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Department
Psychology
Course
PSYC 1010
Professor
Rebecca Jubis
Semester
Winter

Description
York SOS: Students Offering Support PSYC 1010B/E/F/H (Jubis) Midterm-AID Review Package Tutor: Bryan Choi E-mail: [email protected] 1 York SOS: Students Offering Support Preface This document is intended for PSYC 1010 students who are looking for an additional resource to assist their studies in preparation for the course midterm. It has been created with regard to Dr. Jubis’ Fall/Winter 2009/2010 sections and is subject to change for future courses. The focus is on chapters 14, 15, 4, and 13. References 1. Psychology: Themes and Variations (2 ndEdition) Contents 5 Tips for Midterm Success..............................................................................................2 Chapter 14........................................................................................................................3 Chapter 15......................................................................................................................18 Chapter 4........................................................................................................................28 Chapter 13......................................................................................................................41 5 Tips for Midterm Success 1. Get adequate sleep. Sleeping at night helps consolidate what you learned during the day into memory so that it is better recognized or recalled in future. So not only does staying up late the night before a test destroy your concentration during the test the next day, but your brain has not fully digested the information. 2. Do practice questions. Practice questions are found in your textbook, on the textbook website, and/or provided by your professor. Psychology: Themes and Variations (2 ndEdition) has questions in the textbook itself and on its online website. Professors are often lazy and just take a bunch of questions directly from these places for tests (not that there’s anything wrong with that). 3. Memorize acronyms. Acronyms boost recall. For example, use an acronym like “OCEAN” to remember the Big Five personality traits: openness to experience, conscientiousness, extraversion, agreeableness and neuroticism. 4. Cramming isn’t totally bad. The simple fact is that information is fresher when you cram nights before the test, rather than weeks in advance. If you start studying weeks before, make good notes or go through the textbook again carefully so you can review effectively before the test. 5. Don’t ignore the obscure information. Tests usually favour obscure details because everyone studies the main content inside out. It separates who knows the material and who really knows the material. 2 York SOS: Students Offering Support Chapter 14: Psychological Disorders ................................................................................................................................................................................... Abnormal Behaviour: Myths, Realities and Controversies The Medical Model Applied to Abnormal Behaviour - medical model: useful to conceptualize abnormal behaviour as a disease - Thomas Szasz is opposed to medical model: o illness only affects body and not the mind o abnormal behaviour is a deviation from social norms and not an illness - regardless of debate, medical model has been effective in treating and studying abnormality - diagnosis: distinguishing one illness from another - etiology: apparent causation and developmental history of an illness - prognosis: forecast about the probable course of an illness Criteria of Abnormal Behaviour - deviance: behaviour deviates from social norms (varies culture to culture) - maladaptive behaviour: everyday adaptive behaviour is impaired o usually something that interferes with social or occupational functioning - personal distress: subjective distress - people often viewed as disordered if they are extreme in 1 of the 3 above criterion - therefore: diagnosis hinges on value judgments - abnormal-normal exists on a continuum Stereotypes of Psychological Disorders - psychological disorders are incurable o truth: vast majority of mentally ill improve and lead normal, productive lives (even those with more severe psychological disorders) - people with psychological disorders are often violent and dangerous o truth: most predictive factor of violence is past violence, no consistent evidence that psychological disorder is - people with psychological disorders behave in bizarre ways and are very different from normal people o truth: only a small minority act bizarre and seem different Psychodiagnosis - 1952: first edition of Diagnostic and Statistical Manual of Mental Disorders (DSM) published 3 York SOS: Students Offering Support - 1968: second edition (DSM-II) published with improvements but classification scheme still vague and informal like DSM-I - 1980: third edition (DSM-III) published with major improvement because diagnostic criteria more explicit and concrete - 1994: most current version (DSM-IV) published - DSM-III introduced multiaxial system of classification (5 dimensions) o Axis I: clinical syndromes o Axis II: personality disorders and mental retardation o Axis III: general medical conditions o Axis IV: psychosocial and environmental problems (stress) o Axis V: global assessment of functioning (GAF; adaptive functioning in social and occupational behaviour) - 2011: intended year of publication for DSM-V The Prevalence of Psychological Disorders - epidemiology: study of distribution of mental or physical disorders in population o not to be confused with etiology: study of causation - prevalence: percentage of a population that exhibits a disorder during a specified time period o lifetime prevalence: percentage of people who endure a specific disorder at any time in their lives - studies estimating lifetime prevalence of mental illness: o prior to DSM-III: 1/5 o during DSM-III: 1/3 o more recently: 44% and 51% ................................................................................................................................................................................... Anxiety Disorders: class of disorders marked by feelings of excessive apprehension and anxiety Generalized Anxiety Disorder: chronic, high level of anxiety that is not tied to any specific