Psychopathology: Abnormality

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PsychopathologyAbnormality

• In psychology individual differences involves the
  study of the ways that individuals differ in
  terms of their psychological characteristics.
• People differ in many ways in their
  intelligence, aggressiveness, willingness to
  conform, masculinity and femininity, etc.
• An important individual difference is in the
  degree to which a person is mentally healthy.
• This is Psychopathology and it is this area of
  individual differences we study in AS Psychology.
• In order to protect and/or treat people with an
  abnormality psychologists need to be able to
  define them as having abnormal psychopathology.
• So how do we define someone as being abnormal?
  What parameters do we use?
• In groups of 2 or 3 use the paper provided to
  write down a list of things that may make a
  person appear abnormal. What would you look for
  as an indication of abnormal behaviour?
• You have five minutes

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What makes someone abnormal?Your Ideas on
board
So do these ideas fit into one of the four
following categories?
Statistically rare, Going against social norms,
Mentally ill Or Inability to function safely
(danger to self or others)
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Can you define the following behaviour as
abnormal using all four definitions?
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L2
STATISTICAL INFREQUENCY
A very unusual behaviour or trait will be more
than 2 standard deviations from the mean. i.e.
over 130 or under 70 IQ score. This statistically
rare behaviour or trait is likely to be seen as
being abnormal.
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Statistical Infrequency Is all rare behaviour
abnormal and if not how do we decide what is is
this?
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Why is context so important when defining
behaviour as abnormal?
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Statistical Infrequency Limitations/Criticisms

• Mental Health By this definition all rare
  behaviour would be seen as abnormal however,
  depression and anxiety are not rare but clinical
  depression is rare (but is only diagnosed if
  patient attends the doctors so how do we know
  how rare it is?)
• Gender Issues (Females are more likely than males
  to consult a GP). (In our culture females can
  wear makeup and skirts without seeming abnormal
  males ??? Well David Beckham manages it!)
• Cultural Issues (Jewish people mourn by tearing
  their clothes and wailing in public.) (In India
  mentally ill people are thought to be cursed) (In
  china being mentally ill carries such a stigma
  that it is rarely diagnosed) (Some cultures walk
  around naked and you are in the minority if you
  are clothed!) (In the USA 48 of people were
  treated for psychological disorders at some point
  by this definition that would make them
  normal!)
• Age Thumb sucking and bed wetting may be
  considered statistically normal at 2 years old
  but not at 20!
• Desirability of behaviour Many behaviours are
  rare but considered highly desirable (High IQ,
  Great athletic ability). It is difficult to know
  how far you have to deviate from the average to
  be considered abnormal?

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Advantages of this approach

• Statistical Infrequency is an obvious and
  relatively quick and easy way to define
  abnormality.
• It has face validity that odd or rare behaviour
  is seen as abnormal
• Applications of statistical definitions It is
  relatively easy to determine abnormality using
  psychometric tests developed using statistical
  methods.E.g. there is a test for O.C.D.
  Obsessive compulsive disorder.
• You can have a go at the test if you like could
  you be a potential sufferer?
• First watch an O.C.D. sufferer in action!

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L3
DEVIATION FROM SOCIAL NORMS

• Society sets up rules for behaviour based on a
  set of moral standards which become social norms
  (V.I.M.). Any deviation is seen as abnormal
  (Szasz 1972)
• This suggests that madness is a term manufactured
  in order to label the people in society who do
  not conform to the rules of society.
• These unwritten social rules are culturally
  relative (i.e. you cannot judge behaviour
  properly unless it is viewed in the context from
  which it originates as different cultures have
  different social norms and behaviour may differ
  across cultures). A lack of cultural relativism
  can lead to ethnocentrism, where only the
  perspective of your own culture is taken. Social
  norms can also be era-dependent.
• For example, homosexuality was once illegal and
  considered to be a mental disorder because it
  deviated from the social norm. Now there are
  campaigns for gay marriages to be recognized and
  afforded the same benefits as heterosexual
  marriages
• This shows the extent to which this definition of
  abnormality is subject to change.

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AO2 Deviation from Social Norms Limitations /
Issues

• Historical Issues Until early 20th century,
  unmarried women who became pregnant were
  interred in mental institutions.
• Until 1960's in the UK homosexual acts were
  criminal offences
• Until 1973 in USA homosexuality was a mental
  disorder!
• Cultural Issues Russia - a diagnosis of
  insanity was used to detain political
  dissidents.
• Japan - You are deemed insane if you do not
  want to work!
• Western Societies - you can plead insanity as
  a defence - Lorena Bobbit cut of her husband's
  penis - pleaded / temporary insanity!
• Expected Behaviour African/Indian cultures
  consider it normal to talk to the dead.
• Nakedness normal in some cultures.
• Context Singing in park understood if you see
  the film crew!
• SUMMARY
• Social norms is a subjective measurement of
  abnormality as norms change over time and differ
  between cultures.
• This approach has been used as a form of social
  control.
• Social norms are necessary and specific to each
  society to enable members of each
  society to know the rules in order to get along
  together!
• Anti-Social Behaviour can be viewed as abnormal
  under this definition e.g.

