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PSYCHOLOGY
(8th Edition)
David Myers
PowerPoint Slides
Aneeq Ahmad
Henderson State University
Worth Publishers, © 2006
1
Psychological Disorders
&
Therapy
Chapter 16,17
2
3
Psychological Disorders
Perspectives on Psychological
Disorders
 Defining Psychological Disorders
 Understanding Psychological
Disorders
 Classifying Psychological Disorders
 Labeling Psychological Disorders
4
Psychological Disorders
Anxiety Disorders
 Generalized Anxiety Disorder and
Panic Disorder
 Phobias
 Obsessive-Compulsive Disorders
 Post-Traumatic Stress Disorders
 Anxiety Disorder Explanation
5
Psychological Disorders
Mood Disorders
 Major Depressive Disorders
 Bipolar Disorder
 Mood Disorder Explanation
Schizophrenia
 Symptoms of Schizophrenia
 Subtypes of Schizophrenia
6
Psychological Disorders
Schizophrenia
 Understanding Schizophrenia
Personality Disorders
Rates of Psychological
Disorders
7
Psychological Disorders
I felt the need to clean my room … spent four to five
hours 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)
8
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.
9
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.
10
• Psychological Disorder
 a “harmful dysfunction” in
which behavior is judged to be:
atypical--not normal
disturbing--varies with time
and culture
maladaptive--harmful
unjustifiable--sometimes
there’s a good reason
11
Defining Psychological Disorders
Definition (part A) - Mental health workers
view psychological disorders as persistently
harmful thoughts, feelings, and actions.
Definition (part B) - When behavior is deviant,
distressful, and dysfunctional psychiatrists
and psychologists label it as disordered (Comer,
2004).
12
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.
13
Perceived Causes
• movements of sun or moon
• lunacy--full moon
• evil spirits
Ancient Treatments
• exorcism, caged like animals, beaten,
burned, castrated, mutilated, blood
replaced with animal’s blood
•
Trephination (boring holes in the
skull to remove evil forces)
John W. Verano
14
•
Medical MODEL
concept that diseases have physical causes
can be diagnosed, treated, and in most cases, cured
assumes that these “mental” illnesses can be diagnosed on the
basis of their symptoms and cured through therapy, which may
include treatment in a psychiatric hospital
George Wesley Bellows, Dancer in a Madhouse, 1907. © 1997 The Art Institute of Chicago
Philippe Pinel (1745-1826)
from France, insisted
that madness was not
due to demonic
possession, but an
ailment of the mind.
Dance in the madhouse.
15
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.
16
Biopsychosocial Perspective
•
Assumes that biological, socio-cultural,
and psychological factors combine and
interact to produce psychological disorders.
17
18
1. The American Psychiatric Association rendered a
Diagnostic and Statistical Manual of Mental Disorders
(DSM) to describe psychological disorders.
2. The most recent edition, DSM-IV-TR (Text Revision,
2000), describes 400 psychological disorders compared
to 60 in the 1950s.
3. Neurotic Disorder (term seldom used now)
usually distressing but that allows one to think rationally
and function socially
4. Psychotic Disorder -person loses contact with reality
experiences irrational ideas and distorted perceptions
19
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?
20
Multiaxial Classification
Note 16 syndromes in Axis I
21
Multiaxial Classification
Note Global Assessment for Axis V
22
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.”
•The danger of over diagnosis
•The power of diagnostic labels
•Confusion of serious mental
disorders with normal
problems
•The illusion of objectivity
23
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)
24
2. Labels may be helpful for healthcare
professionals when communicating with
one another and establishing therapy.
3. “Insanity” labels raise moral
Rampage
1987-R-91 minutes Rampage delves into the subject of legal
insanity, so often the default defense in modern-time
gruesome crime trials. Alex McArthur plays an outwardly
normal guy who goes on incredible killing and mutilating
sprees until (and even after, when he escapes for a short time)
he's captured. When he comes to trial, the liberal DA
Theodore Kaczynski
(Michael Biehn) is torn between his own leftist leanings and
(Unabomber)
the reality of the heinous crimes for which the accused is
being tried. He must argue for the death penalty
25
Elaine Thompson/ AP Photo
and ethical questions about how
society should treat people who
have disorders and have
committed crimes.
Feelings of excessive apprehension and anxiety.