threat - the anxiety sometimes called free-floating anxiety because it’s nonspecific - constant worry over yesterday’s mistakes, tomorrow’s problems, minor matters Physical symptoms: trembling, muscle tension, diarrhea, dizziness, faintness, sweating, heart palpitations Onset: gradual Prevalence: higher in females 4 York SOS: Students Offering Support Phobic Disorder: persistent and irrational fear of an object or situation that presents no realistic danger - only diagnosed when the fear interferes with everyday behaviour - can form phobia of virtually anything - normally recognize phobia is irrational, but can’t help but be afraid - even imagining phobic image can elicit fear Panic Disorder: recurrent attacks of overwhelming anxiety that usually occur suddenly and unexpectedly - people become apprehensive of when next panic will occur - fear of exhibiting panic in public can result in agoraphobia: fear of going out to public Onset: typically begins in late adolescence or early adulthood Prevalence: 2/3 are female Obsessive-Compulsive Disorder (OCD): persistent, uncontrollable intrusions of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions) - compulsions usually involve stereotyped rituals that temporarily relieve anxiety - certain obsessions tend to be associated specific compulsions o ex. obsession of contamination and cleaning compulsion - recent heterogeneity found (more variations): 4 underlying factors o obsessions and checking o symmetry and order o cleanliness and washing o hoarding Onset: most cases before age 35 Post-Traumatic Stress Disorder (PTSD) - often elicited by a variety of traumatic events - common symptoms: re-experience of trauma as flashbacks or nightmares, emotional numbing, alienation, problems in social relationships, increases sense of vulnerability, elevated arousal, anxiety anger and guilt - higher risk from greater intensity of exposure to trauma or grotesque aftermath, especially the intensity of one’s reaction at the time of trauma Onset: can surface months or years later after exposure Prognosis: recovery is gradual, but for many symptoms don’t fully disappear Etiology of Anxiety Disorders - biological factors: 5 York SOS: Students Offering Support o twin and family studies show a higher concordance rate (% of twin pairs or other pairs of relatives who exhibit same disorder) for anxiety disorders o anxiety sensitivity: person is more sensitive to internal physiological symptoms of anxiety and tend to overreact with more fear than others o disturbance in GABA synapses, since excessive anxiety relieved by drugs that promote GABA synapse activity o abnormality in serotonin circuits implicated in panic disorder and OCD - conditioning and learning: o many anxiety responses acquired by classical conditioning and maintained by operant conditioning  ex. phobia will produce avoidance of phobic stimulus which will reduce anxiety (negative reinforcement) o preparedness: people are biologically prepared by evolutionary history to acquire some fears much more easily than others (Martin Seligman)  evolved module for fear learning: stimuli that threatens survival in evolutionary history activate fear, which is relatively resistant to efforts to suppress o criticism:  many people don’t remember a traumatic conditioning experience that led to phobia o observational learning can lead to conditioned fears - cognitive factors: o higher risk for those who tend to:  misinterpret harmless situations as threatening  focus excessive attention on perceived threats  selectively recall information that seems threatening - stress: o studies support that anxiety disorders are stress-related o high stress often precipitates onset of anxiety disorders ................................................................................................................................................................................... Somatoform Disorders: physical ailments that can’t be fully explained by organic conditions and are largely due to psychological factors - not to be confused with: o psychosomatic diseases: genuine physical ailment caused in part by psychological factors o malingering: deliberate faking of illness Somatization Disorder: marked by history of diverse physical complaints that appear to be psychological in origin 6 York SOS: Students Offering Support - people report endless succession of minor physical ailments that seem to wax and wane in response to the stress in their lives - resistant to suggestion that symptoms might be the result of psychological distress Comorbidity: depression and anxiety disorders Prevalence: higher in females Conversion Disorder: significant loss of physical function (with no apparent organic basis), usually in a single organ system - common symptoms: partial or complete loss of vision or hearing, partial paralysis, severe laryngitis or mutism, loss of feeling or function in limbs Onset: acute (triggered by stress) Hypochondriasis: excessive preoccupation with health concerns and incessant worry about developing physical illnesses - constantly monitor physical condition, looking for signs of illness and overinterpreting every conceivable sign of illness - often skeptical of doctors who say there’s nothing wrong Comorbidity: anxiety and depressive disorders Etiology of Somatoform Disorders - genetic factors have small contribution - personality factors: o histrionic: self-centered, suggestible, excitable, highly emotional, overly dramatic o also those marked by neuroticism - cognitive factors: o tendency to focus excessive attention on internal physiological processes and amplify normal bodily sensations o tendency to draw catastrophic conclusions about minor bodily complaints - people are reinforced by indirect benefits of sick role: o avoid having to confront life’s challenges and responsibilities o attention from others (activates social supports) ................................................................................................................................................................................... Dissociative Disorders: class of disorders in which people lose contact with portions of their consciousness or memory, resulting in disruptions in their sense of identity Dissociative Amnesia: sudden loss of memory or important personal information that is too extensive to be due to normal forgetting 7 York SOS: Students Offering Support - may occur for a