Abnormal Psychology

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Abnormal Psychology
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• 3 major criteria for diagnosing psychological
  disorders
• - 1. Deviance-behavior that is not considered
  to be in the norm
• - 2. Maladaptive behavior-behavior that
  interferes with a persons social or occupational
  functioning
• - 3. Personal distress-how much distress it
  causes the individual

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Costs of Mental Illness - Costs more than 150
billion each year for treatment - Schizophrenia
alone costs up to 30 billion - Lithium for
Bipolar Disorder has saved approximately 145
billion since 1970 - Clozapine for Schizophrenia
has saved approximately 23,000/patient annually
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• Youth and Mental Illness
• - U.S. adolescents appear to be at high risk for
  mental illness
• - Schizophrenia tends to manifest itself in
  adolescence or early adulthood
• - U.S. adolescents are the only group in which
  there continues to be an increase in the death
  rate, from accidents, suicide and homicide

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Warning Signs of trouble

• - marked drop in school performance or
  increase in absenteeism
• - excessive use of alcohol and/or drugs
• - marked changes in sleeping and/or eating
  habits
• - many physical complaints (headaches, stomach
  aches)
• - aggressive or non-aggressive violations of the
  rights of others
• - withdrawal from friends, family and regular
  activities
• - depression demonstrated by continued,
  prolonged negative mood and often accompanied by
  poor
• - appetite and/or difficulty sleeping

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• - frequent outbursts of anger or rage
• - low energy level, poor concentration,
  complaints of boredom
• - loss of enjoyment in what used to be favorite
  activities
• - unusual neglect of personal appearance
• - frequent outbursts of anger or rage
• - low energy level, poor concentration,
  complaints of boredom
• - loss of enjoyment in what used to be favorite
  activities
• - unusual neglect of personal appearance

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Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV-TR)

• - Axis I-Clinical Syndromes-includes many of the
  disorders that are in chapter 14
• - Axis II-Personality Disorders or Mental
  Retardation (See personality disorders)
• - Axis III-General Medical Conditions-assesses
  any chronic physical disorders or conditions that
  may contribute to disorders
• - Axis IV-Psychosocial and Environmental
  Problems-negative life events, troubled
  relationships, trouble with the law, school,
  work, etc.
• - Axis V-Global Assessment of Functioning-After
  assessing axes 1-4, the psychologist makes a
  determination regarding a score that they would
  assess the persons level of functioning. A
  score of a 10 means the person is in persistent
  danger of severely hurting themselves or others
  and a score of 100 means they are functioning at
  a superior level.

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Generalized Anxiety Disorder (GAD)

• "I always thought I was just a worrier. I'd feel
  keyed up and unable to relax. At times it would
  come and go, and at times it would be constant.
  It could go on for days. I'd worry about what I
  was going to fix for a dinner party, or what
  would be a great present for somebody. I just
  couldn't let something go."
• "I'd have terrible sleeping problems. There were
  times I'd wake up wired in the middle of the
  night. I had trouble concentrating, even reading
  the newspaper or a novel. Sometimes I'd feel a
  little lightheaded. My heart would race or pound.
  And that would make me worry more. I was always
  imagining things were worse than they really
  were when I got a stomachache, I'd think it was
  an ulcer."

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Anxiety Disorders

• Class of disorders marked by excessive or
  chronic anxiety or apprehension
• Generalized Anxiety Disorder
• - marked by a chronic, high level of anxiety
  that is not due to anything specific. Age of
  onset may be between 10 and 14 years of age.
• - Causes-No specific threat, symptoms must be
  present for at least 6 months
• - Symptoms-Restlessness or feelings of being
  keyed up or on edge, being easily fatigued,
  difficulty concentrating, irritability, muscle
  tension, sleep disturbance
• - Treatments-Benzodiazepines (Valium and
  Ativan), Tricyclic Antidepressants, Psychotherapy

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Panic Disorder

• "For me, a panic attack is almost a violent
  experience. I feel disconnected from reality. I
  feel like I'm losing control in a very extreme
  way. My heart pounds really hard, I feel like I
  can't get my breath, and there's an overwhelming
  feeling that things are crashing in on me."
• "It started 10 years ago, when I had just
  graduated from college and started a new job. I
  was sitting in a business seminar in a hotel and
  this thing came out of the blue. I felt like I
  was dying."
• "In between attacks there is this dread and
  anxiety that it's going to happen again. I'm
  afraid to go back to places where I've had an
  attack. Unless I get help, there soon won't be
  anyplace where I can go and feel safe from panic."