Anxiety Disorders
distressing, persistent anxiety or maladaptive behaviors that reduce
anxiety
Generalized Anxiety Disorder
person is tense, apprehensive, and in a state of autonomic nervous
system arousal
Panic Disorder
marked by a minutes-long episode of intense dread in which a person
experiences terror and accompanying chest pain, choking, or other
frightening sensation
Phobia
persistent, irrational fear of a specific object or situation
Obsessive-Compulsive Disorder
26
unwanted repetitive thoughts (obsessions) and/or actions (compulsions)
•Marked by a persistent and irrational fear of
an object or situation that disrupts behavior.
SOME COMMON &
UNCOMMON FEARS
This national survey
ranked the relative fear
levels of Americans to
some sources of anxiety.
A fear becomes a phobia
if it provokes a
compelling but irrational
desire to avoid the
dreaded object or
situations.
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
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)
Is a disorder in which a person exhibits two or
more distinct and alternating personalities,
formerly called multiple personality disorder.
formerly called multiple personality disorder
Lois Bernstein/ Gamma Liason
Multiple Personality
Tony, walking down a country road, is shown talking
to himself about his multiple personalities. Dr. Frances
Howland of the Yale University School of Medicine
describes Tony’s case, and viewers are shown Tony’s
therapy sessions as different personalities emerge. The
narrator explains the phenomenon as triggered in
childhood by the need to flee psychologically from
physical or sexual abuse.
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
Emotional extremes of mood disorders
come in two principal forms.
1.
“common cold”
of psych
disorders;
pervasive as
well! #1 reason
why people seek
mental health
services.
Major depressive disorder -a mood disorder in which a person, for no
apparent reason, experiences two or more weeks of depressed moods,
feelings of worthlessness, and diminished interest or pleasure in most
activities; usually rebounds to normalcy.
Mood Disorders: Mania and Depression
Presents vivid examples of the mood fluctuations of
patients who suffer from periodic affective episodes.
41
2. Bipolar Disorder - a mood disorder in which the person alternates
between the hopelessness and lethargy of depression and the overexcited
state of mania
– formerly called manic-depressive disorder
– Manic Episode
» a mood disorder marked by a hyperactive,
wildly optimistic state
Depressive Symptoms
Manic Symptoms
Gloomy
Elation
Withdrawn
Euphoria
Inability to make decisions
Tired
Slowness of thought
Desire for action
Hyperactive
Multiple ideas
42
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
43
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
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 – top 5
list… Lewinsohn et al., (1985, 1995) note that a
theory of depression should explain the
following:
1. Many behavioral & cognitive changes accompany
depression
2. depression is wide spread
3. compared w/ men women are twice as likely to
get major depression, & even more so if they
have been depressed before! (see chart next
slide)
4. most major depressive episodes last less than 6
months
5. stressful events related to work, marriage, and
close relationships often precede depression
46
38,000 adults in 10 countries
confirm what many smaller
studies have found. NOTE –
lifetime risk of depression
varies by culture (1.5% in
Taiwan to 19% in Beirut).
47
Canadian depression rates, by gender & age
Among the 1-3 million
Canadians who
acknowledge having
suffered depression for
at least 2 weeks in the
previous year, young
adults and women were
at most risk.
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%).
Mood Disorders: Hereditary Factors
Illustrates the findings of a 10-year
study that involved 12,000 volunteers
in an Amish community and represents
careful analysis of genetic factors
related to manic-depressive disorders.
Jerry Irwin Photography
Linkage analysis and
association studies link
possible genes and
dispositions for depression.
50
the depressed brain…
neurotransmitters - norepinephrine
arousal and mood => overabundant during mania,
during depression
serotonin also
during depression!
Therapy => Prozac, Zoloft, Paxil, OR regular exercise …
norepinephrine, serotonin
Best thing to beat
the blues…get a
good workout!
Mood Disorders: Medication
and Talk Therapy
Shows the effectiveness of
combining drug therapies with
traditional psychotherapy.
Norepinephrine
No wonder why Oz is
always in a good mood!
He worked out this
morning!
Pre-synaptic
Neuron
Serotonin
Post-synaptic
Neuron
Bipolar Disorder => lithium bicarbonate
51
Social-Cognitive Perspective
The social-cognitive perspective suggests that
depression arises partly from self-defeating
beliefs and negative explanatory styles.
52
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.
Negative moods = negative thoughts. Which comes
first? They coincide. Happiness creates happy
behaviors, negativity creates negative behavior.
53
Example
Explanatory style plays a major role in becoming depressed.
54
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.
55
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.