single traumatic event or for an extended period surrounding the event Dissociative Fugue: people lose memory of their entire lives, along with their sense of personal identity - forget factual information about self but not skills Dissociative Identity Disorder (DID): coexistence in one person of two or more largely complete, and usually very different, personalities - formerly multiple personality disorder - often confused with schizophrenia - various personalities of a person often unaware of each other - transitions between identities often occur suddenly - number of cases exploded by 1990: o some think it was underdiagnosed prior o some think it has been overdiagnosed by clinicians who may even encourage and contribute to its emergence Etiology of Dissociative Disorders - psychogenic amnesia and fugue usually attributed to excessive stress o perhaps also due to personality trait of fantasy proneness and tendency to become intensely absorbed in personal experiences - DID is a mystery o DID is role-playing, promoted by a small minority of therapists and is a creation of North American culture (Spanos) o others propose DID is the result of severe emotional trauma during childhood ................................................................................................................................................................................... Mood Disorders: class of disorders marked by emotional disturbances of varied kinds that may spill over to disrupt physical, perceptual, social and thought processes - unipolar disorder: person experiences one extreme of mood continuum (mania or depression) - bipolar disorder: person experiences both extremes of the mood continuum (mania and depression) Major Depressive Disorder: persistent feelings of sadness and despair and a loss of interest in previous sources of pleasure 8 York SOS: Students Offering Support - common symptoms: hopelessness, socially-withdrawn, negative self-image, self- blame, trouble sleeping, decreased sex drive and appetite, sluggish demeanour, irritability - dysthymic disorder: chronic depression that is insufficient in severity to justify diagnosis of a major depressive episode Comorbidity: anxiety disorders and substance-use disorders Onset: most before age 40 Prevalence: 10% lifetime - increasing due to higher prevalence in younger cohorts (especially those since WWII) - twice as high in women than men (same during childhood) Bipolar Disorder: experience of one or more manic episodes as well as periods of depression - formerly known as manic-depressive disorder - manic phase marked by: elation, euphoria, racing thoughts, flight of ideas, desire for action, impulsivity (can spend money frantically), delusions of grandeur, tirelessness, increased sex drive - cyclothymic disorder: chronic but milder symptoms of bipolar disturbance - rapid-cycling pattern: going through 4+ manic or depressive episodes within a year Onset: 25 median age of onset Diversity in Mood Disorders - specifiers (which provide additional information) may accompany mood disorder diagnosis o seasonal affective disorder (SAD): type of depression that follows a seasonal pattern  most common is winter depression  cause: related to melatonin production and circadian rhythms  treatment: phototherapy whereby patients are exposed systematically to light o postpartum depression: type of depression that sometimes occurs after childbirth  risk factors: previous depressive episodes, adjustment problems, stress, impairments in GABA receptors Mood Disorders and Suicide - suicide is the third leading cause of death in people 15-34 - statistics are complicated when suicides are disguised as accidents 9 York SOS: Students Offering Support - suicide attempts may outnumber completed suicides 20 to 1 - women attempt 3 times more than men - men complete suicide 4 times more than women - 90% of those who complete suicide suffer from some type of psychological disorder o 60% have mood disorder Etiology of Mood Disorders - genetic vulnerability: o concordance rates of 65% for identical twins and 14% for fraternal twins = suggest genetic factors involved in the form as a predisposition o inconsistent evidence found for implicated genes - biological and neurochemical factors: o abnormal levels of norepinephrine and serotonin associated with depression o drug therapy which affect neurotransmitters found to alleviate some mood disturbances = evidence for neurochemical changes causing mood disturbances o associated with reduces hippocampal volume (8%-10% smaller)  stress suppresses neurogenesis in the hippocampal formation which may explain reduced size - dispositional factors: o perfectionism and setting excessively high standards associated with depression o Flett and Hewitt devised multidimensional scale of perfectionism:  self-oriented perfectionism: one’s standards for self  other-oriented perfectionism: one’s standards for others  socially prescribed perfectionism: perceived standards for self by others o Beck suggests 2 personality styles contribute to depression:  sociotropic individual: invested in interpersonal relations, overconcerned with avoiding interpersonal conflict and pleasing others  autonomous individual: oriented toward their own independence and achievement o Blatt distinguishes the introjective personality orientation (excessive self- criticism) and the anaclitic orientation (overdependence on others) - cognitive factors: o Beck’s negative cognitive triad: tendency to have negative views of themselves, their world and their future 10 York SOS: Students Offering Support o Seligman implicated:  learned helplessness: passive “giving up” behaviour produced by exposure to unavoidable aversive events  pessimistic explanatory style: tendency to attribute setbacks to personal flaws rather than situational factors and the tendency to draw global, far-reaching conclusions about their personal inadequacies o hopelessness theory encompasses pessimistic explanatory style, high stress, low self-esteem which contribute hopelessness - interpersonal roots: o depression associated with poor social skills o depressed people tend to invite rejection from those around them and have fewer social supports o depressed people may gravitate to partners who reinforce their negative views about themselves - precipitating stress: o moderate link between precipitating stress and depression ................................................................................................................................................................................... Schizophrenic Disorders: class of disorders marked by delusions, hallucinations, disorganized speech and deterioration of adaptive behaviour General Symptoms - delusions: false beliefs that are maintained even though they clearly are out of touch with reality o ex. delusion of grandeur: one is famous or important - deterioration of adaptive behaviour: trouble with everyday functioning - hallucinations: sensory perception that occurs in the absence of a real, external stimulus or are gross distortions of perceptual input o ex. auditory and visual hallucinations - disturbed emotions: o blunted or flat affect: little emotional responsiveness o inappropriate emotion: inappropriate emotional response to a situation Subtypes - paranoid schizophrenia: dominated by delusions of persecution and grandeur - catatonic schizophrenia: marked by striking motor disturbances, ranging from muscular rigidity to random motor activity 11 York SOS: Students Offering Support o some engage in catatonic stupor: extreme form of withdrawal where one remains motionless and seem oblivious to the environment around them for long periods of time o some engage in catatonic excitement: go hyperactive and incoherent o can oscillate between the stupor and excitement - disorganized schizophrenia: particularly severe deterioration of adaptive behaviour is seen o emotional indifference, frequent incoherence and virtually complete social withdrawal - undifferentiated schizophrenia: marked by idiosyncratic mixtures of schizophrenic symptoms - above 4 subtypes not useful, which prompted new scheme: o negative symptoms: behavioural deficits, such as flattened emotions, social withdrawal, apathy, impaired attention and poverty of speech o positive symptoms: behavioural excesses or peculiarities, such as hallucinations, delusions, bizarre behaviour and wild flights of ideas  associated with better adjustment prior to onset and responsiveness to treatment o has not replaced subtypes because of problems:  most patients have both negative and positive symptoms Course and Outcome - most have a history of peculiar behaviour, along with cognitive and social deficits - usually gradual and insidious - 3 typical courses of treatment: o full recovery (usually for those with milder symptoms) o partial recovery with relapses throughout life o chronic illness with extensive hospitalization Etiology of Schizophrenia - genetic vulnerability: o average of 48% concordance rates for identical twins compared to 17% for fraternal twins o inherited polygenic vulnerability, but no genes implicated yet - neurochemical factors: o dopamine hypothesis: excess dopamine activity  evidence: drugs that treat schizophrenia decrease dopamine activity  inconsistencies still exist o marijuana use for those with genetic vulnerability may lead to schizophrenia 12 York SOS: Students Offering Support - structural abnormalities: o enlarged brain ventricles associated with schizophrenia o also associated with reduced metabolic activity in prefrontal cortex (may contribute to positive symptoms) and increased metabolic activity in an area in the temporal lobe (may contribute to negative symptoms) - neurodevelopmental hypothesis: schizophrenia is caused in part by various disruptions in the normal maturational processes of the brain before or at birth o insults to brain (ex. viral infections or prenatal malnutrition) cause subtle neurological damage which increases vulnerability o correlations between schizophrenia and prenatal exposure to influenza or famine, and minor physical anomalies - expressed emotion (EE): degree to which a relative of a schizophrenic patient displays highly critical or emotionally overinvolved (overprotective) attitudes toward the patient o family’s expressed emotion is a good predictor of schizophrenia and of high relapse rate (family is a source of stress and not support) - precipitating stress: o stress activates vulnerability and triggers relapse ................................................................................................................................................................................... Personality Disorders: class of disorders marked by extreme, inflexible personality traits that cause subjective distress or impaired social and occupational functioning - 10 listed in DSM-IV and organized into 3 clusters: o anxious/fearful: maladaptive efforts to control anxiety and fear about social rejection  avoidance personality disorder: high sensitivity to rejection leads to social withdrawal  dependent personality disorder: completely reliant on another person and subordinating own needs to other’s needs  obsessive-compulsive personality disorder: preoccupation with organization, schedules, lists, trivial details o odd/eccentric: distrustful, socially aloof and unable to connect to others emotionally  schizoid personality disorder: defective in capacity for forming social relationships  schizotypal personality disorder: deficits and oddities in thinking, perception and communication (resembles schizophrenia)  paranoid personality disorder: pervasive and unwarranted suspiciousness and mistrust of people o dramatic/impulsive: 13 York SOS: Students Offering Support  histrionic personality disorder: overly dramatic, egocentric  narcissistic personality disorder: grandiose self-importance  borderline personality disorder: unstable self-image, mood and interpersonal relationships  antisocial personality disorder: marked by impulsive, callous, manipulative, aggressive and irresponsible behaviour that reflects a failure to accept social norms  chronically violate rights of others  often use social charm to cultivate others’ liking or loyalty for purposes of exploitation  more frequent in males than females  many become involved in illegal activities  pursue immediate gratification and are often unstable  etiology: o genetic predisposition, perhaps from under arousal from lacking inhibitions or perhaps overarousal o poor socialization: tend to come from families where discipline was erratic or ineffective, and homes with abuse and neglect Diagnostic Problems - too much overlap with Axis I disorders and with each other = poor reliability - many advocate for dimensional approach: personality disorders are described on