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Chapters 16 & 17Abnormal Psych & Therapies

Part 1: Psychological Disorders

Mental health workers view psychological disorders as _________________ harmful thoughts, feelings, and actions. When behavior is _____________________ (not rational), ___________________ (hinders lifestyle), ____________________ (violates the norm), and _________________ psychiatrists and psychologists label it as disordered. (___________)

- The American Psychiatric Association rendered a ________________________________________________ ______________________________(DSM) to describe psychological disorders. The most recent edition, ____________, describes around 400 psychological disorders compared to the 60 identified in the 1950s.

- Disorders outlined by DSM-V are reliable. Therefore, diagnoses by different professionals are similar. Also, insurance companies usually require a firm diagnosis & code to cover health care costs.

- Others criticize DSM-V for classifying almost anything as a disorder/syndrome.

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Anxiety Disorders

Feelings of __________________________________ and ____________that cause distress or cause maladaptive behaviors to reduce the levels of stress.

________________________________________ (G.A.D) - disorder characterized by persistent and uncontrollable tenseness and apprehension (worrying).

___________________________________________ - minute-long episodes of intense dread which may include feelings of terror, chest pains, choking, or other frightening sensations.

______________ are marked by a persistent and irrational fear of an object or situation that disrupts behavior.

____________________________________________(O.C.D) - persistence of unwanted thoughts (______________) and urges/behaviors (___________________) to engage in senseless rituals that cause distress. *

________________________________________________________ (P.T.S.D) is often caused by severely threatening uncontrollable events. Four or more weeks of the following symptoms: haunting memories (flashbacks), nightmares, social withdrawal, anxiety & insomnia.*

Psychoanalytic Perspective – Freud suggested that we ______________ our painful and intolerable ideas, feelings, and thoughts, resulting in anxiety.

Behavioral Perspective – Learning theorists suggest that (classical) _______________________ leads to anxiety. This anxiety then becomes associated with other objects or events (stimulus generalization) and is reinforced (operant). Investigators believe that fear responses can be passed along to others through ____________________learning (modeling).

Biological Perspective – A PET scan of the brain of a person with OCD shows high metabolic activity (red) in the ______________________ areas are involved with directing attention. Too little of the neurotransmitter __________________ can also contribute to anxiety disorders

Evolutionary Perspective – _______________________________ has led our ancestors to learn to fear snakes, spiders, and other animals. Therefore, fear preserves the species. Perhaps it’s part of Jung’s collective unconscious? Twin studies suggest that our ____________ may be partly responsible for developing fears and anxiety. Twins are more likely to share phobias.

Biopsychosocial Perspective - assumes that biological, socio-cultural, and psychological factors combine and interact to producepsychological disorders.

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Dissociative Disorders

Usually _____________________________ where conscious awareness becomes _________________(dissociated) from previous memories, thoughts, and feelings. A break from the self.

__________________________________________ - consists of having a sense of being unreal, separated from the body, as if watching one’s self in a movie.

__________________________________________ – amnesia caused by some kind of trauma (not by injury). For example, soldiers in combat.*

__________________________________________ (flight) – when a person totally forgets who they are and may develop a completely new identity, personality, etc. in a new place (involves __________). Like “witness protection” from yourself! *

___________________________________________________ (D.I.D) - formerly called Multiple Personality Disorder (MPD), it is a disorder in which a person exhibits _________________________________ and ____________________ personalities (each with its own name, voice, mannerisms, occupations, etc).

Mood Disorders

Characterized by _____________________________________ (variations in mood).

_________________________________________________ occurs when signs of depression last two weeks or more and are not caused by drugs or medical conditions.

_______________________________________lies between a blue mood and major depressive disorder. It is a disorder characterized by ____________________________________________ lasting two years or more.

________________________________, formerly called Manic-Depressive Disorder, it is an alternation between mood - depression and mania (highs & lows). *

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Since depression is so prevalent worldwide, investigators want to develop a theory of depression that will suggest ways to treat it.

