Psychological Disorders

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Psychological Disorders

• Some statistics
• 1 in 6 Americans suffers clinically significant
  mental disorders RIGHT NOW
• The incidences of mental disorders doubles for
  those below the poverty line
• Over 75 of all sufferers experience their first
  symptoms by the age of 24

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Therapies
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Types of Therapy

• Psychotherapyuse of psychological techniques to
  treat emotional, behavioral, and interpersonal
  problems
• Biomedicaluse of medications and other medical
  therapies to treat the symptoms associated with
  psychological disorders

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• Psychoanalysis
• Developed by Sigmund Freud based on his theory of
  personality

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Causes of Psychological Problems

• Undesirable urges and conflicts are repressed
  or pushed to the unconscious
• Unconscious conflicts exert influence on
  behaviors, emotions, and interpersonal dynamics
• Understanding and insight into repressed
  conflicts leads to recognition and resolution

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• Goals
• Psychoanalysis assumes that many psychological
  problems are fueled by the childhood repression
  of impulses and conflicts

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• It is the job of a psychoanalyst to
• bring repressed feelings into conscious
  awareness

• have the patient work through the feelings
• release the negative, repressed energy

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Techniques of Psychoanalysis

• Free associationspontaneous report of all mental
  images, thoughts, feelings as a way of revealing
  unconscious conflicts
• Resistancepatients unconscious attempt to block
  revelation of unconscious material usually sign
  that patient is close to revealing painful
  memories

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More Psychoanalytic Techniques

• Dream interpretationdreams are the royal road
  to the unconscious interpretation often reveals
  unconscious conflicts
• Transferenceprocess where emotions originally
  associated with a significant person are
  unconsciously transferred to the therapist

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Other Dynamic Therapies

• Most therapies today are shorter-term
• Based on goals that are specific and attainable
• Therapists are more directive than traditional
  psychoanalysis
• Traditional psychoanalysis is seldom practiced
  today

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Humanistic
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Humanistic Therapies

• Humanistic perspective emphasizes human
  potential, self-awareness, and free-will
• Humanistic therapies focus on self-perception and
  individuals conscious thoughts and perceptions
• Client-centered (or person-centered) therapy is
  the most common form of humanistic therapy
• Carl Rogers (19021987)developed this technique

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• Goals
• The humanistic therapists goal is to boost
  self-fulfillment by helping people grow in
  self-awareness and self-acceptance.

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• Methods
• Carl Rogers Client-Centered Therapy is a
  widely used humanistic technique.

HI! Remember Me?

• The deeper understanding a therapist portrays,
  the more open a client will be (this empathy is
  also called unconditional positive regard).

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Client-Centered Therapy

• Therapy is non-directivetherapist does not
  interpret thoughts, make suggestions, or pass
  judgment
• Therapy focuses on clients subjective perception
  of self and environment
• Does not speak of illness or cure

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• Methods
• A key aspect of a client-centered therapy session
  is what Rogers called active listening
• involves a therapists technique of listening
  intently, echoing, restating and seeking
  clarification, and acknowledgement of a clients
  expressed verbal and non-verbal emotions

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Therapeutic Conditions

• Genuinenesstherapist openly shares thoughts
  without defensiveness
• Unconditional positive regard for clientno
  conditions on acceptance of person
• Empathic understandingcreates a psychological
  mirror reflecting clients thoughts and feelings

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Behavioral
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Behavior Therapy

• Behavioristic perspective emphasizes that
  behavior (normal and abnormal) is learned
• Uses principles of classical and operant
  conditioning to change maladaptive behaviors
• Behavior change does not require insight into
  causes
• Often called behavior modification

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• Goals-
• Behaviorists believe that problem behaviors are
  the problem, and the goal is not to figure out
  the meanings behind them, but instead to simply
  eliminate or unlearn the problem behavior

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Systematic Desensitization

• Based on classical conditioning
• Uses three steps
• Progressive relaxation
• Development of anxiety hierarchy and control
  scene
• Combination of progressive relaxation with
  anxiety hierarchy

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Sample Anxiety Hierarchy
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• Aversive Conditioning

• In aversive conditioning, a therapist tries to
  replace a positive response to a harmful stimulus
  with a negative response.

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• Aversive Conditioning
• IE. Dave enjoys sucking his thumb at night.
  This is a bad habit. A therapist would cover
  Daves thumb with hot pepper before bed time.
  Dave does not like the taste of hot peppers, and
  therefore he will stop sucking his thumb.

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Aversion Therapy for Alcoholism

• Relatively ineffective, does not generalize very
  well beyond therapy
• Pairs and aversive stimulus with the undesired
  behavior

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• Methods
• In some cases, a token economy is set up. A
  token economy is one in which a therapist rewards
  patients for displaying appropriate behaviors by
  giving them a token, such as a ticket or a
  plastic coin, that they can later exchange for
  prizes or gifts.

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Token Economy

• Based on operant conditioning
• Use for behavior modification in group settings
  (prisons, classrooms, hospitals)
• Has been successful with severely disturbed
  people
• Difficult to implement and administer

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Cognitive Therapy
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Cognitive Therapy

• Based on the assumption that psychological
  problems are due to maladaptive patterns of
  thinking
• Therapy focuses on recognition and alteration of
  unhealthy thinking patterns

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• Goals
• Generally used for depression and anxiety
  disorders
• Cognitive therapists attempt to teach people new,
  more adaptive ways of thinking and acting

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• Goals
• The belief is that our thinking and
  interpretation of external events is what causes
  depression and anxiety, not the events
  themselves. A therapist wants to change the
  thought processes of patients from negative to
  positive to alleviate disorder symptoms.

