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Psyc1010 - Test 4 final.pdf

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PSYC 1010
Rebecca Jubis

PSYC1010 TEST 4 STUDY PACKAGE Package Created by: Yifeng Lu, DalExam-AID Tutor:ietta Cini, Jessie Zhang, Sharmila Sanichara, Khadeejah Gul Frederyck Franco ([email protected]) Anum Aziz ([email protected]) Preface This document was created by the York University chapter of Students Offering Support (York SOS) to accompany our PSYC1010 Exam-AID session. It is intended for students enrolled in Professor Jubis’s sections of 2012/2013 INTRODUCTION TO PSYCHOLOGY – PSYC1010 course who are looking for an additional resource to assist their studies in preparation for the exam. Please do NOT share this with other students and instead tell them about the session or to contact York SOS to make a donation to get a copy of it. ([email protected]) References Myers, David G. (2012). Psychology 10 Edition in Modules. New York, NY: Worth Publishers. Tips for General Midterm Success Use mnemonics to remember concepts better. An example of a mnemonic would be acronyms. Do practice multiple choice questions. Doing these practice questions can assess your understanding of what you have learned and can help you identify areas of weakness. Practice multiple choice questions are found in textbooks, on textbook companion websites, and/or provided by your professor. Read a multiple choice question and try to answer it BEFORE looking at the possible answers. Having an answer in mind before looking at possible answers can reduce the chances of being fooled by wrong answers. Use logic and process of elimination on multiple choice questions. For example, if you know that answer A is wrong, then logically an answer “A and B are correct” in the same question must also be incorrect. When you don’t know the answer, eliminating wrong answers (as opposed to just random guessing) can increase your chances of getting the question right. Practice writing answers to short answer questions. If you know ahead of time what the questions will be on the short answer section, make a list of essential points you want to include in each answer and practice writing the answer on paper. If you don’t know what questions will be on the short answer section, you could try scanning the material to identify concepts that have enough content to be a possible short answer question. Again, you can make a list of essential points you want to include in each answer and practice writing the answer on paper. Even if the question you thought of doesn’t show up on the short answer section, doing this can help solidify what you learned. Don’t spend too much time on a difficult question. It is better to move onto easier questions to ensure getting those marks than to get hung up on a difficult question, especially when time is limited. Get adequate sleep the night before your test. Sleeping at night helps consolidate what you learned during the day into memory so that it is better remembered in future. 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 effectively learned the material. What is Students Offering Support? Students Offering Support is a national network of student volunteers working together to raise funds to raise the quality of education and life for those in developing nations through raising marks of our fellow University students. This is accomplished through our Exam-AID initiative where student volunteers run group review sessions prior to a midterm or final exam for a $20 donation. All of the money raised through SOS Exam-AIDs is funneled directly into sustainable educational projects in developing nations. Not only does SOS fund these projects, but SOS volunteers help build the projects on annual volunteer trips coordinated by each University chapter. Psychological Disorders Module 47-Psychological Disorders  Patterns of thoughts, feelings or actions that are deviant, distressful and dysfunctional  Being different (deviant) from most other people in one’s culture is part of what it takes to define a psychological disorder  Standards for deviant behavior vary by context and by culture, also with time  There is more to a disorder than being deviant  Deviant and distressful behaviors are more likely to be considered disorder when also judged to be a harmful dysfunction  Dysfunction is key to defining a disorder Understanding Psychological Disorders  To explain puzzling behavior, people in earlier times often presumed the work of strange focus-the movement of the stars, god-like powers, or evil spirits  Until the last two centuries, “mad” people were sometimes caged in zoo-like conditions or given “therapies” appropriate to a demon The Medical Model  In opposition to brutal treatments, reformer including Philippe Pinel (1745-1836) in France, insisted that madness is not demon possession but a sickness of the mind caused by severe stresses and inhumane conditions  For Pinel and others, “moral treatment” included boosting patients’ morale by unchaining them and talking with them and by