!
Hello!
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(No Transcript)
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Short Answer Exam Questions(SAQs)

• Deviation from social norms is one definition of
  abnormality You may use your handouts to help
  you with this. (feed back to class later)
• What is a social norm?
• (b) Give one example of how breaking a social
  norm might lead to the behaviour being defined as
  abnormal.
• (c) Outline one other way of defining abnormality

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Starter
L4

• Complete the recap exercise
• Problems with diagnosis Social norms, social
  control and personal freedom.

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Deviation from Ideal Mental HealthSix
Categories that Clinicians Typically Relate to
Mental Health PRAISE Marie Jahoda (1958)

• Personal growth (Self Actualisation should reach
  your potential)
• Reality perception (should know whats real)
• Autonomy (should be independent)
• Integration (should fit in with society and be
  able to cope with stressful situations)
• Self-attitudes (should be positive high self
  esteem)
• Environmental mastery (should cope in your
  environment, be able to function at work and in
  relationships, adjust to new situations and solve
  problems)

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Deviation from Ideal Mental Health
Limitations/Criticisms

• Jahoda 1958 said that it was better to focus on
  positive aspects of mental health rather than the
  negative so this is seen as a positive attempt
  to define abnormality.
• Positive self attitude (Many people have a
  negative self image due to such things as
  Bullying, Persecution of gender and/or race etc
  but are they abnormal?)
• Growth to ones potential or self actualisation
  ( Very few people reach their full potential due
  to such things as Family commitments, Money,
  Social / peer pressure, Gender OR Culture some
  countries women are not allowed to work! are
  they abnormal? CULTURAL RELATIVISIM!)
• Resistance to stress (Integration) Should fit
  in without suffering stress. Some people thrive
  on stress, Personality may make you more
  susceptible, Some people crack under enormous
  amounts of stress prisoner of war camps are
  they abnormal?)
• Autonomy (independence) ability to make our own
  decisions (Some people cannot due to disability
  illness age culture e.g. arranged
  marriages, collectivist societies WE not ME
  prisoners poverty are they abnormal?)
• Perception of reality (Other things than mental
  illness affect our perception of reality e.g.
  Alcohol, drugs/LSD, illness/diabetes are they
  abnormal?)
• Adapting to the environment (More difficult if
  you are poor, black, female, disabled etc. but
  are they abnormal?)
• SUMMARY
• Criteria are so demanding that almost everyone is
  bound to fall into the category of mental ill
  health!

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Failure to function adequately

• A definition of abnormality based on an inability
  to cope with day-to-day life caused by
  psychological distress or discomfort which may
  lead to harm of self or others.

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Failure to Function Adequately

• This is seen as a humane way of addressing
  psychological problems as it allows the
  individual to decide if they need or wish to seek
  help.
• However it does have some limitations as a method
  of defining abnormality such as
• Labelling a label gives a stigma that may stick
  around long after the problem has gone. Can
  affect employment prospects and personal
  relationships.
• Gender issues Bennett 1995 found that societies
  have created masculine stereotypes that alienate
  men from seeking help for psychological problems.
• Enforced detaining in mental institutions
• If behaviour appears abnormal there is no
  institutionalisation providing the individual can
  function adequately and is not harming self or
  others.
• Before 1983 people could be detained in mental
  institutions against their will on the authority
  of a health professional guardian or husband.
  (NOTE Wives could not have husbands detained!)
• Psychiatric prison is the only place in the UK
  that people can be detained against their will.
• Care in the community means that there are not
  enough hospital places for those who want
  residential care. So health professionals leave
  people alone unless there is severe dysfunction.
• SUMMARY
• Leaves power with the individual.
• Not functioning adequately is not seen as serious
  in mental disorder terms.
• Individuals may be aware or unaware of their own
  dysfunction so how can psychiatrists be sure of
  a diagnosis and how can they know for sure when
  a patient is cured?

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We are now going to watch a video about two
people with mental illness. Louisa and
Darryl. As you are watching decide if Louisa
and Darryl fit all 4 definitions of
Abnormality. Then write down any issues that the
program raises regarding difficulties in defining
abnormality and any ethical issues you notice,
for discussion afterwards.
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Summary Activity

• Use notes and handouts to complete a summary mind
  map / poster entitled DEFINING ABNORMALITY.
  Include a concise definition, explanation, and
  example of each method and then list as many as
  possible but at least two limitations associated
  with each method of definition e.g. can be
  era dependent can be ethnocentric (cultural
  relativism) labelling stereotyping
  desirable behaviour. etc.
• Try also to include one Strength
• Then Say how each of these definitions would
  define Anorexia as being abnormal, and what the
  problems defining Anorexia using each definition
  would be.

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Models of Abnormality
L5

• Definitions tell you if a person is abnormal
  (mentally ill) or not.
• A model is a way of describing why they are ill,
  i.e. what is the cause of their mental illness.
• You need to ensure that you can distinguish
  between models and definitions.
• Definitions answer are they or arent they?
  questions, Models try to answer the why are
  they? question.

