Chapter 11 Psychological Disorders and Their Treatment

Chapter 11Chapter 11Psychological Disorders Psychological Disorders

and Their Treatmentand Their Treatment

Prevalence of Psychological DisordersPrevalence of Psychological Disorders In a year in the U.S.:In a year in the U.S.:

20% of persons experience psychological 20% of persons experience psychological problems severe enough to adversely affect problems severe enough to adversely affect their daily living.their daily living.

40% of persons experience at least mild 40% of persons experience at least mild mental health problems. mental health problems.

About 2.1 million people are admitted to About 2.1 million people are admitted to hospitals due to serious psychological hospitals due to serious psychological problems.problems.

Worldwide: Worldwide: About 400 million people are afflicted with About 400 million people are afflicted with

psychological disorders.psychological disorders.

How Should We Understand Psychological How Should We Understand Psychological

Disorders?Disorders?

The The medical modelmedical model proposes that proposes that psychological disorders have a biological psychological disorders have a biological basis and can be classified into discrete basis and can be classified into discrete categories and are analogous to physical categories and are analogous to physical diseases. diseases.

How Should We Understand Psychological How Should We Understand Psychological

Disorders?Disorders? Although not agreeing that all mental health Although not agreeing that all mental health

problems have a biological basis, problems have a biological basis, mainstream psychology has adopted the mainstream psychology has adopted the medical model’s terminology.medical model’s terminology. Symptom: a sign of a disorderSymptom: a sign of a disorder Diagnosis: distinguishing one disorder from Diagnosis: distinguishing one disorder from

anotheranother Etiology:Etiology: a disorder’s apparent causes and a disorder’s apparent causes and

developmental historydevelopmental history Prognosis:Prognosis: prediction about the likely course of prediction about the likely course of

a disordera disorder

DefiningDefining Psychological DisordersPsychological Disorders

A pattern of atypical behaviorA pattern of atypical behavior

Results in personal distress orResults in personal distress or

Significant impairment in a person’s social or Significant impairment in a person’s social or occupational functioning occupational functioning

DefiningDefining Psychological DisordersPsychological Disorders

Major criteria used to differentiate normal Major criteria used to differentiate normal from disordered behavior:from disordered behavior: Atypical Atypical

Significantly above or below the average in its Significantly above or below the average in its frequency of occurrencefrequency of occurrence

Violates cultural normsViolates cultural norms

Maladaptive Maladaptive Interferes with ability to perform normal Interferes with ability to perform normal

activitiesactivities

Causes personal distressCauses personal distress Individuals who report experiencing troubling Individuals who report experiencing troubling

emotions are often considered to have emotions are often considered to have psychological problems. psychological problems.

Numerous Theoretical ExplanationsNumerous Theoretical Explanations

Five primary perspectives Five primary perspectives to understand to understand mental illnessmental illness::

PsychodynamicPsychodynamic: D: Disordered behavior is controlled isordered behavior is controlled by unconscious forces shaped by childhood by unconscious forces shaped by childhood experiences.experiences.

BehavioralBehavioral: D: Disordered behavior is caused by isordered behavior is caused by identifiable factors in the person’s environment and identifiable factors in the person’s environment and results from learning.results from learning.

CognitiveCognitive: ineffective or inaccurate thinking is the : ineffective or inaccurate thinking is the root cause of mental illness root cause of mental illness

Numerous Theoretical ExplanationsNumerous Theoretical Explanations

Five primary perspectives Five primary perspectives to understand to understand mental illnessmental illness::

SocioculturalSociocultural: Mental illness is the product of : Mental illness is the product of broad social and cultural forces .broad social and cultural forces .

BiologicalBiological: Disordered behavior is caused by : Disordered behavior is caused by biological conditionsbiological conditions, such as genetics, hormone , such as genetics, hormone levels, orlevels, or neurotransmitter activity in the brain.neurotransmitter activity in the brain.

Combined ModelsCombined Models Diathesis-stress model: a Diathesis-stress model: a

predisposition to a given disorder predisposition to a given disorder (diathesis) that combines with (diathesis) that combines with environmental stressors to trigger a environmental stressors to trigger a psychological disorderpsychological disorder

Bio-psycho-social model. Takes into Bio-psycho-social model. Takes into account predispositions, personal account predispositions, personal experience, and life circumstances.experience, and life circumstances.

