Chapter 15 Lecture Slides - Psy Treatment PDF

15 Abnormal Psychology: Disorders and Treatment © 2019 Cengage. All rights reserved. module 15.1 An Overview of Abnormal Behavior After...

15 Abnormal Psychology: Disorders and Treatment © 2019 Cengage. All rights reserved. module 15.1 An Overview of Abnormal Behavior After studying this module, you should be able to: Describe and evaluate a definition of mental illness. Describe DSM-5 and give examples of the categories it lists. Evaluate the assumptions behind DSM and the categorical approach to mental illness. © 2019 Cengage. All rights reserved. Psychological Disorders Almost one half of people will qualify for a psychological disorder during their lifetime. © 2019 Cengage. All rights reserved.  Defining Abnormal Behavior What is normal behavior? What is abnormal and what determines when something is? What is a “mental illness?” Should our goal be to be happy all the time? © 2019 Cengage. All rights reserved.  Example Betty is a 52-year-old female who has been crying “on and off” for the past several months. For the past two weeks, she has spent most of the day in bed feeling “blue.” She also stated that she felt “completely drained of energy.” Her appetite has been down over the last two weeks and she has lost 15 pounds. Betty is a housewife who raised three children. Her youngest left their home seven months ago. Since then, she has felt lonely and a little bored during the day. © 2019 Cengage. All rights reserved.  Questions Is Betty normal? Does she have a mental illness? © 2019 Cengage. All rights reserved.  Example Dante is a 25-year-old man with 9 years of education. His father left when he was five years old and he and his sister was raised by his mother. Dante dropped out of high school to help care for his younger sister and to work. His mother abuses alcohol and struggles with depression. She worked two jobs and was often absent from the home. Dante has been “depressed” for “as long as he can remember. He has been hospitalized twice for trying to commit suicide. © 2019 Cengage. All rights reserved.  What is abnormal? Sometimes it is difficult to determine. Many times we base this decision on two things: – 1) Deviance: Is the behavior inconsistent with what would be the expected behavior in a given culture – 2) Dysfunction: Does it cause impairment in functioning © 2019 Cengage. All rights reserved.  Normal or Abnormal? A woman puts offerings on the grave of her dead husband. She thinks it makes him happy because he is “looking down on her.” A man likes to break the ice layer above water and then swim in the freezing water below A man drives a nail into his hand © 2019 Cengage. All rights reserved. Are you confused? That’s okay. Mental Disorders are not directly observable so identifying them is partially subjective. It is hard to identify them with certainty © 2019 Cengage. All rights reserved.  Rosenhan On being sane in insane places (1973) 3 women, 5 men gain access to 12 psychiatric hospitals – While being admitted, they state they have auditory hallucinations – After admission, claim hallucinations are gone. Act normal and state they feel fine © 2019 Cengage. All rights reserved. Rosenhan: Misdiagnosis Hospitalizations range from 7 to 52 days (Average = 19 days) None suspected of feigning (except by other patients 35/118) All prescribed medications Released with dx of schizophrenia in remission (one bipolar) © 2019 Cengage. All rights reserved. Power of a diagnostic label After diagnostic label is given, normal behaviors seen as pathological: – Researcher taking notes is engaging in “writing behavior.” Some staff verbally abusive, say bad things about patients in the presence of the patients. Act as if they are not there. © 2019 Cengage. All rights reserved.  DSM and the Categorical Approach to Psychological Disorders To standardize their definitions and diagnoses, psychiatrists and psychologists developed the Diagnostic and Statistical Manual of Mental Disorders (DSM ) – Current edition is DSM-5-TR as of 2022 – Is a listing of mental disorders along with objective criteria that determine whether someone has a disorder © 2019 Cengage. All rights reserved.  Organization of DSM-5-TR Mental Disorders are organized into categories of disorders like… Depressive Disorders Trauma and Stressor-Related Disorders Personality Disorders Each disorder is described and there are a list of criteria that must be met before someone is deemed to have that diagnosis like… Depressed mood most of the day, nearly everyday as indicated by subjective report or indicated by others for a period of two weeks. The one criteria that almost all (maybe all) diagnoses have is: They all require that there is some sort of loss of functioning. © 2019 Cengage. All rights reserved.  