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Each model is based on a Psychological Approach
or Perspective (point of view)

• Psychological Perspectives or Approaches refer
  the different types of psychologists, and how
  they view things differently from each other
• Each approach will give different explanations
  for the same behaviour.
• The four approaches we are going to look at are
  the Biological, Behavioural, Psychodynamic and
  Cognitive. Can you remember the differences
  between these?
• For example how would each approach explain
  violent behaviour differently?

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Approaches/Perspectives in Psychology
A1
It is due to your Physiology i.e. your
Hormones Genetics Evolution Brain Damage
Biological Approach
Learned from violent parents or peers
Behavioural Approach
Unconscious need to release aggression
Psychodynamic Approach
You have distorted thinking or have reasoned that
it will get you what you want
Cognitive Approach
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KISSING
HOW WOULD THE DIFFERENT APPROACHES IN PSYCHOLOGY
EXPLAIN IT? Write down a quick note of your
ideas For how the Biological, Behavioural,
Psychodynamic and Cognitive approaches would
explain it!
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Biological Model of Abnormality

• KEY FEATURES OF THE
• BIOLOGICAL APPROACH TO
• PSYCHOPATHOLOGY (Abnormality) (TO LEARN)
• Assumption 1 The Biological or Medical Model of
  abnormality assumes that mental abnormality has
  physiological causes. These abnormalities may be
  caused by chemical malfunctions in the brain or
  by genetic disorders. For example, too much
  dopamine in the brain is linked with the mental
  illness called schizophrenia. It is also clear
  that the eating disorder called anorexia nervosa
  has a genetic component.
• Assumption 2 The Medical Model also assumes that
  mental disorders can be treated in ways similar
  to physical disorders. In other words, we can
  cure the patient by using medical treatments.
  Treatments include medication (drugs), ECT and
  psychosurgery.

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• BIOLOGICAL CAUSES OF PSYCHOPATHOLOGY
• Genetic factors
• inherited predispositions to certain mental
  illnesses (Anorexia Nervosa, Tourettes Downs
  Syndrome)
• Biochemistry
• excessive or low amounts of certain biochemicals
  in the brain (Dopamine Schizophrenia, Serotonin
  - Depression)
• Neuroanatomy
• brain damage or inherited
  structural/organisational defects
  (Autism)
• Treatment (acts on physiology)
• Drugs (chemotherapy)
• Genetic counselling / gene therapy possibly to
  come
• Electroconvulsive therapy (ECT)
• Psychosurgery

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Best explanations......

• Work in pairs and decide which would be the best
  biological explanation/s for the following
  disorders. Justify your thoughts.
• Anorexia
• Tourettes Syndrome
• Dementia
• Depression
• Schizophrenia
• Phobic Disorders
• OCD

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EVALUATION - MEDICAL MODEL

• Strength 1 The main strength of the Medical
  Model is that it is scientific. The results of
  treatment can be measured and manipulated until
  we have a satisfactory outcome. For example, we
  can vary the dosage of Prozac until the depressed
  patient is able to function adequately.
• Strength 2 A second strength is that the patient
  is seen as being ill and therefore not
  responsible (to blame) for their behaviour.
  Although the label of mental illness still
  carries a stigma in our society. It is reassuring
  to most people to learn that their behaviour has
  an organic/medical cause that can be corrected by
  medical treatment.
• Limitation 1 The main limitation of the Medical
  Model is that it may be useful in dealing with
  the symptoms of mental illness but it may not be
  effective in resolving the underlying causes.
  Mental illness may have multiple causes,
  including cognitive and behavioural causes. The
  MM does not take these into consideration. It is
  always dangerous to reduce a complex phenomenon
  to a single explanation (reductionism).
• Limitation 2 A second limitation is that medical
  intervention may have undesirable side effects.
  Very few drugs can be used without negative side
  effects. For example, prolonged use of Prozac is
  associated with suicidal thoughts. Drugs may also
  encourage addiction and dependency similar to
  nicotine addiction. In addition, techniques such
  as ECT and psychosurgery are invasive,
  unpredictable and often irreversible.

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Defining AbnormalityTourettes Syndrome

• When watching the video make notes on the
  behaviour seen.
• First write down the four definitions of
  abnormality and Rosenhan Seligmans seven
  elements of abnormality. Note down when behaviour
  seen falls into each definition or element i.e.
• Statistical Infrequency
• Deviation from Social Norms
• Deviation from ideal mental health (use handout)
• Failure to function adequately (Maladaptiveness)
• The 7 of the elements of abnormality defined by
  Rosenhan Seligman illustrate with examples
  from the video.
• Consider the limitations of each definition and
  explanations.
• Then consider the evidence that Tourettes
  Syndrome is a biological
  illness?
  Write down the main
  pieces of evidence for this.
• Make sure you make notes for discussion
  afterwards.