The Diathesis-Stress ModelThe Diathesis-Stress Model

Psychological DisordersPsychological Disorders

Bio-psycho-social Bio-psycho-social PerspectivePerspective assumes that assumes that

biological, biological, sociocultural, and sociocultural, and psychological psychological factors combine factors combine and interact to and interact to produce produce psychological psychological disordersdisorders

Biological(Evolution, individual

genes, brain structures

and chemistry)

Psychological(Stress, trauma,

learned helplessness, mood-related perceptions

and memories)

Sociocultural(Roles, expectations, definition of normality

and disorder)

Models from Outside PsychologyModels from Outside Psychology Spirit PossessionSpirit Possession

TrephiningTrephining LunacyLunacy

CursesCurses Family/generationalFamily/generational Occult (voodoo, witchcraft)Occult (voodoo, witchcraft)

SinSin GuiltGuilt Unforgiveness, bitternessUnforgiveness, bitterness

Risks of Using Diagnostic Labels Risks of Using Diagnostic Labels

David Rosenhan demonstrated diagnostic David Rosenhan demonstrated diagnostic labels’ biasing effects.labels’ biasing effects. Misdiagnosis of insanity by hospital personnel due to Misdiagnosis of insanity by hospital personnel due to

their bias toward calling a healthy person sicktheir bias toward calling a healthy person sick

Diagnostic labels can harm patients in Diagnostic labels can harm patients in several ways.several ways. Label may “dehumanize” patients by encouraging Label may “dehumanize” patients by encouraging

mental health practitioners to treat them as labels mental health practitioners to treat them as labels rather than as unique individuals with problems. rather than as unique individuals with problems.

Labeled individuals may experience discrimination Labeled individuals may experience discrimination and may cause people to expect those labeled to and may cause people to expect those labeled to behave abnormally and thus to misperceive normal behave abnormally and thus to misperceive normal behavior as disordered. behavior as disordered.

Benefits of Using Diagnostic LabelsBenefits of Using Diagnostic Labels

Despite ethical concerns, diagnostic labels Despite ethical concerns, diagnostic labels are used because they serve several are used because they serve several important functions:important functions:

Summarize patient’s symptoms or problems, and Summarize patient’s symptoms or problems, and thus, communicate great deal of information with a thus, communicate great deal of information with a single word single word

Convey information about possible causes of the Convey information about possible causes of the disorderdisorder

Convey information about the patient’s prognosisConvey information about the patient’s prognosis

DSM Classification SystemDSM Classification System

Diagnostic and Statistical Manual of Mental Diagnostic and Statistical Manual of Mental Disorders (DSM) use to diagnose mental Disorders (DSM) use to diagnose mental disordersdisorders

Published by the American Psychiatric Published by the American Psychiatric Association.Association.

Since 1980, DSM has been updated Since 1980, DSM has been updated several times and is now in its fourth several times and is now in its fourth edition, text revision, or DSM-IV-TR.edition, text revision, or DSM-IV-TR.

DSM Classification SystemDSM Classification System

DSMDSM classification system is descriptive classification system is descriptive rather than explanatory, meaning that:rather than explanatory, meaning that: it is not based on a particular theory concerning it is not based on a particular theory concerning

the cause(s) of psychological disorders. the cause(s) of psychological disorders. diagnoses are based mainly on observable symptoms.diagnoses are based mainly on observable symptoms.

DSMDSM provides clearer directions concerning provides clearer directions concerning number, duration, and severity of symptoms number, duration, and severity of symptoms necessary to assign a diagnosis. necessary to assign a diagnosis. By recognizing that two patients with same disorder By recognizing that two patients with same disorder

may substantially differ from one another, clinicians may substantially differ from one another, clinicians much more likely to acknowledge uniqueness of all much more likely to acknowledge uniqueness of all patients.patients.

Anxiety Disorders: Distressing, Anxiety Disorders: Distressing, Persistent Anxiety, Maladaptive BehaviorPersistent Anxiety, Maladaptive Behavior

Characterized by distressing, persistent Characterized by distressing, persistent anxiety or maladaptive behavior anxiety or maladaptive behavior

About 25 percent of the population will About 25 percent of the population will experience this disorder in our lifetime. experience this disorder in our lifetime.

Anxiety disorders occur across the life span Anxiety disorders occur across the life span and commonly co-occur with many other and commonly co-occur with many other disorders, such as depression and substance disorders, such as depression and substance abuse. abuse.

Anxiety Disorders: Distressing, Anxiety Disorders: Distressing, Persistent Anxiety, Maladaptive Behavior Persistent Anxiety, Maladaptive Behavior

Five major anxiety disorders: Five major anxiety disorders:

Panic disorder: Panic disorder: brief episodes of intense anxiety brief episodes of intense anxiety with no apparent reason with no apparent reason

Phobic disorder: Phobic disorder: strong irrational fears of specific strong irrational fears of specific objects or situations, called objects or situations, called phobiasphobias

Generalized anxiety disorder (GAD): Generalized anxiety disorder (GAD): a constant a constant state of moderate anxiety state of moderate anxiety

Anxiety Disorders: Distressing, Anxiety Disorders: Distressing, Persistent Anxiety, Maladaptive Behavior Persistent Anxiety, Maladaptive Behavior