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Panic Disorder

• characterized by sudden and unexpected attacks
  of anxiety. Age of onset usually between 15 and
  19
• - Causes-defects in the brain (specifically the
  brain stem, limbic system and frontal cortex)
• - Symptoms-heart palpitations, sweating,
  trembling, feeling of choking, shortness of
  breath, fear of dying, chest pain or discomfort,
  feeling dizzy.
• - Treatments-Tricyclic Antidepressants, SSRIs,
  MAOIs, Antianxiety drugs (e.g., Xanax, Ativan),
  Cognitive-Behavioral treatments

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Phobias

• "I'm scared to death of flying, and I never do it
  anymore. I used to start dreading a plane trip a
  month before I was due to leave. It was an awful
  feeling when that airplane door closed and I felt
  trapped. My heart would pound, and I would sweat
  bullets. When the airplane would start to ascend,
  it just reinforced the feeling that I couldn't
  get out. When I think about flying, I picture
  myself losing control, freaking out, and climbing
  the walls, but of course I never did that. I'm
  not afraid of crashing or hitting turbulence.
  It's just that feeling of being trapped. Whenever
  I've thought about changing jobs, I've had to
  think, "Would I be under pressure to fly?" These
  days I only go places where I can drive or take a
  train. My friends always point out that I
  couldn't get off a train traveling at high speeds
  either, so why don't trains bother me? I just
  tell them it isn't a rational fear."

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Phobic Disorder

• - marked by a persistent and irrational fear of
  things that dont really pose a threat. Age of
  onset often between 7 and 9 years of age
• - Causes-may run in families and be present in
  females more often, usually a classically
  conditioned response
• - Symptoms-marked and persistent fear that is
  excessive or unreasonable, intentional avoidance
  of object or situation
• - Treatment-Mostly behavior therapy, but can
  also use Antianxiety drugs (e.g., Valium),
  Tricyclic Antidepressants, MAOIs, Psychotherapy

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Social Phobia

• "In any social situation, I felt fear. I would be
  anxious before I even left the house, and it
  would escalate as I got closer to a college
  class, a party, or whatever. I would feel sick in
  my stomach-it almost felt like I had the flu. My
  heart would pound, my palms would get sweaty, and
  I would get this feeling of being removed from
  myself and from everybody else."
• "When I would walk into a room full of people,
  I'd turn red and it would feel like everybody's
  eyes were on me. I was embarrassed to stand off
  in a corner by myself, but I couldn't think of
  anything to say to anybody. It was humiliating. I
  felt so clumsy, I couldn't wait to get out."

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Obsessive-Compulsive

• "I couldn't do anything without rituals. They
  invaded every aspect of my life. Counting really
  bogged me down. I would wash my hair three times
  as opposed to once because three was a good luck
  number and one wasn't. It took me longer to read
  because I'd count the lines in a paragraph. When
  I set my alarm at night, I had to set it to a
  number that wouldn't add up to a 'bad' number."
• "I knew the rituals didn't make sense, and I was
  deeply ashamed of them, but I couldn't seem to
  overcome them until I had therapy."
• "Getting dressed in the morning was tough,
  because I had a routine, and if I didn't follow
  the routine, I'd get anxious and would have to
  get dressed again. I always worried that if I
  didn't do something, my parents were going to
  die. I'd have these terrible thoughts of harming
  my parents. That was completely irrational, but
  the thoughts triggered more anxiety and more
  senseless behavior. Because of the time I spent
  on rituals, I was unable to do a lot of things
  that were important to me."

