Psychology Chapter 18 – Psychological Disorders Chapter 19 – Methods of Therapy

1. PsychologyChapter 18 – Psychological DisordersChapter 19 – Methods of Therapy R. M. Tolles

2. Psychological Disorders • Psychological Disorder a “harmful dysfunction” in which behavior is judged to be: • Atypical • not enough in itself • Disturbing • varies with time and culture • Maladaptive • harmful • Unjustifiable • By what standard?

3. Defined as Function • Individual is not functioning adequately based on either his/her standards or according to significant others in the person’s life. • Almost all the disorders we discuss have symptoms that everyone experiences. Diagnosis of disorder depends of intensity, length of time and how much it’s impacting on the person. • Depression • Anxiety • Psychosis?

4. Psychological Disorders • 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

5. Problems with medical model • Effects of labeling person, especially if based on limited number of symptoms • May limit true understanding of behavior in favor of “listed” symptoms and assumptions about outcome • Confirmation bias: future information interpreted in a biased way based on label • Similar problems can exist with diagnosis physical ailments

6. Psychological Disorders • Bio-Psycho-Social Perspective • assumes that biological, sociocultural, and psychological factors combine and interact to produce psychological disorders

7. Bio-Psycho-Social Approach

8. Bio-Psycho-Social Approach • These factors change over time. Hence, it’s harmful to place a constant label on a person • “Normal” behavior changes over cultures, sub-cultures and time. • E.g., is gang behavior or violence “abnormal”? • It’s more important to understand behavior (and symptoms) then worry about labels.

9. Classifying Psychological Disorders (medical approach dominates) • DSM-IV • American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) • a widely used system for classifying psychological disorders • presently distributed as DSM-IV-TR (text revision)

10. Classifying Psychological Disorders • Neurotic Disorder usually distressing but that allows one to think rationally and function socially • Psychotic Disorder • person loses contact with reality • experiences irrational ideas and distorted perceptions

11. Rates of Psychological Disorders

12. Anxiety Disorders • 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 • Persistence (out of control) • Problem in identifying source

13. Anxiety Disorders • 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 • Person comes to fear the panic attack itself and start to avoid any situations or places that might provoke an attack

14. Anxiety Disorders • Phobia • persistent, irrational fear of a specific object or situation • Obsessive-Compulsive Disorder • unwanted repetitive thoughts (obsessions) and/or actions (compulsions)

15. Anxiety Disorders • Common and uncommon fears

16. Anxiety Disorders

17. Causes: Learning Perspective • Fears are learned thought classical conditioning • Stimulus generalization often occurs • Development of behaviors to avoid the anxiety • Perhaps also through observational learning

18. Causes: Biological Influence • Research with identical twins and non-human primates suggest a genetic aspect

19. Anxiety Disorders • PET Scan of brain of person with Obsessive/ Compulsive disorder • High metabolic activity (red) in frontal lobe areas involved with directing attention (impulse control and executive function) • Effectiveness of drug therapy

20. Dissociative Disorders • Dissociative Disorders • conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings • Not uncommon when in a highly traumatic situation to feel “removed” from the situation. Problem is when this becomes more then a brief situation

21. Dissociative Disorder • Dissociative Identity Disorder • rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities • formerly called multiple personality disorder • At Issue: Is it a real phenomena • Skeptics– Everyone has difference aspects of their personality. These get exaggerated by person and perhaps encourage by therapist • Believers– Personality differences are dramatic (even handedness might be effected) and person may have many personalities (e.g., 3 faces of eve– 28) • Origins from sever trauma especially in childhood • Both may be right

22. Personality Disorders • Personality Disorders (vs. mood disorder) • disorders characterized by inflexible and enduring behavior patterns that impair social functioning

23. Types of Personality Disorders • Fearful, afraid of rejection, withdrawn • Extreme eccentrics– “The Character” • Narcissistic– Over exaggerates self importance • Borderline– Unstable identity, emotions, relationships, etc.

24. Personality Disorders • Antisocial Personality Disorder • disorder in which the person (usually man) exhibits a lack of conscience for wrongdoing, even toward friends and family members • may be aggressive and ruthless or a clever con artist • Most criminals do not have this– they show concern for family and friends

25. Murderer Normal Personality Disorders • PET scans illustrate reduced activation in a murderer’s frontal cortex

26. Mood Disorders • Mood Disorders • characterized by emotional extremes • 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

27. Mood Disorders • Manic Episode • a mood disorder marked by a hyperactive, wildly optimistic state • 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

28. Mood Disorders-Depression • Canadian depression rates

29. Mood Disorders- Suicide

30. Depressed state Manic state Depressed state Mood Disorders-Bipolar • PET scans show that brain energy consumption rises and falls with emotional switches

31. Mood Disorders-Depression • Altering any one component of the chemistry-cognition-mood circuit can alter the others

32. Mood Disorders-Depression • The vicious cycle of depression can be broken at any point

33. Schizophrenia • Schizophrenia • literal translation “split mind” • a group of severe disorders characterized by: • disorganized and delusional thinking • disturbed perceptions • inappropriate emotions and actions

34. Schizophrenia • Delusions • false beliefs, often of persecution or grandeur, that may accompany psychotic disorders • Hallucinations • sensory experiences without sensory stimulation

35. Schizophrenia

36. Causes of Schizophrenia • Evidence of both chemical and anatomical differences in the brain • There are clear genetic predispositions

37. Schizophrenia

38. Causes of Schizophrenia • Viral infections during pregnancy? • Role of environment is unclear

39. Anti-Psychotic Drugs for Treatment • Clorazil: Sometimes awakens catatonic patients. • Clozapine: Dampens responsiveness to irrelevant stimuli. • Thorazine: Omits delusions and hallucinations.

40. Psychosurgery • Frontal Lobe Lobotomy: Cut fibers in the frontal lobe. In the 1950s many were conducted, today is is generally illegal, only used in the most severe cases.

41. Cognitive Therapy • Tries to teach people more positive ways of thinking. Attempts to replace negative thoughts with rational responses. • Internalized Sentences: Talking to one’s self, using self-defeating thoughts. Personalize failure; overgeneralize, jump to conclusions.

42. Cognitive Therapy • Thought Processes: Need to change thoughts from being internalized, stable and global. • Rational-Emotive Therapy: Albert Ellis (Aaron Beck), vigorously challenges peoples illogical, self-defeating attitudes and assumptions to stop catastrophizing and awufilizing.

43. Humanistic Therapy • Try to move one toward self-fulfillment and to take responsibility for their actions. • Client-Centered Therapy: (Rogers), listening with genuine acceptance to help them begin to heal themselves (non-directive).

44. Humanistic Therapy • Existential Therapy: Helps clients find meaning in existence. Gives them the power to control their own destinies. • Active Listening: Echoing, Restating, and seeking clarification of what a person expresses.

45. Humanistic Therapy • Unconditional Positive Regard: Therapists must be warm and show unshakeable regard for their client. They must be genuine and honest.

46. Group Therapy • Helps patients express their problems and show that they are not alone in suffering from this illness.

47. Gestalt Therapy • Commonly used in institutions and prisons. Focuses on looking at an individual as a whole. Can teach individuals to be more self-assertive and to use more self-revelation.

48. Family Therapy • Usually used to help children and adolescents. Role-Play, facilitate good communication.

49. Eclectic Approach • Combine one or more treatments to most effectively treat the client. More popular type of treatment.

50. Effectiveness of Psychotherapy • Good Relationships with therapist seems to be more effective than type of treatment used. • Alternatives: Encounter Groups, self-help tapes, books