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 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”).
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
(apathy).
Patients with schizophrenia may continually
rub an arm, rock a chair, or remain motionless
for hours (catatonia).
Schizophrenia is a cluster of disorders. These
subtypes share some features, but there are
other symptoms that differentiate these
subtypes.
60
Positive and
Negative
Symptoms
Schizophrenia: Symptoms
In this module, mental health professionals observe a patient named Jerry, a
classic schizophrenic. Jerry’s case and medication schedule are described, and his
disordered speech and behavior are shown. Prominent psychiatrists describe
schizophrenia and the prognosis for those diagnosed with this disease; a locked
psychiatric ward provides a graphic illustration.
positive symptoms: Schizophrenics
+ symptoms = presence of
have inappropriate symptoms
inappropriate behavior
(hallucinations, disorganized thinking,
deluded ways) that are not present in normal
- symptoms = absence of
individuals.
appropriate behaviors
negative symptoms:
Schizophrenics also have an
absence of appropriate symptoms
(apathy, expressionless faces,
rigid bodies) that are present in
normal individuals.
chronic => slow
developing => recovery is
doubtful
acute / reactive =>
immediate reaction =>
recovery is more likely
61
Subtypes
62
**most dreaded psychological disorder =>
disease of the brain exhibited in symptoms of
the mind!
DOPAMINE
LEVELS ARE
HIGH!
Brain Abnormalities
Dopamine Overactivity: Researchers found that
schizophrenic patients express higher levels of
dopamine D4 receptors in the brain.
=> MORE HALLUCINATIONS AND PARANOIA
**AMPHETAMINES AND COCAINE WILL INCREASE
63
Abnormal Brain Activity
**Brain Anatomy => PET scans reveals activity in the thalamus
when hallucinating; shrinking of cerebral tissue (involving the
hypothalamus and amygdala)=> greater the shrinkage, greater
the problem…this is a problem of not a single area of the brain,
but rather several brain regions!
Paul Thompson and Arthur W. Toga, UCLA Laboratory of Neuro
Imaging and Judith L. Rapport, National Institute of Mental Health
64
RISK OF DEVELOPING
SCHIZOPHRENIA
My identical twin (who has
Schizophrenia) has an
enlarged fluid-filled cranial
cavity & I do NOT! Since
not all IT get Schiz., there
MUST be other factors as
well such as … viruses,
nutritional or oxygen
deprivation at birth etc.
Both Photos: Courtesy of Daniel R. Weinberger, M.D., NIH-NIMH/ NSC
Lifetime risks of
developing schiz. vary
w/ one’s genetic
relatedness to
someone having this
disorder….risk
increases w/ genetic
closeness to relative
w/ schiz. (approx. 7%
from a sibling to over
40% from an
identical twin.)
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, 1991).
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 (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.
69
Warning Signs
Early warning signs of schizophrenia include:
1. A mother’s long lasting schizophrenia.
2. Birth complications, oxygen deprivation and
low-birth weight.
3. Short attention span and poor muscle
coordination.
4. Disruptive and withdrawn behavior.
5. Emotional unpredictability.
6. Poor peer relations and solo play.
70
Definition: Personality disorders
are characterized by inflexible and
enduring behavior patterns that
impair social functioning.
*They are usually without anxiety,
depression, or delusions.
*SOME CLUSTERS / TYPES:
•
•
•
•
•
Avoidant personality disorder
Schizoid personality disorder
Histrionic personality disorder
Narcissistic personality disorder
Borderline personality disorder
71
Antisocial Personality Disorder
A disorder in which the person (usually men) exhibits a
lack of conscience for wrongdoing, even toward friends
and family members.
 may be aggressive and ruthless or a clever con artist
Formerly, this person was called a sociopath or psychopath.
72
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.
COLD BLOODED
AROUSABILITY
& RISK OF CRIME
levels of stress hormone adrenaline were
measured in 2 groups of 13 yr. Old
Swedish boys. In both stressful and nonstressful situations, those who were later
convicted of a crime (as 18-26 yr olds)
showed relatively low arousal =>fearless
approach to life!!!!
73
PET scans of 41 murderers revealed reduced activity in the
murder’s frontal lobes, a brain area that helps brake impulsive,
aggressive behavior. Frontal lobe damage can impair people’s
discerning right from wrong.
