Abnormal Psychology and Treatment

1. Abnormal Psychology and Treatment

2. Calendar for this Unit • Art or Music, and Mental Illness—Sign up for your day—Week 1: Diagnose and Week 2: Treat • Vocabulary—Chapter 16 Due Friday! • Vocabulary—Chapter 17 Due Next Friday! • Mental Illness and Treatment Role Play • Groups of 3 (patient, therapist, narrator) • 5 sources • Have fun—props, puppets, drama, etc.

3. Q--What is normal?

4. Defining Abnormality • 1/7 Americans and 1/10 Worldwide—Why? • Is it an illness? • Yes! Schizophrenia vs. Type 1 Diabetes • DSM IV TR—Designed to diagnose—not treat! • Abnormality • Maladaptive • Disturbing to others • Atypical • Irrational

5. Defining Abnormality • Insanity is a legal term • Causes of Abnormality—Mobile Survey/Notes • Psychoanalytic • Humanistic • Behavioral • Cognitive* • Sociocultural • Biomedical • Eclectic*

6. Psychoanalytic • Cause of mental illness--Internal, Unconscious Conflicts mostly stemming from childhood • Freud, Horney, Erikson, Adler, and Jung

7. Humanistic • Cause of mental illness--Failure to strive toward one’s potential— self actualization or being out of touch with one’s true feelings • Maslow and Rogers

8. Behavioral • Cause of mental illness—reinforcement history and the environment • Skinner, Watson, and Bandura

9. Cognitive • Cause of mental illness—irrational, dysfunctional thoughts or maladaptive ways of thinking

10. Sociocultural • Cause of mental illness—Dysfunctional society; not you but the society that you live in

11. Biomedical • Cause of mental illness—organic problems, biochemical imbalances, genetic predispositions • Psychiatrists

12. Eclectic • Clinical psychologists do not tend to subscribe to just one perspective, but instead utilize many and accept and use ideas from a number of perspective

13. Sybil—Scenes 1,2,3 • What aspects of abnormality are displayed? • What perspective of mental illness best explains Sybil’s problems?

14. Types of Disorders • Intern Syndrome???? • Anxiety • Somatoform • Dissociative • Mood or Affective • Schizophrenic • Personality

15. Anxiety Disorders Simple or Specific Phobia Claustrophobia Arachnophobia Agoraphobia Social Phobia Famous People With Anxiety

16. Anxiety Disorders GAD Panic Disorder Acute /Instense Anxiety • Generalized Anxiety Disorder • Constant Low Level Anxiety • http://www.webmd.com/video/generalized-anxiety-disorder

17. ANXIETY DISORDERS http://www.webmd.com/video/teen-with-ocd OCD—Obsessive Compulsive Disorder Germs Medical Issues Symmetry Cleanliness Numbers And more! Look at Checklist! http://www.brainphysics.com/screener.php

18. ANXIETY DISORDERS • PTSD— • Post Traumatic Stress Disorder • Caused by trauma from war, rape, accidents, etc. • Symptoms— • Flashbacks • Nightmares • Severe Anxiety • Drug Abuse

19. Causes of Anxiety • Psychoanalytic—unresolved, internal conflicts between ID, Ego, and Superego • EX.—ID wishing to rid yourself of a bad parent and the Superego saying that it is wrong to have such a wish • Behaviorists—anxiety is learned • EX.--classical conditioning of phobias • Cognitive—dysfunctional, irrational thinking • EX.—setting too high of standards for yourself

20. Sybil—Scenes 4,5,6 • What examples of anxiety did you see? • If you were going to diagnose Sybil with an anxiety disorder, what would it be? • What is the most probable cause for Sybil’s anxiety?

21. Somatoform Disorders Psychological problem manifests in a physical way Somatization Hypochondriasis Conversion Psychophysical Munchausen Munchausen by Proxy

22. Causes of Somatoform • Psychodynamic or psychoanalytic—unresolved conflicts that cannot be resolved • Behaviorists—have been reinforced for being sick or for their behavior either through an actual reward or the removal of something unpleasant • Cognitive—don’t know how to positively get attention

23. Dissociative Disorders—disruption in cognition Psychogenic Amnesia DID Dissociative Identity Disorder AKA—multiple personality disorder • No organic or physical basis • Selective, Localized, Generalized • Fugue

24. Causes of Dissociative Disorders • Psychoanalytic—extremely traumatic events have been repressed and the split consciousness results • Behaviorists—patients find dissociating rewarding because they don’t have to think about the trauma. Amnesia is “easier” than dealing with it • Very rare and many question legitimacy • E. Loftus would question it—why?