L5
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The Psychological Modelsof Abnormality(there
are three of these)
L7

• Psychodynamic
• Behavioural
• Cognitive

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Psychodynamic ApproachMain Assumptions

• Assumption 1 The Psychodynamic Model assumes
  that experiences in our earlier years can affect
  our emotions, attitudes and behaviour in later
  years without us being aware that it is
  happening. Freud suggested that abnormal
  behaviour is caused by unresolved conflicts in
  the Unconscious. These conflicts create anxiety,
  and we use defence mechanisms such as repression
  and denial to protect our Ego against this
  anxiety. However, if defence mechanisms are
  over-used, they can lead to disturbed abnormal
  behaviour.
• Assumption 2 The Psychodynamic Model assumes
  that if repressed memories can be recovered from
  the Unconscious through psychotherapy, and if the
  patient experiences the emotional pain of these
  repressed memories, the conflicts will be
  resolved and the patient will be cured (catharsis
  closure i.e. lancing the psychological boil) .
  Modern psychoanalysis suggests patients must also
  come to understand these memories cognitively.

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(Inner parent the Conscience)
(Inner child I want It I want it NOW!)
(Self Protector Voice of reason)
Recap Freuds Theory of Personality
Complete Activity Sheet The Psychodynamic Model
(Item A) Question (a) (b)
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Recap Psychosexual Stages of Development
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EVALUATION OF THE PSYCHODYNAMIC APPROACH

• Strength 1 One strength of the Psychodynamic
  Model is that it reminds us that experiences in
  childhood can affect us throughout our lives. It
  accepts that everybody can suffer mental
  conflicts and neuroses through no fault of their
  own.
• Strength 2 The model also suggests there is no
  need for medical intervention such as drugs, ECT
  or psychotherapy, and that the patient, with the
  help of a psychoanalyst, can find a cure through
  his own resources. (which empowers the individual
  discourages helplessness)
• Weakness 1 The main limitation of the
  Psychodynamic Model is that it cannot be
  scientifically observed or tested. There is no
  way of demonstrating if the Unconscious actually
  exists. There is no way of verifying if a
  repressed memory is a real or false memory unless
  independent evidence is available. In other
  words, most of the theory must be taken on faith.
• Weakness 2 Any evidence recovered from a patient
  must be analysed and interpreted by a therapist.
  This leaves open the possibility of serious
  misinterpretation or bias because two therapists
  may interpret the same evidence in entirely
  different ways. Psychoanalysis is time-consuming
  and expensive. It may not even work in a
  comprehensive view of 7000 cases, Eysenck (1952)
  claimed that psychodynamic therapy does more harm
  than good.

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Activity Fairy Tale Psychoanalysis

• How can you explain the behaviour of the Fairy
  tale characters using the Psychodynamic model.
• Match up the correct example with the most likely
  explanation.
• Use the ego defence mechanism sheet to help you
  with this.
• You can cut them out and move them about if it
  helps!

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The Behavioural Model
L8
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KEY FEATURES OF THE BEHAVIOURAL APPROACH
TOPSYCHOPATHOLOGY (Abnormality)

• Assumption 1 The Behavioural Model of
  Abnormality assumes that all behaviour is learned
  through experience. All behaviour, including
  abnormal behaviour, is learned through the
  processes of classical and/or operant
  conditioning. Classical Conditioning involves
  learning through association. Operant
  conditioning involves learning through rewards
  (positive and negative reinforcement) and
  punishment. Or through modelling and Social
  Learning Theory. (as in Banduras BoBo doll
  study)
• Assumption 2 The model assumes that what has
  been learned/acquired can be unlearned through
  the processes of conditioning, classical or
  operant. Undesirable or maladaptive behaviour can
  be replaced by desirable or adaptive behaviour.
  For example, we can use behavioural therapies
  such as Desensitization and token economies.

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CLASSICAL CONDITIONING

• Classical Conditioning was one of the first types
  of learning to be discovered. It was studied by
  Ivan Pavlov using his dogs.

Ivan Pavlov
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How this can cause a phobia..

• Classical Conditioning
• We learn to associate one thing with another e.g.
• Child on mums knee
• Child sees spider (NS) unafraid doesnt know
  what spider is!
• Mum sees spider
• Mum screams and drops baby!
• Baby associates spider with fear and lump on head
  (UCS)!
• Baby sees spider
• Baby cries! (CR)

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• Operant conditioning
• A behaviour that has a positive effect is more
  likely to be repeated
• Positive and negative reinforcement (escape from
  aversive stimulus) are agreeable
• Punishment is disagreeable
• Therefore treatment is by positive negative
  reinforcement and punishment (used in schools to
  treat disruptive children and in treatment of
  disorders such as anorexia)

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OPERANT CONDITIONING
B. F. Skinner (1904-1990) Operant Conditioning
The PIGEON The Skinner Box
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How can this cause abnormal behaviour?

• We can learn to associate and action with a
  reward or sanction e.g.
• Boy sees sweets at checkout
• Boy wants sweets but mum says No!
• Boy screams and shouts and has a tantrum
• Mum gives boy sweets reinforcing the bad
  behaviour
• Boy learns that tantrums getting what he
  wants!
• So next time boy wants sweets..

