuals (positive symptoms).
Schizophrenics also have an absence of
appropriate symptoms (apathy, expressionless
faces, rigid bodies) that are present in normal
individuals (negative symptoms).
63
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.
64
Subtypes
65
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.
66
Abnormal Brain Activity
Brain scans show abnormal activity in the
frontal cortex, thalamus, and amygdala of
schizophrenic patients. Adolescent
schizophrenic patients also have brain lesions.
Paul Thompson and Arthur W. Toga, UCLA Laboratory of Neuro
Imaging and Judith L. Rapport, National Institute of Mental Health
67
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
68
Viral Infection
Schizophrenia has also been observed in
individuals who contracted a viral infection
(flu) during the middle of their fetal
development.
69
Genetic Factors
The likelihood of an individual suffering from
schizophrenia is 50% if their identical twin has
the disease (Gottesman, 1991).
0 10 20 30 40 50
Identical
Both parents
Fraternal
One parent
Sibling
Nephew or niece
Unrelated
70
Genetic Factors
The following shows the prevalence of
schizophrenia in identical twins as seen in
different countries.
71
Psychological Factors
Psychological and environmental factors can
trigger schizophrenia if the individual is
genetically predisposed (Nicols & 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.
72
Warning Signs
Early warning signs of schizophrenia include:
1. A mother’s long lasting schizophrenia.
2.
4.
Birth complications, oxygen
deprivation and low-birth weight.
Short attention span and poor muscle
coordination.
Disruptive and withdrawn behavior.
5.
6.
Emotional unpredictability.
Poor peer relations and solo play.
3.
73
Personality Disorders
Personality disorders
are characterized by
inflexible and
enduring behavior
patterns that impair
social functioning.
They are usually
without anxiety,
depression, or
delusions.
74
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.
75
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.
76
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
compared to normals (Raine et al., 1999; 2000).
Courtesy of Adrian Raine,
University of Southern California
Normal
Murderer
77
Understanding Antisocial
Personality Disorder
The likelihood that one will commit a crime doubles
when childhood poverty is compounded with
obstetrical complications (Raine et al., 1999; 2000).
78
Rates of Psychological Disorders
79
Rates of Psychological Disorders
The prevalence of psychological disorders during
the previous year is shown below (WHO, 2004).
80
Risk and Protective Factors
Risk and protective factors for mental disorders
(WHO, 2004).
81
Risk and Protective Factors
82
Therapy
Chapter 17
83
Therapy
The Psychological Therapies
 Psychoanalysis
 Humanistic Therapies
 Behavior Therapies
 Cognitive Therapies
 Group and Family Therapies
84
Therapy
Evaluating Psychotherapies
 The Effectiveness of Psychotherapy
 The Relative Effectiveness of
Different Therapies
 Alternative Therapies Evaluated
 Commonalities Among
Psychotherapies
 Culture and Values in
Psychotherapies
85
Therapy
The Biomedical Therapies
 Drug Therapies
 Brain Stimulation Psychosurgery
Preventing Psychological
Disorders
86
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
87
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 (1745-1826)
88
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, curing him or her of psychological
disorders.
An eclectic approach uses various forms of
healing techniques depending upon the client’s
unique problems.
89
Psychological Therapies
We will look at four major forms of
psychotherapies based on different theories of
human nature:
1.
2.
3.
4.
Psychoanalytical theory
Humanistic theory
Behavioral theory
Cognitive theory
90
Psychoanalysis
The first formal psychotherapy to emerge was
psychoanalysis, developed by Sigmund Freud.
Edmund Engleman
Sigmund Freud's famous couch
91
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.
92
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
93
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.
94
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.
95
Psychodynamic Therapies
Influenced by Freud, in a face-to-face setting,
psychodynamic therapists understand
symptoms and themes across important
relationships in a patient’s life.
96
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.
97
Humanistic Therapies
Humanistic therapists aim to boost selffulfillment by helping people grow in selfawareness and self-acceptance.
98
Person-Centered Therapy
Developed by Carl Rogers, person-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.
99
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.
100
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.
101
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.
102
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.
103
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
104
Systematic Desensitization
A type of exposure therapy that associates a
pleasant, relaxed state with gradually increasing
anxiety-triggering stimuli commonly used to
treat phobias.
105
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.
106
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.
107
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.
108
Cognitive Therapy
Teaches people adaptive ways of thinking and
acting based on the assumption that thoughts
intervene between events and our emotional
reactions.
109
Cognitive 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.
110
Cognitive Therapy for Depression
Rabin et al., (1986)
trained depressed
patients to record
positive events each day,
and relate how they
contributed to these
events. Compared to
other depressed patients,
trained patients showed
lower depression scores.
111
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.”
112
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).
113
Group Therapy
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.
114
Family Therapy
Family therapy treats the family as a system.
Therapy guides family members toward
positive relationships and improved
communication.
115
Evaluating Therapies
Who do people turn to for help with
psychological difficulties?
116
Evaluating Psychotherapies
Within psychotherapies cognitive therapies are
most widely used, followed by psychoanalytic
and family/group therapies.
117
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?
118
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.
119
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.
120
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.
121
Outcome Research
Research shows that treated patients were 80%
better than untreated ones.
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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
123
Evaluating Alternative Therapies
Lilienfeld (1998) suggests comparing scientific
therapies against popular therapies through
electronic means. The results of such a search
are below:
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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.
125
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.
126
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.
127
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.
128
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.
129
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.
130
The Biomedical Therapies
These include physical, medicinal, and other
forms of biological therapies.
1. Drug Treatments
2. Surgery
3. Electric-shock therapy
131
Drug Therapies
Psychopharmacology is the study of drug effects
on mind and behavior.
With the advent of drugs, hospitalization in mental
132
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
133
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.
134
Schizophrenia Symptoms
Inappropriate symptoms
present (positive
symptoms)
Appropriate symptoms
absent (negative
symptoms)
Hallucinations,
disorganized thinking,
deluded ways.
Apathy, expressionless
faces, rigid bodies.
135
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.
136
Atypical Antipsychotic
Clozapine (Clozaril) blocks receptors for
dopamine and serotonin to remove the negative
symptoms of schizophrenia.
137
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.
138
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.
139
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.
140
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.
141
Alternatives to ECT
Transcranial Magnetic
Stimulation (TMS)
In TMS, a pulsating
magnetic coil is placed
over prefrontal regions
of the brain to treat
depression with
minimal side effects.
142
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.
143
Psychosurgery
Psychosurgery is used as a last resort in
alleviating psychological disturbances.
Psychosurgery is irreversible. Removal of brain
tissue changes the mind.
144
Psychosurgery
http://www.epub.org.br
Modern methods use
stereotactic
neurosurgery and
radiosurgery (Laksell,
1951) that refine older
methods of
psychosurgery.
http://www.epub.org.br
145
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.
146
Psychological Disorders are
Biopsychosocial in Nature
147