Psychological Disorders

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Psychological Disorders

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

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Psychological Therapies
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• With the development of drugs in the 1950s, the
  major push was to localize therapy and to
  deinstitutionalize patients

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Preventative Efforts offer therapy at the onset
of a disorder

• Primary Prevention hopes to minimize societal
  incidents of unemployment or homelessness as the
  result of having a disorder.

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• Secondary Prevention deals with helping at risk
  patients, such as those who living in a war zone.
  
• Tertiary Prevention aims at helping those
  already with a disorder avoid situations that may
  add to their already complicated lives.

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• There are over 250 identifiable types of
  psychotherapy, though the most influential are
• Psychodynamic Therapies
• Humanistic Therapies
• Behavior Therapies
• Cognitive Therapies
• Group and Family Therapies
• Bio-Medical Therapies
• Any therapist who uses a combination of therapies
  is said to be using an eclectic approach to
  therapy

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• Psychoanalysis

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

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

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

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• Methods
• Free Association is a method of exploring the
  unconscious, in which a person relaxes and says
  whatever comes to mind, no matter how trivial or
  embarrassing

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• Free Association
• During free association, though, patients almost
  instinctively begin to edit themselves, feeling
  that some information is too trivial, irrelevant,
  or shameful. - These blocks in the flow of free
  association are called resistance

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• Resistance
• Resistance hints at anxiety and the repression of
  sensitive material. A psychotherapist wants to
  first make a patient aware of these areas, and
  then explore their underlying meanings further.
• The notation of hidden meanings in resistance and
  later, dreams, and the insights provided, is
  called interpretation

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• Interpretation
• Interpretation recognition by therapist and
  patient of repressed issues to deal with.and
  then begins the suggestions of underlying wishes,
  feelings, desires, or conflicts.
• How do those underlying issues further fit into
  the larger picture of the patients disorder

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• Methods
• Dream Interpretation is a psychotherapists
  understanding of the latent content of a
  patients dream.

• Latent content refers to the underlying, but
  censored, real meaning of a dream.

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• Methods
• While revealing their secrets, their desires, and
  their repressed feelings, patients may begin to
  experience strong feelings (positive or
  negative), towards their therapists.
• - Transferring emotions from one experience to
  the therapist is called transference.

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• Methods
• A modern variation of psychoanalysis is called
  interpersonal psychotherapy.
• Helps people gain insight into the roots of their
  difficulties by focusing on current
  relationships, rather than past or repressed
  feelings.
• especially effective with those patients
  suffering from depression.

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• Humanistic Therapies

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

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• Methods
• Humanists hope to accomplish their goals by
• Focusing on the present and the future, rather
  than the past
• Exploring feelings as they occur, rather than
  repressed, past feelings
• Dealing with conscious thoughts, rather than the
  unconscious

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• Methods
• Humanists hope to accomplish their goals by

• Having patients take immediate responsibility for
  their thoughts and actions, rather than hiding
  them
• Promoting growth, rather than dwelling on a
  cure for an illness

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• Methods
• Re-enforce the idea of free will, or the
  realization that people are capable of
  controlling their own destiny (as opposed to
  determinism)

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

HI! Remember Me?

• Focuses on a therapists ability to exhibit
  genuineness, acceptance, and empathy for their
  clients.
• The deeper understanding a therapist portrays,
  the more open a client will be (this empathy is
  also called unconditional positive regard).

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

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• Behavior Therapies

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

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• Methods
• Behaviorists believe that we learn various
  behaviors and emotions through classical and
  operant conditioning , so its a good assumption
  that maladaptive behaviors (disorders) are
  learned behaviors as well.
• If so, behaviorists believe that disorders can be
  unlearned.

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• a young child has a bedwetting problem.
• A behaviorist would have the child sleep on a
  moisture-sensitive mattress hooked up to an
  alarm.
• Every time the child wet the bed, an alarm would
  go off.
• Eventually the child will learn to awaken
  themselves at the onset of a full-bladder feeling.

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• If a claustrophobic fear of elevators is a
  learned aversion to confined spaces, then a
  behaviorist would put something relaxing in the
  elevator to alleviate the fear response
  (soothing, classical music?).

Associating the trigger (enclosed spaces) with a
new, less fearful response (relaxation) is
called counter conditioning.
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• Methods
• For example, if a young child cries hysterically
  as soon as he enters the doctors office, his
  mother may bring along some of his favorite toys
  when they go to the office. Associating the
  trigger with a new, less fearful response is
  called counter-conditioning.

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• Methods
• There are three types of classical counter
  conditioning.
• Systematic Desensitization
• Implosive Therapy
• Aversive Conditioning

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• Systematic Desensitization
• IE. Billy is afraid of rabbits and other furry
  creatures. Rabbits Fear.
• Billy enjoys eating. Eating Happy.
• Billys therapist wants to eliminate Billys fear
  of rabbits. His therapist will attempt to
  associate the fear-inducing rabbits with
  something that makes Billy happy, like dinner
  time.

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• Systematic Desensitization
• IE. When Billy sits down for dinner, his
  therapist puts a rabbit in the room, in a far
  away corner. Billy hardly notices.
• On succeeding days, his therapist gradually
  moves the rabbit closer and closer during dinner
  time.
• Within two months, Billy is able to hold the
  rabbit in his lap during dinner time. His fear
  of rabbits has been countered.

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• Systematic Desensitization is also known as
  exposure therapy. A therapist is attempting to
  gradually substitute a positive response for a
  negative response to a harmless stimulus.

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• US UR US UR
• Rabbit Fear Dinner Relaxed
• A therapist wants to eliminate the fear
  response to rabbits.