Five major anxiety disorders: Five major anxiety disorders:

Obsessive-compulsive disorder: Obsessive-compulsive disorder: repetitive, repetitive, unwanted, and distressing actions and/or unwanted, and distressing actions and/or thoughts thoughts

Post-traumatic stress disorder: Post-traumatic stress disorder: occurs among occurs among individuals who have experienced or witnessed individuals who have experienced or witnessed traumatic eventstraumatic events

Later reexperience the event through Later reexperience the event through nightmares, flashbacks, and avoid situations or nightmares, flashbacks, and avoid situations or persons that trigger flashbackspersons that trigger flashbacks

Anxiety DisordersAnxiety DisordersCommon Obsessions and Compulsions AmongPeople With Obsessive-Compulsive Disorder

Thought or Behavior Percentage*Reporting Symptom

Obsessions (repetitive thoughts)

Concern with dirt, germs, or toxins 40

Something terrible happening (fire, death, illness) 24

Symmetry order, or exactness 17

Excessive hand washing, bathing, tooth brushing, 85or grooming

Compulsions (repetitive behaviors)

Repeating rituals (in/out of a door, 51up/down from a chair)Checking doors, locks, appliances, 46car brake, homework

Anxiety DisordersAnxiety Disorders

PET Scan of brain of PET Scan of brain of person with person with obsessive/ obsessive/ compulsive disordercompulsive disorder

High metabolic High metabolic activity (red) in activity (red) in frontal lobe areas frontal lobe areas involved with involved with directing attentiondirecting attention

Etiology of Anxiety DisordersEtiology of Anxiety Disorders Genetic and biological factors:Genetic and biological factors:

Genetic heritage may predispose us to more easily Genetic heritage may predispose us to more easily develop phobic reactions or develop phobic reactions or to respond intensely to to respond intensely to stressful events.stressful events.

Behavioral or conditioning factors:Behavioral or conditioning factors: Classical conditioning may instill conditioned emotional Classical conditioning may instill conditioned emotional

responses, and operant conditioning may reinforce and responses, and operant conditioning may reinforce and maintain the person’s avoidance responses. maintain the person’s avoidance responses.

Cognitive factors:Cognitive factors: People suffering from panic disorder closely monitor People suffering from panic disorder closely monitor

their physiological reactions, and often exaggerate the their physiological reactions, and often exaggerate the significance of their physiological symptoms. significance of their physiological symptoms.

Mood Disorders: Emotional ExtremesMood Disorders: Emotional Extremes

Characterized by emotional extremes that Characterized by emotional extremes that cause significant disruption in daily cause significant disruption in daily functioning. functioning. To qualify as a mood disorder, emotional extremes To qualify as a mood disorder, emotional extremes

must persist for a long time.must persist for a long time.

Most common mood disorder is depressionMost common mood disorder is depression Characterized by extreme and persistent negative Characterized by extreme and persistent negative

moods and the inability to experience pleasure by moods and the inability to experience pleasure by participating in activities one previously enjoyed participating in activities one previously enjoyed (Kramlinger, 2001) (Kramlinger, 2001)

Mood Disorders: Emotional ExtremesMood Disorders: Emotional Extremes Depressed individuals:Depressed individuals:

Often experience physiological problems such Often experience physiological problems such as lack of appetite, weight loss, fatigue, and as lack of appetite, weight loss, fatigue, and sleep disorderssleep disorders

Often experience behavioral symptoms, such Often experience behavioral symptoms, such as slowed thinking and acting, social as slowed thinking and acting, social withdrawal, and decreased activity withdrawal, and decreased activity

Exhibit cognitive symptoms, such as low self-Exhibit cognitive symptoms, such as low self-esteem, thinking about death and/or suicide, esteem, thinking about death and/or suicide, and having little hope for the futureand having little hope for the future

Mood Disorders-Mood Disorders-DepressionDepression

The The vicious vicious cycle of cycle of depressiodepression can be n can be broken at broken at any pointany point

1Stressful

experiences

4Cognitive and

behavioral changes

2Negative

explanatory style

3Depressed

mood

Mood Disorders-Mood Disorders-DepressionDepression

Percentageof population

aged 18-84experiencing

majordepression

at somepoint In life

20

15

10

5

0USA Edmonton Puerto Paris West Florence Beirut Taiwan Korea New Rico Germany Zealand

Around the worldwomen are more

susceptible todepression


Bipolar disorder: characterized by swings Bipolar disorder: characterized by swings between the emotional extremes of between the emotional extremes of mania and depressionmania and depression

Less common than major depressive Less common than major depressive disorder, occurring in about 1 percent of the disorder, occurring in about 1 percent of the population population

Unlike major depression, this disorder occurs Unlike major depression, this disorder occurs about equally in men and women and tends about equally in men and women and tends to occur earlier than major depression to occur earlier than major depression


Bipolar disorder Bipolar disorder

Bipolar patients’ depressive episodes Bipolar patients’ depressive episodes differ from the depressive episodes in differ from the depressive episodes in major depression in that they tend to major depression in that they tend to be more severe, are accompanied by be more severe, are accompanied by higher suicide risks, and have a distinct higher suicide risks, and have a distinct pattern of brain activity during sleep. pattern of brain activity during sleep.