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Obsessive-Compulsive Disorder

• An unusual disorder of ritual and doubt.
• Obsessions are persistent and intrusive thoughts,
  images, ideas or impulses.
• Compulsions are repetitive, purposeful behaviors
  that are performed in response to an obsession.
  
• They understand that their actions are
  unreasonable, but cannot stop themselves. Age of
  onset is usually between 9 and 12 years of age.

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OCD

• Causes-may be genetic, may be due to
  neurotransmitter activity, there has been some
  indication that some have the onset of this
  disorder after having strep throat (they think
  that possibly the antibodies that are supposed to
  fight the infection actually attack the basil
  ganglia)

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OCD

• - Symptoms-Obsessions recurrent and persistent
  thoughts, excessive worry about real-life
  problems, impulses which may be deemed
  inappropriate. Compulsions repetitive
  behaviors or mental acts that a person feels
  driven to perform as a result of the obsession,
  behaviors done to reduce distress. Person
  recognizes that obsessions or compulsions are
  unreasonable. Marked distress, time consuming or
  significantly interferes with a persons normal
  routine.

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OCD

• - Treatments-Behavior therapy (systematic des.,
  flooding, thought stopping), Tricyclic
  Antidepressants, SSRIs (today, Luvox is commonly
  used, also may use Prozac or Zoloft)

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Post-Traumatic Stress Disorder

• "I was raped when I was 25 years old. For a long
  time, I spoke about the rape as though it was
  something that happened to someone else. I was
  very aware that it had happened to me, but there
  was just no feeling."
• "Then I started having flashbacks. They kind of
  came over me like a splash of water. I would be
  terrified. Suddenly I was reliving the rape.
  Every instant was startling. I wasn't aware of
  anything around me, I was in a bubble, just kind
  of floating. And it was scary. Having a flashback
  can wring you out."
• "The rape happened the week before Thanksgiving,
  and I can't believe the anxiety and fear I feel
  every year around the anniversary date. It's as
  though I've seen a werewolf. I can't relax, can't
  sleep, don't want to be with anyone. I wonder
  whether I'll ever be free of this terrible
  problem."

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Post-Traumatic Stress Disorder (PTSD)

• - display of persistent anxiety following an
  overwhelming traumatic event
• - Causes-traumatic event that is not a usual
  event in the normal human experience
• - Symptoms-traumatic event is persistently
  reexperienced, may have images or thoughts of the
  event, recurrent distressing dreams of the event,
  reliving the event, insomnia, exaggerated startle
  response.
• - Treatments-Psychotherapy (systematic des.,
  flooding), Cognitive-Behavioral therapy

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Somatoform Disorders

• Disorders in which the person may feel physical
  pain or problems but there is no physiological
  basis for them, they are psychological in nature.

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Types of Somatoform Disorders

• Somatization Disorder When the person
  experiences a wide variety of physical problems
  that are due to psychological problems.
• Conversion Disorder When the person experiences
  a loss of physical functioning in a body part
  with no physical reason for this to happen. May
  effect, vision, hearing, use of limbs.
• Hypochondriasis When the person is excessively
  worried about their health, worry about
  developing illnesses and often manufacture the
  symptoms of various illnesses in their head.

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Causes and Treatments

• Causes of these disorders May be due to
  increased sensitivity of autonomic nervous
  system, while others feel it is a personality or
  cognitive defect. People who are histrionic,
  that is, self-centered, suggestible, excitable,
  and highly emotional may be more susceptible.
• Treatment Psychoanalysis or cognitive therapy
  may be helpful.