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Social Learning Theory Imitation of role models
Reinforcement can also lead to abnormal
behaviour-

• Girl watches mother (role model) who has OCD
  washing ritualistically every item in house
  daily.
• Girl cleans own things in same way copying mum!
• Evidence
• Banduras
• BoBo Doll exp. gt

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Advantages Limitations

• Advantage 1 Behavioural approaches, especially
  when combined with cognitive approaches, have
  proved very effective in treating clients with
  phobias and other neurotic disorders, such as
  obsessive-compulsive disorders. They are less
  successful with more serious disorders such as
  schizophrenia and psychosis.
• Advantage 2 There is also the advantage that
  therapy can focus directly on the clients
  maladaptive behaviour. There is no need to refer
  to the clients previous history or to his
  medical history. Behaviourists believe that
  changing the behaviour from maladaptive to
  adaptive is sufficient for a cure.
• Limitation 1 One limitation of the BM is that
  only behaviour is considered. The thoughts and
  feelings of cognition are not taken into
  consideration. However, a human being is much
  more than a bundle of behaviours, and thinking
  and feelings need to be considered. Behavioural
  therapy may change the behaviour without
  resolving the underlying causes of that
  behaviour.
• Limitation 2 The BM ignores possible medical
  causes of abnormal behaviour. For example, we
  know that there is a genetic element in anorexia,
  that the lack of glucose can deepen depression,
  and that excessive dopamine is linked with
  several mental disorders. It is likely that the
  Behavioural Model takes too narrow a focus of
  what constitutes human psychology. Humans are
  more than rats in Skinner boxes.

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Activity Explaining mental illness using the
behavioural model

• Anorexia Nervosa is an eating disorder where
  sufferers gradually starve themselves sometimes
  with fatal consequences.
• Work in Pairs and Use Classical conditioning,
  Operant conditioning, and Social learning theory
  (modelling) to explain the development of
  Anorexia Nervosa. (write down your explanations)
• You will have 10 minutes and will then feedback
  to the class.

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The Cognitive Model Main Assumptions

• Assumption 1 The Cognitive Model of Abnormality
  assumes that how we think influences how we feel
  and how we behave. The ways in which we process
  information (cognition) directly affect the ways
  we behave. The Cognitive Model suggests that
  disordered thinking can cause disordered or
  abnormal behaviour. Disordered thinking includes
  irrational assumptions and negative views about
  the self, the world and the future.
• Assumption 2 The Cognitive Model assumes that
  cognitive disorders are the result of negative or
  disorganised thinking and, therefore, they can be
  made positive or organised. Thoughts can be
  monitored, evaluated and altered. Individuals can
  modify their thinking, challenge their irrational
  cognitions and self-defeating thoughts. So the
  model assumes cognitive change will lead to
  behavioural change.

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Becks (1976) cognitive triad

• negative (irrational) thoughts that depressed
  individuals have about...
• Themselves I am helpless and inadequate
• The world The world is full of insuperable
  obstacles
• The future I am worthless, so theres no chance
  that the future will be any better than the
  present

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• EVALUATION OF THE COGNITIVE APPROACH
• Strength 1 A major strength of the Cognitive
  Model is that it concentrates in current
• thought processes. It does not depend on the past
  history of the client, for example,
• recovering repressed memories from the
  Unconscious. This is an advantage because
• details about a persons past are often unclear,
  irrelevant, misleading and
• misremembered.
• Strength 2 A second strength is that Cognitive
  Therapies, especially when used together
• with Behavioural Therapy, have a good success
  rate in helping clients. It is a popular and
• much-used approach. It also empowers the
  individual to take responsibility for his own
• thinking processes by monitoring, evaluating and
  altering self-defeating thought
• processes.
• Weakness 1 Like all other approaches,
  psychological and medical, the Cognitive Model
• rarely supplies the complete solution to abnormal
  behaviour by itself. There may be
• medical and environmental influences affecting a
  persons behaviour. Focussing only on
• a persons cognition may be too narrow an
  approach.

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TREATMENT METHODS
L9

• Behavioural Approach (Aversion Therapy (counter
  conditioning), Systematic Desensitisation
  Therapy, Flooding Token Economy)
• Psychodynamic Approach (Psychotherapy which
  may include Dream Analysis, Projective Therapy
  ink blot/pictures, Hypnosis, Free Word
  Association)
• Biological Approach (Drug (chemo) Therapy (anti
  anxiety /anti depressant and sedatives etc.)
  ECT, Psychosurgery)
• Cognitive Approach (Cognitive Behavioural
  Therapy (CBT))

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BiologicalTherapiesPsychosurgery

• MOA Removes brain tissue in an effort to change
  behaviour. (unsure of how!)
• Lobotomy (Moniz - Nobel Prize).
• Calmed violent patients, but produced lethargy
  could destroy patients personalities (zombies).
• Side-effects also included apathy, diminished
  intellectual powers, impaired judgements, coma,
  and even death

Antonio Egas Moniz
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Psychosurgery Summary

• Modern methods
• Stereotactic neurosurgery (most common method
  today)
• much more accurate and do less damage
• Effectiveness
• Effective if performed precisely and on the
  appropriate patient i.e. severely
  depressed/suicidal as last resort
• Research shows 33 high effectiveness, 33
  moderate effect, 33 minimal or no effect
• Appropriateness
• Only appropriate in severely depressed or
  compulsive and suicidal patients who have not
  responded to other therapies.
• Only appropriate under BMA rules if have
  patients fully informed consent.

