Abnormal Psychology and Therapy Project

1. Abnormal Psychology and Therapy Project Danielle Alley, Claire Cook, Natalie Hagy, Spencer Schlecht

2. Topic #1 Abnormal behavior

3. Abnormal behavior • behavior that is deviant, maladaptive, or personally distressful over a relatively long period of time • deviant- atypical or statistically unusual • maladaptive- interferes with person’s ability to function effectively in world • personal distress- person engaging in behavior finds it troubling

4. Biological Approach • attributes to organic, internal causes • focuses on brain, genetic factors, and neurotransmitters • medical model- describes psychological disorders as medical diseases with a biological origin

5. Psychological Approach • emphasizes contributions of experiences, thoughts, emotions, and personality characteristics • probe rewards and punishers in environment

6. Sociocultural approach • emphasizes social context in which a person lives • includes gender, ethnicity, socioeconomic status, family relationships, and culture • poverty causes stress • stress the way cultures handle disorders

7. Biopsychological approach • biological factors, psychological factors, and sociocultural factors • not everyone predispositioned to a disorder will get it • factors combine in unique ways

8. Classifying abnormal behavior • provides common basis for communicating • allows predictions of how likely a disorder is to occur, who is susceptible, and how to treat it • may be relief for patient • stigma- mark of shame that may cause others to avoid person

9. DSM-IV Classification system • first published in 1952 • DSM-IV published in 1994 and revised in 2000 • new version DSM-V came out 2013 • 112 original disorders, now 374 • classifies on basis of 5 axes • axis 1- all diagnostic categories except personality disorders and mental retardation • axis 2- personality disorders and mental retardation • axis 3- general medical conditions • axis 4- psychosocial and environmental problems • axis 5- current level of functioning

10. Sleep Disorders Sexual/Gender ID Disorders Substance-related Disorders Schizophrenia List of Disorders Anxiety Disorder Somatoform Disorder Factitious Disorders Dissociative Disorders Delirium Dementia Amnesia Mood Disorders Eating Disorders

11. Topic #8: Therapy

12. Biological Therapies • Treatments that reduce or eliminate the symptoms of psychological disorders by altering aspects of body functioning • 3 main topics: Drug Therapy & Electroconvulsive Therapy & Psychosurgery

13. Psychotherapeutic Drug Therapy • First known as herbs • Most commonly used treatment • Can be prescribed by Psychiatrists and other medical doctors • Effective but not fully understood

14. Antianxiety Drugs aka Tranquilizers • Work to make the individual calm by binding to anxiety inducing receptor sites • Benzodiazepines are fast inducing Tranquilizers • ex) Xanax, Valium, Librium • Nonbenzodiazepines (buspirone) are slow inducing Tranquilizers for general use • Potentially Addictive - Dangerous with combination of other drugs • Why use them? • Helps individuals cope with stress TEMPORARILY but often can be misused

15. Antidepressant Drugs regulate Mood • Four classes: 1) Tricyclics - work by increasing neurotransmitter levels (serotonin/endorphins) *help 60-70% of cases Ex) Elavil 2) Tetracyclic - noradrenergic and specific serotonergic antidepressants, enhance serotonin and endorphin levels in brain *most effective drug in reducing depression Ex) Avanza 3) MAO inhibitors (monoamine oxidase) - block enzyme MAO, allowing endorphins and serotonin to break down in the brain *most dangerous antidepressant Ex) Nardil 4) SSRI inhibitor (Selective Serotonin Reuptake) - interfere with reabsorption of serotonin in the brain *increasingly more popular for psychiatrists to prescribe Ex) Prozac

16. Antidepressant Drugs (continued) • Why use them? • Other than treating mood disorders, also treats generalized anxiety disorder, panic disorder, eating and sleeping disorders, social phobia, post-traumatic stress disorder, and eating/sleeping disorder • Increasingly used for sleeplessness and chronic pain • Lithium - lightest of solid elements in the periodic table, used to treat bipolar disorder • Largely unknown how it’s used

17. Do Antidepressants Increase Suicide Risk in Children? • 12-year old Caitlin McIntosh hanged herself shortly after being prescribed antidepressants • FDA followed the incident with a study prescribing children eligible in the study with antidepressants or a placebo • 2% on placebo reported spontaneous suicidal thoughts • 4% on antidepressants reported suicidal thoughts • FDA issued “black box” warning • Future FDA studies showed no link of increased depression in children/adults