25. Sybil—Scene 7, 10, 11 • What signs of somatoform disorders did Sybil and/or her mom show of a somatoform disorder? • What is the likely cause of the mother’s somatoform behavior? • What signs does Sybil show of DID? • What is the likely cause of the disorder?

26. Mood or Affective Disorders • Major Depression—aka: Unipolar Depression • DSM says you have to: • depressed more than 2 weeks • Absence of clear reason • Loss of Appetite • Fatigue • Change in sleep • Lack of interest • Feelings of worthlessnes • Seasonal Affective Disorder--SAD • Bipolar Depression—aka: Manic-Depression • Depressed episodes are similar to major depression • Manic episodes • High energy • Heightened sense of confidence & power • Anxious/Irritable • Risky Behavior • Don’t think about negative consequences

27. Causes of Mood Disorders • Psychoanalysts –anger directed inward, loss during early stages, overly punitive superego • Behaviorists—brings some amount of reinforcement such as attention or sympathy • Aaron Beck (cognitive) caused by unreasonably negative ideas about themselves, world, and future— Cognitive Triad • Cognitive psychologists would also look at attributions—pessimism, internal, external, global, specific

28. Causes of Mood Disorders • Martin Seligman—Learned Helplessness • Shocked Dogs • Relate to humans?!? • Unable to fix the situation, so they give up • Biological— • low levels of serotonin and or norepinephrine and unipolar • More receptors for acetylcholine and bipolar • Genetic Component—run in families

29. Schizophrenia • Types of Schizophrenia • Paranoid • Delusions of persecution • Disorganized • Clang association (+ symp.) • Neologisms (+ symp.) • Innappropriate Affect • Flat Affect (neg. symp.) • Catatonic (negative symp.) • Waxy flexibility (neg. symp.) • Undifferentiated • Disorganized thinking Most severe mental illness Disorder characterized by: Disturbed thoughts, behaviors, movement Hallucinations Delusions—persecution and grandeur Disorganized thoughts and speech—word salad, clang associations

30. Schizophrenia Simulator • http://www.janssen.com/mindstorm_video.html

31. Causes of Schizophrenia • Genetic—if a close family member has schizophrenia, then you are more likely to suffer—5th chromosome abnormality (bio) • Twin Studies—Monozygotic vs. Dizygotic • Dopamine Hypothesis—more dopamine (bio) • Enlarged ventricles—takes away frontal lobe development in late teen years, early 20s (bio) • Double Bind parent??? (cognitive, sociocultural) • Diathesis-Stress Model—environmental stressors activate genetic predispositions (bio/) • Drug use (bio)

32. Sybil—Scenes 19,20, 21 • What symptoms of depression does Sybil or one of her personalities display? • What is the cause of her depression? • What symptoms of schizophrenia does Hattie display? • What do you think caused her schizophrenia?

33. Personality Disorders • Personality Disorders are characterized by a maladaptive way in behaving that seems to be imbedded in the personality during development Histrionic Paranoid Dependent Anti-social Narcissistic—DSM? Compulsive Obsessive Passive-Aggressive Schizoid/Avoidant Borderline

34. Causes of Personality Disorders • Psychoanalytic—unresolved conflict between the id and superego • Behavioral—some maladaptive aspect of the personality has been reinforced • Sociocultural—dysfunctional society has caused personality flaws • Cognitive—maladaptive thinking cause personality flaw • Humanistic—personality flaw developed by conflict between ideal self and real self

35. Other Mental Illnesses in the DSM-IV-TR • Paraphillias—sexual disorders • Pedophillia, zoophillia, fetish, voyeur, masochist, sadist • Anorexia-Nervosa and Bulemia • Loss of 15% of body mass, fear of food, distorted body image • Substance Use Disorder— • Substance dependence—addiction • ADHD??? • Overdiagnosed • Autism • Less social and emotional contact, language delayed, and don’t seek parent assistance

36. Sybil—Scenes 26, 27, 28 • Does Sybil suffer from any personality disorders? If so, why do you think she developed it? • Does her dad seem to suffer from a personality disorder? If so, why do you think it developed?