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Electroconvulsive Therapy (ECT)
2
Video Clip ECT (Trust me Im a Dr.)
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Electroconvulsive Therapy (ECT)
L2

• Appropriate for treating severely depressed /
  suicidal patients. Sometimes given without their
  consent (if sectioned).
• Introduced during the late 1930s (Ugo Cerletti).
• Effective in lifting mood. Can stop suicidal
  thoughts rapidly therefore can save lives.
• MOA Increases norepinephrine (neurotransmitter
  that elevates mood) but not sure of MOA
• Perform about 20,000 per year in the U.K.
• May cause brain damage as..
• Substantial memory loss (especially short term
  memory).

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E.C.T.

• The guidelines for the administration of ECT. In
  general are
• Patient is anesthetized.
• Given muscle relaxant.
• Shocked with about 100 volts for a half to 3-4
  seconds.
• Patient experiences slight seizures that last
  from 30 seconds to 1 minute.
• 3-6 treatments per week for several weeks (Though
  this protocol varies).
• Entire session (from prep. time to recovery time)
  takes between 1 to 2 hours.
• Effectiveness gt70 improve

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Drug (Chemo) Therapy

• Most widely used Biomedical Therapy, as it is
  cheap, relatively fast acting and easy to give.
• Appropriateness treatment when taken
  responsibly, and with the close supervision of a
  doctor. Drugs are given appropriate to a
  specific symptom e.g. anti -(anxiety,
  depressive and psychotic drugs).
• Effectiveness they are generally extremely
  effective at treating symptoms. (but many have
  side effects such as addiction). Drugs have
  liberated many people from mental hospitals
  deinstitutionalization (a big ). Since the mid
  50's, 70 of persons diagnosed with schizophrenia
  lived in mental hospitals - today, less than 5.

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Types of drugs

• Anti Anxiety Drugs Benzodiazepines (BZs)
• Reduce tension and anxiety. (downers) e.g.
  (Valium)
• MOA Enhance the action of neurotransmitter GABA
  resulting in reduction in activity of brain
  calming effect
• Common Side Effects drowsiness, fatigue, weight
  gain, interactions with other medications.
• Anti Depressive Drugs
• Opposite of anti-anxiety drugs (uppers).
• MOA Increase of serotonin etc. (arousal-inducing
  neurotransmitters). SSRI (e.g., Prozac)
  interferes with re-absorption of serotonin,
  creating high levels (brain arousal).
• Common Side Effects dizziness, dry mouth,
  nausea.
• Anti Psychotic Drugs Neuroleptics
• Major Tranquilizers.
• MOA Decrease production of the neurotransmitter
  Dopamine.
• Relieves hallucinations, hostility.
• Requires very close supervision by a
  physician/psychiatrist.
• Most popular Thorazine.
• Common Side Effects Weight gain, constipation,
  dizziness, drowsiness, dry mouth, nasal
  congestion

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Strengths Limitations

• Strengths of drug treatment
• Research (Kahn) showed that compared to a
  placebo, BZs were more effective at reducing
  anxiety.
• Drugs are generally extremely effective at
  treating symptoms
• Drugs are easy, relatively fast acting and cheap
  to use.
• Weaknesses of drug treatment
• Addiction BZs create a physiological dependence
  creating marked withdrawal symptoms when stopped.
  Should be limited to 4 weeks use because of this.
• Side Effects General (see individual drugs) In
  BZs they can be paradoxical (opposite to that
  expected) i.e. can cause aggressiveness. Also
  memory problems storage difficulty.
• Sticking Plaster Treats the symptoms not the
  problem so when drugs are stopped the symptoms
  return. So best paired with psychological
  therapies that address the problems.
• Drugs have liberated many people from mental
  hospitals deinstitutionalization (a big ).
  Since the mid 50's, 70 of persons diagnosed with
  schizophrenia lived in mental hospitals - today,
  less than 5.

59
Psychodynamic Therapies

• Psychoanalysis MOA treatments concentrate on
  making the unconscious conscious (gaining INSIGHT
  discovering the reasons for their problems).
  Then the mind can be cleansed of maladaptive
  thoughts and emotions (lancing the psychological
  boil release of negative energy or CATHARSIS)
  This is accomplished by using interviews to ask
  about past, early experiences, parents, and
  siblings, inner fears and innate drives. It may
  include Dream analysis interpretation of
  symbolism in dreams. Projective tasks and/or Free
  and word association saying whatever enters
  your head!
• Catharsis can then lead to healing (CLOSURE)

60
Activity Psychoanalytical Techniques

• Now we are going to have a go at two
  Psychoanalytical treatment techniques
• Word Association
• Projective Task (Ink blots)
• Be prepared to criticise this techniques after we
  have completed them.