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Differences from other problems

• Malingering
• those who fake a disease or disorder
• Are fully aware of why they are engaging in these
  behaviors

• Factitious Disorder
• Symptoms under voluntary control, but dont know
  why (Munchausen Syndrome)
• When done to others it is referred to as by proxy
  (Munchausen Syndrome by proxy)

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Dissociative Disorders

• When a person experiences bouts of memory
  loss, due to loss of consciousness and have
  disruptions in their sense of identity.
• Dissociative Amnesia A sudden loss of memory
  for important personal information that is too
  severe to be considered normal. May occur for
  one traumatic event or period of time.
• Dissociative Fugue When a person loses their
  memory for their entire life along with who they
  are and what their identity is. May forget name,
  family, where they live, etc.

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• Dissociative Identity Disorder When there is
  the existence of two or more personalities
  coexisting in the same body (used to be called
  Multiple Personality Disorder). The host
  personality is supposedly unaware of any other
  personalities, however, some have reported that
  one or more of the other personalities may be
  aware of what is happening.
• Causes It is thought that the cause of
  Dissociative Identity Disorder is some type of
  repeated, chronic psychological trauma during
  childhood. Dissociative amnesia or fugue may be
  brought on by excessive stress.
• Treatment Psychoanalysis is usually a treatment

Chris Sizemore
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Personality Disorders

• - May be characterized by any of the following
  affects a persons sense of self as well as
  others, lacks appropriate emotional responses,
  impersonal functions, lacks impulse control,
  behavior that is inflexible, inability to
  function in social, occupational and other
  functions of life, onset traced back to early
  adolescence or early adulthood
• Disorders that are considered odd/eccentric
• Schizoid Personality Disorder
• - odd eccentric behavior, tend to be loners, may
  be perceived to be cold and unfeeling, trouble
  keeping jobs and maintaining relationships, show
  very little emotion

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• Paranoid Personality Disorder
• - suspicious and mistrustful of others, refuse
  to accept criticism or blame, may be cautious,
  scheming, devious, or argumentative, does not
  like to confide in others, difficult to get along
  with
• Schizotypal Personality Disorder
• - suspicious, shows signs of paranoia, aloof and
  impersonal, shows signs of magical thinking,
  unusual perceptual thinking, may have speech that
  resembles schizophrenia (disorganized)

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Antisocial personality disorders

• failure to conform to social norms with respect
  to lawful behaviors as indicated by repeatedly
  performing acts that are grounds for arrest
• deceitfulness, as indicated by repeated lying,
  use of aliases, or conning others for personal
  profit or pleasure
• impulsivity or failure to plan ahead
• irritability and aggressiveness, as indicated by
  repeated physical fights or assaults
• reckless disregard for safety of self or others
• consistent irresponsibility, as indicated by
  repeated failure to sustain consistent work
  behavior or honor financial obligations
• lack of remorse, as indicated by being
  indifferent to or rationalizing having hurt,
  mistreated, or stolen from another

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Borderline personality disorder

• frantic efforts to avoid real or imagined
  abandonment.
• a pattern of unstable and intense interpersonal
  relationships characterized by alternating
  between extremes of idealization and devaluation
• identity disturbance markedly and persistently
  unstable self-image or sense of self
• impulsivity in at least two areas that are
  potentially self-damaging (e.g., spending, sex,
  substance abuse, reckless driving, binge eating)
• recurrent suicidal behavior, gestures, or
  threats, or self-mutilating behavior
• affective instability due to a marked reactivity
  of mood (e.g., intense episodic dysphoria,
  irritability, or anxiety usually lasting a few
  hours and only rarely more than a few days)
• chronic feelings of emptiness
• inappropriate, intense anger or difficulty
  controlling anger (e.g., frequent displays of
  temper, constant anger, recurrent physical
  fights)
• transient, stress-related paranoid ideation or
  severe dissociative symptoms

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Histrionic personality disorder

• is uncomfortable in situations in which he or she
  is not the center of attention
• interaction with others is often characterized by
  inappropriate sexually seductive or provocative
  behavior
• displays rapidly shifting and shallow expression
  of emotions
• consistently uses physical appearance to draw
  attention to self
• has a style of speech that is excessively
  impressionistic and lacking in detail
• shows self-dramatization, theatricality, and
  exaggerated expression of emotion
• is suggestible, i.e., easily influenced by others
  or circumstances
• considers relationships to be more intimate than
  they actually are