37. Caution!!!!!!!! • Is it a good idea to label people as depressed or as a hypochondriac? Is there really a benefit to giving a person a label? • Rosenhan—Who’s Crazy Here Anyway? • Discuss with a neighbor what Rosenhan concluded and what info we can take from his study! • Clinical Psychologists more likely to label—Counseling Psychologists not so much!

38. History of Treatment • Trephining • Enlightenment—Dorothea Dix • Deinstitutionalization • Preventative Efforts • Primary—reduce socieatal problems • Secondary—work with at risk persons • Tertiary—keep mental illness from getting worse

39. Treatment Options • Finish Sybil—29, 31 • What type of therapy do you think Dr. Wilbur uses with Sybil? • Do you think it was ethical/appropriate for Dr. Wilbur to get so close to Sybil? Psychoanalytic Humanistic Behavioral Cognitive* Sociocultural Biomedical Eclectic*

40. http://abcnews.go.com/GMA/video/charlie-sheen-not-bipolar-bi-winning-13017875http://abcnews.go.com/GMA/video/charlie-sheen-not-bipolar-bi-winning-13017875 Patient: Charlie Sheen Diagnosis:______________ Treatment Proposal:_____________________

41. http://abcnews.go.com/GMA/video/lindsay-lohan-speaks-out-13026910http://abcnews.go.com/GMA/video/lindsay-lohan-speaks-out-13026910 Patient: Lindsay Lohan Diagnosis: ___________________ Treatment Proposal:____________________

42. Patient: Marshall Bruce Mathers III aka Eminem, Slim Shady Diagnosis:____________ Treatment Proposal:____________

43. Psychoanalytic • Must bring repressed memories and conflict with id/superego to the surface so ego and conscious can deal with it. • If you do the work, you won’t have symptom substitution • Hypnosis • Free Association • Role play! • Dream Analysis • Manifest vs. Latent • Resistance • Transference • Countertransference • Dr. Wilbur—Example • Psychodynamic--Insight

44. Humanistic • Must help CLIENT remove roadblocks to self actualization and resolve incongruence between real self and ideal self in a non-directive way • Need for unconditional positive regard • Carl Rogers—I’m OK, You’re OK • Active Listening • Role Play! • Free Will vs. Determinism • Client Centered or Person Centered Therapy • Modeling Congruence

45. Other Types of Humanist Therapies • Existential Therapy • Life is worthwhile • Has purpose • Don’t Worry, Be Happy! • Gestalt Therapy • Much more directive • Empty Chair Technique • WHOLE selves • Integrate self into one • Who would be in your empty chair and what would you say to them?

46. Behavioral • Must counter condition the patient in a more adaptive way • Mary Cover Jones—Counter Conditioning • Joseph Wolpe—Systematic Desentization • Relaxation • Flooding • In vivo vs. Convert • Extinguishing Fear • Aversive Conditioning • Token Economy • Biofeedback

47. Anxiety Hierarchy—Systematic Desensitization • in vivo vs. covert desensitization Most Anxiety Provoking Least Anxiety Provoking

48. Cognitive • Must fix maladaptive thinking in a directive way • Fix unhealthy attributional styles and replace it with more effective attributions • Aaron Beck—Cognitive Therapy—Cognitive Triad • Cognitive Behavioral Therapy or CBT • Rational Emotive Behavioral Therapy or RBET • Albert Ellis Role Play with someone in class to get rid of an irrational belief they have!

49. Sociocultural • Most help patient by fixing his/her environment—ie—family, friends, workplace, etc. • YOU don’t exist in a vacuum • Family Therapy • Couples Counseling • Group Therapy • AA/NA • Self Help Groups

50. Biological or Somatic Therapies • Treating mental illness from a biological approach like you would any illness • Psychiatrists • Family MDs • Other MDs • NOT typically Psychologists • Medicine • Psychosurgery • Lesioning vs. Lobotomy • Diet/Exercise • ECT/Shock Therapy