1. Behavioral and cognitive changes2. Common causes of depression (stressful life events)

3. Gender differences

4. Depressive episodes usually self-terminate.5. Depression is increasing, especially in the teens.

The most severe form of behavioral response to depression is ____________. Each year some 1 million people commit suicide worldwide.

Biological Perspective – A reduction of the neurotransmitters _________________________ and __________________ has been found in depression. Drugs that alleviate mania reduce norepinephrine. Mood disorders tend run in families. The rate of depression is higher in _______________ (50%) than fraternal twins (20%). In addition, PET scans show that brain energy consumption rises and falls with manic and depressive episodes.

Social-Cognitive Perspective – Suggests that depression arises partly from ________________________ beliefs and _____________________________ styles.

Psychotic Disorders - Schizophrenia

Schizophrenia strikes young people as they _________________ into adults. It affects men and women equally, but men suffer from it more severely than women.

The literal translation is “____________________” (a break from reality), but is not the same as DID (a break from the self). Schizophrenia is a group of severe _________________ disorders characterized by the following:

1. ___________________ (word salad) & __________________ (distorted) thinking2. Disturbed _________________ (hallucinations – auditory, visual, olfactory…) 3. _______________________ emotions & actions (or show no emotion/________________)

Schizophrenia is a cluster of disorders. These subtypes share some features, but there are other symptoms that differentiate these subtypes. *

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Schizophrenics __________ inappropriate symptoms (hallucinations, disorganized thinking, deluded ways) that are not present in normal individuals (______________ symptoms - inward). Schizophrenics also have an ______________of appropriate symptoms (apathy, expressionless faces, rigid bodies) that are present in normal individuals (_________________ symptoms - outward).

When schizophrenia is ___________ to develop (chronic/process) “recovery” is doubtful. Such schizophrenics usually display negative (outward) symptoms. When schizophrenia _______________ develops (acute/reactive) “recovery” is better. Such schizophrenics usually show positive (inward) symptoms.

Biological Perspective – Schizophrenia is a disease of the brain exhibited by the symptoms of the mind. Researchers found that schizophrenic patients express higher levels of __________________ receptors in the brain. Brain scans show abnormal activity in the _____________ cortex, ________________, and ________________ of schizophrenic patients. Schizophrenia patients may exhibit morphological changes in the brain like enlargement of fluid-filled ventricles. The likelihood of an individual suffering from schizophrenia is 50% if their ________________ twin has the disease. Poor fetal nutrition and viral infection during fetal development, along with oxygen deprivation have been linked to schizophrenia. Malnutrition, methamphetamine and cocaine abuse, and social conditions (urban life, racial discrimination, adversity and family dysfunction) have also been contributed to the development of the disorder.

Personality Disorders

Personality disorders are characterized by inflexible and enduring behavior patterns that ________________________________________. They are usually ______________ anxiety, depression, or delusions.

Avoidant Personality Disorder – the person commonly withdraws due to fear of rejection

Narcissistic Personality Disorder – the person is very self-absorbed and have delusions of grandeur

Borderline Personality Disorder – the person has unstable emotions and relationships and ultimately an unstable identity

* Antisocial Personality Disorder – the person (usually male) exhibits a _______________________________________________ for wrongdoing, even toward friends and family members. Formerly, this person was called a sociopath or psychopath.

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Dependent Personality Disorder – the person is abnormally dependent on other people

Biological Perspective - Like mood disorders and schizophrenia, antisocial personality disorder has biological and psychological reasons. Youngsters with personality disorders, before committing a crime, respond with ______________________ of stress hormones than others do at their age. They also show reduced activity in the _________________ ________. In addition, the likelihood that one will commit a crime doubles when childhood _____________ is compounded with _______________________________.

Somatoform Disorders

Disorders that usually involve abnormal _____________________________ or _____________________.

