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Psychopathology: Abnormality

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Title: Psychopathology: Abnormality


1
PsychopathologyAbnormality
  • In psychology individual differences involves the
    study of the ways that individuals differ in
    terms of their psychological characteristics.
  • People differ in many ways in their
    intelligence, aggressiveness, willingness to
    conform, masculinity and femininity, etc.
  • An important individual difference is in the
    degree to which a person is mentally healthy.
  • This is Psychopathology and it is this area of
    individual differences we study in AS Psychology.
  • In order to protect and/or treat people with an
    abnormality psychologists need to be able to
    define them as having abnormal psychopathology.
  • So how do we define someone as being abnormal?
    What parameters do we use?
  • In groups of 2 or 3 use the paper provided to
    write down a list of things that may make a
    person appear abnormal. What would you look for
    as an indication of abnormal behaviour?
  • You have five minutes

2
What makes someone abnormal?Your Ideas on
board
So do these ideas fit into one of the four
following categories?
Statistically rare, Going against social norms,
Mentally ill Or Inability to function safely
(danger to self or others)
3
Can you define the following behaviour as
abnormal using all four definitions?
4
(No Transcript)
5
L2
STATISTICAL INFREQUENCY
A very unusual behaviour or trait will be more
than 2 standard deviations from the mean. i.e.
over 130 or under 70 IQ score. This statistically
rare behaviour or trait is likely to be seen as
being abnormal.
6
Statistical Infrequency Is all rare behaviour
abnormal and if not how do we decide what is is
this?
7
Why is context so important when defining
behaviour as abnormal?
8
Statistical Infrequency Limitations/Criticisms
  • Mental Health By this definition all rare
    behaviour would be seen as abnormal however,
    depression and anxiety are not rare but clinical
    depression is rare (but is only diagnosed if
    patient attends the doctors so how do we know
    how rare it is?)
  • Gender Issues (Females are more likely than males
    to consult a GP). (In our culture females can
    wear makeup and skirts without seeming abnormal
    males ??? Well David Beckham manages it!)
  • Cultural Issues (Jewish people mourn by tearing
    their clothes and wailing in public.) (In India
    mentally ill people are thought to be cursed) (In
    china being mentally ill carries such a stigma
    that it is rarely diagnosed) (Some cultures walk
    around naked and you are in the minority if you
    are clothed!) (In the USA 48 of people were
    treated for psychological disorders at some point
    by this definition that would make them
    normal!)
  • Age Thumb sucking and bed wetting may be
    considered statistically normal at 2 years old
    but not at 20!
  • Desirability of behaviour Many behaviours are
    rare but considered highly desirable (High IQ,
    Great athletic ability). It is difficult to know
    how far you have to deviate from the average to
    be considered abnormal?

9
Advantages of this approach
  • Statistical Infrequency is an obvious and
    relatively quick and easy way to define
    abnormality.
  • It has face validity that odd or rare behaviour
    is seen as abnormal
  • Applications of statistical definitions It is
    relatively easy to determine abnormality using
    psychometric tests developed using statistical
    methods.E.g. there is a test for O.C.D.
    Obsessive compulsive disorder.
  • You can have a go at the test if you like could
    you be a potential sufferer?
  • First watch an O.C.D. sufferer in action!

10
(No Transcript)
11
L3
DEVIATION FROM SOCIAL NORMS
  • Society sets up rules for behaviour based on a
    set of moral standards which become social norms
    (V.I.M.). Any deviation is seen as abnormal
    (Szasz 1972)
  • This suggests that madness is a term manufactured
    in order to label the people in society who do
    not conform to the rules of society.
  • These unwritten social rules are culturally
    relative (i.e. you cannot judge behaviour
    properly unless it is viewed in the context from
    which it originates as different cultures have
    different social norms and behaviour may differ
    across cultures). A lack of cultural relativism
    can lead to ethnocentrism, where only the
    perspective of your own culture is taken. Social
    norms can also be era-dependent.
  • For example, homosexuality was once illegal and
    considered to be a mental disorder because it
    deviated from the social norm. Now there are
    campaigns for gay marriages to be recognized and
    afforded the same benefits as heterosexual
    marriages
  • This shows the extent to which this definition of
    abnormality is subject to change.

12
AO2 Deviation from Social Norms Limitations /
Issues
  • Historical Issues Until early 20th century,
    unmarried women who became pregnant were
    interred in mental institutions.
  • Until 1960's in the UK homosexual acts were
    criminal offences
  • Until 1973 in USA homosexuality was a mental
    disorder!
  • Cultural Issues Russia - a diagnosis of
    insanity was used to detain political
    dissidents.
  • Japan - You are deemed insane if you do not
    want to work!
  • Western Societies - you can plead insanity as
    a defence - Lorena Bobbit cut of her husband's
    penis - pleaded / temporary insanity!
  • Expected Behaviour African/Indian cultures
    consider it normal to talk to the dead.
  • Nakedness normal in some cultures.
  • Context Singing in park understood if you see
    the film crew!
  • SUMMARY
  • Social norms is a subjective measurement of
    abnormality as norms change over time and differ
    between cultures.
  • This approach has been used as a form of social
    control.
  • Social norms are necessary and specific to each
    society to enable members of each
    society to know the rules in order to get along
    together!
  • Anti-Social Behaviour can be viewed as abnormal
    under this definition e.g.