continuous personality dimensions o as opposed to the current categorical approach: personality disorders are discontinuous diagnostic categories ................................................................................................................................................................................... Psychological Disorders and the Law Insanity - don’t use “not guilty by reason of insanity” (NGRI) in Canadian system anymore, it’s “not criminally responsible on account of mental disorder” (NCRMD) o implies that crimes are intentional and that those with mental disorders can commit crime without knowledge of its ramifications o defendant may be:  absolutely discharged  conditionally discharged  ordered to a psychiatric facility 14 York SOS: Students Offering Support - M’Naghten rule: insanity exists when a mental disorder makes a person unable to distinguish right from wrong - mental health professionals important when defendants are unfit to stand trial - issue of automatism: one is not accountable if one had no control over behaviour o ex. killing someone while sleepwalking o defendant is not guilty and released without conditions ................................................................................................................................................................................... Culture and Psychology - relativistic view: criteria of mental illness vary greatly across cultures o therefore: DSM-IV reflects a Western, white, urban, upper- and middle- class orientation - pancultural view: criteria of mental illness are much the same around the world and that basic standards of normality and abnormality are universal - both views are valid Are Equivalent Disorders Found around the World? - most principle categories of serious psychopathology identified in all cultures - have found culture-bound disorders: abnormal syndromes found only in a few cultural groups o Windigo: intense craving for human flesh and fear that one will turn into a cannibal seen only in Algonquin cultures o anorexia nervosa seen only in affluent Western cultures Are Symptom Patterns Culturally Invariant? - the stronger the biological component, the more a disorder tends to be displayed in similar ways across cultures - however variation can still be found despite strong biological component ................................................................................................................................................................................... Featured Study: Does Negative Thinking Cause Depression? Results and Discussion - 17% of those high in negative thinking later developed depression, whereas 1% of those low in negative thinking later developed depression - conclusion: negative thinking makes people more vulnerable to depression - study strength: prospective which can provide insight on causation 15 York SOS: Students Offering Support ................................................................................................................................................................................... Personal Application: Understanding Eating Disorders Eating Disorders: severe disturbances in eating behaviour characterized by preoccupation with weight and unhealthy efforts to control weight Anorexia Nervosa: intense fear of gaining weight, disturbed body image, refusal to maintain normal weight and dangerous measures to lose weight - restricting type: reduction in food intake (starving) - binge-eating/purging type: lose weight by vomiting after meals, misusing laxatives and diuretics or by engaging in excessive exercise - morbid fear of obesity means they are never satisfied with their weight o only satisfaction comes from losing weight - leads to amenorrhea (loss of menstrual cycles in women), low blood pressure, gastrointestinal problems, osteoporosis (loss of bone density), cardiac problems - leads to death in 5%-10% of patients Bulimia Nervosa: habitually engaging in out-of-control overeating followed by unhealthy compensatory efforts, such as self-induced vomiting, fasting, abuse of laxatives and excessive exercise - typically retain a normal body weight because vomiting prevents absorption of only half of consumed food and laxatives and diuretics have negligible impact on caloric intake - common symptoms: cardiac arrhythmias, dental problems, metabolic deficiencies, gastrointestinal problems - differences from anorexia nervosa: o bulimia nervosa less life-threatening o bulimia nervosa patients more likely to recognize they have a problem and cooperate with treatment Binge-Eating Disorder: distress-inducing eating binges that are not accompanied by the purging, fasting and excessive exercise seen in bulimia - potential new disorder in DSM-V History, Prevalence and Course - product of modern, affluent Western culture because food is plentiful and desirability to be thin is widely endorsed - 90%-95% are female o probably due to greater pressure on women to be thin - most tend to be young people 16 York SOS: Students Offering Support - anorexia: o onset: 14-18 o prevalence: 1% o 40%-50% fully recover with treatment, while 20%-25% does not benefit at all - bulimia: o onset: 15-21 o 2%-3% prevalence o 70% recover with treatment Etiology of Eating Disorders - genetic vulnerability: o evidence from twin and family studies, not as strong compared to other disorders - personality factors: o anorexia patients tend to be obsessive, rigid, emotionally restrained, perfectionistic o bulimia patients tend to be impulsive, overly sensitive and low in self- esteem - cultural values: o women socialized that attractive women are thin - role of family: o overinvolved parents leads to children seeking independence by exerting extreme control over their body (prompts pathological eating) o mothers may add additional pressure to be thin - cognitive factors: o rigid, all-or-none thinking, etc. ................................................................................................................................................................................... Critical Thinking Application: Working with Probabilities in Thinking about Mental Illness - representativeness heuristic: estimated probability of an event is based on how similar the event is to the typical prototype (best example) of that event o ex. best example of a mentally ill person may be a crazy homeless guy, but 44% of