Chapter 16 Specific Disorders and Treatments

1. Chapter 16Specific Disorders and Treatments

2. Progress in Abnormal Psychology • The growth of understanding of mental disorders and their treatment has paralleled the progress of medical science. • Although we have much yet to learn, we now can make accurate distinctions between a wide range of disorders and we can tailor treatments to meet the needs of those suffering from specific disorders.

3. Module 16.1 • Anxiety and Avoidance Disorders

4. Disorders Characterized by Excessive Anxiety • Anxiety refers to a certain amount of fear and caution in the face of potential hazards. • A certain amount of anxiety is normal. • Anxiety is considered pathological when it interferes with daily functioning.

5. Disorders Characterized by Excessive Anxiety • Generalized anxiety disorder • Generalized anxiety disorder (GAD) is the experience of almost constant and exaggerated worry. • There is no basis for the worries but the person is tense, irritable and tired. • About 5% of the general population will experience GAD. • Often it is co-diagnosed with other mood disorders such as depression.

6. Disorders Characterized by Excessive Anxiety • Panic disorder • Panic disorder (PD) is characterized by frequent periods of anxiety and occasional attacks of panic. • Panic attacks involve rapid breathing, increased heart rate, chest pains, sweating, trembling and faintness. • Panic attacks usually last just a few minutes, but can be much longer.

7. Disorders Characterized by Excessive Anxiety • Panic disorder • Panic disorder is experienced by 1-3% of adults and occurs in many cultures. • More women than men are diagnosed with Panic Disorder. • Hyperventilation, or rapid deep breathing, is a key symptom.

8. Disorders Characterized by Excessive Anxiety • Panic disorder • Hyperventilation causes the body to react as if suffocation were occurring. • The person’s subjective interpretation of the symptoms of hyperventilation can cause an increase in panic or a calming down. • People with panic disorder tend to interpret these episodes as uncontrollable and life threatening. • The constant anxiety they experience increases the likelihood of further panic attacks.

9. Disorders Characterized by Excessive Anxiety • Panic disorder • Treatments for panic disorder include: • Psychotherapy • Anti-depressant drugs • Advice: “Don’t worry about panic attacks; they won’t kill you.”

10. Disorders Characterized by Excessive Anxiety • Panic disorder • Common co-existing disorders include: • Social phobia – severe avoidance of other people and fear of doing anything in public. • Agoraphobia – an intense fear of open or public places.

11. Disorders Characterized by Excessive Anxiety • Phobias • Avoidance behaviors are highly resistant to extinction. • Phobia is the most common type disorder involving avoidance behaviors. • A phobia is strong and persistent fear of a specific object or situation – so strong it interferes with daily living.

12. Disorders Characterized by Excessive Anxiety • Phobias • The Prevalence of Phobias • Not all extreme fears qualify as phobias. • About 11% of U.S. adults suffer from a phobia at some point in their lives. • About 5-6% are experiencing a phobia at any given time. • Phobia usually does not persist across the lifetime – many young adults lose them by middle age.

13. Figure 16.2 Most phobias do not last a lifetime. Young people with phobias often lose them by middle age.

14. Disorders Characterized by Excessive Avoidance • Phobias • Acquiring a phobia: • Some fears are innate but many are learned. • Some phobias can be traced to a specific event. • The early behaviorists were the first to demonstrate how fears might be learned. • This does not account for the fact that some phobias are much more common and easily acquired than others.

15. Disorders Characterized by Excessive Avoidance • Phobias • The most common phobias include: • Open spaces • Closed spaces • Heights • Lightening and thunder • Certain animals – (snakes, spiders, dogs) • Illnesses/germs

16. Figure 16.4 A lab-reared monkey learns to fear snakes from the reactions of a wild-reared monkey. But if the snake is not visible, the lab-reared monkey fails to learn any fear.

17. Figure 16.4 A lab-reared monkey learns to fear snakes from the reactions of a wild-reared monkey. But if the snake is not visible, the lab-reared monkey fails to learn any fear.

18. Figure 16.4 A lab-reared monkey learns to fear snakes from the reactions of a wild-reared monkey. But if the snake is not visible, the lab-reared monkey fails to learn any fear.