!
Hello!
13
(No Transcript)
14
Short Answer Exam Questions(SAQs)
  • Deviation from social norms is one definition of
    abnormality You may use your handouts to help
    you with this. (feed back to class later)
  • What is a social norm?
  • (b) Give one example of how breaking a social
    norm might lead to the behaviour being defined as
    abnormal.
  • (c) Outline one other way of defining abnormality

15
Starter
L4
  • Complete the recap exercise
  • Problems with diagnosis Social norms, social
    control and personal freedom.

16
Deviation from Ideal Mental HealthSix
Categories that Clinicians Typically Relate to
Mental Health PRAISE Marie Jahoda (1958)
  • Personal growth (Self Actualisation should reach
    your potential)
  • Reality perception (should know whats real)
  • Autonomy (should be independent)
  • Integration (should fit in with society and be
    able to cope with stressful situations)
  • Self-attitudes (should be positive high self
    esteem)
  • Environmental mastery (should cope in your
    environment, be able to function at work and in
    relationships, adjust to new situations and solve
    problems)

17
Deviation from Ideal Mental Health
Limitations/Criticisms
  • Jahoda 1958 said that it was better to focus on
    positive aspects of mental health rather than the
    negative so this is seen as a positive attempt
    to define abnormality.
  • Positive self attitude (Many people have a
    negative self image due to such things as
    Bullying, Persecution of gender and/or race etc
    but are they abnormal?)
  • Growth to ones potential or self actualisation
    ( Very few people reach their full potential due
    to such things as Family commitments, Money,
    Social / peer pressure, Gender OR Culture some
    countries women are not allowed to work! are
    they abnormal? CULTURAL RELATIVISIM!)
  • Resistance to stress (Integration) Should fit
    in without suffering stress. Some people thrive
    on stress, Personality may make you more
    susceptible, Some people crack under enormous
    amounts of stress prisoner of war camps are
    they abnormal?)
  • Autonomy (independence) ability to make our own
    decisions (Some people cannot due to disability
    illness age culture e.g. arranged
    marriages, collectivist societies WE not ME
    prisoners poverty are they abnormal?)
  • Perception of reality (Other things than mental
    illness affect our perception of reality e.g.
    Alcohol, drugs/LSD, illness/diabetes are they
    abnormal?)
  • Adapting to the environment (More difficult if
    you are poor, black, female, disabled etc. but
    are they abnormal?)
  • SUMMARY
  • Criteria are so demanding that almost everyone is
    bound to fall into the category of mental ill
    health!

18
Failure to function adequately
  • A definition of abnormality based on an inability
    to cope with day-to-day life caused by
    psychological distress or discomfort which may
    lead to harm of self or others.

19
Failure to Function Adequately
  • This is seen as a humane way of addressing
    psychological problems as it allows the
    individual to decide if they need or wish to seek
    help.
  • However it does have some limitations as a method
    of defining abnormality such as
  • Labelling a label gives a stigma that may stick
    around long after the problem has gone. Can
    affect employment prospects and personal
    relationships.
  • Gender issues Bennett 1995 found that societies
    have created masculine stereotypes that alienate
    men from seeking help for psychological problems.
  • Enforced detaining in mental institutions
  • If behaviour appears abnormal there is no
    institutionalisation providing the individual can
    function adequately and is not harming self or
    others.
  • Before 1983 people could be detained in mental
    institutions against their will on the authority
    of a health professional guardian or husband.
    (NOTE Wives could not have husbands detained!)
  • Psychiatric prison is the only place in the UK
    that people can be detained against their will.
  • Care in the community means that there are not
    enough hospital places for those who want
    residential care. So health professionals leave
    people alone unless there is severe dysfunction.
  • SUMMARY
  • Leaves power with the individual.
  • Not functioning adequately is not seen as serious
    in mental disorder terms.
  • Individuals may be aware or unaware of their own
    dysfunction so how can psychiatrists be sure of
    a diagnosis and how can they know for sure when
    a patient is cured?

20
We are now going to watch a video about two
people with mental illness. Louisa and
Darryl. As you are watching decide if Louisa
and Darryl fit all 4 definitions of
Abnormality. Then write down any issues that the
program raises regarding difficulties in defining
abnormality and any ethical issues you notice,
for discussion afterwards.
21
Summary Activity
  • Use notes and handouts to complete a summary mind
    map / poster entitled DEFINING ABNORMALITY.
    Include a concise definition, explanation, and
    example of each method and then list as many as
    possible but at least two limitations associated
    with each method of definition e.g. can be
    era dependent can be ethnocentric (cultural
    relativism) labelling stereotyping
    desirable behaviour. etc.
  • Try also to include one Strength
  • Then Say how each of these definitions would
    define Anorexia as being abnormal, and what the
    problems defining Anorexia using each definition
    would be.

22
Models of Abnormality
L5
  • Definitions tell you if a person is abnormal
    (mentally ill) or not.
  • A model is a way of describing why they are ill,
    i.e. what is the cause of their mental illness.
  • You need to ensure that you can distinguish
    between models and definitions.
  • Definitions answer are they or arent they?
    questions, Models try to answer the why are
    they? question.