people develop at least one DSM disorder in their life (meaning “normal” people develop mental illness too) - cumulative probability: probability one of several disorder is higher than any disorder by itself - conjunctive probabilities: probability of having more than one disorder is lower than the probability of having one disorder 17 York SOS: Students Offering Support o conjunctive fallacy: occurs when people estimate the odds of 2 uncertain events happening together are greater than the odds of either event happening alone - availability heuristic: estimated probability of an event is based on the ease with which relevant instances come to mind - hindsight bias: tendency to overestimate the degree to which a past event was predictable after knowing the result ................................................................................................................................................................................... Chapter 15: Treatment of Psychological Disorders ................................................................................................................................................................................... Introduction - psychotherapy refers to interventions for mental and psychological problems o encompasses a range of treatment contexts - Ewan Cameron conducted CIA-funded brainwashing research - LSD had initial optimism in treatment, but later programs were terminated …………………………………………………………………………………………………………………………………………… The Elements of the Treatment Process - 400+ treatments estimated o insight therapies: involves all talk therapy o behaviour therapies: based on behaviour principles o biomedical therapies: interventions aimed at biological functioning Clients - 90% of people are as concerned about mental health as physical health - host of problems: most common are excessive anxiety or depression - people tend to delay treatment for psychological problems - stigma (seeking treatment is personal weakness) prevents people from seeking help Therapists - psychologists: o counselling psychologists: deal with everyday problems and adjustment o clinical psychologists: deal with mental disorders o require Ph.D., Psy.D. or Ed.D. o use either insight or behaviour therapy o may conduct psychological testing and research 18 York SOS: Students Offering Support - psychiatrists: physicians who specialize in diagnosis and treatment of psychological disorders o some also treat everyday behavioural problems o usually referred to by family physician o require an M.D. o primarily use drug therapy - other mental health professionals: o clinical social workers tend to work with patients and families to ease the patient’s integration back to the community o psychiatric nurses play a role in hospital inpatient treatment o counsellors provide therapeutic services  generally work in schools, colleges, human service agencies ………………………………………………………………………………………………………………………………………….... Insight Therapies: involve verbal interactions intended to enhance clients’ self- knowledge and thus promote healthful changes in personality and behaviour Psychoanalysis: emphasis on recovery of unconscious conflicts, motives and defences through techniques such as free association and transference - Freud usually treated anxiety-dominant disturbances which he called neuroses o caused by unconscious conflicts left over from early childhood o people use defence mechanisms to avoid confronting intrapsychic conflict of id, ego and superego - free association: clients spontaneously express their thoughts and feelings exactly as they occur with as little censorship as possible - dream analysis: therapist interprets the symbolic meaning of the client’s dreams - interpretation: therapist’s attempts to explain the inner significance of the client’s thoughts, feelings, memories and behaviours - resistance: largely unconsciously defensive manoeuvres intended to hinder the progress of therapy - transference: clients unconsciously start relating to their therapist as though the therapist in ways that mimic critical relationships in their lives o therapists encourage transference because re-enactment brings unconscious conflict to the surface so that the therapist can work with it - once unconscious conflicts are found and resolved (thus gaining insight), neurotic defences are released - modern psychodynamic therapies: descendants of psychoanalysis o classical psychoanalysis not widely practiced anymore o interpretation, resistance and transference continue to play key roles 19 York SOS: Students Offering Support Client-Centered Therapy: emphasis on providing supportive emotional climate for clients, who play a key role in determining the pace and direction of their therapy - created by Carl Rogers, a.k.a. person-centered therapy - anxiety is caused by incongruence: discrepancy between person’s self-concept and reality o ex. believe one is hard-working but receive negative feedback from peers o this causes person to rely on defence mechanisms and to distort their reality which stifles personal growth o excessive incongruence thought to be rooted in client’s overdependence on others for approval and acceptance - goals: foster self-acceptance (help them accept their real self) and personal growth - therapeutic climate: warm, supportive, accepting o genuineness: honest and spontaneous, not phony or defensive o unconditional positive regard: complete, nonjudgmental acceptance of the client as a person o empathy: understand the world through the client’s point of view (must communicate this to the client) - therapeutic process: o in client-centered, therapist provides clarification (empathic mirroring which increases client’s awareness of themselves and chance to achieve insight) o Greenberg and Johnson developed emotion-focused coupled therapy:  first have partners identify relationship issues and underlying emotions  next have partners address their needs and arrive at solutions Therapies Inspired by Positive Psychology - positive psychology emphasizes positive, adaptive, creative and fulfilling aspects of human existence - well-being therapy: enhances self-acceptance, purpose in life, autonomy, and personal growth - positive psychotherapy: gets clients to recognize their strengths, appreciate their blessings, savour positive experiences, forgive those who have wronged them and find meaning in life Group Therapy: simultaneous treatment