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Narcissistic personality disorder

• has a grandiose sense of self-importance (e.g.,
  exaggerates achievements and talents, expects to
  be recognized as superior without commensurate
  achievements)
• is preoccupied with fantasies of unlimited
  success, power, brilliance, beauty, or ideal love
  
• believes that he or she is "special" and unique
  and can only be understood by, or should
  associate with, other special or high-status
  people (or institutions)
• requires excessive admiration
• has a sense of entitlement, i.e., unreasonable
  expectations of especially favorable treatment or
  automatic compliance with his or her expectations
  
• is interpersonally exploitative, i.e., takes
  advantage of others to achieve his or her own
  ends
• lacks empathy is unwilling to recognize or
  identify with the feelings and needs of others
• is often envious of others or believes that
  others are envious of him or her
• shows arrogant, haughty behaviors or attitudes

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Avoidant personality disorder

• avoids occupational activities that involve
  significant interpersonal contact, because of
  fears of criticism, disapproval, or rejection
• is unwilling to get involved with people unless
  certain of being liked
• shows restraint within intimate relationships
  because of the fear of being shamed or ridiculed
• is preoccupied with being criticized or rejected
  in social situations
• is inhibited in new interpersonal situations
  because of feelings of inadequacy
• views self as socially inept, personally
  unappealing, or inferior to others
• is unusually reluctant to take personal risks or
  to engage in any new activities because they may
  prove embarrassing

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Dependent personality disorder

• has difficulty making everyday decisions without
  an excessive amount of advice and reassurance
  from others
• needs others to assume responsibility for most
  major areas of his or her life
• has difficulty expressing disagreement with
  others because of fear of loss of support or
  approval.
• has difficulty initiating projects or doing
  things on his or her own (because of a lack of
  self-confidence in judgment or abilities rather
  than a lack of motivation or energy)
• goes to excessive lengths to obtain nurturance
  and support from others, to the point of
  volunteering to do things that are unpleasant
• feels uncomfortable or helpless when alone
  because of exaggerated fears of being unable to
  care for himself or herself

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Obsessive-compulsive personality disorder

• is preoccupied with details, rules, lists, order,
  organization, or schedules to the extent that the
  major point of the activity is lost
• shows perfectionism that interferes with task
  completion (e.g., is unable to complete a project
  because his or her own overly strict standards
  are not met)
• is excessively devoted to work and productivity
  to the exclusion of leisure activities and
  friendships (not accounted for by obvious
  economic necessity)
• is overconscientious, scrupulous, and inflexible
  about matters of morality, ethics, or values (not
  accounted for by cultural or religious
  identification)
• is unable to discard worn-out or worthless
  objects even when they have no sentimental value
• is reluctant to delegate tasks or to work with
  others unless they submit to exactly his or her
  way of doing things
• adopts a miserly spending style toward both self
  and others money is viewed as something to be
  hoarded for future catastrophes
• shows rigidity and stubbornness

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Mood Disorders

• 1) Major Depression A whole body illness
  involving body, mood and thoughts. Affects the
  way the person eats, sleeps and how they feel
  about themselves. Symptoms can last for weeks,
  months or years. Usually lasts around 9 months,
  but if it goes longer, it will usually dissipate
  within 2 years.