19. Disorders Characterized by Excessive Avoidance • Phobias • Behavior therapy for phobias • Systematic desensitization – reduces fear by gradually exposing people to the object under controlled conditions. Virtual reality is now being employed for this kind of therapy. • Flooding or implosion – a sudden and large-scale exposure to the object under controlled conditions.

20. Disorders Characterized by Excessive Avoidance • Phobias • Drug therapies for phobias and anxieties • Benzodiazepines, a common type of tranquilizer, are often prescribed for anxiety disorders. • They suppress symptoms only temporarily and can be addictive. • Anti-depressants, which are not likely to be taken habitually, are used more effectively.

21. Disorders Characterized by Excessive Avoidance • Obsessive-compulsive disorder • There are two distressing symptoms that comprise obsessive-compulsive disorder. • Obsessions are repetitive, unwelcome streams of thought. • Compulsions are repetitive, almost irresistible actions. • Obsessive thoughts generally lead to compulsive actions. • Checking and cleaning are two very common compulsive behaviors.

22. Disorders Characterized by Excessive Avoidance • Obsessive-compulsive disorder • Therapies for obsessive-compulsive disorder: • Exposure therapy is very similar to systematic desensitization. • The patient is exposed to the situation that brings on the compulsive behavior, but is prevented from engaging in it. • The most common drug treatments for this disorder utilize clomipramine and other serotonin reuptake inhibiters.

23. Anxieties and Avoidance • Phobias and anxiety disorders involve the interaction and influence of cognition and emotion upon each other. • People who suffer from these conditions are aware that their reactions are exaggerated, but this awareness doesn’t cure the problem. • These disorders are challenging but psychologists continue to improve the efficacy of available treatments.

24. Module 16.2 • Substance-Related Disorders

25. Substance Dependence (Addiction) • Individuals who find it difficult or impossible to quit a dangerous habit are said to have an addiction to it or a dependence on it. • People vary widely in how this affects their daily lives and functioning.

26. Substance Dependence (Addiction) • Nearly all addictive drugs stimulate the dopamine receptors in the nucleus accumbens. • Activation of these synapses causes increased attention. • This activation is accompanied by feelings of great pleasure.

27. Substance Dependence (Addiction) • There are two symptoms involved in the development of a drug addiction. • Tolerance – decreased effects of a given dose. • Withdrawal – unpleasant sensations when the drug is not used (or too little is used given the development of tolerance). • Activities and substances that are not drugs can produce addictions – suggesting that addiction is a function of the person, not the drug alone.

28. Substance Dependence (Addiction) • Is substance dependence a disease? • It depends in part on how we define “disease.” • Psychologists currently favor the use of continuum from “no addiction” to “severe addiction.”

29. Substance Dependence (Addiction) • Nicotine dependence • Cigarette smoking is based on nicotine addiction. • People are generally able to quit smoking more easily if they have a replacement source of nicotine (i.e. a patch). • Low-nicotine/low-tar cigarettes do not help people to quit.

30. Figure 16.7 “Low-nicotine” cigarettes have a row of small holes in the filter; room air is supposed to enter through those holes when the smoker inhales and therefore dilute the tobacco smoke. If people smoke such cigarettes without covering the air holes, little tar and nicotine pass through the cigarette, as we see from the relatively clean filter tip. However, if people cover the holes with their fingers or tape, they will receive about as much tar and nicotine as they would from any other filtered cigarette.

31. Substance Dependence (Addiction) • Alcoholism • Alcoholism is defined as the habitual overuse of alcohol. • Treatment of chronic alcoholism is very difficult. • In order for treatment of alcoholism to be effective, we need to detect the problem in its early stages. • We need to identify the factors that put certain people at risk.

32. Substance Dependence (Addiction) • Alcoholism • Type I alcoholism develops gradually over the lifespan. • It is equally prevalent in men and women. • It is generally less severe in its health consequences. • Type II alcoholism has an early onset. • It is much more prevalent in men and more severe.