Mood Disorders-BipolarMood Disorders-Bipolar PET scans show that brain energy PET scans show that brain energy

consumption rises and falls with emotional consumption rises and falls with emotional swingsswings

Depressed state Manic state Depressed state

SuicideSuicide A major danger of depression is suicide. A major danger of depression is suicide.

As many as 30% of people with severe mood As many as 30% of people with severe mood disorders die from suicide. disorders die from suicide.

In the U.S. suicide rates are higher In the U.S. suicide rates are higher among: among: Men than women;Men than women; Elderly adults than younger adults; Elderly adults than younger adults; Unemployed (& retired) adults than employed Unemployed (& retired) adults than employed

persons; persons; Widowed adults than married adults;Widowed adults than married adults; Native & European Americans than Asian. Hispanic, Native & European Americans than Asian. Hispanic,

and African Americans.and African Americans.

Etiology of mood disordersEtiology of mood disorders

Genetic/ biological influence?Genetic/ biological influence? Bipolar patients show imbalances in neural circuits using Bipolar patients show imbalances in neural circuits using

serotonin, norepinephrine, etc.? Enlarged amygdala?serotonin, norepinephrine, etc.? Enlarged amygdala? Major depressive disorder: Major depressive disorder: Family, twin, and adoption Family, twin, and adoption

studies indicate at least a moderate genetic influence on studies indicate at least a moderate genetic influence on depression. depression.

Cognitive contributions: Cognitive contributions: Depressed persons have negative views and they Depressed persons have negative views and they

misinterpret daily experiences so that their negative misinterpret daily experiences so that their negative outlook is supported. outlook is supported.

Behavioral psychologists propose that depression Behavioral psychologists propose that depression results from low social reinforcement.results from low social reinforcement.

Gender & Mood DisordersGender & Mood Disorders Why is depression more common among Why is depression more common among

women?women? May due to biological factors. May due to biological factors. Sociocultural factors: Sociocultural factors: Women have fewer educational Women have fewer educational

and occupational opportunities, receive less money for their and occupational opportunities, receive less money for their work, and experience more violence due to their gender work, and experience more violence due to their gender than men.than men.

Difference in diagnosis?Difference in diagnosis? Women may be diagnosed more frequently because Women may be diagnosed more frequently because

they are more likely to seek help for their problems.they are more likely to seek help for their problems. Gender bias among mental health professionals may Gender bias among mental health professionals may

result in women and men with identical symptoms result in women and men with identical symptoms being diagnosed differently, i.e., wbeing diagnosed differently, i.e., women labeled as omen labeled as depressed and men diagnosed with other conditionsdepressed and men diagnosed with other conditions

Dissociative Disorders: Loss of Contact Dissociative Disorders: Loss of Contact with Consciousness or Memorywith Consciousness or Memory

Characterized by disruptions in Characterized by disruptions in consciousness, memory, sense of identity, consciousness, memory, sense of identity, or perception or perception

Dissociative amnesia: a sudden loss of memory Dissociative amnesia: a sudden loss of memory of one’s identity and other personal informationof one’s identity and other personal information

Dissociative fugue: a sudden departure from Dissociative fugue: a sudden departure from home or work, combined with loss of memory home or work, combined with loss of memory of identity and the assumption of a new identityof identity and the assumption of a new identity

Dissociative Disorders: Loss of Contact Dissociative Disorders: Loss of Contact with Consciousness or Memorywith Consciousness or Memory

Dissociative identity disorder (DID): Dissociative identity disorder (DID): characterized by the presence of two or characterized by the presence of two or more distinct identities or personalities, more distinct identities or personalities, which take turns controlling the person’s which take turns controlling the person’s behavior (also known as multiple behavior (also known as multiple personality disorder)personality disorder)

Etiology of Dissociative Disorders Etiology of Dissociative Disorders Psychodynamic theory: results from the Psychodynamic theory: results from the

individual’s attempt to repress some individual’s attempt to repress some troubling event troubling event

Biological explanation: patient may have a Biological explanation: patient may have a neurological problem that has not yet neurological problem that has not yet been detected been detected

Cognitive perspective: individuals learn to Cognitive perspective: individuals learn to dissociate as a way to cope with intense dissociate as a way to cope with intense distress distress

