Psychological Dysfunction and Treatment

1. Psychological Dysfunction and Treatment Disorders are given psychological labels and listed in the DSM

2. Manual used by psychiatrists for diagnosing patients with psychological problems

3. DSM was developed by psychiatrists to achieve certain goals --Provide Standard Criteria for classification of mental disorders such as schizophrenia, bipolar disorder, depression or obsessive compulsive disorder (OCD). --Vehicle for Communication between mental health professionals as now there can be more agreement about what constitutes a disorder.

4. Critiques of the DSM • The classification encourage people to be are viewed through the negative filter of their diagnosis. • Instead of seeing a person as normal but with high anxiety they are seen as a person with a generalized anxiety disorder. • Many labels serve as stigmas that negatively influence how people are perceived. • The emphasis of the DSM leans excessively toward the biological model as the cause of disorders—that is, genetic and brain-based.

5. Five revisions of DSM each dramatically increasing the number of disorders • The symptom-based criteria sets of DSM-IV have led to an endless multiplication of mental conditions and disorders. • A volume that was only 119 pages long in its second (1968) edition has swelled to 886 pages in less than thirty years. • To read more: http://www.minddisorders.com/Del-Fi/Diagnostic-and-Statistical-Manual-of-Mental-Disorders.html#ixzz5VXaIFw3X

6. Source of Psychological Disorders • Is the cause of psychological problems biological or learned? • Genetic or Acquired from experiences? • . • Many problematic behaviors have been learned which also means they can be unlearned

7. Need HPA Axis to survive and protect us when under threat • A person who experienced excessive stress during childhood will have an overly developed stress axis. • This causes them to overreact to all events, even minor sources of stress. • Also, when under constant threat, the brain gives insufficient attention to the development of the cerebral cortex & hippocampus • Helps explain why children who experienced early trauma have deficits in reasoning and problem-solving.

8. How can children learn to become anxious: Raised in Stressful Environment • Overly protective, intrusive &/or demanding parents • Very unstable and unpredictable early environment • Parents model excessive number of anxieties and fears, as Mrs. Hughes did for Howard toward germs

9. These Factors Cause Children to Learn to become Anxious • Observational Learning: Parents or caregivers or siblings display frequent anxiety • Very nerve-wracking to be over-controlled as well as given pressure of unreasonable demands • Too early and extensive day care &/or too little stability in one’s early environment

10. Classical Conditioning Paradigm • How Howard Hughes develop phobia toward germs UCS UCR CS CR

11. In the film Shine, David Helfgot and volatile, demanding & abusive father UCS UCR CS CR

12. Anxiety Disorders

13. General Anxiety Disorder

14. Panic Disorder: Anxiety Levels can result in Panic Attacks Symptoms: Racing heart Feel faint and/or dizzy Tingling or numbness in hands or arms Sense of impending doom Chest pains Difficulty with breathing Feel a loss of control

15. Social Anxiety Disorder

16. Behavioral Clinic that teaches socially phobic people to learn how to reach out • Model and rehearse simple and appropriate ways to initiate a social interaction • Give weekly assignments that start very simple and move forward step-by-step • Report back to group every week on successes the previous week

17. Obsessive Compulsive Disorder

18. Common Thoughts or Obsessions • Fear of dirt or contamination by germs • Fear of doing harm to another • Obsess if proper order and neatness has not been maintained • Excessive doubt and need for constant reassurances • Fear of thinking evil or sinful thoughts

19. Common Compulsions • Repeatedly showering or washing hands • Refuse to shake hands or touch door knobs • Repeatedly checking things, as locks • Constantly arranging things in certain order • Collecting or hoarding items of no value

20. Aviator: Life Howard Hughes

21. Childhood of Howard Hughes • 1) He grew up with a mother who forced him to endure odd cleaning rituals, as dousing himself with mineral oil daily. • 2) She disapproved of him making friends as believed they were carriers of disease, resulting in him spending much of his childhood alone or with his mother. • 3) Mother insisted on giving Howard hand baths until he reached his teens. • 4) She watched for slightest changed in physical condition, sniffles, a cough as well as any abnormality in his feet, teeth or digestion and then would whisk to a doctor, in the process lavishing much attention and sympathy. • 5) Observers were amazed at the extreme closeness between Howard and his mother and how often they would kiss and hug.

