Personality Stability vs. Situation?
Personality • Traits vs. States vs. Types • 18,000 personality terms to 32 traits to- • Big five: • Extraversion (outgoing, sociable, positive) • Neuroticism (prone to negative emotions) • Conscientiousness (organized, efficient, disciplined) • Openness to experience (non-conventional, curious) • Agreeableness (trusting & easygoing with others) 40 to 60% heritable
Situationism • Low correlations across situations • Strong vs. weak situations • But-brain differences and heritability • Introverts more sensitive to external stimuli • More reactive central nervous system • Low pain tolerance • Underactive Nor-epi system • Sensation seeking extraverts
Heritability: Big five correlations • Identical twins vs. fraternal twins : Identical Fraternal • Reared together- .51 .23 • Reared apart- .50 .21
Personality Theories • Psychoanalytic • Childhood experience, ucs influence, dynamics, conflict, defenses, development and identification • Humanistic • Focus on self & self-actualization, existential approach, flow & happiness • Social-Cognitive Theory • Beliefs, thoughts & personal constructs shape behavior • Behavioral Theory • Learning history, self-perception theory, self-control
Defining Abnormality • Medical approach • Statistical approach • Functional approach These reflect two basic views of disorders --brain based --behavior/experience/situation based The “two worlds” of psychiatry
DSM-IV • Axis 1: Syndromes (Scz, Depress, etc.) • Axis 2: Retardation & Personality Disorders • Axis 3: General Medical Condition • Axis 4: Social/Environmental Problems • Axis 5: Global Assessment & Coping • Older classification (primarily of Axis 1 & 2) dichotomized: Neuroses & Psychoses • Mood (Dep. Bipolar) vs. Thought (Scz) Disrdr
Some Interim Conclusions • Psychoses (focus on SCZ) is a disorder of heredity and/or prenatal environment • But it’s also a disorder of poverty (and that may be bidirectional)! • Another view of prevalence and recent dramatic changes in prevalence
Incidence & Prevalence • Schizophrenia: approx. 1% • Bipolar Disorder: approx. 1% • Depression: approx. M 13% F 21%
Different Therapies for Different Conditions • Medical: Brain targeted drug interventions examples: --SCZ: Dopamine receptor blockers (the better the block the more effective it is) --Other neurotransmitters involved as well --Depression: ex. Norepinephrine uptake or release+, Serotonin release+, & a host of other neurotransmitter controls involved -- Electro-convulsive shock therapy!
Psychological Therapies • Psychoanalytic • Behavioral • Client-centered • Cognitive-behavioral • Existential • Eclectic • Situational
Commonalities • Just as there are some common underlying aspects of disorders (chemical imbalance, brain disease, stress, social disconnection) there are commonalities of psychotherapy. • Correcting the neurological imbalance can correct our thinking and so can working directly on our thinking and behavior. • A two-pronged approach may be best.
One More Outcome Study • In a recent meta-analysis comparing drug with psychotherapy approaches to treating depression, drugs resulted in a 55% improvement, psychotherapy 52% and a combination of the two 85%!! (New England J. of Medicine, 5-18-’00.) • Mind and body interact, we shouldn’t be surprised!
Some Over-arching Issues • Therapy works! • Comparative studies • It’s the therapist as much as the theory • Meta analyses • Cost is driving the system now!
What to do? • Keep wits about you & get recommendations from knowledgeable people • Don’t try to tough it out--it’s not weakness! • Make sure therapist listens and understands • Realize that there are setbacks along the way and that it takes time • Remember that heredity vs. environment isn’t “either-or” but a set of interactions--so changing situations is important in any case • Finally, remember that most people get better!