61
Freuds Dream Analysis
Latent Content
Manifest Content of Dream
Male genitals, especially penis
Umbrellas, knives, poles, swords, airplanes,
guns, serpents, neckties
Female genitals, especially vagina
Boxes, caves, pockets, pouches, the mouth, jewel
cases, ovens, closets
Sexual intercourse
Climbing, swimming, flying, riding (a horse, an
elevator, a roller coaster)
Parents
Kings, queens, emperors, empresses
Siblings
Little animals
62
Appropriateness, Effectiveness, Evidence
Strenths Limitations

• Bergin (1971) Meta-analysis (Effectiveness)
• Psychoanalysis produced an 73 success rate and
  was better than a placebo or no treatment.
• H.J. Eysenck (1952)
• Psychoanalysis is bad for you!
• Sloane et al. (1975)
• Behaviour therapy and Psychoanalysis both had 80
  improvement rate vs 48 control group
• Luborksy and Spence (1978) (Appropriateness)
• Useful in the treatment of anxiety disorders,
  depression, sexual disorders, but not
  schizophrenia
• Useful with patients who are better educated
• Strengths Limitations
• Unscientific, un-falsifiable, unqualified
  therapists, expensive and time consuming,
  techniques require subjective interpretation and
  rely on the memory of the client, making them
  unreliable.
• Good for treating Sexual Problems.
• Recognises the importance of early childhood in
  development of personality and behaviour, so may
  aid prevention of mental illnesses.

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1.Behavioural Therapies Based on Classical
Conditioning

• MOA Re-learning adaptive new behaviours to
  replace the maladaptive behaviour.
• Flooding or Implosion Therapy
• Exposure to the feared stimulus 70 effective!
• Systematic desensitisation
• Wolpe (1958)
• Based on counter-conditioning (gradually learning
  to re-associate the stimulus with a more positive
  response).
• Aversion therapy
• Associate unwanted behaviour with a very
  unpleasant unconditioned stimulus-

64
Behaviour Therapies

• All these Learning techniques are used to alter
  behaviours these techniques include using
• Classical conditioning as in
• Aversion therapy e.g.
• Systematic desensitization e.g. Driving
  phobia?!!!!

65
Systematic Desensitization
66
Appropriateness Effectiveness

• Appropriate ONLY for behaviour that has been
  learned.
• Behaviour therapy is as effective as other forms
  of therapy (Smith et al., 1980)
• It is very effective with
• Anxiety disorders (Ost, 1989)
• Obsessive-compulsive disorder (van Oppen et al.,
  1995)
• Specific phobia (Ost, 1989) ( i.e. flooding 70
  effective)
• Not very effective with disorders with a genetic
  component, such as schizophrenia

67
Limitations / Criticisms

• - Simplistic and Deterministic limits all
  behaviour to simple cause and effect.
• - Mechanical in its application do this and
  this will happen
• - There are ethical questions relating to both
  research and treatment methods. (Little Albert
  Treating Gay Men)
• Treats only the behaviour not the causes of the
  behaviour.
• Does not consider individual differences (blank
  slate?) we may all learn differently.
• Scientific approach with good supporting
  evidence easy to research.
• Therapies are successful for phobias, OCD and
  anxiety disorders etc
• ? New learning or re-education is it always
  possible?
• ? What is unwanted behaviour? How is it defined
  and who by? Used for punishment/social control
  (gay men)

68
COGNITIVE THERAPIES

• Cognitive Behavioural Therapy
• Cognitive Restructuring Therapy
• Rational Emotive Therapy
• Stress Inoculation Hardiness Training.

69
Cognitive Behavioural Therapy

• Appropriateness Cognitive behavioural therapy
  (CBT) is used to help solve problems in people's
  lives, such as anxiety, depression,
  post-traumatic stress disorder (PTSD) or drug
  misuse. CBT was developed from two earlier types
  of psychotherapy
• Cognitive therapy, designed to change people's
  thoughts, beliefs, attitudes and expectations.
  (i.e. Changing negative thoughts to positive)
  Includes Stress Innoculation and Hardiness
  training (both cognitive methods)
• Behavioural therapy (designed to change how
  people acted/behaved).
• American psychotherapist Aaron Beck developed CBT
  believing that the way we think about a situation
  affects how we act but also that our
  actions/behaviours can affect how we think and
  feel.
• MOA It is therefore necessary to change both the
  act of thinking (cognition) and behaviour at the
  same time. This is known as cognitive behavioural
  therapy. CBT says that your problems are often
  created by you. It is not the situation itself
  that is making you unhappy, but how you think
  about it and how you react to it. Video Clip
  (Trust me I am a Dr.)