Is the DSM a good thing? Advantages: – Gives common terminology to help communication – Helps with reliability of diagnoses – Helps classify participants for research purposes © 2019 Cengage. All rights reserved.  Concerns re. DSM or similar system Concerns: – Diagnoses can be stigmatizing – People with same diagnosis can present very differently – Diagnostic categories may not reflect real world/be useful © 2019 Cengage. All rights reserved.  “Mental Disorders” What is Medical/ a Dimensional mental Model Categorical Model disorder ? © 2019 Cengage. All rights reserved.  Medical/Categorical Model Mental disorders are viewed as Major Depressive reflecting discrete Disorder disease entities. You have a mental Categorize those that have it and those that don’t into disorder or you two separate groups. don’t. Dichotomous yes/no decision Common in medicine © 2019 Cengage. All rights reserved.  Dimensional Model Mental disorders Amount of depression compared to average level exist on a of depression in continuum. Those population. with mental disorders have a behavior with more/less frequency and/or intensity. © 2019 Cengage. All rights reserved.  Dimensional Model Highlights of dimensional model We may be more interested in severity than a yes/no categorization – How different are Betty and Dante? Those with or without mental disorder possess same trait. Less emphasis on diagnosis © 2019 Cengage. All rights reserved.  Anxiety Disorders Generalized Anxiety Disorder (GAD) Generalized anxiety disorder (GAD) – disorder in which people have frequent and exaggerated worries about many things. Panic Disorder (PD) Panic disorder (PD) – condition marked by frequent periods of anxiety and occasional attacks of panic—rapid breathing, increased heart rate, chest pains, sweating, faintness, and trembling – Linked to having strong autonomic responses, such as rapid heartbeat and hyperventilation. – Possibly due in part to hypersensitivity to normal body sensations © 2019 Cengage. All rights reserved.  Anxiety Disorders Agoraphobia – an excessive fear of open or public places where leaving would be difficult Social phobia – a severe avoidance of other people and a fear of doing anything in public © 2019 Cengage. All rights reserved.  Specific Phobia Specific Phobia – a fear that interferes with normal living – Avoidance behaviors are highly resistant to extinction. – We more readily develop fear of some things over other things Common objects of phobias include: – Public places – Public speaking – Heights – Air travel – Snakes or other dangerous animals – Blood – Lightning storms © 2019 Cengage. All rights reserved.  Obsessive-Compulsive Disorder Obsessive-compulsive disorder (OCD) – a condition with repetitive thoughts and actions so much so that is causes decline in functioning – Obsession – a repetitive, unwelcome stream of thought – Compulsion – a repetitive, almost irresistible action. Usually consumes significant amount of time. Common compulsions: – Cleaning – Checking – Counting – Hoarding © 2019 Cengage. All rights reserved.  Substance Use Disorders In previous editions of the DSM = Defined disorders by whether there was substance dependence or substance abuse. Current DSM does not distinguish them but they are useful concepts. – Dependence: Does the person experience physical symptoms if he/she tries to discontinue use? – Abuse: Is there continued use despite negative consequences? © 2019 Cengage. All rights reserved.  Substance Use Disorders Addictive substances stimulate dopamine synapses in the nucleus accumbens, a brain area that is associated with attention and reward. After people develop a compulsive habit of gambling, video game playing, or other activities, those activities also elicit dopamine release in the nucleus accumbens. It is hard to determine what should be considered an addiction (Sex addiction, internet use, gaming?) © 2019 Cengage. All rights reserved.  Depressive Disorders Major depressive disorder Persistent Depressive disorder © 2019 Cengage. All rights reserved.  