replacing brutality with gentleness  By the 1800s, hospitals replaced asylums and medical world began searching for physical causes and treatment of mental disorders  Today, this medical model recognizable in terminology of mental health movement: a mental illness (also called a psychopathology) needs to be diagnosed on the basis of its symptoms and treated through therapy, which may include time in psychiatric hospital The Biopsychosocial Approach  Today’s psychologists content that all behavior, whether called normal or disordered arises from interaction of nature (genetic and physiological factors) and nurture (past and present experiences)  Cultures differ in their source of stress and produce different ways of coping  Not all disorders are culture-bound. Depression and schizophrenia occur world wide  To assess the whole set of includes genetic predispositions and physiological states, inner psychological dynamics and social and culture circumstances- the biopsychosocial model helps  This approach recognizes the mind and body are inseparable  Negative emotions contribute to physical illness and physical abnormalities contribute to negative emotions  We are mind embodied and socially embedded Classifying Psychological Disorders  In psychiatry and psychology classification orders and describes symptoms  Diagnostic classification aims not only to describe a disorder but also to predict its future course, imply appropriate treatment and stimulate research into its cause  To study a disorder we must first name and describe it  Current authoritative scheme for classifying psychological disorders is the DSM-IV-TR  Most practitioners find it a helpful and practical tool  One aim of the new DSM-5 is to support the integration of psychiatric diagnoses into mainstream medical practice  It defines a diagnostic process and 16 clinical syndromes  Without presuming to explain their causes, it describes disorders including psychological disorders How are psychological disorders diagnosed? Based on assessments, interviews, and observations, many clinicians diagnose by answering the following questions from the five levels, or axes of DSM-IV-TR Axis 1: Is a Clinical Syndrome present? Using specifically defined criteria, clinicians may select none, one, or more syndromes for a list Axis 2: Is a personality disorder or mental retardation (intellectual development disorder) present? Clinicians may or may not also select one of these two conditions Axis 3: Is a general medical condition such as diabetes, hypertension or arthritis, also present? Axis 4: Are psychosocial or environmental problems, such as school or housing issues, also present Axis 5: What is the Global Assessment of this person’s functioning? Clinicians assign a code from 0-100. Labeling Psychological Disorders  The DSM has other critics who register a more fundamental complaint-that these labels are at best arbitrary and value judgments masquerade science- labels create preconceptions that guide our perceptions and our interpretations  Labels bias perceptions, they can also change reality can serve as self-fulfilling prophecies  Benefits of diagnostic labels: mental health professionals use labels to communicate about their cases, to comprehend the underlying causes, and to discern effective treatment programs  Diagnostic definitions also inform patient’s self-understand, they are useful in research that explores the causes and treatment of disorders Rates of Psychological Disorders  Who is most vulnerable to psychological disorders? At what times of life?  To answer such questions, various countries have conducted lengthy, structures interviews with representative samples of thousands of their citizens  The studies found that those most vulnerable to mental disorders varies with the disorder  One predictor of mental disorder, poverty, crosses ethnic and gender lines  Disorders usually strike in early adulthood Module 48 – Anxiety Disorder  Anxiety disorder 0 psychological disorders characterized by distressing, persistent anxiety or maladaptive behaviours that reduce anxiety Generalized Anxiety Disorder  An anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal  Unfocused, out-of-control, negative feeling, pathological worry  2/3 are women  worry continually, are often jittery, agitated, and sleep deprived  concentration is difficult as attention switches from worry to worry  furrowed brows, twitching eyelids, trembling, perspiration, fidgeting  worst characteristics - person may not be able to identify, and therefore deal with or avoid its cause  Freud – anxiety is free-floating  May lead to depressed mood and high blood pressure  Many of those with this disorder were maltreated and inhibited as children  By age 50 – this disorder becomes fairly rare Panic disorder  Anxiety disorder marked by unpredictable, minutes-long episodes of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensations  Strikes suddenly, wreaks havoc, and disappears  1/75 – anxiety suddenly escalates into a terrifying panic attack  Heart palpitations, shortness of breath, chocking