Abnormal Psychology and Treatment

Calendar for this Unit

• Art or Music, and Mental Illness—Sign up for your day—Week 1: Diagnose and Week 2: Treat

• Vocabulary—Chapter 16 Due Friday!• Vocabulary—Chapter 17 Due Next Friday!• Mental Illness and Treatment Role Play– Groups of 3 (patient, therapist, narrator)– 5 sources– Have fun—props, puppets, drama, etc.

Q--What is normal?

Defining Abnormality

• 1/7 Americans and 1/10 Worldwide—Why?• Is it an illness? – Yes! Schizophrenia vs. Type 1 Diabetes

• DSM IV TR—Designed to diagnose—not treat!• Abnormality– Maladaptive– Disturbing to others– Atypical– Irrational

Defining Abnormality

• Insanity is a legal term• Causes of Abnormality—Mobile Survey/Notes– Psychoanalytic– Humanistic– Behavioral– Cognitive*– Sociocultural– Biomedical– Eclectic*

Psychoanalytic

• Cause of mental illness--Internal, Unconscious Conflicts mostly stemming from childhood

• Freud, Horney, Erikson, Adler, and Jung

Humanistic

• Cause of mental illness--Failure to strive toward one’s potential— self actualization or being out of touch with one’s true feelings

• Maslow and Rogers

Behavioral

• Cause of mental illness—reinforcement history and the environment

• Skinner, Watson, and Bandura

Cognitive

• Cause of mental illness—irrational, dysfunctional thoughts or maladaptive ways of thinking

Sociocultural

• Cause of mental illness—Dysfunctional society; not you but the society that you live in

Biomedical

• Cause of mental illness—organic problems, biochemical imbalances, genetic predispositions

• Psychiatrists

Eclectic

• Clinical psychologists do not tend to subscribe to just one perspective, but instead utilize many and accept and use ideas from a number of perspective

Sybil—Scenes 1,2,3

• What aspects of abnormality are displayed?

• What perspective of mental illness best explains Sybil’s problems?

Types of Disorders

• Intern Syndrome????• Anxiety• Somatoform• Dissociative• Mood or Affective• Schizophrenic• Personality

Anxiety Disorders

Simple or Specific PhobiaClaustrophobiaArachnophobiaAgoraphobiaSocial Phobia

Famous People With Anxiety

Anxiety Disorders

GAD• Generalized Anxiety

Disorder• Constant Low Level

Anxiety• http://www.webmd.

com/video/generalized-anxiety-disorder

Panic Disorder• Acute /Instense

Anxiety

ANXIETY DISORDERS

http://www.webmd.com/video/teen-with-ocd

OCD—Obsessive Compulsive Disorder•Germs•Medical Issues•Symmetry•Cleanliness•Numbers•And more!Look at Checklist!http://www.brainphysics.com/screener.php

ANXIETY DISORDERS

• PTSD—• Post Traumatic Stress

Disorder

•Caused by trauma from war, rape, accidents, etc.

•Symptoms—FlashbacksNightmaresSevere AnxietyDrug Abuse

Causes of Anxiety

• Psychoanalytic—unresolved, internal conflicts between ID, Ego, and Superego– EX.—ID wishing to rid yourself of a bad parent and the

Superego saying that it is wrong to have such a wish

• Behaviorists—anxiety is learned– EX.--classical conditioning of phobias

• Cognitive—dysfunctional, irrational thinking– EX.—setting too high of standards for yourself

Sybil—Scenes 4,5,6

• What examples of anxiety did you see?

• If you were going to diagnose Sybil with an anxiety disorder, what would it be?

• What is the most probable cause for Sybil’s anxiety?

Somatoform Disorders

Psychological problem manifests in a physical waySomatizationHypochondriasisConversion PsychophysicalMunchausenMunchausen by Proxy

Causes of Somatoform

• Psychodynamic or psychoanalytic—unresolved conflicts that cannot be resolved

• Behaviorists—have been reinforced for being sick or for their behavior either through an actual reward or the removal of something unpleasant

• Cognitive—don’t know how to positively get attention

Dissociative Disorders—disruption in cognition

Psychogenic Amnesia• No organic or

physical basis• Selective, Localized,

Generalized• Fugue

DID• Dissociative Identity

Disorder• AKA—multiple

personality disorder

Causes of Dissociative Disorders

• Psychoanalytic—extremely traumatic events have been repressed and the split consciousness results

• Behaviorists—patients find dissociating rewarding because they don’t have to think about the trauma. Amnesia is “easier” than dealing with it

• Very rare and many question legitimacy• E. Loftus would question it—why?

Sybil—Scene 7, 10, 11

• What signs of somatoform disorders did Sybil and/or her mom show of a somatoform disorder?

• What is the likely cause of the mother’s somatoform behavior?