70
Effectiveness of CBT

• CBT is often favoured over other therapies
  because it aims to get rid of the problem not
  just the symptoms.
• Evans (1992) CBT is at least as good as drug
  therapy in preventing a relapse
• Keller (2001) combination of CBT and drug therapy
  more effective than either therapy alone
• Butler (2006) effectiveness depends on the
  disorder. When the problem is severe, a
  combination of drugs and CBT is best. E.g. Drugs
  may reduce disturbed thoughts of Schizophrenics
  allowing CBT to be used effectively.

71
Strengths and Limitations

• Treatment very effective, especially when
  combined with drug therapy.
• Patient has a certain amount of control over
  their treatment and can use the techniques taught
  to them to deal with future problems and
  situations.
• Assumption is that patient is to blame for
  their problems. This is the only therapy that
  assumes that the patient is at fault.

72
The Therapy Game

• You will be put in groups of either
  Psychiatrists, Psychotherapists, Behavioural
  Therapists or Cognitive Therapists
• You are now the potential therapists of the
  following patients.
• Can you explain their abnormal behaviour?
• Can you suggest an appropriate treatment?
• You must stick strictly to the model/approach of
  your particular group when answering these
  questions.
• The team with the most appropriate explanation
  and treatment will win the patient.
• The team with the most patients wins the game!

73
Patient No. 1

• You have 2 minutes to discuss the case with your
  fellow therapists and decide
• What is the likely cause of the patients abnormal
  behaviour?
• Which treatment is the most suitable and why?

74
Patient No. 2

• You have 2 minutes to discuss the case with your
  fellow therapists and decide
• What is the likely cause of the patients abnormal
  behaviour?
• Which treatment is the most suitable and why?

75
Patient No. 3

• You have 2 minutes to discuss the case with your
  fellow therapists and decide
• What is the likely cause of the patients abnormal
  behaviour?
• Which treatment is the most suitable and why?

76
Patient No. 4

• You have 2 minutes to discuss the case with your
  fellow therapists and decide
• What is the likely cause of the patients abnormal
  behaviour?
• Which treatment is the most suitable and why?

77
Patient No. 5

• You have 2 minutes to discuss the case with your
  fellow therapists and decide
• What is the likely cause of the patients abnormal
  behaviour?
• Which treatment is the most suitable and why?

78
The End
79
Key Term Abnormality

• Behaviour that is considered to deviate from the
  norm (statistical or social), or ideal mental
  health. It is dysfunctional because it is harmful
  or causes distress to the individual or others
  and so is considered to be a failure to function
  adequately. Abnormality is characterised by the
  fact that it is an undesirable state that causes
  severe impairment in the personal and social
  functioning of the individual, and often causes
  the person great anguish depending on how much
  insight they have into their illness

80
Key Term Anorexia nervosa

• An eating disorder characterised by the
  individual being severely underweight 85 or
  less than expected for size and height. There is
  also anxiety, as the anorexic has an intense fear
  of becoming fat and a distorted body image. The
  individual does not have an accurate perception
  of their body size, seeing themselves as
  normal, when they are in fact significantly
  underweight, and they may minimise the dangers of
  being severely underweight

81
Key Term Bulimia nervosa

• An eating disorder in which excessive (binge)
  eating is followed by compensatory behaviour such
  as self-induced vomiting or misuse of laxatives.
  It is often experienced as an unbreakable cycle
  where the bulimic impulsively overeats and then
  has to purge to reduce anxiety and feelings of
  guilt about the amount of food consumed, which
  can be thousands of calories at a time. This
  disorder is not associated with excessive weight
  loss

82
Key Term Cultural relativism

• The view that one cannot judge behaviour properly
  unless it is viewed in the context from which it
  originates. This is because different cultures
  have different constructions of behaviour and so
  interpretations of behaviour may differ across
  cultures. A lack of cultural relativism can lead
  to ethnocentrism, where only the perspective of
  ones own culture is taken

83
Key Term Deviation from ideal mental health

• Deviation from optimal psychological well-being
  (a state of contentment that we all strive to
  achieve). Deviation is characterised by a lack of
  positive self-attitudes, personal growth,
  autonomy, accurate view of reality, environmental
  mastery, and resistance to stress all of which
  prevent the individual from accessing their
  potential, which is known as self-actualisation

84
Key Term Eating disorder

• A dysfunctional relationship with food. The
  dysfunction may be gross under-eating (anorexia),
  bingepurging (bulimia), over-eating (obesity),
  or healthy eating (orthorexia). These disorders
  may be characterised by faulty cognition and
  emotional responses to food, maladaptive
  conditioning, dysfunctional family relationships,
  early childhood conflicts, or a biological and
  genetic basis, but the nature and expression of
  eating disorders show great individual variation

85
Key Term Statistical infrequency/deviation from
statistical norms

• Behaviours that are statistically rare or deviate
  from the average/statistical norm as illustrated
  by the normal distribution curve, are classed as
  abnormal. Thus, any behaviour that is atypical of
  the majority would be statistically infrequent,
  and so abnormal (e.g., schizophrenia is suffered
  by 1 in 100 people and so is statistically rare)

86
Factors Important to Mental Health
The factors that drive or motivate individuals,
according to Maslow (1954)