22. Hughes also developed life-long obsession with germs • Not like anyone touching him • Over-react to people around him to be messy or dirty, especially when under stress • Wash his hands many times every day • Become more and more reclusive through the years

23. Last 20 years live alone in hotel room

24. Cognitive therapy for anxiety: challenge a person’s distorted perceptions • Will touching doorknobs cause contamination & then serious illness? • What will be the dire consequences of not washing your hands more than 5 times a day? • Are people really watching and judging you when you walk into a restaurant or library? • Are you really having a heart attack during a panic episode? • So what if not do a job perfectly?! So what if not get an A on every tests?! • Can control habitual anxious thinking & so reduce anxious feelings

25. Behavioral Therapy: Exposure & Response Prevention Using Systematic Desensitization expose a person to their fear in small steps Create a hierarchy of fears from the most to the least Then prevent habitual response that person usually makes to that feared stimulus

26. Behavioral Changes for Anxiety • Practice the “relaxation response:" Starts with the mind which, in turn, relaxes the body • Learn deep muscle relaxation exercises: Starts with the body which, in turn, relaxes the mind (Yoga)

27. Behavioral Therapy: Can learn behaviors that effectively reduce anxiety Meditation

28. Yoga

29. Depression

31. Causes of Depression: operant conditioning • Child receive much extinction &/or lots of discouraging feedback • Receive very little positive, encouraging feedback • Not encouraged to become independent—or develop a sense of autonomy • Given sense that they are not valued, lovable or competent

32. Social Learning Explanation of Cause of Depression • Determine how one’s thinking patterns are overly negative—always focusing on what one has done wrong. • One’s negative thinking leads to negative moods and depression • Negative moods leads to inactivity which, in turn, increases ones negative thinking.

33. What are examples of negative thinking when we are depressed? • Believe cannot control environment so feeling helpless and hopeless • Learn selective perception: focus on what did wrong, not what did right as what parents did • Develop pessimistic attitude and low self-esteem • When experience loss or set-backs, over-react and become depressed and blame self

34. Feeling Good Handbook • All or nothing thinking • Discounting the positive • Believe need to be perfect or have failed • Buy into view ‘am a loser,’ no matter what

35. Cognitive-Behavioral Therapy • Identify cognitive distortions and practice more positive and productive thinking patterns • Change behavior patterns from being inactive and start to become engaged and involved with a social community, volunteer work, exercise, etc—working in small steps

36. Behaviors to reduce depression • Step-by-step increase in level of exercise do on daily basis: start at 250 steps per day & week by week increase up to 10,000 • Increase social network: create one social interaction during a week • Join new social groups via meetup.com

37. Cure for Depression—Become active and productive

38. Books Cognitive Behavioral Therapy

39. Cognitive Behavioral Books focused on specific problems

40. Schizophrenia is most serious psychological dysfunction • Diathesis-Stress Model: Born with genetic defect that predisposes them to overreact to stressors OR • Early severe stressful events cause abnormal neurodevelopment that has caused nervous system to be hyper sensitive to stressors

41. Early Trauma results in an overly developed Stress Axis: HPA Axis

42. Abnormalities found in schizophrenics • Over-reactivity of hypothalamic-pituitary-adrenal axis • Structural brain changes, including hippocampus damage and cerebral atrophy • Elevation of release of cortisol and dopamine when exposed to stress

43. What could these neurological abnormalities explain? • Oversensitivity to stress • Cognitive impairments • Relationship between psychotic and hallucinations, delusions and paranoia

44. Problem with biological model • Impede adequate consideration of relevance of stress, trauma, neglect and loss in early childhood • Diathesis-stress model only measure stressors a few weeks or months prior to outbreak so not consider early life events • Gross imbalance in examining biological psychological and social factors

45. “Genotype-environment interaction in schizophrenic-spectrum disorder” • British Journal of Psychiatry (2004) • 36% of high-genetic risk adoptees raised in dysfunctional families develop symptoms • 5.8% of high-genetic risk adoptees raised in healthy families • Demonstrates protective effect of family

46. Factors in Environment: High Degree of Stress Early in Life • Genetic risk combined with volatile, hostile unpredictable, judgmental and/or overly protective environment

47. Healthy Families • Have good sense of humor and can laugh at themselves • Respect each other’s need for privacy and not engage in mind reading • Negotiate and compromise

48. Findings of Adoptee studies • Genes do not operate alone • Environmental factors play a significant role • Much of environmental influences are result of family environment • Developing brain vulnerable early in life

49. Traits of Healthy Families • Speak clearly and are not rigid nor confusing • Friendly environment & able to disagree without upsetting other members • Can express happiness or sadness to each other

50. Treatment for Schizophrenia:Limited to Biological Treatments