• What signs does Sybil show of DID?• What is the likely cause of the disorder?

Mood or Affective Disorders

• Major Depression—aka:Unipolar Depression• DSM says you have to:

– depressed more than 2 weeks

– Absence of clear reason– Loss of Appetite– Fatigue– Change in sleep– Lack of interest– Feelings of worthlessnes

• Seasonal Affective Disorder--SAD

• Bipolar Depression—aka:Manic-Depression

• Depressed episodes are similar to major depression

• Manic episodes – High energy– Heightened sense of

confidence & power– Anxious/Irritable– Risky Behavior– Don’t think about negative

consequences

Causes of Mood Disorders

• Psychoanalysts –anger directed inward, loss during early stages, overly punitive superego

• Behaviorists—brings some amount of reinforcement such as attention or sympathy

• Aaron Beck (cognitive) caused by unreasonably negative ideas about themselves, world, and future— Cognitive Triad

• Cognitive psychologists would also look at attributions—pessimism, internal, external, global, specific

Causes of Mood Disorders

• Martin Seligman—Learned Helplessness

• Shocked Dogs• Relate to humans?!?– Unable to fix the

situation, so they give up

• Biological—• low levels of serotonin

and or norepinephrine and unipolar

• More receptors for acetylcholine and bipolar

• Genetic Component—run in families

Schizophrenia• Types of Schizophrenia– Paranoid• Delusions of persecution

– Disorganized• Clang association (+ symp.)• Neologisms (+ symp.)• Innappropriate Affect

– Flat Affect (neg. symp.)

– Catatonic (negative symp.)• Waxy flexibility (neg. symp.)

– Undifferentiated• Disorganized thinking

Most severe mental illnessDisorder characterized by:Disturbed thoughts, behaviors, movementHallucinationsDelusions—persecution and grandeurDisorganized thoughts and speech—word salad, clang associations

Schizophrenia Simulator

• http://www.janssen.com/mindstorm_video.html

Causes of Schizophrenia• Genetic—if a close family member has schizophrenia,

then you are more likely to suffer—5th chromosome abnormality (bio)– Twin Studies—Monozygotic vs. Dizygotic

• Dopamine Hypothesis—more dopamine (bio)• Enlarged ventricles—takes away frontal lobe

development in late teen years, early 20s (bio)• Double Bind parent??? (cognitive, sociocultural)• Diathesis-Stress Model—environmental stressors

activate genetic predispositions (bio/)• Drug use (bio)

Sybil—Scenes 19,20, 21

• What symptoms of depression does Sybil or one of her personalities display?

• What is the cause of her depression?• What symptoms of schizophrenia does Hattie

display?• What do you think caused her schizophrenia?

Personality Disorders

• Personality Disorders are characterized by a maladaptive way in behaving that seems to be imbedded in the personality during development

HistrionicParanoidDependentAnti-socialNarcissistic—DSM?CompulsiveObsessivePassive-AggressiveSchizoid/AvoidantBorderline

Causes of Personality Disorders• Psychoanalytic—unresolved conflict between the

id and superego• Behavioral—some maladaptive aspect of the

personality has been reinforced• Sociocultural—dysfunctional society has caused

personality flaws• Cognitive—maladaptive thinking cause

personality flaw• Humanistic—personality flaw developed by

conflict between ideal self and real self

Other Mental Illnesses in the DSM-IV-TR• Paraphillias—sexual disorders– Pedophillia, zoophillia, fetish, voyeur, masochist, sadist

• Anorexia-Nervosa and Bulemia– Loss of 15% of body mass, fear of food, distorted body

image • Substance Use Disorder—– Substance dependence—addiction

• ADHD???– Overdiagnosed

• Autism– Less social and emotional contact, language delayed,

and don’t seek parent assistance

Sybil—Scenes 26, 27, 28

• Does Sybil suffer from any personality disorders? If so, why do you think she developed it?

• Does her dad seem to suffer from a personality disorder? If so, why do you think it developed?

Caution!!!!!!!!

• Is it a good idea to label people as depressed or as a hypochondriac? Is there really a benefit to giving a person a label?

• Rosenhan—Who’s Crazy Here Anyway?– Discuss with a neighbor what Rosenhan concluded

and what info we can take from his study!– Clinical Psychologists more likely to label—

Counseling Psychologists not so much!

History of Treatment

• Trephining• Enlightenment—Dorothea Dix• Deinstitutionalization• Preventative Efforts– Primary—reduce socieatal problems– Secondary—work with at risk persons– Tertiary—keep mental illness from getting worse

Treatment Options

• Finish Sybil—29, 31

• What type of therapy do you think Dr. Wilbur uses with Sybil?

• Do you think it was ethical/appropriate for Dr. Wilbur to get so close to Sybil?