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
74
Understanding Antisocial
Personality Disorder
bio-psycho-social roots of crime
Danish male babies whose backgrounds were marked BOTH by obstetrical complications and social
stresses associated with poverty were twice as likely to be criminal offenders by ages 20-22 as those
in either the biological or social risk groups. The likelihood that one will commit a crime doubles
when childhood poverty is compounded with obstetrical complications (Raine et al., 1999; 2000).
Biological
risk factors
@ birth
Double the
RISK! When
nature and
nurture
interact!
75
NIMH => US National Institute of Mental Health: representative sample
of 20,000 institutionalized and community resident revealed 1 in 3 US adults
had experienced a psychological disorder AND 1 in 5 was currently
experiencing a disorder. The 3 most common were:
Phobic disorder
Alcohol abuse / dependence (men 5 to 1 vs. females)
Mood disorder (women 2 to 1 vs. males)
76
Rates of Psychological Disorders
The prevalence of psychological disorders during
the previous year is shown below (WHO, 2004).
77
Risk and Protective Factors
Risk and protective factors for mental disorders
(WHO, 2004).
78
Risk and Protective Factors
79
PSYCHOLOGY
(8th Edition)
David Myers
PowerPoint Slides
Aneeq Ahmad
Henderson State University
Worth Publishers, © 2006
80
Therapy
Chapter 17
81
Therapy
The Psychological Therapies
 Psychoanalysis
 Humanistic Therapies
 Behavior Therapies
 Cognitive Therapies
 Group and Family Therapies
82
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
83
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)
84
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.
85
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
86
Dorthea Dix (1745-1826)
Philippe Pinel (1745-1826)
1. PSYCHOTHERAPY- an emotionally charged, confiding interaction between a trained therapist
and someone who suffers from psychological difficulties
Eclectic Approach - an approach to psychotherapy that, depending on the client’s problems,
uses techniques from various forms of therapy
Psychoanalysis- Freud believed the patient’s free associations, resistances, dreams, and
transferences – and the therapist’s interpretations of them – released previously repressed
feelings, allowing the patient to gain self-insight
use has rapidly decreased in recent years
Resistance- blocking from consciousness of anxiety-laden material
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
e.g. love or hatred for a parent
87
Psychoanalysis
The first formal psychotherapy to emerge was
psychoanalysis, developed by Sigmund Freud.
Edmund Engleman
Sigmund Freud's famous couch
88
Therapy
Evaluating Psychotherapies
 The Effectiveness of Psychotherapy
 The Relative Effectiveness of
Different Therapies
 Alternative Therapies Evaluated
 Commonalities Among
Psychotherapies
 Culture and Values in
Psychotherapies
89
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.
90
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
91
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.
92
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.
93
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.
94
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.
95
Humanistic Therapies
Humanistic therapists aim to boost selffulfillment by helping people grow in selfawareness and self-acceptance.
96
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.
97
2. HUMANISITIC APPROACH
Client-Centered Therapy
developed by Carl Rogers
therapist uses techniques such as active listening within a
genuine, accepting, empathic environment to facilitate clients’
growth
Active Listening-empathic listening in which the listener echoes,
restates, and clarifies
98
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.
99
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.
100
3. BEHAVIOR THERAPY- therapy that applies learning
principles to the elimination of unwanted behaviors
Counter conditioning
-procedure that conditions new responses to stimuli that trigger
unwanted behaviors
-based on classical conditioning
-includes systematic desensitization and aversive conditioning
-treat anxieties by exposing people (in imagination or reality)
to the things they fear and avoid
101
Systematic Desensitization
-type of counter conditioning
-associates a pleasant, relaxed state with gradually
increasing anxiety-triggering stimuli
-commonly used to treat phobias
102
Aversive Conditioning
-type of counter conditioning that associates an unpleasant
state with an unwanted behavior
nausea ---> alcohol
OPERANT CONDITIONING => Token Economy
-an operant conditioning procedure that rewards desired behavior
-patient exchanges a token of some sort, earned for exhibiting the desired behavior, for
various privileges or treats
103
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.
104
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
105
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.
106
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.
107
COGNITIVE THERAPY
-teaches people new, more adaptive ways of
thinking and acting
-based on the assumption that thoughts
intervene between events and our emotional
reactions
The Cognitive Revolution
½ OF ALL FACULTY IN
ACCREDITED CLINICAL
PSYCH. DOCTORAL
PROGRAMS NOW ALIGN
THEMSELVES W/ A
COGNITIVE OR
COG-BEH. THERAPY
ORIENTATION.