18. Antipsychotic Drugseases Tension/Schizophrenia • Used to diminish agitated behavior, reduce tension, decrease hallucinations, improve social behavior, and produce better sleep patterns with severe psychological disorders • Neuroleptics are the most commonly used type • **only cure symptoms • Side effects:lack of pleasure (decrease in dopamine), tardive dyskinesia (involuntary face movements), • Atypical Antipsychotic Medications have less side effects, but are largely unknown • Administering small doses over long periods of time improves the drug effects

19. Electroconvulsive Therapy aka Shock Therapy • Sets off seizure in the brain, like epilepsy • Idea began with Hippocrates, noticing malaria induced convulsions would cure insanity • Ugo Cerletti produced shock therapy in 1937 • Used improperly, leading to Ernest Hemingway and Sylvia Plath to commit suicide • Administered to those not responding to drug or psychotherapy • Effectiveness? • Same effectiveness as other treatments, but works MUCH faster • Controversy over memory loss • Recently move to deep brain stimulation • doctors apply high frequency brain stimulation in acute parts of the brain for OCD/treatment-resistant depression

20. Psychosurgery destruction of brain tissue • Biological therapy that removes irreplaceable brain tissue in order to improve an individual’s temperament • Developed by Antonio Egas Moniz in the 1930s, winning the Nobel Peace Prize • Works by severing connections between the frontal lobe and the thalamus • Walter Freeman popularized “prefrontal lobotomies” • Over 3000 patients turned into a vegetable-like state • Drug therapy overtook lobotomies in the 70s • Today, only severely debilitating conditions are treated through psychosurgery

21. Walter Freeman Documentary https://www.youtube.com/watch?v=_0aNILW6ILk

22. Topic #5 Schizophrenia

23. Schizophrenia- Overview • Severe psychological disorder characterized by highly disordered thought process • Referred to as psychotic because so far removed from reality

24. Schizophrenia- Positive symptoms Positive symptoms-distortion or excess of normal function • hallucinations • sensory experiences in absence of real stimuli • usually auditory • visual-seeing things that aren’t there • delusions • false, unusual, and sometimes magical beliefs that are not part of culture • Thought disorder • disorganized and confused thoughts • word salad- incoherent loose word associations • neologisms-making up new words • Referential thinking- ascribing personal meaning to random events • Disorders of movement • unusual mannerisms, body movements, and facial expressions • catatonia- state of immobility and unresponsiveness for long periods of time

25. Schizophrenia- Symptoms (Cont.) Negative Symptoms reflect social withdrawal, behavioral deficits, and the loss/decrease of normal functions • flat affect • display of little or no emotion • inability to read emotions of others • lack of positive emotional experience in daily life • inability to plan, initiate, and engage in goal-directed behavior Cognitive symptoms are often subtle and detected only in neuropsychological tests • difficulty sustaining attention • problems holding information in memory • inability to interpret information and make decisions

26. Causes- Biological/Structural • Suspect genetic link-current research • enlarged ventricles • small prefrontal cortex and low activity level in this area • changes in distribution/characteristics of brain cells prenatally • excess dopamine

27. Causes- psychological • rooted in person’s difficult childhood experiences with parents- outdated view • stress may be a factor • diathesis-stress model- combination of biogenetic disposition and stress cause schizophrenia

28. Sociocultural factors • not considered a cause, but alters course • individuals in non industrialized nations fare better than in industrialized nations • marriage, warm supportive friends, and employment lead to better coping • individuals can enjoy marriage, productive work, and friends

29. Genes and schizophrenia • as genetic relatedness to someone with schizophrenia increases, individual risk also increases • twins have highest rate (identical 48% and fraternal 17%) • children (13%)

30. Case Study Rich Wheeler, 26 years old, neatly groomed, and friendly and cheerful in disposition, was removed from an airplane by airport police because he was creating a disturbance -- from his own account probably because he was “on another dimension”. On arrest, he was oriented to the extent of knowing where he was, his name, and the current date, but his report of these facts was embedded in a peculiar and circumstantial context involving science fiction themes. Investigation revealed he had been discharged from a nearby state mental hospital three days earlier. He was brought to another hospital by police. On admission, physical examination and laboratory studies were normal, but Rich claimed he was Jesus Christ and that he could move mountains. His speech was extremely difficult to follow because of incoherence and derailment. For example, he explained his wish to leave the city “because things happen here I don’t approve of. I approve of other things but I don’t approve of the other things. And believe me it’s worse for them in the end.” He complained that the Devil wants to kill him, and that his food contains “ground-up corpses”. He was born, he claimed, from his father’s sexual organs. Background investigation revealed that Rich’s difficulties began, after a successful academic start, in elementary school: “I could comprehend but I couldn’t store...it’s like looking at something but being unable to take it in.” He thereafter maintained a D average until he dropped out halfway through his junior year of high school. He has never held a full-time job, and his social adjustment has always been poor. He showed no interest in girls until he married, at age 19, a woman patient he’d met during one of the earliest of some 20 of his hospitalizations, beginning at age 16. A daughter was born in consequence of this match, but Rich lost track of both her and his wife; he has shown no further interest in women. Rich himself is the oldest of five children; there is no known mental disorder in any of his first-degree (i.e. siblings and parents) relatives.