23
Each model is based on a Psychological Approach
or Perspective (point of view)
  • Psychological Perspectives or Approaches refer
    the different types of psychologists, and how
    they view things differently from each other
  • Each approach will give different explanations
    for the same behaviour.
  • The four approaches we are going to look at are
    the Biological, Behavioural, Psychodynamic and
    Cognitive. Can you remember the differences
    between these?
  • For example how would each approach explain
    violent behaviour differently?

24
Approaches/Perspectives in Psychology
A1
It is due to your Physiology i.e. your
Hormones Genetics Evolution Brain Damage
Biological Approach
Learned from violent parents or peers
Behavioural Approach
Unconscious need to release aggression
Psychodynamic Approach
You have distorted thinking or have reasoned that
it will get you what you want
Cognitive Approach
25
KISSING
HOW WOULD THE DIFFERENT APPROACHES IN PSYCHOLOGY
EXPLAIN IT? Write down a quick note of your
ideas For how the Biological, Behavioural,
Psychodynamic and Cognitive approaches would
explain it!
26
Biological Model of Abnormality
  • KEY FEATURES OF THE
  • BIOLOGICAL APPROACH TO
  • PSYCHOPATHOLOGY (Abnormality) (TO LEARN)
  • Assumption 1 The Biological or Medical Model of
    abnormality assumes that mental abnormality has
    physiological causes. These abnormalities may be
    caused by chemical malfunctions in the brain or
    by genetic disorders. For example, too much
    dopamine in the brain is linked with the mental
    illness called schizophrenia. It is also clear
    that the eating disorder called anorexia nervosa
    has a genetic component.
  • Assumption 2 The Medical Model also assumes that
    mental disorders can be treated in ways similar
    to physical disorders. In other words, we can
    cure the patient by using medical treatments.
    Treatments include medication (drugs), ECT and
    psychosurgery.

27
  • BIOLOGICAL CAUSES OF PSYCHOPATHOLOGY
  • Genetic factors
  • inherited predispositions to certain mental
    illnesses (Anorexia Nervosa, Tourettes Downs
    Syndrome)
  • Biochemistry
  • excessive or low amounts of certain biochemicals
    in the brain (Dopamine Schizophrenia, Serotonin
    - Depression)
  • Neuroanatomy
  • brain damage or inherited
    structural/organisational defects
    (Autism)
  • Treatment (acts on physiology)
  • Drugs (chemotherapy)
  • Genetic counselling / gene therapy possibly to
    come
  • Electroconvulsive therapy (ECT)
  • Psychosurgery

28
Best explanations......
  • Work in pairs and decide which would be the best
    biological explanation/s for the following
    disorders. Justify your thoughts.
  • Anorexia
  • Tourettes Syndrome
  • Dementia
  • Depression
  • Schizophrenia
  • Phobic Disorders
  • OCD

29
EVALUATION - MEDICAL MODEL
  • Strength 1 The main strength of the Medical
    Model is that it is scientific. The results of
    treatment can be measured and manipulated until
    we have a satisfactory outcome. For example, we
    can vary the dosage of Prozac until the depressed
    patient is able to function adequately.
  • Strength 2 A second strength is that the patient
    is seen as being ill and therefore not
    responsible (to blame) for their behaviour.
    Although the label of mental illness still
    carries a stigma in our society. It is reassuring
    to most people to learn that their behaviour has
    an organic/medical cause that can be corrected by
    medical treatment.
  • Limitation 1 The main limitation of the Medical
    Model is that it may be useful in dealing with
    the symptoms of mental illness but it may not be
    effective in resolving the underlying causes.
    Mental illness may have multiple causes,
    including cognitive and behavioural causes. The
    MM does not take these into consideration. It is
    always dangerous to reduce a complex phenomenon
    to a single explanation (reductionism).
  • Limitation 2 A second limitation is that medical
    intervention may have undesirable side effects.
    Very few drugs can be used without negative side
    effects. For example, prolonged use of Prozac is
    associated with suicidal thoughts. Drugs may also
    encourage addiction and dependency similar to
    nicotine addiction. In addition, techniques such
    as ECT and psychosurgery are invasive,
    unpredictable and often irreversible.

30
Defining AbnormalityTourettes Syndrome
  • When watching the video make notes on the
    behaviour seen.
  • First write down the four definitions of
    abnormality and Rosenhan Seligmans seven
    elements of abnormality. Note down when behaviour
    seen falls into each definition or element i.e.
  • Statistical Infrequency
  • Deviation from Social Norms
  • Deviation from ideal mental health (use handout)
  • Failure to function adequately (Maladaptiveness)
  • The 7 of the elements of abnormality defined by
    Rosenhan Seligman illustrate with examples
    from the video.
  • Consider the limitations of each definition and
    explanations.
  • Then consider the evidence that Tourettes
    Syndrome is a biological
    illness?
    Write down the main
    pieces of evidence for this.
  • Make sure you make notes for discussion
    afterwards.