108
Person’s emotional
reactions are
produced not directly
by the event but by
the person’s thoughts
in response to the
event.
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
FAMILY THERAPY
-treats the family as a 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
114
Regression toward the mean
tendency for extremes of unusual
events/ EMOTIONS/ behaviors/
scores/performances to fall back
(regress) toward their average
state
***thus anything we try in the
interim may seem to be effective
**apply to therapy!
115
Psychopharmacology
•study of the effects of drugs on mind and
behavior
•Lithium =>chemical that provides an
effective drug therapy for the mood swings of
bipolar
(manic-depressive) disorders
The emptying of U.S. mental
hospitals:
After the widespread introduction
of antipsychotic drugs, starting in
1955, the number of residents in
state and county mental hospitals
declined sharply. Rush to
deinstitutionalize the mentally ill
=> homelessness increased!
116
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
117
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.
118
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.
119
Atypical Antipsychotic
Clozapine (Clozaril) blocks receptors for
dopamine and serotonin to remove the negative
symptoms of schizophrenia.
120
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.
121
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.
122
Brain Stimulation
Electroconvulsive Therapy (ECT)
therapy for severely depressed
patients, although controversial, it is
the preferred treatment for
depression that DOES NOT respond
to drug therapy. A brief electric
current is sent through the brain of
an anesthetized patient, might result
in a slight memory loss.
Psychosurgery
surgery that removes or destroys
brain tissue in an effort to change
behavior
lobotomy
now-rare psychosurgical
procedure once used to calm
uncontrollably emotional or
violent patients
123
124
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.
125
Evaluating Therapies
Who do people turn to for help with
psychological difficulties?
126
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?
127
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.
128
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.
129
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.
130
Outcome Research
Research shows that treated patients were 80%
better than untreated ones.
131
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
132
Evaluating Alternative Therapies
Lilienfeld (1998) suggests comparing scientific
therapies against popular therapies through
electronic means. The results of such a search
are below:
133
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.
134
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.
135
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.
136
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.
137
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.
138
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.
139
The Biomedical Therapies
These include physical, medicinal, and other
forms of biological therapies.
1. Drug Treatments
2. Surgery
3. Electric-shock therapy
140
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.
141
Schizophrenia Symptoms
Inappropriate symptoms
present (positive
symptoms)
Appropriate symptoms
absent (negative
symptoms)
Hallucinations,
disorganized thinking,
deluded ways.
Apathy, expressionless
faces, rigid bodies.
142
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.
143
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.
144
Psychosurgery
Psychosurgery is used as a last resort in
alleviating psychological disturbances.
Psychosurgery is irreversible. Removal of brain
tissue changes the mind.
145
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
146
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.
147
Psychological Disorders are
Biopsychosocial in Nature
148
•3D’s
•Medical model
•Pinel
•Biopsychosocial approach
•DSM-IV
•AXIS 1 & 2
•AXIS 3,4,5
•GAD
•Panic Disorder
•Phobias
•OCD
•PTSD
•DID
•Depression
•Bipolar Disorder
•glucose
•Suicide
•Linkage studies
•Schizophrenia
DIRECTIONS
•Dopamine
Using the term you have chosen create a
•Twin studies
•Personality disorders piece of graffiti or a cartoon to hang in
the room. Include:
•Frontal lobe
•Term
•D. Dix
•picture depicting/illustrating the term
•Psychotherapy
•definition/ explanation/ symptoms etc
•Eclectic approach
BE Creative and hang ANYWHERE
you want to in the classroom!
•Transference
•Free association
•Active listening
•Exposure therapy
•Systematic desensitization
•Aversive conditioning
•Family therapy
•Regression toward the mean
•Psychopharmacology
•SSRI’s
•ECT
149
•lobotomy
150
Some things to remember (do not limit yourself to this list!):
NAMES: Pinel, Rogers, Freud, etc..
Perspectives of Psych => diagnosis & treatment
Models of Psychological disorders
DSMVI ( +/-)
Correct terminology “political correctness”
Disorders =>definitions, symptoms, treatments
Play psychiatrists
Subtypes of schizophrenia
Therapies/ Treatments
Psychoanalysis => free association
Humanism => client centered therapy/ active listening
VOCAB terms: Transference/ resistance
Behavior/ “learning” treatments / examples => token economy
psychopharmacology
mental hospitals
disorders and “brain and biology” => neurotransmitters: dopamine, seratonin, norepinephrine
META-Analysis
Ellis => RET
151