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• Systematic Desensitization
• US CS UR
• Dinner Rabbit Relaxed
• After Counter-Conditioning
• CS CR
• Rabbit Relaxed

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• Implosive Therapy floods patients with their
  worst fears first, in hopes that by confronting
  their worst fears, theyll learn how to not back
  down

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• Aversive Conditioning

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

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

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• US UR
• Thumb Sucking Enjoyment
• US UR
• Hot Peppers Sickness
• A therapist wants to eliminate the enjoyment
  derived from thumb sucking.

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• Aversive Conditioning
• US CS UR
• Hot Peppers Thumb Sickness
• After Reconditioning
• CS CR
• Thumb Sucking Sickness

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• Methods
• Behavior therapists who use operant counter
  conditioning
• Use positive reinforcers to shape behavior in a
  step-by-step manner by rewarding closer and
  closer approximations of the desired behavior
• Withhold reinforcement, or punish, for undesired
  behaviors
• Deter negative behaviors by simply ignoring them,
  and only acknowledging closer approximations of
  the desired behavior (shaping)

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• Methods
• The rewards used to modify behavior vary, from
  praise to food, depending on the individual,
  their disorder, and the therapist

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

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• Cognitive Therapies

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

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

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

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

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

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

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

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• IE. A client has an obsessive compulsive
  disorder, which included ritually washing their
  hands again and again. A cognitive-behavior
  therapist would show the client a PET scan that
  rationally explained the behavior as abnormal,
  not the fault of the client.
• Next, through behavior therapy, a therapist would
  counter condition the disorder by having the
  client pick up their favorite instrument and play
  until the compulsion passed.

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• Group and Family Therapies

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• Aims
• Group therapy is generally for people
  experiencing family conflicts or those whose
  behavior is distressing to others.

• Benefits
• others have same disorder
• share therapy ideas
• receive feedback
• you are not alone

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• Aims
• Provide a sense of community, safety, and
  connectedness
• Support and friendship

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• Methods
• Usually groups of six to ten individuals
• Averaging up to 90 minutes per week

• Family Therapy promotes the idea that families
  are a unit that depends on each member to be
  positive and to communicate

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• Alternative Therapies

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Therapeutic Touch

• A practitioner moves their hands a few inches
  from a patients body, purportedly pushing
  energy fields into balance

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Eye Movement Desensitization Reprocessing (EMDR)

• Usually for disorders associated with trauma and
  anxiety.
• A patient is asked to close their eyes and to
  think about a traumatic scene from their life.
• A therapist waves their hand in front of their
  eyes as they are thinking, causing rapid eye
  movement

Does this resemble the stress-less REM of sleep?

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Light Exposure Therapy

• Especially for seasonal affective disorder, or
  depression brought on seasonal changes from
  summer to winter (less light). The therapy
  includes timed doses of intense light in light
  boxes.

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Electroconvulsive Therapy

• Patients brains are given momentary shock
  treatments, generally for about 30 seconds.

• Patients are given an anesthetic so that they are
  not conscious, and a muscle relaxant to prevent
  any injuries that may occur from convulsions.

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• Electroconvulsive Therapy
• Especially used in cases of deep depression, but
  historically/barbarically used for almost
  anything determined to be abnormal behavior.
• May work by helping the release of norepinephrine
  in the brain, which is responsible for elevating
  arousal and mode.
• May work by calming areas of the brain that are
  overactive during depressed periods.

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• Psychosurgery
• Surgery that removes or destroys brain tissue in
  an effort to change behavior.
• Once popular, but no more, a lobotomy cuts the
  nerves that connect the frontal lobe to the
  emotion-controlling centers in the inner-brain.

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• Psychopharmacology
• The study of the effects of drugs on the mind and
  behavior
• Introduced in the 1950s
• Greatly reduced those confined to a hospital
• currently applied to just about anything

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• Careful
• The normal recovery rate from drug therapy isnt
  100
• The placebo effect may skew results meaning,
  patients assume that because they are taking a
  pill, they must be getting better
• so the pill isnt necessarily effective, but the
  belief in it is

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• Antipsychotic Drugs
• Drugs used for the purpose of calming psychotic
  patients those patients with fundamental mental
  derangement (such as schizophrenia) characterized
  by defective or lost contact with reality (ie.
  hallucinations, paranoia, apathy, withdrawal)
• IE. Thorazine, Clozaril, Haldol

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• Antipsychotic drugs work by attaching themselves
  to receptor sites for dopamine, thus blocking
  their transmission from neuron to neuron.
  Excessive dopamine in the bodys system is linked
  to schizophrenia.

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• Antianxiety Drugs
• Are used for the purpose of alleviating the
  symptoms stemming from frightening situations and
  fear-inducing stimuli
• IE. Xanax, Valium

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• Antianxiety drugs work by depressing the central
  nervous system activity

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• Antidepressant Drugs
• The purpose is to lift people up from a state of
  depression
• IE. Prozac, Paxil, Zoloft

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• Antidepressant drugs work by increasing the
  availability of norepinephrine and/or serotonin,
  which elevate arousal and mood

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• These drugs are often called reuptake-inhibitors
• They block the reuptake of neurotransmitters
• Therefore more of the neurotransmitter is left
  in the synapse and its effects are felt for
  longer periods of time

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• Lithium is an anti-depressant used mainly for
  manic-depressives (bipolar)

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Some Criticisms of Drug Therapy

• Doesnt address the root causes of behavior
  disorders
• May cause addiction
• Increased risks for suicide with some drugs?
• May cause other symptoms, disorders or diseases