L5
31
The Psychological Modelsof Abnormality(there
are three of these)
L7
  • Psychodynamic
  • Behavioural
  • Cognitive

32
Psychodynamic ApproachMain Assumptions
  • Assumption 1 The Psychodynamic Model assumes
    that experiences in our earlier years can affect
    our emotions, attitudes and behaviour in later
    years without us being aware that it is
    happening. Freud suggested that abnormal
    behaviour is caused by unresolved conflicts in
    the Unconscious. These conflicts create anxiety,
    and we use defence mechanisms such as repression
    and denial to protect our Ego against this
    anxiety. However, if defence mechanisms are
    over-used, they can lead to disturbed abnormal
    behaviour.
  • Assumption 2 The Psychodynamic Model assumes
    that if repressed memories can be recovered from
    the Unconscious through psychotherapy, and if the
    patient experiences the emotional pain of these
    repressed memories, the conflicts will be
    resolved and the patient will be cured (catharsis
    closure i.e. lancing the psychological boil) .
    Modern psychoanalysis suggests patients must also
    come to understand these memories cognitively.

33
(Inner parent the Conscience)
(Inner child I want It I want it NOW!)
(Self Protector Voice of reason)
Recap Freuds Theory of Personality
Complete Activity Sheet The Psychodynamic Model
(Item A) Question (a) (b)
34
Recap Psychosexual Stages of Development
35
EVALUATION OF THE PSYCHODYNAMIC APPROACH
  • Strength 1 One strength of the Psychodynamic
    Model is that it reminds us that experiences in
    childhood can affect us throughout our lives. It
    accepts that everybody can suffer mental
    conflicts and neuroses through no fault of their
    own.
  • Strength 2 The model also suggests there is no
    need for medical intervention such as drugs, ECT
    or psychotherapy, and that the patient, with the
    help of a psychoanalyst, can find a cure through
    his own resources. (which empowers the individual
    discourages helplessness)
  • Weakness 1 The main limitation of the
    Psychodynamic Model is that it cannot be
    scientifically observed or tested. There is no
    way of demonstrating if the Unconscious actually
    exists. There is no way of verifying if a
    repressed memory is a real or false memory unless
    independent evidence is available. In other
    words, most of the theory must be taken on faith.
  • Weakness 2 Any evidence recovered from a patient
    must be analysed and interpreted by a therapist.
    This leaves open the possibility of serious
    misinterpretation or bias because two therapists
    may interpret the same evidence in entirely
    different ways. Psychoanalysis is time-consuming
    and expensive. It may not even work in a
    comprehensive view of 7000 cases, Eysenck (1952)
    claimed that psychodynamic therapy does more harm
    than good.

36
Activity Fairy Tale Psychoanalysis
  • How can you explain the behaviour of the Fairy
    tale characters using the Psychodynamic model.
  • Match up the correct example with the most likely
    explanation.
  • Use the ego defence mechanism sheet to help you
    with this.
  • You can cut them out and move them about if it
    helps!

37
The Behavioural Model
L8
38
KEY FEATURES OF THE BEHAVIOURAL APPROACH
TOPSYCHOPATHOLOGY (Abnormality)
  • Assumption 1 The Behavioural Model of
    Abnormality assumes that all behaviour is learned
    through experience. All behaviour, including
    abnormal behaviour, is learned through the
    processes of classical and/or operant
    conditioning. Classical Conditioning involves
    learning through association. Operant
    conditioning involves learning through rewards
    (positive and negative reinforcement) and
    punishment. Or through modelling and Social
    Learning Theory. (as in Banduras BoBo doll
    study)
  • Assumption 2 The model assumes that what has
    been learned/acquired can be unlearned through
    the processes of conditioning, classical or
    operant. Undesirable or maladaptive behaviour can
    be replaced by desirable or adaptive behaviour.
    For example, we can use behavioural therapies
    such as Desensitization and token economies.

39
CLASSICAL CONDITIONING
  • Classical Conditioning was one of the first types
    of learning to be discovered. It was studied by
    Ivan Pavlov using his dogs.

Ivan Pavlov
40
How this can cause a phobia..
  • Classical Conditioning
  • We learn to associate one thing with another e.g.
  • Child on mums knee
  • Child sees spider (NS) unafraid doesnt know
    what spider is!
  • Mum sees spider
  • Mum screams and drops baby!
  • Baby associates spider with fear and lump on head
    (UCS)!
  • Baby sees spider
  • Baby cries! (CR)

41
  • Operant conditioning
  • A behaviour that has a positive effect is more
    likely to be repeated
  • Positive and negative reinforcement (escape from
    aversive stimulus) are agreeable
  • Punishment is disagreeable
  • Therefore treatment is by positive negative
    reinforcement and punishment (used in schools to
    treat disruptive children and in treatment of
    disorders such as anorexia)

42
OPERANT CONDITIONING
B. F. Skinner (1904-1990) Operant Conditioning
The PIGEON The Skinner Box
43
How can this cause abnormal behaviour?
  • We can learn to associate and action with a
    reward or sanction e.g.
  • Boy sees sweets at checkout
  • Boy wants sweets but mum says No!
  • Boy screams and shouts and has a tantrum
  • Mum gives boy sweets reinforcing the bad
    behaviour
  • Boy learns that tantrums getting what he
    wants!
  • So next time boy wants sweets..