__________________________ – fear of or believing that you have illnesses that you don’t really have*

__________________________ – developing physical symptoms without an actual biological cause (usually caused by trauma, stress/anxiety…)

___________________________________ – belief that one or more of the features/parts of your body are abnormal/grotesque and needs to be fixed

Childhood Disorders

__________________________________________________ (ADHD) – Controversial disorder with 3 key symptoms: _________________, ____________________, and _________________________.

________________________ * - marked by ____________________ or development, _______________________________________ (decreased eye contact; inability to carry on a conversation), ____________________________ (understanding of others’ point of view),

________________________________ (stick to routine; distress when it changes). Tends to occur more in males than in females and may be accompanied by a savant syndrome.

__________________ – facial tics, blurted out words or sounds such as Tourette’s Syndrome (motor or vocal tics)

___________________________ – disorders in which the person fakes symptoms or inflicts symptoms on self or others to gain attention/sympathy (malingering = sickness for personal or monetary gain) such as Munchausen Syndrome where a person claims to have symptoms and undergoes many treatments/surgeries to receive attention or Munchausen Syndrome by Proxy where a person induces illnesses in others (usually parents do this to kids) to receive indirect attention

Part II: Therapy

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Maltreatment of the insane throughout the ages was the result of irrational views. Many patients were subjected to strange, debilitating, and downright dangerous treatments. Philippe Pinel in France and ______________________ in America founded humane movements to care for the mentally ill.

_________________________ involves an emotionally charged, confiding _____________________ between a trained therapist and a mental patient.

1. Psychoanalytical 3. Behavioral 2. Humanistic 4. Cognitive

__________________________ uses __________ or other procedures that act on the patient’s nervous system, curing him or her of psychological disorders.

An ________________________ uses ________________________ of healing techniques depending upon the client’s unique problems.

Psychoanalytic Therapy

The first formal psychotherapy to emerge was psychoanalysis, developed by Sigmund Freud. Since psychological problems originate from childhood repressed impulses and conflicts, the aim of psychoanalysis is to bring repressed feelings into ______________________________________ where the patient can deal with them. When energy devoted to id-ego-superego conflicts is released, the patient’s anxiety lessens.

Freud developed the method of ________________________________ to unravel the unconscious mind and its conflicts. The patient lies on a couch and speaks about whatever comes to his or her mind. Comes under criticism because is cannot be proven or disproven and takes a long time and is very expensive.

Humanistic Therapy

Humanistic therapists aim to boost _________________________________ by helping people grow in self-awareness and self-acceptance.

Unlike psychodynamic therapies, humanistic therapies focus on: The present and future, not past conflicts Conscious issues, not unconscious conflicts Taking responsibility for one’s feelings and behaviors, not finding what is “hidden” Promoting individual growth, not curing illnesses

- Person in therapy called client (not patient)

Developed by Carl Rogers, ______________________________ therapy is a form of humanistic therapy.The therapist listens to the needs of the patient in an accepting and non-judgmental way (__________________________________________) , addressing problems in a productive way and building

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his or her self-esteem. Therapist also demonstrates empathy and genuineness.

- The therapist engages in ____________________________ and echoes, restates, and clarifies the patient’s thinking, acknowledging expressed feelings.

Behavioral Therapy

Therapy that applies ____________________ principles to the elimination of unwanted behaviors. To treat phobias or sexual disorders, behavior therapists do not delve deeply below the surface looking for inner causes. ____________________________________ procedures enable therapists to use behavior modification, in which desired behaviors are rewarded and undesired behaviors are either unrewarded or punished.

_____________________________ involves exposing people to fear-driving objects in real or virtual environments. __________________________________________ (Counter-conditioning) is a type of exposure therapy that associates a pleasant, relaxed state with gradually increasing anxiety-triggering stimuli (commonly used to treat ______________).

- __________________________________ is a type of counterconditioning that associates an unpleasant state with an unwanted behavior. With this technique, temporary conditioned aversion to alcohol has been reported (but doesn’t seem to work long-term).