31. Case Study (cont). Unable to maintain employment, Rich has been supported mainly on federal disability welfare--and by virtue of patienthood in public hospitals. His hospital admissions and discharges show a substantial correlation with his varying financial status; that is, he tends to be released from the hospital around the first of the month, when his welfare check is due, and to be readmitted (or alternatively sent to jail) following some public altercation after his money has run out. Numerous attempts to commit Rich to the hospital indefinitely on an involuntary basis have failed because he is able to appear competent at court appearances. However, he has been declared incompetent to receive his own checks, and various relatives have stepped forward to handle his finances. Now they are afraid to do so because Rich set his grandmother’s house afire, having concluded (erroneously, as it turned out) that she was withholding some of his money. He has also threatened others and has been arrested several times for carrying concealed weapons. In the present hospitalization, two different antipsychotic medications were tried over a period of five weeks, with no discernible improvement. Rich still claimed supernatural powers and special connections with several national governments; was still refusing food because of its contamination with ground corpses; and was still threatening bodily harm to persons he found uncooperative. A further attempt was made to commit him and to place his affairs under legal guardianship. As Rich had rather boastfully predicted, this attempt failed because of his defense of himself, and the court dismissed the action. He was discharged to a protected boarding house but disappeared four days later. (Adapted from Spitzer, et al, 1983) http://www.youtube.com/watch?v=bWaFqw8XnpA

32. Topic #9: Psychotherapy

33. Psychotherapy - psychotherapy: a nonmedical process that helps individuals with psychological disorders recognize and overcome their problems - may be given alone or in conjunction with biological therapy administered by psychiatrists and other medical doctors - psychotherapists employ a number of strategies to alleviate symptoms of psychological disorders: talking, interpreting, listening, rewarding, and modeling - licensing and certification are two ways in which society retains control over psychotherapy practitioners

34. Main Types of Mental Health Professionals

35. Psychodynamic Therapies -psychodynamic therapies: treatments that stress the importance of the unconscious mind, extensive interpretation by the therapist, and the role of early childhood experiences in the development of an individual’s problems. -goal is to help individuals recognize the maladaptive ways in which they have been coping with problems and the sources of their unconscious conflicts

36. Psychoanalysis -psychoanalysis: Freud’s therapeutic technique for analyzing an individual’s unconscious thoughts -Freud believed that a person’s current problems could be traced to childhood experiences, many of which involved unconscious sexual conflicts -main techniques that psychoanalysis therapists use free association, interpretation, dream analysis, analysis of transference, and analysis of resistance -free association: a psychoanalytic technique that involves encouraging individuals to say aloud whatever comes to mind, no matter how trivial or embarrassing -interpretation: a psychoanalyst’s search for symbolic, hidden meanings in what the client says and does during therapy -dream analysis: a psychoanalytic technique for interpreting a person’s dreams -transference: a client’s relating to the psychoanalyst in ways that reproduce or relive important relationships in the individual’s life -resistance: a client’s unconscious defense strategies that interfere with the psychoanalyst's understanding of the individual’s problems

37. Contemporary Psychodynamic Therapists -contemporary psychodynamic therapists still probe unconscious thoughts about early childhood experiences to gain insight into their clients’ current problems -BUT they accord more power to the conscious mind and to a person’s current relationships, less stress on sex -instead of lying on the couch and appointments several times a week, today patients sit face to face to the therapist and meet on a weekly basis -Heinz Kohut, contemporary psychodynamic therapist

38. Humanistic Therapies -humanistic therapies: treatments, unique in their emphasis on people’s self-healing capacities, that encourage clients to understand themselves and grow personally -emphasis on conscious rather than unconscious thoughts, present rather than past, and self-fulfillment rather than illness -client-centered therapy: (aka Rogerian therapy or nondirective therapy) a form of humanistic therapy, developed by Rogers, in which the therapist provides a warm, supportive atmosphere to improve the client’s self-concept and to encourage the client to gain insight into problems -goal is to help the client identify and understand his or her own genuine feelings -reflective speech: a technique in which the therapist mirrors the client’s own feelings back to the client -therapist must enter into an authentic relationship with the client, not as a physician diagnosing a disease but as one human being connecting with another -Rogers - condition of worth/ unconditional positive regard, empathy, and genuineness