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• DEPRESSION CONTINUED
• Causes 1) Some types run in families, 2) low
  levels of serotonin, 3) low self-esteem, 4) those
  who are pessimistic, 5) those overwhelmed by
  stress, 6) serious loss, 7) chronic illness, 8)
  difficult relationships, 9) financial problems
• Symptoms 1) persistent sad, anxious, empty
  mood, 2) feelings of hopelessness, 3) feelings of
  guilt, worthlessness, helplessness, 4) loss of
  interest in pleasures or hobbies, 5) insomnia or
  oversleeping, 6) weight loss or weight gain, 7)
  decreased energy/fatigue, 8) thoughts of suicide
  or death

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Depression continued

• Treatments 1) Antidepressants (Tricyclics,
  MAOIs, SSRIs), 2) Psychotherapy (talking
  therapies, gaining insight), 3) ECT (for severe
  depression), Lithium (for recurrent major
  depression), 4) behavior therapy (gaining
  self-reinforcements for positive behavior)

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Teen Depression

• Approximately 1 in 33 children and 1 in 8
  adolescents are affected by depression at any
  given time
• Suicide is the 3rd leading cause of death for
  15-24 year olds and the 6th leading cause for
  5-14 year olds
• 70 of those diagnosed do not get any treatment

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• High risk loss, attention disorders, conduct or
  anxiety disorders
• High risk Teenage girls, minorities
• Treatment is most effective when there is early
  intervention, yet most people do not know the
  symptoms of depression

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• Often, a teen with depression may be seen as a
  normal teen angst as they may appear angry,
  belligerent, irritable and hostile
• When this extends beyond 6 months, however, this
  is considered to be a problem

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Bipolar Disorder

• Bipolar Disorder A disorder that is
  characterized by episodes of depression and
  mania.
• Causes 1) runs in families, 2) many different
  genes may be working together
• Symptoms
• Depression See major depression
• Mania 1) inappropriate elation, 2)
  inappropriate irritability, 3) severe insomnia,
  4) increased talking, 5) disconnected and racing
  thoughts, 6) inappropriate social behavior, 7)
  feelings of grandiosity, 8) racing thoughts, 9)
  abuse of drugs and alcohol

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• Bipolar is a continuous range.
• At one end is severe depression, above which is
  moderate depression and then mild low mood, which
  many people call "the blues" when it is
  short-lived but is termed "dysthymia" when it is
  chronic.

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Descriptions by Bipolars

• Depression I doubt completely my ability to do
  anything well. It seems as though my mind has
  slowed down and burned out to the point of being
  virtually useless. I am haunted with the
  total, the desperate hopelessness of it all.
  Others say, "It's only temporary, it will pass,
  you will get over it," but of course they haven't
  any idea of how I feel, although they are certain
  they do. If I can't feel, move, think or care,
  then what on earth is the point?

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• Hypomania At first when I'm high, it's
  tremendous ideas are fast like shooting stars
  you follow until brighter ones appear. All
  shyness disappears, the right words and gestures
  are suddenly there uninteresting people, things
  become intensely interesting. Sensuality is
  pervasive, the desire to seduce and be seduced is
  irresistible. Your marrow is infused with
  unbelievable feelings of ease, power, well-being,
  omnipotence, euphoria you can do anything but,
  somewhere this changes.

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• Mania The fast ideas become too fast and there
  are far too many overwhelming confusion replaces
  clarity you stop keeping up with itmemory goes.
  Infectious humor ceases to amuse. Your friends
  become frightened. everything is now against the
  grain you are irritable, angry, frightened,
  uncontrollable, and trapped.

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• Treatments
• 1) Lithium
• 2) Antipsychotic drugs
• 3) Psychosocial treatment
• 4) Psychoeducation
• 5) Family Therapy
• 6) Psychotherapy (individual and group therapy)

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• Seasonal Affective Disorder Disorder in which
  there is some form of depression associated with
  the time of year (usually found in fall and
  winter.
• Causes Thought that the pineal gland monitors
  the amount and quality of light that our eyes
  receive. The Pineal body secretes chemicals,
  which controls sleep and may switch the body into
  a hibernating mode for the winter months.
• Symptoms 1) depression occurs during certain
  seasons in the year, 2) weight gain, 3) excessive
  sleeping, 4) loss of interest in pleasures or
  hobbies
• Treatments Light therapy (phototherapy)

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Eating Disorders

• Anorexia may have intense fear of becoming
  overweight, heavy preoccupation with food. May
  starve themselves to the point of creating a
  chemical imbalance in their bodies and may shut
  down their organs. Some of died of heart
  attacks. May be intensely afraid of gaining
  weight. Age of onset usually in teen years.