of several clients in a group - typically 4-15 people, 8 is ideal - work on unmasking problems and then finding solutions 20 York SOS: Students Offering Support - therapists must still select participants, set group goals, initiate and maintain therapeutic process, protect clients from harm, models supportive behaviour - advantages: o save time and money o participants find people with similar and even worse issues than them o promotes social skills usage in a safe environment o group acts a social support Evaluating Insight Therapies - for any therapy, recovery can be accounted by spontaneous remission: recovery from a disorder that occurs without formal treatment o client improved from therapy or naturally? - studies show insight therapies are superior to no treatment and placebo treatment and the effects of therapy are reasonably durable o roughly equal efficacy with drug therapies How do Insight Therapies Work? - diverse psychotherapies all share common factors: o therapeutic alliance with professional helper o emotional support and empathic understanding from therapist o cultivation of hope and positive expectations in client o provision of a rationale for client’s problems and a plausible method for reducing problems o giving client opportunity to express feelings, confront problems, gain new insights and learn new patterns of behaviour ------------------------------------------------------------------------------------------------- Behaviour Therapies: application of learning principles to direct efforts to change clients’ maladaptive behaviours (not help client gain insight like in insight therapies) Systematic Desensitization: behaviour therapy used to reduce phobic clients’ anxiety responses through counterconditioning - devised by Joseph Wolpe - assumption: anxiety responses acquired through classical conditioning o neutral stimulus (NS) gains anxiety response of a phobic object/situation (unconditioned stimulus, UCS) - goal: weaken association between conditioned stimulus (CS) and conditioned response (CR) of anxiety - first, build anxiety hierarchy: a list of anxiety-arousing stimuli ranked by the intensity of their anxiety response (from least to greatest) 21 York SOS: Students Offering Support - second, train client in deep muscle relaxation - third, client works through hierarchy while learning to remain relaxed while imagining each stimulus o client imagines (later usually encounters real) the object/situation until it produces little or no anxiety, and then moves up the hierarchy Aversion Therapy: aversive stimulus is paired with a stimulus that elicits an undesirable response - goal: condition something with negative responses so that one will come to avoid it - not widely used, usually part of a larger treatment program if used Social Skills Training: improves interpersonal skills that emphasizes modelling, behavioural rehearsal and shaping - group or individual format - modelling: client observes appropriate responses from friends and colleagues - behavioural rehearsal: client practices social techniques in structured role-plays and then eventually in real-life (homework) - shaping: client is encouraged to handle more and more complicated social skills and situations Cognitive-Behavioural Treatments: varied combinations of verbal interventions and behaviour modification techniques - combination of cognitive and behaviour therapy - cognitive therapy: specific strategies to correct habitual thinking errors that underlie various types of disorders o depression is caused by cognitive errors o goal: change clients’ negative thoughts and maladaptive beliefs o first, clients taught to detect negative automatic thoughts o next, behavioural techniques of modelling, systematic monitoring, behavioural rehearsal, homework are used to counteract negative thoughts, maladaptive beliefs and promote desirable behaviour - Miechenbaum developed self-instructional training: clients taught to develop and use verbal statements that help them to cope with difficult contexts - Zindel Segal developed mindfulness-based cognitive therapy: integrates mindfulness meditation and cognitive therapy o mindfulness: full attention is given to the present-moment experience and that experience is employed equanimously, in that whatever arises is acknowledged and examined nonevaluatively 22 York SOS: Students Offering Support Evaluating Behaviour Therapies - not well suited for some types of problems - there is evidence for its efficacy - effective in treating phobias, OCD, sexual dysfunction, schizophrenia, drug- related problems, eating disorders, psychosomatic disorders, hyperactivity, autism, mental retardation …………………………………………………………………………………………………………………………………………… Biomedical Therapies: physiological interventions intended to reduce symptoms associated with psychological disorders - assumption: psychological disorders caused, at least in part, by biological malfunctions - people tend to think of psychosurgery and lobotomies, but these went into decline in the 1950s o cingulotomy still practiced for extreme situations Psychopharmacotherapy: treatment of mental disorders with medication - a.k.a. drug therapy Antianxiety Drugs: relieve tension, apprehension and nervousness - immediately work and are effective, but the effects are short-lived - prescribed for people with anxiety disorders and also those with chronic nervous tension - side effects: drowsiness, light-headedness, dry mouth, etc. - con: potential for abuse, dependence and overdose Antipsychotic Drugs: gradually reduce psychotic symptoms, including hyperactivity, mental confusion, hallucinations and delusions - treat schizophrenia and schizoaffective disorders - decrease activity at dopamine synapses - side effects: drowsiness, constipation, dry mouth, symptoms of Parkinson’s disease (ex. muscle tremors, muscular rigidity) o tardive dyskinesia: neurological disorder marked by involuntary writhing and tic-like movements of the mouth, tongue, face, hands or feet - atypical antipsychotic drugs effective for those who don’t respond to conventional antipsychotics o pro: produce fewer undesired side effects than conventional antipsychotics o con: increase susceptibility to diabetes and cardiovascular problems - atypicals now the first line of defense (despite higher costs) 23 York SOS: Students Offering Support Antidepressant Drugs: gradually elevate mood and help bring people out of depression - before 1987, 2 main types: tricyclics (ex. Evavil) and MAO inhibitors (ex. Nardil) o tricyclics have fewer problems than MAO inhibitors - today, more likely to prescribe selective serotonin reuptake inhibitors, which block the reuptake of serotonin in synapses o as effective as tricyclics, with fewer dangerous side effects o criticism: increases suicide risk in adolescents and young adults o newest class is selective norepinephrine reuptake inhibitors (SNRI): inhibits reuptake of serotonin and norepinephrine in synapses  slightly stronger than SSRIs but more side effects Mood Stabilizers: drugs used to control mood swings in patients with bipolar mood disorders - lithium has been used to prevent future manic and depressive episodes, also to bring them out of a current manic or depressive episode o levels must be closely monitored, too much lithium can be toxic and lethal - new alternatives: o ex. valproate: as effective as lithium and fewer side effects Evaluating Drug Therapies - can be effective for those who don’t respond to psychotherapy - controversial regardless: o drugs are not as effective as they are advertised o superficial, short-lived curative effects o high relapse rates o many drugs have damaging side effects o pharmaceutical industry has gained substantial influence over research enterprise, research mostly funded by them  consequence: minimization of unfavourable results, exaggeration of favourable results and compromised objectivity Electroconvulsive Therapy (ECT): biomedical treatment in which electric shock is used to produce a cortical seizure accompanied by convulsions - patient given a light anesthetic - unilateral shock administered to right hemisphere most common, which triggers a brief convulsive seizure - usage peaked in the 1940s and 1950s, until drug therapies arrived - controversy: 24 York SOS: Students Offering Support o lucrative business for psychiatrist, little effort on their part to administer ECT o treatment is painful, dehumanizing and terrifying (however, there have been vast improvements in its applications) - effectiveness: o evidence suggests a conservative use of ECT for treating severe mood disorders, those who haven’t responded to antidepressants o high relapse rate: 50% of patients relapse with a year o proposed mechanism:  works at neurotransmitter activity, but evidence for this is fragmented and inconclusive  opponents suggest patients try to pull out of depression because ECT is so aversive (inconclusive) - risks: o side effects: impaired attention, memory loss, cognitive deficits New Brain Stimulation Techniques - transcranial magnetic stimulation (TMS): temporary enhancement or depression of activity in a specific brain area by means of applying a magnetic field from a coil mounted on a small paddle (non-invasive procedure) o found to improve depression symptoms o minimal side effects - deep brain stimulation (DBS): thin electrode is surgically implanted in the brain and connected to an implanted pulse generator so that various electrical currents can be delivered to brain tissue adjacent to the electrode o some success in treating motor disturbances in Parkinson’s disease, tardive dyskinesia and schizophrenia ------------------------------------------------------------------------------------------------- Current Trends and Issues in Treatment Blending Approaches to Treatment - clinicians often use several techniques with a client - practice has become eclectic: drawing ideas from 2 or more system of therapy instead of committing to just one system - theoretical integration: 2 ore more systems of therapy are combined to take advantage of the strengths of each - technical eclecticism: borrowing ideas, insights and techniques from a variety of sources while tailoring one`s intervention strategy to the unique needs of each client 25 York SOS: Students Offering Support Increasing Multicultural Sensitivity in Treatment - psychotherapy reflects Western cultural values - ethnic minorities tend to underuse therapeutic services o cultural barriers: norm is to not seek formal help, but informal help from family members, etc. o language barriers: mental health services sometimes don’t speak the language o institutional barriers: therapists can’t provide for the client because the therapist has not had multicultural exposure - Canada especially is very multicultural, therapists need to be more sensitive to diverse populations - pan-Amerindian healing movements increasing at Aboriginal centres - possible solutions: o train more ethic minority therapists o incorporate cultural factors into the therapeutic approach …………………………………………………………………………………………………………………………………………… Institutional Treatment in Transition - mental hospital: medical institution specializing in providing inpatient care for psychological disorders Disenchantment with Mental Hospitals - by 1950s, hospitals found to be contributing to disorders, not curing them o due to inadequate funding, overpopulation of patients under care of small staffs, environment was demoralizing - spawned the community mental health movement in the 1960s: o emphasis on local, community-based care o reduced dependence on hospitalization o prevention of psychological disorders Deinstitutionalization: transferring treatment of mental illness from inpatient institutions to community-based facilities that emphasize outpatient care - prompted by: o emergence of effective drug therapies for severe disorders o deployment of community mental health centers to coordinate local care - pros: o many have benefited from not being hospitalized or for less time o discharged patients enjoy the freedom - cons: 26 York SOS: Students Offering Support o many of the discharged had no “halfway houses” to live in and inadequate services to rehabilitate them back into normal society Mental Illness, the Revolving Door and Homelessness - admission to psychiatric hospitalization has increased = revolving door effect o once they stabilize in inpatient care, they are discharged back to a community that doesn’t rehabilitate them effectively, and soon enough their symptoms return and are readmitted - growing homeless population also blamed on deinstitutionalization o important to keep in mind that economic trends have contributed to homeless problem - solution: o some advocate increasing quality and availability of intermediate care
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