Depressive disorders Major depressive disorder – condition in which someone experiences little interest, pleasure, or motivation for weeks at a time Characterized by depressive episodes (Periods of time during which mood dips). There are some specifiers to identify certain conditions such as: – With seasonal pattern No manic or hypomanic episodes © 2019 Cengage. All rights reserved.  Depressive disorders Persistent depressive disorder: – Persistent negative mood more often than not for a period of two years (one year for children) – No manic/hypomanic episodes © 2019 Cengage. All rights reserved.  Treatments for Depression (slide 1 of 3) Antidepressant Medications Common classes of antidepressants: Newer/1st line medications 1) Selective serotonin reuptake inhibitors (SSRIs) –block reuptake of only serotonin 2) Selective serotonin/norephrine reuptake inhibitors (SNRI’s) – block reuptake of serotonin and norepiphrine Older medications 1) Tricyclic drugs – interfere with ability to reabsorb dopamine, norepinephrine, and serotonin after releasing them 2) Monoamine oxidase inhibitors (MAOIs) – block the metabolic breakdown of dopamine, norepinephrine, and serotonin. Almost never prescribed anymore Although antidepressants affect the synapses within an hour or so, their behavioral effects begin after four to six weeks of treatment. Antidepressants are equally effective in general but SSRI’s have fewer side effects so are used first. © 2019 Cengage. All rights reserved.  Bipolar Disorder Bipolar disorder – a condition previously known as manic- depressive disorder, in which someone alternates between mood extremes – Bipolar I: Presence of manic episodes and or depressive episodes – Bipolar II: Presence of hypomanic episodes and/or depressive episodes – Manic – a period of time when someone has elevated mood or increased energy/irritability in which people are constantly active, uninhibited, and often irritable – Hypomanic: Time when someone has elevated mood and increased energy but behavior is not so severe that it results in large decline in functioning © 2019 Cengage. All rights reserved.  Schizophrenia Schizophrenia – a condition marked by some combination of: 1) hallucinations, 2) delusions, 3) disorganized speech and thought, 4) movement disorder, and 5) loss of normal emotional responses and social behaviors – The symptoms must include at least one of the first three and at least two of the five overall. © 2019 Cengage. All rights reserved.  Schizophrenia – Hallucinations – perceptions that do not correspond to anything in the real world. (Sensory information that does not come from real world) Visual hallucinations are very rare and generally not vivid or detailed. Almost all hallucinations are auditory – Delusion – belief that is strongly held despite evidence against it (People are following/monitoring you, your thoughts are being broadcast, tv. Characters are giving you secret messages, someone shot you in the head and the bullet has a camera in it and is monitoring you) © 2019 Cengage. All rights reserved. Schizophrenia is NOT multiple personality disorder Roses are red, Violets are blue, I’m schizophrenic and so am I! Every time you say that a psychology textbook cries. © 2019 Cengage. All rights reserved. Also, dementia has nothing to do with schizophrenia or psychotic disorders That’s so demented! Dementia: Loss of cognitive functioning to an extent that it interferes with daily Uggggghhhhhh… functioning. © 2019 Cengage. All rights reserved.  Schizophrenia Prevalence Schizophrenia is: – Most frequently diagnosed in young adults in their 20s Average age = 18 for men Average age = 25 for women – More common in men than women – More severe in men © 2019 Cengage. All rights reserved.  Dissociative disorders Dissociative identity disorder (DID; aka multiple personality disorder) – Personality splits off into separate subpersonalities. One is in control at a given time (dominant) – Thought to be caused by attempt to dissociate from a traumatic experience by creating another personality – Average case: 8 personalities for men. 15 for women. Reports have been made with people with 130+ © 2019 Cengage. All rights reserved.  Dissociative identity disorder Personalities. – Personalities display different: Abilities and tastes Physiological characteristics – (Different EEG patterns, blood pressure, heart rate, and allergies) – Treatment Reintegration therapy (Recently viewed as unethical) Presently, treatment focuses on function/coping skills © 2019 Cengage. All rights reserved. module 15.5 Treatment of Mental Illness After studying this module, you should be able to: Distinguish among forms of psychotherapy. Describe how researchers evaluate the effectiveness of psychotherapy. Describe possible ways of providing psychotherapeutic help inexpensively to more people. List possible methods to prevent psychological disorders. Discuss the insanity defense and other societal issues related to mental illness. © 2019 Cengage. All rights reserved.  