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• Bulimia Binging and purging, may not look thin
  as they tend to stay at a more normal weight, may
  vomit, use laxatives, or enemas. Age of onset is
  often adolescence or early adulthood. May find
  they were initially anorexic. Acids from
  vomiting may cause rotting teeth, damaged
  esophagus and gums.

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• Causes May be caused by either societal or
  cultural norms and standards as to what is
  acceptable for body types or may be some other
  type of issue such as control.
• Treatment Psychoanalysis, Cognitive therapy,
  Behavioral therapy, Antidepressants

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Schizophrenic Disorders

• Class of disorders that may be characterized by
  delusions, hallucinations, disorganized speech
  and maladaptive behavior. People are often on
  medications for life.
• 4 types
• 1. Paranoid type marked by delusions of
  persecution and delusions of grandeur.
• 2. Catatonic type marked by either long
  periods of motionlessness and unaware of
  environment or periods of hyperactive movement
  and incoherent speech.

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• 3. Disorganized type marked by emotional
  indifference, incoherent speech, random babbling
  and silliness
• 4. Undifferentiated type demonstrates
  behaviors from the other three categories.
• Causes May be the only disorder that people
  agree has a genetic component. May be related to
  neurotransmitter activity, especially an excess
  of dopamine. May have structural abnormalities of
  the brain.
• Treatments Medications are usually effective.
  L-dopa, a drug that inhibits dopamine activity,
  is currently being used.

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Therapies

• Psychotherapy
• Likely to seek therapy are insured,
  divorced/separated, single, over 16 years of age,
  females
• Psychologists may earn a Ph.D., Psy.D., or Ed.D.
  They have 5 to 7 years of training beyond
  bachelors degree. Also there is a requirement
  of 1 to 2 years in a clinical setting.
• Psychiatrists earn an M.D. degree. Graduate
  training requires 4 years of coursework in
  medical school. There is also a requirement of a
  4 year apprenticeship in a residency at a
  hospital.

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Insight Therapies

• 1) Psychoanalysis-deals with unconscious
  conflicts, motives, and defenses through
  techniques such as free association and
  transference. (Freud)
• a) free association where the client
  spontaneously express their thought and feelings
  exactly as they occur, with very little
  censorship.
• b) dream analysis when therapist interprets
  symbolic meanings of clients dreams

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• c) talking therapies in which the client talks,
  trying to reach catharsis (release of emotions)
• Possible negative problems during therapy
• a) resistance a mostly unconscious defense
  mechanism that may hinder the progress of therapy
• b) transference when the client transfers
  feelings for their critical relationships onto
  the therapist
• c) countertransference when the therapist
  transfers feelings they have for others onto the
  client

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• 2) Client-centered therapy-therapy in which the
  client plays a major role in determining the pace
  and direction of therapy. The client is thought
  to be their own best therapist. Therapist
  serves as a facilitator, they provide
  clarification. Carl Rogers, founder of this
  method of therapy, states

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• It is the client who knows what hurts, what
  directions to go, what problems are crucial, what
  experiences have been deeply buried. It began to
  occur to me that unless I had a need to
  demonstrate my own cleverness and learning, I
  would do better to rely upon the client for the
  direction of movement in the process

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• Rogers believed that the therapist should be
• genuine
• empathetic (feeling for the client)
• have unconditional positive regard (be
  nonjudgmental towards the client regardless of
  what they tell the therapist)

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• 3) Cognitive therapy helps the client to
  recognize and overcome negative thoughts about
  themselves. (Aaron Beck and Albert Ellis).
  Client is trained to detect their automatic
  thought processes. Often utilized with
  behavioral therapy today.
• 4) Group therapy when several clients are
  treated at the same time. Participants often act
  as the therapist while the therapist serves as
  a facilitator.
• Advantages
• 1) saves time and money
• 2) clients realize that their misery
  is not unique
• 3) participants can work on social
  skills