44
Social Learning Theory Imitation of role models
Reinforcement can also lead to abnormal
behaviour-
  • Girl watches mother (role model) who has OCD
    washing ritualistically every item in house
    daily.
  • Girl cleans own things in same way copying mum!
  • Evidence
  • Banduras
  • BoBo Doll exp. gt

45
Advantages Limitations
  • Advantage 1 Behavioural approaches, especially
    when combined with cognitive approaches, have
    proved very effective in treating clients with
    phobias and other neurotic disorders, such as
    obsessive-compulsive disorders. They are less
    successful with more serious disorders such as
    schizophrenia and psychosis.
  • Advantage 2 There is also the advantage that
    therapy can focus directly on the clients
    maladaptive behaviour. There is no need to refer
    to the clients previous history or to his
    medical history. Behaviourists believe that
    changing the behaviour from maladaptive to
    adaptive is sufficient for a cure.
  • Limitation 1 One limitation of the BM is that
    only behaviour is considered. The thoughts and
    feelings of cognition are not taken into
    consideration. However, a human being is much
    more than a bundle of behaviours, and thinking
    and feelings need to be considered. Behavioural
    therapy may change the behaviour without
    resolving the underlying causes of that
    behaviour.
  • Limitation 2 The BM ignores possible medical
    causes of abnormal behaviour. For example, we
    know that there is a genetic element in anorexia,
    that the lack of glucose can deepen depression,
    and that excessive dopamine is linked with
    several mental disorders. It is likely that the
    Behavioural Model takes too narrow a focus of
    what constitutes human psychology. Humans are
    more than rats in Skinner boxes.

46
Activity Explaining mental illness using the
behavioural model
  • Anorexia Nervosa is an eating disorder where
    sufferers gradually starve themselves sometimes
    with fatal consequences.
  • Work in Pairs and Use Classical conditioning,
    Operant conditioning, and Social learning theory
    (modelling) to explain the development of
    Anorexia Nervosa. (write down your explanations)
  • You will have 10 minutes and will then feedback
    to the class.

47
The Cognitive Model Main Assumptions
  • Assumption 1 The Cognitive Model of Abnormality
    assumes that how we think influences how we feel
    and how we behave. The ways in which we process
    information (cognition) directly affect the ways
    we behave. The Cognitive Model suggests that
    disordered thinking can cause disordered or
    abnormal behaviour. Disordered thinking includes
    irrational assumptions and negative views about
    the self, the world and the future.
  • Assumption 2 The Cognitive Model assumes that
    cognitive disorders are the result of negative or
    disorganised thinking and, therefore, they can be
    made positive or organised. Thoughts can be
    monitored, evaluated and altered. Individuals can
    modify their thinking, challenge their irrational
    cognitions and self-defeating thoughts. So the
    model assumes cognitive change will lead to
    behavioural change.

48
Becks (1976) cognitive triad
  • negative (irrational) thoughts that depressed
    individuals have about...
  • Themselves I am helpless and inadequate
  • The world The world is full of insuperable
    obstacles
  • The future I am worthless, so theres no chance
    that the future will be any better than the
    present

49
  • EVALUATION OF THE COGNITIVE APPROACH
  • Strength 1 A major strength of the Cognitive
    Model is that it concentrates in current
  • thought processes. It does not depend on the past
    history of the client, for example,
  • recovering repressed memories from the
    Unconscious. This is an advantage because
  • details about a persons past are often unclear,
    irrelevant, misleading and
  • misremembered.
  • Strength 2 A second strength is that Cognitive
    Therapies, especially when used together
  • with Behavioural Therapy, have a good success
    rate in helping clients. It is a popular and
  • much-used approach. It also empowers the
    individual to take responsibility for his own
  • thinking processes by monitoring, evaluating and
    altering self-defeating thought
  • processes.
  • Weakness 1 Like all other approaches,
    psychological and medical, the Cognitive Model
  • rarely supplies the complete solution to abnormal
    behaviour by itself. There may be
  • medical and environmental influences affecting a
    persons behaviour. Focussing only on
  • a persons cognition may be too narrow an
    approach.

50
TREATMENT METHODS
L9
  • Behavioural Approach (Aversion Therapy (counter
    conditioning), Systematic Desensitisation
    Therapy, Flooding Token Economy)
  • Psychodynamic Approach (Psychotherapy which
    may include Dream Analysis, Projective Therapy
    ink blot/pictures, Hypnosis, Free Word
    Association)
  • Biological Approach (Drug (chemo) Therapy (anti
    anxiety /anti depressant and sedatives etc.)
    ECT, Psychosurgery)
  • Cognitive Approach (Cognitive Behavioural
    Therapy (CBT))

51
BiologicalTherapiesPsychosurgery
  • MOA Removes brain tissue in an effort to change
    behaviour. (unsure of how!)
  • Lobotomy (Moniz - Nobel Prize).
  • Calmed violent patients, but produced lethargy
    could destroy patients personalities (zombies).
  • Side-effects also included apathy, diminished
    intellectual powers, impaired judgements, coma,
    and even death

Antonio Egas Moniz
52
Psychosurgery Summary
  • Modern methods
  • Stereotactic neurosurgery (most common method
    today)
  • much more accurate and do less damage
  • Effectiveness
  • Effective if performed precisely and on the
    appropriate patient i.e. severely
    depressed/suicidal as last resort
  • Research shows 33 high effectiveness, 33
    moderate effect, 33 minimal or no effect
  • Appropriateness
  • Only appropriate in severely depressed or
    compulsive and suicidal patients who have not
    responded to other therapies.
  • Only appropriate under BMA rules if have
    patients fully informed consent.