Types of Psychotherapy Psychodynamic Therapies Psychodynamic therapies – Much of what influences us is unconscious. Mental illness is due to conflict between ID, Ego, and Superego Psychoanalysis – bring unconscious into awareness © 2019 Cengage. All rights reserved.  Psychodynamic Treatments Techniques: Free association – procedure in which a client says everything that comes to mind Transference – situation in which clients transfer onto the therapist the behaviors and feelings they originally established toward their father, mother, or other important person Working through – Examine same issue repeatedly before it is resolved © 2019 Cengage. All rights reserved.  Behavioral/CBT treatments Behavior Therapy Behavior therapy – treatment that begins with a clear, well-defined goal, such as eliminating test anxiety, and then attempts to achieve it through manipulation of environmental contingencies (reinforcement and punishment). Set up self rewards etc. Cognitive Therapies Cognitive therapy – procedure that seeks to improve psychological well-being by changing people’s interpretation of events Cognitive-behavior therapy – treatment in which therapists set explicit behavioral goals, but also try to change people’s interpretation of situations. Thoughts effect feelings. Recognize negative thought patterns and change them. Test your assumptions. © 2019 Cengage. All rights reserved.  CBT Therapists Cognitive behavior therapy: Negative thought patterns examples: – Black and white thinking – Globalization – Should and must © 2019 Cengage. All rights reserved.  Mindfulness therapies Mindfulness therapies: Understand that suffering is normal experience in life. Learn to observe emotions, not react, and let them pass. – Do not stay in automatic pilot. Be conscious and actively aware – Concentrate on the here and now – Walk with your wounds. Bus metaphor – Feelings are not wrong or bad. “Negative” feelings are adaptive. You do not need to be rid of them. Observe them in a nonjudgmental way. © 2019 Cengage. All rights reserved.  How Effective is Psychotherapy?/ Comparing Theories The average person in therapy improves more than at least 80 percent of the equally troubled people not in therapy. In general, all mainstream therapies appear about equally effective. What is important is common factors (factors common in all therapies) like…therapeutic alliance, warmth, client openness © 2019 Cengage. All rights reserved.  Social Issues Related to Mental Illness The Insanity Defense Some defendants accused of a crime are acquitted for reasons of insanity, which is a legal rather than a medical or psychological concept. M’Naghten rule – Someone is legally insane if he or she was so mentally disordered at the time of an act as not to understand what he or she was doing Rarely invoked (about 1%) © 2019 Cengage. All rights reserved.  Deinstitutionalization (1955) Deinstitutionalization When medications are discovered (most anti- psychotics) there was movement to get people out of institutions 1955: 600k inpatients in U.S. 2010: Less than 40k © 2019 Cengage. All rights reserved.  Deinstitutionalization Patients released with very planning or support. Outpatient care, community mental health = primary mode of therapy Negatives: Repeat hospitalization is norm. More mentally ill homeless than before Hard for severely mental ill to get treatment. 100k mentally ill are homeless 135k mentally ill are imprisoned 5-10% of death row inmates have severe mental illness © 2019 Cengage. All rights reserved.  The Future of Psychotherapy and Prospects for Prevention Community psychologists – those who try to help people change their environment, both to prevent disorders and to promote a positive sense of mental well-being Prevention – Catch disorder early or before it occurs and intervene – In order to cope with demand for mental health, we have shifted toward prevention Examples of effective prevention programs: – Educate pregnant women about prenatal care. – Educate people about the risks of smoking. – Screen for early loss of memory at hospitals or elderly care seminars © 2019 Cengage. All rights reserved.