Schizophrenia: Disturbances in Almost All Schizophrenia: Disturbances in Almost All Areas of Psychological FunctioningAreas of Psychological Functioning

Characterized by severe impairment in Characterized by severe impairment in thinking, including hallucinations, delusions, or thinking, including hallucinations, delusions, or loose associationsloose associations

Diagnosed when symptoms persist for at least Diagnosed when symptoms persist for at least six months, are not due to some other six months, are not due to some other condition, and cause significant impairment in condition, and cause significant impairment in daily functioning daily functioning

Schizophrenics often cannot work, manage a Schizophrenics often cannot work, manage a home or apartment successfully, or care for home or apartment successfully, or care for their basic needs. their basic needs.

SchizophreniaSchizophrenia

DelusionsDelusions false beliefs, often of persecution false beliefs, often of persecution

or grandeur, that may accompany or grandeur, that may accompany psychotic disorderspsychotic disorders

HallucinationsHallucinations false sensory experiences such as false sensory experiences such as

seeing something without any external seeing something without any external visual stimulusvisual stimulus

Risk of Developing SchizophreniaRisk of Developing Schizophrenia

Personality Disorders: Inflexible Behavior Personality Disorders: Inflexible Behavior

Patterns That Impair Social FunctioningPatterns That Impair Social Functioning

Personality disorders: general styles of living Personality disorders: general styles of living that are ineffective and lead to problems for that are ineffective and lead to problems for the person and for othersthe person and for others

Ten personality disorders in the Ten personality disorders in the DSM-IV-TR.DSM-IV-TR.


Patterns That Impair Social FunctioningPatterns That Impair Social Functioning Three common personality disorders are:Three common personality disorders are:

Paranoid personalitiesParanoid personalities:: habitually distrustful and habitually distrustful and suspicious of others’ motives suspicious of others’ motives

Histrionic personalities: excessively emotional Histrionic personalities: excessively emotional and attention seeking, often turning minor and attention seeking, often turning minor incidents into full-blown dramas incidents into full-blown dramas

Narcissistic personalities: desire constant Narcissistic personalities: desire constant admiration from others admiration from others


Patterns That Impair Social FunctioningPatterns That Impair Social Functioning The personality disorder that receives the most The personality disorder that receives the most

attention is the antisocial personality disorder.attention is the antisocial personality disorder.

Exhibit a persistent pattern of disregard for and violation of Exhibit a persistent pattern of disregard for and violation of the rights of others the rights of others

Repeatedly exhibit antisocial behavior across all realms of Repeatedly exhibit antisocial behavior across all realms of life, lying, cheating, stealing, and manipulating others life, lying, cheating, stealing, and manipulating others

When caught, they take no responsibility and feel no When caught, they take no responsibility and feel no remorse.remorse.

Personality DisordersPersonality Disorders

Adrenalineexcretion(ng/min)

15

10

5

0 Nonstressfulsituation

Stressfulsituation

Those with criminalconvictions have lower

levels of arousal

No criminal convictionCriminal conviction

Personality DisordersPersonality Disorders

PET scans illustrate reduced activation in a murderer’s frontal cortex

Normal Murderer

Etiology of Personality DisordersEtiology of Personality Disorders A genetic component: related to abnormal brain A genetic component: related to abnormal brain

development or chronic underarousal of both development or chronic underarousal of both the autonomic and central nervous systemsthe autonomic and central nervous systems

May be caused by the interaction of both May be caused by the interaction of both

biological and environmental factors. biological and environmental factors.

Children in chaotic households who have a Children in chaotic households who have a biological predisposition for this disorder may biological predisposition for this disorder may not learn to control their impulses, and so not learn to control their impulses, and so behave in ways to maximize their benefit even if behave in ways to maximize their benefit even if this means violating social rules. this means violating social rules.

What Are the Therapies for Psychological What Are the Therapies for Psychological

Disorders?Disorders? The two broad categories of therapy:The two broad categories of therapy:

Psychotherapy: Psychotherapy: psychological methods that psychological methods that include a personal relationship between a trained include a personal relationship between a trained therapist and a clienttherapist and a client

Biomedical therapies:Biomedical therapies: the treatment of the treatment of psychological disorders by altering brain psychological disorders by altering brain functioning with physical or chemical functioning with physical or chemical interventionsinterventions



The two broad categories of therapy:The two broad categories of therapy:

Psychotherapy: psychological methods Psychotherapy: psychological methods including including a personal relationship between a personal relationship between a trained therapist and a clienta trained therapist and a client

Biomedical therapies:Biomedical therapies: altering brain altering brain functioning with physical or chemical functioning with physical or chemical interventionsinterventions



Three mental health professions:Three mental health professions: PsychiatryPsychiatry Social workSocial work PsychologyPsychology