33. Table 16.3 Type I and Type II alcoholism

34. Substance Dependence (Addiction) • Alcoholism: Risk factors • Research studies indicate that tendency to addiction is influenced by genetics. • Type II alcoholism shows a strong genetic basis. • Some people with no family history of alcoholism develop an alcohol problem.

35. Substance Dependence (Addiction) • Alcoholism: Risk factors • Exposure to parental conflict, inadequate supervision, and abuse can increase the likelihood of alcoholism emerging later in life. • Culture also has an influence – prevalence rates vary in different nations and ethnic groups.

36. Substance Dependence (Addiction) • Treatment for alcoholism • It is very difficult for most people to quit alcohol and the other drugs. • Only 10-20% are successful and relapses are very common. • Many recovering addicts seek help from mental-health professionals or self-help groups. • Such help improves the chances of successful recovery, but offers no guarantees.

37. Substance Dependence (Addiction) • Treatments for alcoholism • Detoxification is a program of supervised recovery provided in a hospital setting. • Outpatient mental-health treatment has about the same rate of success as detoxification.

38. Substance Dependence (Addiction) • Treatments for alcoholism • The most widespread treatment for alcoholism is offered by Alcoholic Anonymous (AA). • AA is a self-help group comprised of people who abstain from alcohol use and offer help and support to each other.

39. Substance Dependence (Addiction) • Treatments for alcoholism • Antabuse is the trade name for disulfiram. • Alcoholics who take Antabuse daily become very sick when they drink alcohol. • This treatment is only moderately effective.

40. Substance Dependence (Addiction) • Treatments for alcoholism • Controlled drinking refers to reducing consumption of alcohol from dependent/abusive to moderate levels. • Some physicians believe that abstinence is workable for all alcoholics and believe this is a viable alternative. • Harm reduction is a similar approach applied to drug abuse. • These methods are highly controversial

41. Substance Dependence (Addiction) • Opiate dependence • A very difficult withdrawal syndrome complicates recovery from dependence on opiate drugs (i.e. heroin, morphine). • Some opiate addicts go “cold turkey” in order to stop using.

42. Substance Dependence (Addiction) • Opiate dependence • Recovery programs commonly offer methadone as a less dangerous replacement for opiates. • This is a harm reduction strategy that allows recovering opiate addicts to remain employed and avoid criminal behavior.

43. Table 16.4 Comparison of methadone with morphine

44. Substances, the Individual, and Society • How we handle the problem of substance dependence and abuse in our society remains an area of intense debate. • Our current strategies have not eliminated widespread use. • As a citizen, you may be called upon to think about these issues and help to shape changes in our national drug policy. As you have learned, there are complex and difficult issues involved.

45. Module 16.3 • Mood Disorders

46. Mood Disorders • Depression • Major depression • Major depression is an extreme condition. • It usually persists for months. • The person experiences little interest in anything, little pleasure, and little motivation to be productive.

47. Mood Disorders • Depression • Major depression • Loss of interest in food and sex are common. • The person has feelings of worthlessness, guilt and powerlessness over their lives. • Sleep abnormalities are associated with depression (there is a characteristic rapid onset of REM sleep). • The person may attempt suicide.

48. Figure 16.9 When most people go to sleep at their usual time, they progress slowly to stage 4 and then back through stages 3 and 2, reaching REM sleep toward the end of their first 90-minute cycle. Depressed people, however, reach REM more rapidly, generally in less than 45 minutes. They also tend to awaken frequently during the night.

49. Mood Disorders • Depression • Seasonal affective disorder (SAD) • Consistent depression associated with a particular season of winter is called seasonal affective disorder. • It is most common in areas that have little sunlight in the winter. • It can be relieved by light therapy, which requires the depressed person to sit in front of a bright light for a few hours each day.

50. Figure 16.10 Most people feel slightly better during the summer (when the sun is out most of the day) than during the winter (when there are fewer hours of sunlight). People with seasonal affective disorder (SAD) feel good in the summer and seriously depressed in the winter (or good in the winter and depressed in the summer). Seasonal affective disorder is commonest in far northern locations such as Scandinavia, where the summer days are very long and bright and the winter days are very short and dark. The disorder is unheard-of in tropical locations such as Hawaii, where the amount of sunlight per day varies only slightly between summer and winter.