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• Behavior Therapies-based on the principles of
  classical, operant and observational learning.
• 1. Aversion therapy-an aversive stimulus is
  paired with a stimulus that brings on an
  undesirable response.
• 2. Systematic desensitization-clients slowly
  faces phobic stimulus in a step-by-step process
  in which they relieve themselves of anxiety at
  each step
• 3. Flooding-clients are quickly exposed to
  phobic stimulus not allowing for time to relieve
  anxiety

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• 3. Token economies giving tokens for correct
  behavior that can be later exchanged for desired
  goods.
• 4. Social skills training-designed to improve
  interpersonal skills that emphasizes modeling,
  behavioral rehearsal and shaping (reinforcing
  each step towards desired goal behavior)
• 5. Biofeedback-a bodily function (such as heart
  or blood pressure) is monitored, and information
  about the bodily function is given back to the
  client. Helps control physiological processes.

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Biomedical Therapies

• 1. Psychopharmacotherapy-treatment of mental
  disorders with medication
• a) Antianxiety drugs relieve tension,
  apprehension and nervousness. Effects are seen
  rather immediately and can last for several
  hours. Most popular are Xanax and Valium.

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• b) Antipsychotic drugs
• primarily used to treat Schizophrenia, but
  may be given to those with severe mood disorders
  who become delusional.
• appear to decrease the levels of dopamine in
  a persons system.
• Most popular are Thorazine, Mellaril and
  Haldol.
• Antipsychotics may have a negative side
  effect called tardive dyskinesia, which has
  symptoms similar to Parkinsons disease
  (involuntary writing and ticklike movements of
  the mouth, tongue, face, hands and feet).

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• c) Antidepressant drugs drugs that gradually
  elevate mood and help bring people out of a
  depression. Takes several weeks to see
  improvement. There are three types
• 1. Tricyclics the first group of
  antidepressant drugs. Have a tendency to have
  more side effects than SSRIs. (Elavil)
• 2. MAOIs (monoamine oxidase
  inhibitors)-Second group of antidepressant meds.
  One has to be very careful about certain foods
  and meds taken with these drugs as they could
  have potentially fatal results. (Nardil)
• 3. SSRIs (selective serotonin reuptake
  inhibitors)-Newest class of antidepressant drugs.
  Include meds such as Prozac, Paxil, and Zoloft.

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• d) Lithium-chemical used to control mood swings
  in patients with bipolar disorder. Lithium
  levels in the blood must be monitored carefully
  because high levels could be toxic or even fatal.

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• 2. Electroconvulsive Therapy (ECT)-treatment in
  which electric shock is used to produce a
  cortical seizure accompanied by convulsions.
  Primarily used on those with severe depression.
  May lead to gaps in memory or short-term memory
  loss. Seems to rewire the brains circuitry.
• 3. Lobotomy-Procedure in which cells in the
  forebrain are lesioned. Has been used to treat
  severe schizophrenics.

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EMDR

• Stands for Eye Movement Desensitization and
  Reprocessing
• Patient identifies past visual imagery related
  to the traumatic
• memory, a negative belief about self, and related
  body sensations.
• While focusing on the above, the patient
  follows the
• therapists finger moving their eyes across their
  field of vision
• for 20-30 seconds or more. Other lateralizing
  stimuli (tones or
• tapping) are also used.
• Distress from the memories, beliefs and
  sensations is
• managed so the patient can return to the
  procedure.
• Once started, EMDR does follow where the
  patients thoughts
• lead.
• The outcome, over time, is a belief in positive
  characteristics
• of self and decreased distress over trauma
  experiences.

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• Theories on how EMDR works
• Eye movement invokes the same brain circuitry
• as REM sleep allowing memories to move from
• unprocessed amygdala-evoked memories to
• semantic memory.