Two specialty areas in psychology:Two specialty areas in psychology: Clinical psychology Clinical psychology Counseling psychologyCounseling psychology

Psychodynamic TherapiesPsychodynamic Therapies

A group of psychotherapies based on the work of A group of psychotherapies based on the work of Sigmund Freud that say that psychological disorders Sigmund Freud that say that psychological disorders stem from unconscious forcesstem from unconscious forces

Important psychodynamic terms:Important psychodynamic terms: Free association: therapy technique in which clients Free association: therapy technique in which clients

say whatever comes to mindsay whatever comes to mind

Resistance: anything client does to interfere with Resistance: anything client does to interfere with free chain of thought or therapeutic progressfree chain of thought or therapeutic progress

Transference: client transfers feelings for Transference: client transfers feelings for significant others early in life to therapist significant others early in life to therapist (countertransference)(countertransference)

Behavior TherapiesBehavior Therapies

Psychotherapies that apply learning Psychotherapies that apply learning principles to the elimination of unwanted principles to the elimination of unwanted behaviors.behaviors.

Counterconditioning is based on classical Counterconditioning is based on classical conditioning.conditioning.

Counterconditioning: involves conditioning new Counterconditioning: involves conditioning new responses to stimuli that trigger unwanted responses to stimuli that trigger unwanted behaviorsbehaviors

Counterconditioning: Three TechniquesCounterconditioning: Three Techniques Systematic desensitizationSystematic desensitization::

used to treat phobias in which client is gradually used to treat phobias in which client is gradually exposed to feared object, while remaining relaxedexposed to feared object, while remaining relaxed

Response prevention:Response prevention: used to treat obsessive-compulsive disorder; client used to treat obsessive-compulsive disorder; client

is exposed to situation that triggers the compulsive is exposed to situation that triggers the compulsive behavior but is not permitted to engage in the ritualbehavior but is not permitted to engage in the ritual

Aversive conditioning:Aversive conditioning: a classically conditioned aversive response is a classically conditioned aversive response is

conditioned to occur in response to a stimulus that conditioned to occur in response to a stimulus that has previously been associated with an undesired has previously been associated with an undesired behaviorbehavior

Aversive Conditioning for AlcoholismAversive Conditioning for Alcoholism



Humanistic Therapies Focus on Feelings Humanistic Therapies Focus on Feelings

and Personal Growthand Personal Growth

Goal: To help people get in touch withGoal: To help people get in touch with their feelings,their feelings, their “true selves”their “true selves” their purpose in life their purpose in life

Humanistic Therapies Focus on Feelings Humanistic Therapies Focus on Feelings

and Personal Growthand Personal Growth Humanistic therapies: help people get in Humanistic therapies: help people get in

touch with their feelings, with their “true touch with their feelings, with their “true selves,” and with their purpose in life selves,” and with their purpose in life Client-centered therapy: Carl Rogers Client-centered therapy: Carl Rogers

Therapists should be facilitatorsTherapists should be facilitators of personal of personal growth providing supportive environment—growth providing supportive environment—clients discover their “true selves.” clients discover their “true selves.”

Gestalt therapy: Fritz PerlsGestalt therapy: Fritz Perls Therapists help people become aware of their Therapists help people become aware of their

true feelings or some other important aspect of true feelings or some other important aspect of the self. the self.

Cognitive Therapies: Focus on Altering Cognitive Therapies: Focus on Altering

Dysfunctional Thought PatternsDysfunctional Thought Patterns Cognitive therapies seek to identify and then modify faulty Cognitive therapies seek to identify and then modify faulty

cognitive processes. cognitive processes.

Rational-emotive behavior therapy Rational-emotive behavior therapy (REBT): Albert Ellis (REBT): Albert Ellis

Mental distress is caused by the irrational Mental distress is caused by the irrational thinking people have about those events. thinking people have about those events.

Cognitive-behavior therapy (CBT): Aaron Cognitive-behavior therapy (CBT): Aaron Beck Beck Depressed people have negative views of Depressed people have negative views of

themselves, the world, and their future, and themselves, the world, and their future, and they misinterpret everyday events to support they misinterpret everyday events to support these negative views.these negative views.

Cognitive TherapyCognitive Therapy

Cognitive TherapyCognitive Therapy teaches people new, more teaches people new, more

adaptive ways of thinking and adaptive ways of thinking and actingacting

based on the assumption that based on the assumption that thoughts intervene between thoughts intervene between events and our emotional events and our emotional reactionsreactions


The The Cognitive Cognitive RevolutionRevolution


Cognitive-Behavior TherapyCognitive-Behavior Therapy a popular integrated therapy that a popular integrated therapy that

combines cognitive therapy combines cognitive therapy (changing self-defeating thinking) (changing self-defeating thinking) with behavior therapy (changing with behavior therapy (changing behavior)behavior)


A cognitive A cognitive perspective perspective on on psychological psychological disordersdisorders

Lost job

Depression

Internal beliefs:I’m worthless. It’s hopeless.