53
Electroconvulsive Therapy (ECT)
2
Video Clip ECT (Trust me Im a Dr.)
54
Electroconvulsive Therapy (ECT)
L2
  • Appropriate for treating severely depressed /
    suicidal patients. Sometimes given without their
    consent (if sectioned).
  • Introduced during the late 1930s (Ugo Cerletti).
  • Effective in lifting mood. Can stop suicidal
    thoughts rapidly therefore can save lives.
  • MOA Increases norepinephrine (neurotransmitter
    that elevates mood) but not sure of MOA
  • Perform about 20,000 per year in the U.K.
  • May cause brain damage as..
  • Substantial memory loss (especially short term
    memory).

55
E.C.T.
  • The guidelines for the administration of ECT. In
    general are
  • Patient is anesthetized.
  • Given muscle relaxant.
  • Shocked with about 100 volts for a half to 3-4
    seconds.
  • Patient experiences slight seizures that last
    from 30 seconds to 1 minute.
  • 3-6 treatments per week for several weeks (Though
    this protocol varies).
  • Entire session (from prep. time to recovery time)
    takes between 1 to 2 hours.
  • Effectiveness gt70 improve

56
Drug (Chemo) Therapy
  • Most widely used Biomedical Therapy, as it is
    cheap, relatively fast acting and easy to give.
  • Appropriateness treatment when taken
    responsibly, and with the close supervision of a
    doctor. Drugs are given appropriate to a
    specific symptom e.g. anti -(anxiety,
    depressive and psychotic drugs).
  • Effectiveness they are generally extremely
    effective at treating symptoms. (but many have
    side effects such as addiction). Drugs have
    liberated many people from mental hospitals
    deinstitutionalization (a big ). Since the mid
    50's, 70 of persons diagnosed with schizophrenia
    lived in mental hospitals - today, less than 5.

57
Types of drugs
  • Anti Anxiety Drugs Benzodiazepines (BZs)
  • Reduce tension and anxiety. (downers) e.g.
    (Valium)
  • MOA Enhance the action of neurotransmitter GABA
    resulting in reduction in activity of brain
    calming effect
  • Common Side Effects drowsiness, fatigue, weight
    gain, interactions with other medications.
  • Anti Depressive Drugs
  • Opposite of anti-anxiety drugs (uppers).
  • MOA Increase of serotonin etc. (arousal-inducing
    neurotransmitters). SSRI (e.g., Prozac)
    interferes with re-absorption of serotonin,
    creating high levels (brain arousal).
  • Common Side Effects dizziness, dry mouth,
    nausea.
  • Anti Psychotic Drugs Neuroleptics
  • Major Tranquilizers.
  • MOA Decrease production of the neurotransmitter
    Dopamine.
  • Relieves hallucinations, hostility.
  • Requires very close supervision by a
    physician/psychiatrist.
  • Most popular Thorazine.
  • Common Side Effects Weight gain, constipation,
    dizziness, drowsiness, dry mouth, nasal
    congestion

58
Strengths Limitations
  • Strengths of drug treatment
  • Research (Kahn) showed that compared to a
    placebo, BZs were more effective at reducing
    anxiety.
  • Drugs are generally extremely effective at
    treating symptoms
  • Drugs are easy, relatively fast acting and cheap
    to use.
  • Weaknesses of drug treatment
  • Addiction BZs create a physiological dependence
    creating marked withdrawal symptoms when stopped.
    Should be limited to 4 weeks use because of this.
  • Side Effects General (see individual drugs) In
    BZs they can be paradoxical (opposite to that
    expected) i.e. can cause aggressiveness. Also
    memory problems storage difficulty.
  • Sticking Plaster Treats the symptoms not the
    problem so when drugs are stopped the symptoms
    return. So best paired with psychological
    therapies that address the problems.
  • Drugs have liberated many people from mental
    hospitals deinstitutionalization (a big ).
    Since the mid 50's, 70 of persons diagnosed with
    schizophrenia lived in mental hospitals - today,
    less than 5.

59
Psychodynamic Therapies
  • Psychoanalysis MOA treatments concentrate on
    making the unconscious conscious (gaining INSIGHT
    discovering the reasons for their problems).
    Then the mind can be cleansed of maladaptive
    thoughts and emotions (lancing the psychological
    boil release of negative energy or CATHARSIS)
    This is accomplished by using interviews to ask
    about past, early experiences, parents, and
    siblings, inner fears and innate drives. It may
    include Dream analysis interpretation of
    symbolism in dreams. Projective tasks and/or Free
    and word association saying whatever enters
    your head!
  • Catharsis can then lead to healing (CLOSURE)

60
Activity Psychoanalytical Techniques
  • Now we are going to have a go at two
    Psychoanalytical treatment techniques
  • Word Association
  • Projective Task (Ink blots)
  • Be prepared to criticise this techniques after we
    have completed them.