39. Behavior Therapies -change in behavior is key -therapists offer action-oriented strategies to help people change behavior, not underlying thoughts or emotions -behavior therapies: treatments, based on the behavioral and social cognitive theories of learning, that use principles of learning to reduce or eliminate maladaptive behavior -therapists believe that understanding why someone is depressed isn’t enough, to overcome depression the person needs to eliminate problematic symptoms or behaviors -behavior therapy has been shown to be effective in treating OCD -behavioral treatments are useful in individuals whose cognitive abilities are limited

40. Classical and Operant Conditioning Techniques Classical Conditioning Techniques -used by therapists to treat phobias of clients -systematic desensitization: a method of behavior therapy that treats anxiety by teaching the client to associate deep relaxation with increasingly intense anxiety-producing situations -flooding - exposing an individual to feared stimuli to an excessive degree while not allowing the person to avoid the stimuli -aversive conditioning is used to avoid behaviors such as smoking, swearing, and drinking alcohol Operant Conditioning Techniques -consequences of a person’s behavior are changed to ensure that healthy, adaptive replacement behaviors are followed by positive reinforcement

41. Ellis’s Rational-Emotive Behavior Therapy -rational-emotive behavior therapy (REBT): a therapy based on Ellis’s assertion that individuals develop a psychological disorder because of irrational and self-defeating beliefs and whose goal is to get clients to eliminate these beliefs by rationally examining them -once people convert their important desires into demands, they often create dysfunctional, exaggerated beliefs -a client is shown how to dispute his or her dysfunctional beliefs and how to convert them to realistic and logical thoughts -successful outcome means getting the client to live in reality, where life is sometimes tough and bad things happen

42. Cognitive Therapy Techniques • Challenging idiosyncratic meanings • Question the evidence • Reattribution • Examine options and alternatives • Decatastrophize • Fantasize consequences • Examine advantages and disadvantages • Turn adversity to advantage • Guided association • Scaling • Thought stopping • Distraction • Labeling of distortions

43. Beck’s Cognitive Therapy -similar to Ellis, Beck’s approach derives from the idea that the goal of therapy is to help people recognize and discard self-defeating cognitions -individuals learn to make connections between their patterns of thinking and their emotional responses -emotions are a product of cognitions, by changing cognitions people can then change how they feel -with therapist’s help, clients learn to recognize logical errors in their thinking and to challenge the accuracy of these automatic thoughts -REBT is very directive and confrontational, more like bringing down a sledgehammer on irrational beliefs -Beck’s involves more or an open-ended dialogue between the therapist and individual, more subtle process of coaxing a client to recognize that these beliefs promote thoughts that influence feelings -both more effective than drug therapy

44. Cognitive-Behavior Therapy -cognitive-behavior therapy: a therapy that combines cognitive therapy and behavior therapy with the goal of developing self-efficacy -similar to Bandura’s beliefs of self-efficacy -basically the therapist gives the individual positive messages to repeatedly tell themselves -self-instructional methods are cognitive-behavior techniques aimed at teaching individuals to modify their own behavior

45. Cognitive Therapy for Psychological Disorders -cognitive therapy has successfully treated some anxiety disorders (such as panic disorders, PTSD, OCD, phobias), mood disorders, schizophrenia, and personality disorders -cognitive therapy and drug therapy are very effective in treating psychological disorders -just as good if not better than drug therapy -earliest application was used to help treat depression

46. Therapy Integrations -integrative therapy: a combination of techniques from different therapies based on the therapist’s judgement of which particular methods will provide the greatest benefit for the client -characterized by openness to various ways of applying diverse therapies -no “one size fits all” approach when it comes to therapy -integrative therapy is at work when psychotherapy and drug therapy are used -therapy integrations help to take a broader look at individuals’ problems

47. Topic #10: Sociocultural Approach & Issues in Treatment

48. Sociocultural Approach • Primarily useful for Western Culture • Examines how cultural context affects behavior • Ex.) Latinos have less personal space

49. Different Types of Therapy • Group Therapy- brings together individuals who share a disorder • Puts people into context of relationships • Couples therapy- Group therapy with married or unmarried couples with problems dealing with the relationship • Often deals with poor communication

50. Different Types of Therapy (cont.) • Family Therapy- Group therapy with family members • Four widely used techniques • Validation • Reframing • Structural change • Detriangulation