Lost job

Internal beliefs:My boss is a jerk.I deserve something better.

Nodepression

Child, Group & Family TherapyChild, Group & Family Therapy

Child therapiesChild therapies Common approach used—play therapyCommon approach used—play therapy

Therapist provides children with toys and Therapist provides children with toys and drawing materialsdrawing materials

Assumption is that whatever is troubling them Assumption is that whatever is troubling them will be expressed in playwill be expressed in play


Group therapiesGroup therapies Simultaneous treatment of several clients under Simultaneous treatment of several clients under

the guidance of a therapist the guidance of a therapist

Variation of group therapy is the self-help groupVariation of group therapy is the self-help group::

Several people regularly meeting and discussing their Several people regularly meeting and discussing their problems with one another without the guidance of a problems with one another without the guidance of a therapisttherapist


Family and couples therapiesFamily and couples therapies

Family therapies—dFamily therapies—designed to constructively esigned to constructively modify the dysfunctional relationships among modify the dysfunctional relationships among family membersfamily members

Couples therapy—dCouples therapy—designed to help couples esigned to help couples improve the quality of their relationshipimprove the quality of their relationship

Who Does Therapy?Who Does Therapy?

Where do Where do people turn people turn for help?for help?

Who Does Therapy?Who Does Therapy?Therapists and Their TrainingType Description

Psychiatrist Physicians (M.D.) who specialize in the treatment of psychological disorders. Not all psychiatrists have had extensive training in psychotherapy

Can prescribe medications.

Clinical Ph.D. In psy6chology or Psy.D.

Clinical or A two-year Master of Social Work plus postgraduate supervisionpsychiatric About half have earned the National Association of Social Workers’Social worker designation of clinical social worker.

Counselors LPC, Marriage & Family (MFT)PastoralAbuse

Evaluating TherapyEvaluating Therapy

Client PerceptionsClient Perceptions Consumer Reports StudyConsumer Reports Study

Clinician’s PerceptionsClinician’s Perceptions Outcome ResearchOutcome Research Spontaneous RemissionSpontaneous Remission Regression toward the meanRegression toward the mean

Does Therapy Work?Does Therapy Work? Meta-analysisMeta-analysis

procedure for statistically combining the procedure for statistically combining the results of many different research studiesresults of many different research studies

Poor outcome Good outcome

Averageuntreated

person

Averagepsychotherapy

client

Number ofpersons

80% of untreated people have pooreroutcomes than average treated person

Alternative TherapiesAlternative Therapies

Disconnect between Research and Disconnect between Research and TherapyTherapy

Alternative TherapiesAlternative Therapies Therapeutic touchTherapeutic touch Eye movement desensitizationEye movement desensitization Light exposure therapyLight exposure therapy

Commonalities among TherapiesCommonalities among Therapies

A new perspectiveA new perspective

Trusting, caring relationshipTrusting, caring relationship

Culture and values (therapist-client Culture and values (therapist-client match)match)

Biomedical TherapiesBiomedical Therapies

PsychopharmacologyPsychopharmacology study of the effects of drugs on mind study of the effects of drugs on mind

and behaviorand behavior LithiumLithium

chemical that provides an effective drug chemical that provides an effective drug therapy for the mood swings of bipolar therapy for the mood swings of bipolar (manic-depressive) disorders(manic-depressive) disorders

Biomedical TherapiesBiomedical Therapies The emptying of U.S. mental hospitalsThe emptying of U.S. mental hospitals

Introduction of antipsychotic drugs

Rapid declinein the mental

hospitalpopulation

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990Year

700

600

500

400

300

200

100

0

State and countymental hospital

residents, inthousands

Biomedical Therapies Biomedical Therapies

Today in the United States, less Today in the United States, less than one-third the number of than one-third the number of people are full-time residents in people are full-time residents in psychiatric hospitals. psychiatric hospitals. Reason for this sharp decrease—the Reason for this sharp decrease—the

widespread use of drug therapies in widespread use of drug therapies in treating psychological disorders treating psychological disorders

This form of therapy is often less This form of therapy is often less expensive than psychological therapies. expensive than psychological therapies.

Use of Drugs in Treating Psychological Use of Drugs in Treating Psychological DisordersDisorders

Biomedical TherapiesBiomedical TherapiesProzac blocks normalreuptake of the neuro-transmitter serotonin;excess serotonin in

dynapse enhances itsmood-lifting effect.