61
Freuds Dream Analysis
Latent Content
Manifest Content of Dream
Male genitals, especially penis
Umbrellas, knives, poles, swords, airplanes,
guns, serpents, neckties
Female genitals, especially vagina
Boxes, caves, pockets, pouches, the mouth, jewel
cases, ovens, closets
Sexual intercourse
Climbing, swimming, flying, riding (a horse, an
elevator, a roller coaster)
Parents
Kings, queens, emperors, empresses
Siblings
Little animals
62
Appropriateness, Effectiveness, Evidence
Strenths Limitations
  • Bergin (1971) Meta-analysis (Effectiveness)
  • Psychoanalysis produced an 73 success rate and
    was better than a placebo or no treatment.
  • H.J. Eysenck (1952)
  • Psychoanalysis is bad for you!
  • Sloane et al. (1975)
  • Behaviour therapy and Psychoanalysis both had 80
    improvement rate vs 48 control group
  • Luborksy and Spence (1978) (Appropriateness)
  • Useful in the treatment of anxiety disorders,
    depression, sexual disorders, but not
    schizophrenia
  • Useful with patients who are better educated
  • Strengths Limitations
  • Unscientific, un-falsifiable, unqualified
    therapists, expensive and time consuming,
    techniques require subjective interpretation and
    rely on the memory of the client, making them
    unreliable.
  • Good for treating Sexual Problems.
  • Recognises the importance of early childhood in
    development of personality and behaviour, so may
    aid prevention of mental illnesses.

63
1.Behavioural Therapies Based on Classical
Conditioning
  • MOA Re-learning adaptive new behaviours to
    replace the maladaptive behaviour.
  • Flooding or Implosion Therapy
  • Exposure to the feared stimulus 70 effective!
  • Systematic desensitisation
  • Wolpe (1958)
  • Based on counter-conditioning (gradually learning
    to re-associate the stimulus with a more positive
    response).
  • Aversion therapy
  • Associate unwanted behaviour with a very
    unpleasant unconditioned stimulus-

64
Behaviour Therapies
  • All these Learning techniques are used to alter
    behaviours these techniques include using
  • Classical conditioning as in
  • Aversion therapy e.g.
  • Systematic desensitization e.g. Driving
    phobia?!!!!

65
Systematic Desensitization
66
Appropriateness Effectiveness
  • Appropriate ONLY for behaviour that has been
    learned.
  • Behaviour therapy is as effective as other forms
    of therapy (Smith et al., 1980)
  • It is very effective with
  • Anxiety disorders (Ost, 1989)
  • Obsessive-compulsive disorder (van Oppen et al.,
    1995)
  • Specific phobia (Ost, 1989) ( i.e. flooding 70
    effective)
  • Not very effective with disorders with a genetic
    component, such as schizophrenia

67
Limitations / Criticisms
  • - Simplistic and Deterministic limits all
    behaviour to simple cause and effect.
  • - Mechanical in its application do this and
    this will happen
  • - There are ethical questions relating to both
    research and treatment methods. (Little Albert
    Treating Gay Men)
  • Treats only the behaviour not the causes of the
    behaviour.
  • Does not consider individual differences (blank
    slate?) we may all learn differently.
  • Scientific approach with good supporting
    evidence easy to research.
  • Therapies are successful for phobias, OCD and
    anxiety disorders etc
  • ? New learning or re-education is it always
    possible?
  • ? What is unwanted behaviour? How is it defined
    and who by? Used for punishment/social control
    (gay men)

68
COGNITIVE THERAPIES
  • Cognitive Behavioural Therapy
  • Cognitive Restructuring Therapy
  • Rational Emotive Therapy
  • Stress Inoculation Hardiness Training.

69
Cognitive Behavioural Therapy
  • Appropriateness Cognitive behavioural therapy
    (CBT) is used to help solve problems in people's
    lives, such as anxiety, depression,
    post-traumatic stress disorder (PTSD) or drug
    misuse. CBT was developed from two earlier types
    of psychotherapy
  • Cognitive therapy, designed to change people's
    thoughts, beliefs, attitudes and expectations.
    (i.e. Changing negative thoughts to positive)
    Includes Stress Innoculation and Hardiness
    training (both cognitive methods)
  • Behavioural therapy (designed to change how
    people acted/behaved).
  • American psychotherapist Aaron Beck developed CBT
    believing that the way we think about a situation
    affects how we act but also that our
    actions/behaviours can affect how we think and
    feel.
  • MOA It is therefore necessary to change both the
    act of thinking (cognition) and behaviour at the
    same time. This is known as cognitive behavioural
    therapy. CBT says that your problems are often
    created by you. It is not the situation itself
    that is making you unhappy, but how you think
    about it and how you react to it. Video Clip
    (Trust me I am a Dr.)