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• IE. People with depression or anxiety disorders
  will interpret suggestions as criticism,
  disagreements as dislike, friendliness as pity.
  If a sufferer loses their job, they think Im
  worthless and its hopeless that Ill find
  another job.
• A therapist wants to change these negative
  interpretations to positive thoughts and actions.

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• IE. A student has anxiety over a test. Im
  going to fail. I always fail. The test is hard,
  everyone is prepared, and Ill probably forget
  everything anyway.

• A therapist may counter this with, I didnt do
  very well in that subject either, but I still
  passed and look where I am now. And youre much
  brighter than I was at your age. The test will
  be difficult for everyone. Besides, you dont
  need a perfect score to pass the exam.

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• IE. In addition, have the student look at their
  past, good grades to prove to them that they are
  capable.
• The goal is to dispute the negative thoughts,
  diffuse the stress, and enter positive thoughts
  and encouragement.

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• Methods
• A variation of this therapy is called
  cognitive-behavior therapy. This therapy aims to
  alter the way people act and to alter the way
  they think.

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Rational-Emotive Therapy
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Rational Emotive Therapy

• Developed by Albert Ellis
• ABC model
• Activating Event
• Beliefs
• Consequences
• Identification and elimination of core irrational
  beliefs

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Aaron Becks Cognitive Therapy

• Problems due to negative cognitive bias that
  leads to distorted perceptions and
  interpretations of events
• Recognize the bias then test accuracy of these
  beliefs
• Therapist acts as model and aims for a
  collaborative therapeutic climate

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Cognitive Behavioral Therapy

• Integrates cognitive and behavioral techniques.
  Based on the assumption that thoughts, moods, and
  behaviors are interrelated

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Group and Family therapy
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Group and Family Therapy

• Group therapyone or more therapists working with
  several people at the same time.
• Family therapybased on the assumption that the
  family is a system and treats the family as a
  unit.
• Couple therapyrelationship therapy that helps
  with difficulty in marriage or other committed
  relationships

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• Goals
• Group therapy is generally for people
  experiencing family conflicts or those whose
  behavior is distressing to others.
• Offers the benefit of allowing people to discover
  that there are others with the same disorder, to
  share therapy ideas, to receive feedback, and to
  know that you are not alone

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• Goals
• Provides a sense of community, safety, and
  connectedness
• Support and friendship

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Effectiveness of Psychotherapy

• Meta-analyses show that psychotherapy is more
  effective than no treatment
• Generally no differences among the types of
  psychotherapy it does depend on the disorders

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Factors in Successful Therapy

• Therapeutic relationshipcaring and mutually
  respectful
• Therapist characteristicscaring attitude,
  ability to listen, sensitive
• Client characteristicsmotivated, actively
  involved, emotionally and socially mature

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The rates of improvement for more than 2,000
people in weekly psychotherapy and for 500 people
who did not receive psychotherapy. Clearly,
psychotherapy accelerates both the rate and the
degree of improvement for those experiencing
psychological problems. SOURCE McNeilly
Howard, 1991.
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Biomedical Therapies
Widespread use of antipsychotic medications
began in the mid-1950s Can be related to
number of patients in mental hospitals
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Typical Antipsychotic Medications

• Typical antipsychotics
• Effective against positive symptoms of
  schizophrenia
• Have uncomfortable side effects
• Globally alter brain dopamine levels
• Tardive dyskinesiapossible motor side effect
  that could be permanent with long term drug use

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Atypical Antipsychotic Medications

• Atypical antipsychotics
• Newer drugs that may also be effective against
  negative symptoms of schizophrenia
• Affect levels of serotonin as well as dopamine
• Have uncomfortable side effects
• Symptoms return when medication is discontinued

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Antianxiety medications

• Benzodiazepines (Valium, Xanax)
• reduce anxiety through increasing level of GABA
• side effects include decreased coordination,
  reaction time, alertness, addiction
• Non-benzodiazepine(Buspar)
• may take a few weeks to work
• does not reduce alertness

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Lithium

• Used to treat bipolar disorder (manic-depression)
• Used to interrupt acute manic attacks and prevent
  relapse
• Can have serious side effects and must be closely
  monitored

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Anti-Depressant Medication

• First generationtricyclics and MAO inhibitors
• Effective for about 75 of patients
• Produce troubling side effects
• MAO inhibitors can have serious physiological
  side effects when taken with some common foods
• Tricyclics caused weight gain, dry mouth,
  dizziness, sedation

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Anti-Depressant Medication

• Second generationchemically different but no
  more effective than earlier drugs (Wellbutrin,
  Desyrel)
• Selective serotonin reuptake inhibitors
  (SSRI)have fewer undesirable side effects than
  earlier drugs (Prozac, Paxil, Zoloft)

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Electroconvulsive Therapy

• Used for severe depression
• Very effective for quick relief of symptoms of
  severe depression (can be used until medication
  begins to work)
• May have cognitive side effects such as memory
  loss
• Very controversial treatment