Therapists may create a ______________________________ in which patients exchange a token of some sort (usually a __________________ reinforcer), earned for exhibiting the desired behavior, for various privileges or treats (perhaps a _________________ reinforcer). It’s often used by parents and teachers.

Will the desired behaviors continue and/or undesirable behaviors come back when the training/reinforcement stops?Is it really ethical for one human being to “train” another?

Cognitive Therapy

Teaches people adaptive ways of ________________ and acting based on the assumption that thoughts intervene between events and our emotional reactions. Cognitive therapists often combine the _______________ of self-defeated thinking with efforts to modify behavior. _____________________________ therapy aims to alter the way people act (behavior therapy) and alter the way they think (cognitive therapy).

Albert Ellis developed the ___________________________________ that irrational thoughts led to self-defeating emotions. Therapists present common irrational beliefs to clients and help to train them to cognitively restructure/reappraise their thinking.

Ellis developed the ABCD model to explain this:

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• A = Activating event that triggers the emotion (e.g. failing a test)

• B = Belief System: how person appraises the event (e.g. “I’m stupid and no good at this subject”)

• C = emotional/behavioral Consequences of the appraisal in step B (e.g. feeling worthless and dumb)

• D = Disputing their erroneous beliefs in step B (e.g. “I’m not dumb. I just did not study hard enough and go in for the extra help that I needed”)

Alternative Therapies

Many different types exist (color, musical, touch, etc.). _________________________________________ (SAD), a form of depression, has been effectively treated by light exposure therapy.

Biomedical Therapy

These include physical, medicinal, and other forms of biological therapies (including __________ treatment, _______________, or ____________________________ therapy).

_________________________ is the study of drug effects on mind and behavior. With the advent of drugs, ______________________ in mental institutions has rapidly declined. However, many patients are left homeless on the streets due to their ill-preparedness to cope independently outside in society.

-_________________ antipsychotics remove a number of ________________symptoms (inward) associated with schizophrenia such as agitation, delusions, and hallucinations (Thorazine).

________________ antipsychotics remove ______________ symptoms (outward) associated with schizophrenia such as apathy, jumbled thoughts, concentration difficulties,

and difficulties in interacting with others (Clozapine & Risperdal).● Clozapine blocks receptors for __________________ and serotonin to remove the negative symptoms.

- ___________________ drugs depress the central nervous system and reduce anxiety and tension by elevating the levels of the __________ neurotransmitter (Xanax and Ativan).

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- __________________________ drugs like Prozac, Zoloft, and Paxil are Selective Serotonin Reuptake Inhibitors (SSRIs) that improve the mood by elevating levels of __________________ by inhibiting reuptake.

- ____________________________ drugs like Lithium Carbonate, a common salt, has been used to stabilize manic episodes in bipolar disorders. It moderates the levels of __________________________ and glutamate neurotransmitters.

______________________________________ (ECT) is used for severely ___________________ patients who do not respond to drugs. The patient is anesthetized and given a muscle relaxant. Patients usually get a 100 volt shock that relieves them of depression.

Psychosurgery was popular even in Neolithic times. ______________________ (trephination/lobotomy) is used as a last resort in alleviating psychological disturbances. Removal of brain tissue changes the mind and psychosurgery is irreversible

Types of Therapy & Therapists

_______________________ normally consists of 6-9 people attending a 90-minute session that can help more people and costs less. Clients benefit from knowing others have similar problems. _______________________ treats the family as a system. Therapy guides family members toward _____________relationships and ________________ communication. Marriage counseling is a form of this.

______________________________________ usually have PhDs. They are experts in research, assessment, and therapy, all of which is verified through a supervised internship. Clinical or Psychiatric ___________________ usually have a Masters of Social Work. Postgraduate supervision prepares some social workers to offer psychotherapy, mostly to people with everyday personal and family problems. ___________________ are physicians who specialize in the treatment of psychological disorders. Not all psychiatrists have extensive training in psychotherapy, but as MDs they can prescribe medications.

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