70
Effectiveness of CBT
  • CBT is often favoured over other therapies
    because it aims to get rid of the problem not
    just the symptoms.
  • Evans (1992) CBT is at least as good as drug
    therapy in preventing a relapse
  • Keller (2001) combination of CBT and drug therapy
    more effective than either therapy alone
  • Butler (2006) effectiveness depends on the
    disorder. When the problem is severe, a
    combination of drugs and CBT is best. E.g. Drugs
    may reduce disturbed thoughts of Schizophrenics
    allowing CBT to be used effectively.

71
Strengths and Limitations
  • Treatment very effective, especially when
    combined with drug therapy.
  • Patient has a certain amount of control over
    their treatment and can use the techniques taught
    to them to deal with future problems and
    situations.
  • Assumption is that patient is to blame for
    their problems. This is the only therapy that
    assumes that the patient is at fault.

72
The Therapy Game
  • You will be put in groups of either
    Psychiatrists, Psychotherapists, Behavioural
    Therapists or Cognitive Therapists
  • You are now the potential therapists of the
    following patients.
  • Can you explain their abnormal behaviour?
  • Can you suggest an appropriate treatment?
  • You must stick strictly to the model/approach of
    your particular group when answering these
    questions.
  • The team with the most appropriate explanation
    and treatment will win the patient.
  • The team with the most patients wins the game!

73
Patient No. 1
  • You have 2 minutes to discuss the case with your
    fellow therapists and decide
  • What is the likely cause of the patients abnormal
    behaviour?
  • Which treatment is the most suitable and why?

74
Patient No. 2
  • You have 2 minutes to discuss the case with your
    fellow therapists and decide
  • What is the likely cause of the patients abnormal
    behaviour?
  • Which treatment is the most suitable and why?

75
Patient No. 3
  • You have 2 minutes to discuss the case with your
    fellow therapists and decide
  • What is the likely cause of the patients abnormal
    behaviour?
  • Which treatment is the most suitable and why?

76
Patient No. 4
  • You have 2 minutes to discuss the case with your
    fellow therapists and decide
  • What is the likely cause of the patients abnormal
    behaviour?
  • Which treatment is the most suitable and why?

77
Patient No. 5
  • You have 2 minutes to discuss the case with your
    fellow therapists and decide
  • What is the likely cause of the patients abnormal
    behaviour?
  • Which treatment is the most suitable and why?

78
The End
79
Key Term Abnormality
  • Behaviour that is considered to deviate from the
    norm (statistical or social), or ideal mental
    health. It is dysfunctional because it is harmful
    or causes distress to the individual or others
    and so is considered to be a failure to function
    adequately. Abnormality is characterised by the
    fact that it is an undesirable state that causes
    severe impairment in the personal and social
    functioning of the individual, and often causes
    the person great anguish depending on how much
    insight they have into their illness

80
Key Term Anorexia nervosa
  • An eating disorder characterised by the
    individual being severely underweight 85 or
    less than expected for size and height. There is
    also anxiety, as the anorexic has an intense fear
    of becoming fat and a distorted body image. The
    individual does not have an accurate perception
    of their body size, seeing themselves as
    normal, when they are in fact significantly
    underweight, and they may minimise the dangers of
    being severely underweight

81
Key Term Bulimia nervosa
  • An eating disorder in which excessive (binge)
    eating is followed by compensatory behaviour such
    as self-induced vomiting or misuse of laxatives.
    It is often experienced as an unbreakable cycle
    where the bulimic impulsively overeats and then
    has to purge to reduce anxiety and feelings of
    guilt about the amount of food consumed, which
    can be thousands of calories at a time. This
    disorder is not associated with excessive weight
    loss

82
Key Term Cultural relativism
  • The view that one cannot judge behaviour properly
    unless it is viewed in the context from which it
    originates. This is because different cultures
    have different constructions of behaviour and so
    interpretations of behaviour may differ across
    cultures. A lack of cultural relativism can lead
    to ethnocentrism, where only the perspective of
    ones own culture is taken

83
Key Term Deviation from ideal mental health
  • Deviation from optimal psychological well-being
    (a state of contentment that we all strive to
    achieve). Deviation is characterised by a lack of
    positive self-attitudes, personal growth,
    autonomy, accurate view of reality, environmental
    mastery, and resistance to stress all of which
    prevent the individual from accessing their
    potential, which is known as self-actualisation

84
Key Term Eating disorder
  • A dysfunctional relationship with food. The
    dysfunction may be gross under-eating (anorexia),
    bingepurging (bulimia), over-eating (obesity),
    or healthy eating (orthorexia). These disorders
    may be characterised by faulty cognition and
    emotional responses to food, maladaptive
    conditioning, dysfunctional family relationships,
    early childhood conflicts, or a biological and
    genetic basis, but the nature and expression of
    eating disorders show great individual variation

85
Key Term Statistical infrequency/deviation from
statistical norms
  • Behaviours that are statistically rare or deviate
    from the average/statistical norm as illustrated
    by the normal distribution curve, are classed as
    abnormal. Thus, any behaviour that is atypical of
    the majority would be statistically infrequent,
    and so abnormal (e.g., schizophrenia is suffered
    by 1 in 100 people and so is statistically rare)

86
Factors Important to Mental Health
The factors that drive or motivate individuals,
according to Maslow (1954)
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