PsychoanalyticHumanisticBehavioralCognitive*SocioculturalBiomedicalEclectic*

Patient: Charlie SheenDiagnosis:______________Treatment Proposal:_____________________

http://abcnews.go.com/GMA/video/charlie-sheen-not-bipolar-bi-winning-13017875

Patient: Lindsay LohanDiagnosis: ___________________Treatment Proposal:____________________

http://abcnews.go.com/GMA/video/lindsay-lohan-speaks-out-13026910

Patient: Marshall Bruce Mathers III aka Eminem, Slim Shady

Diagnosis:____________Treatment Proposal:____________

Psychoanalytic

• Must bring repressed memories and conflict with id/superego to the surface so ego and conscious can deal with it.

• If you do the work, you won’t have symptom substitution

• Hypnosis• Free Association

– Role play!

• Dream Analysis– Manifest vs. Latent

• Resistance• Transference

– Countertransference

• Dr. Wilbur—Example• Psychodynamic--Insight

Humanistic

• Must help CLIENT remove roadblocks to self actualization and resolve incongruence between real self and ideal self in a non-directive way

• Need for unconditional positive regard

• Carl Rogers—I’m OK, You’re OK

• Active Listening– Role Play!

• Free Will vs. Determinism

• Client Centered or Person Centered Therapy

• Modeling Congruence

Other Types of Humanist Therapies

• Existential Therapy– Life is worthwhile– Has purpose– Don’t Worry, Be Happy!

• Gestalt Therapy– Much more directive– Empty Chair Technique– WHOLE selves– Integrate self into one– Who would be in your

empty chair and what would you say to them?

Behavioral

• Must counter condition the patient in a more adaptive way

• Mary Cover Jones—Counter Conditioning

• Joseph Wolpe—Systematic Desentization– Relaxation

• Flooding– In vivo vs. Convert– Extinguishing Fear

• Aversive Conditioning• Token Economy• Biofeedback

Anxiety Hierarchy—Systematic Desensitization

• in vivo vs. covert desensitization

Least Anxiety Provoking

Most Anxiety

Provoking

Cognitive

• Must fix maladaptive thinking in a directive way

• Fix unhealthy attributional styles and replace it with more effective attributions

• Aaron Beck—Cognitive Therapy—Cognitive Triad

• Cognitive Behavioral Therapy or CBT

• Rational Emotive Behavioral Therapy or RBET

• Albert Ellis

Role Play with someone in class to get rid of an irrational belief they have!

Sociocultural

• Most help patient by fixing his/her environment—ie—family, friends, workplace, etc.

• YOU don’t exist in a vacuum

• Family Therapy• Couples Counseling• Group Therapy• AA/NA• Self Help Groups

Biological or Somatic Therapies

• Treating mental illness from a biological approach like you would any illness

• Psychiatrists• Family MDs• Other MDs• NOT typically

Psychologists

• Medicine• Psychosurgery– Lesioning vs. Lobotomy

• Diet/Exercise• ECT/Shock Therapy

Psychopharmacology or Chemotherapy

– Anti Depressants—increase serotonin activity• Tricyclics• MAOIs• SSRIs– Prozac

– Anti Anxiety• Barbiturates–Miltown

• Benzodiazapines– Valium and Xanax

Mood Stabilizers—Lithium—Heavy Metal

Treat Bipolar

Anti Psychotics--Schizophrenia• Thorazine• Haldol– Side Effects:» Tardive

Dyskenia

A Beautiful Mind

• Insulin Shock Therapy Scene—Scene 15

Eclectic

• Using a variety of approaches to help your patient/client

• What combo would you prefer to use?

• Write here!

Types of Therapists

• Psychiatrists—MD– Only therapist type that

can prescribe medicine– Favor biomedical and

not as well trained in psychotherapy

• Psychoanalysts– Freudian Methods

• Clinical Psychologists– PhDs--Diagnose

• Counseling Psychologists– Masters in Family

Therapy--JEFF– Deal with less serious

issues

How Effective is Therapy???

Very Effective Not Very Effective

Outdated studies indicate that 66% of people get better with therapy or without therapy! However, new research indicates

that even if people who get better are not seeking formal counseling, they are seeking therapy in less formal ways!

Schizophrenia FRQ—Stand Up Review!• Often misunderstood, schizophrenia is a psychological

disorder affecting one percent of the population. In treating the disorder, psychologists work to identify its nature and origins. – Identitify two characteristics used to diagnose schizophrenia– Discuss a research finding that supports a genetic basis for

schizophrenia– What is the dopamine hypothesis regarding the origins of

schizophrenia?– Describe how medications used to treat schizophrenia affect the

actions of neurotransmitters at the synapse.– Identify a risk inherent in the treatment of schizophrenia.– People often times confuse schizophrenia with DID (Dissociative

Identity Disorder). Identify two characteristics that differeniate DID from Schizophrenia.