sensations, trembling, dizziness typically accompany the panic – may be misperceived as heart attack  smokers are 2x at risk Phobias  anxiety disorder marked by persistent, irrational fear and avoidance of a specific object, activity or situation  many people accept their phobias and live with them while others cannot  specific phobias: animals, insects, heights, blood, close spaces o these phobias have specific trigger – e.g. stuck in an elevator  social phobia o shyness taken to an extreme o no specific trigger o intense fear of being scrutinized by others, avoid potentially embarrassing social situations  worries about anxiety can amplify anxiety symptoms o people who have experienced panic attacks may come to avoid situations where panic has struck before  agoraphobia – fear or avoidance of situations in which escape might be difficult or help unavailable when panic strikes o people avoid being outside of home, inside an elevator, etc Obsessive-Compulsive disorder  an anxiety disorder characterized by unwanted repetitive thoughts (obsessions) and or actions (compulsions)  we all have some sense of obsessive-compulsive behavior but if it persistently interfere with everyday living and cause distress, then it’s a disorder  common obsessions and compulsions among children and adolescents with OCD o obsessions (repetitive thoughts)  concern with dirt, germs, or toxins  something terrible happening  symmetry, order, or exactness o compulsions (repetitive behaviors)  excessive hand washing, bathing, tooth brushing or grooming  repeating rituals  checking doors, locks, appliances, car brakes, homework  more common in younger population Post-traumatic stress disorder (PTSD)  an extreme disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, and/or insomnia that lingers for four weeks or more after a traumatic experience  it is defined less by the event itself but more by the traumatic memory of it  the greater one’s emotional distress during a trauma, the higher risk for PTSD symptoms o e.g. among those witnessed 9/11, PTSD was doubled for survivors who were inside rather than outside the World Trade Center  sensitive limbic system seems to increase vulnerability by flooding body with stress hormones again and again as images of the experience erupt into consciousness  aberrant and persistent right temporal lobe activations  genes may also play a role o combat-exposed men have identical twins who did not have experience in combat but the non-exposed twin tends to share their brother’s risk for cognitive difficulties such as unfocused attention – so some PTSD symptoms were genetically predisposed and combat was the trigger  “debriefing” survivors right after trauma by getting them to revisit the experience and vent emotions ahs proven generally ineffective and sometimes harmful  Exceptional amount of resilience is seen in trauma survivors who do not develop PTSD  Post traumatic growth – positive psychological changes as a result of struggling with extremely challenging circumstances and life crises  People whose life history includes some adversity tend to enjoy better mental health and well being than those with series of traumatic experience and those with none Understanding Anxiety Disorder  Freud – psychoanalytic theory proposed that, beginning in childhood, people repress intolerable impulses, ideas, and feelings and that this submerged mental energy sometimes produces mystifying symptoms, such as anxiety  Today’s psychologists – leaning and biological Learning perspective  Fear conditioning o When bad events happen unpredictably and uncontrollably, anxiety often develops o Through conditioning, the short list of naturally painful and frightening events can multiply into long list of human fears. o Two specific learning processes can contribute to such anxiety  Stimulus generalization – e.g. when a person attacked by a fierce dog later develops a fear of all dogs  Reinforcement – maintain our phobias and compulsions after they arise  Avoiding or escaping the feared situation reduces anxiety – reinforcing phobic/compulsive behaviour  E.g. if washing your hands gives you relief of anxiety, you may wash your hands again when those feelings return  Observational learning o By observing others’ fears, we learn to fear  E.g. nearly all monkeys reared in the wild fear snakes but lab-reared do not  Cognition o Our interpretations and irrational beliefs also make for anxiety o People with anxiety disorder also tend to be hyper-vigilant  E.g. sound of pounding heard = heart attack  Lone spider near bed = infestation Biological perspective  Natural selection o We seem biologically prepared to fear threats faced by our ancestors – spiders, snakes, and other animals, closed spaces, heights, storms and darkness o Those that did not fear about these occasional threats were less likely to have descendants o Fear of flying  biological predisposition to fear confinement and heights o But some things we do not learn  E.g. WWII air raids produced little phobias  those population exposed to it did not become panicked but