Vesiclescontainingneurotrans-mitters

Sendingneuron

Actionpotential

Neurotransmittermolecule

Synapticgap

ReceptorsReceiving neuron

Reuptake Prozac

Message is sent across synaptic gap.

Message is received; excess neurotransmitter molecules are reabsorbed

by sending neuron.

Serotonin

Antipsychotic Drugs Reduce Dopamine ActivityAntipsychotic Drugs Reduce Dopamine Activity Antipsychotic drugs: Antipsychotic drugs:

a group of medications that are effective a group of medications that are effective in treating the delusions, hallucinations, in treating the delusions, hallucinations, and loose associations of schizophrenia by and loose associations of schizophrenia by blocking dopamine receptors & thereby blocking dopamine receptors & thereby reducing dopamine activityreducing dopamine activity

Do not actually “cure” schizophrenia. Do not actually “cure” schizophrenia. They merely help control its severe They merely help control its severe symptomssymptoms. .

Classes of Psychoactive DrugsClasses of Psychoactive Drugs

AntipsychoticsAntipsychotics ThorazineThorazine ClozapineClozapine Olanzapine, etc.Olanzapine, etc.

Block dopamine receptor sitesBlock dopamine receptor sites Treat Schizophrenia & other psychosesTreat Schizophrenia & other psychoses May cause sluggishness & muscle May cause sluggishness & muscle

tremorstremors


AntianxietyAntianxiety Valium, Librium, Xanax, etc.Valium, Librium, Xanax, etc. Tend to be addictiveTend to be addictive


AntidepressantsAntidepressants Increase availability of epinephrine or Increase availability of epinephrine or

serotoninserotonin Prozac, Zoloft, Paxil, etc. world’s most Prozac, Zoloft, Paxil, etc. world’s most

widely prescribed drugs widely prescribed drugs Require about a month for full Require about a month for full

effectivenesseffectiveness

Antidepressant Drugs: Increase Serotonin Antidepressant Drugs: Increase Serotonin and Norepinephrineand Norepinephrine

MAO inhibitors (MAOI) MAO inhibitors (MAOI) inhibit the enzyme inhibit the enzyme involved in breaking down norepinephrine and involved in breaking down norepinephrine and serotoninserotonin are are called the monoamine oxidase called the monoamine oxidase inhibitorsinhibitors (MAOI) (MAOI). .

Tricyclics are antidepressant drugs that have Tricyclics are antidepressant drugs that have milder side effects than MAOI inhibitorsmilder side effects than MAOI inhibitors

Antidepressants that affect only serotonin are Antidepressants that affect only serotonin are selective serotonin reuptake inhibitors (SSRIs). selective serotonin reuptake inhibitors (SSRIs).

Biomedical TherapiesBiomedical Therapies

Electroconvulsive Therapy (ECT)Electroconvulsive Therapy (ECT) therapy for severely depressed therapy for severely depressed

patients in which a brief electric patients in which a brief electric current is sent through the brain of current is sent through the brain of an anesthetized patientan anesthetized patient

PsychosurgeryPsychosurgery surgery that removes or destroys surgery that removes or destroys

brain tissue in an effort to change brain tissue in an effort to change behaviorbehavior

Electroconvulsive Therapy (ECT)Electroconvulsive Therapy (ECT)

A physiological treatment for severe depression A physiological treatment for severe depression in which a brief electric shock is administered to in which a brief electric shock is administered to the brain of an anesthetized patientthe brain of an anesthetized patient

Although ECT is effective in treating severe Although ECT is effective in treating severe depression, no one knows for sure why it works.depression, no one knows for sure why it works.

Several temporary negative side effects, Several temporary negative side effects, including confusion, loss of memory, and including confusion, loss of memory, and impaired motor coordinationimpaired motor coordination

Electroconvulsive TherapyElectroconvulsive Therapy

Psychosurgery: Destroys Portions of the Psychosurgery: Destroys Portions of the

Brain Brain Most radical & controversial treatment Most radical & controversial treatment

A seldom-used surgical procedure in which A seldom-used surgical procedure in which brain tissue thought to cause the disorder is brain tissue thought to cause the disorder is destroyed.destroyed.

Today, MRI-guided precision psychosurgery Today, MRI-guided precision psychosurgery is performed only in extreme cases and it is performed only in extreme cases and it focuses on much smaller brain areas than focuses on much smaller brain areas than those involved in lobotomies. those involved in lobotomies.

LobotomyLobotomy

now-rare psychosurgical procedure now-rare psychosurgical procedure once used to calm uncontrollably once used to calm uncontrollably emotional or violent patientsemotional or violent patients

cut the nerves that connect the cut the nerves that connect the frontal lobes to the emotion-frontal lobes to the emotion-controlling centers of the brain controlling centers of the brain

Documents

Chapter 11 Psychological Disorders and Their Treatment