more indifferent to planes in their neighborhood now  Gene o Some people are just more anxious than others o Among monkeys – fearfulness runs in the family o In humans, vulnerability to anxiety disorders rises when an afflicted relative is an identical twin o Identical twins also may develop similar phobias, even when raised separately o Gene influence disorders by regulating neurotransmitters o Some studies point to an anxiety gene that affects brain levels of serotonin o Genes regulate the neurotransmitter glutamate – too much glutamate then brain’s alarm center becomes overactive  The brain o Over-arousal of brain areas involved in impulse control and habitual behaviour o When disordered brain detects that something is amiss, it seems to generate a mental hiccup of repeating thoughts or actions o Anti-depressant drugs used Module 49-Mood Disorders Mood disorders: psychological disorder characterized by emotional extremes. They come in two forms - Major depressive disorder: prolonged hopelessness and lethargy - Bipolar disorder: person alternates between depression and mania Major Depressive Disorder - Can be called the common cold of psychological disorders - Number one reason why people seek mental health - Leading cause for disability world wide - Depressed mood is a response to past and current loss - Not totally bad because it slows us down, defuses aggression, helps us go of unattainable goals and restrains risk - You have major depressive disorder if at least five of the following symptoms over a two week period of time in the absence of drugs o Depressed mood most of the day o Not interest or pleasure in activates o Sleeping to much or not sleeping o Recurrent thoughts of death and suicide o Daily problems in thinking Bipolar Disorder - A mood disorder in which a person alternates between hopelessness and lethargy and overexcited state of mania o Mania: a mood disorder marked by a hyperactive wildly optimistic state - People with this claim twice as many lost workdays Understanding mood disorders 1. Many behavioral and cognitive changes accompany depression - Inactive and feel unmotivated - Often recall negative information - Expect negative results 2. Depression is widespread 3. Women’s risk of major depression is nearly double men - Factors that put women at risk: child abuse, low self-esteem, marital problems 4. Most major depressive episodes self-terminate - Return to normal without any help 5. Stressful events related to work marriage often precede depression - All puts a person at the risk of depression 6. With each new generation depression is striking earlier (late teens) and affect more people with the highest rates in developed countries The Biological perspective - Genetic influence o Mood disorders run in families o Increase if you have a parent or sibling with the disorder - The depressed brain o Studies conducted shows insight into brain activity during depressed and manic stats and into the effect of certain neurotransmitters during these stats o Shows decreased brain activity during slowed down depressives stats, and more activity during period of mania o Positive emotions: left frontal lobe and adjacent brain reward center are active during positive emotions and less active during depressed stats o When your depressed your frontal lobes are 7 percent smaller - With bipolar disorder o Structural different such as decrease axonal white matter or enlarged fluid filled ventricles - Neurotransmitter system influence mood disorders o Norepinephrine which increase arousal and boost moods is scarce during depression and overabundant during mania - Drugs that relieve depression tend to increase norepinephrine or serotonin supplies by blocking either their reuptake o Doing things that boost serotonin is good The social cognitive perspective - Explores the role of thinking and acting - Everything is dark and bad for depressed people - Depressed people tend to explain bad events in terms that they are o Stable: it is going to last forever o Global: it’s going to affect everything I do o Internal: its all my fault  This results in hopelessness Explanatory style and depression: after a negative experience a depression prone person many respond with a negative explanatory style Example: break up with a partner Stable : I’ll never get over this Temporary: this is hard to take but I will get through this Global: without my partner I can’t Specific: I miss my partner by seem to do anything right thankful I have my friends Internal: its all my fault External: it takes two Depression Successful coping Depression vicious cycle 1. Stressful experiences 2. Negative explanatory style 3. Depressed mood 4. Cognitive behavioral changes - You can break the cycle at any of these points by moving to a different environment, reversing our self-blame and negative attributions Module 50 Schizophrenia 50-1: Symptoms of Schizophrenia - Schizophrenia means “split mind” o Refers to a split from reality that shows itself in disorganized thinking, disturbed perceptions, and inappropriate emotions and actions - Psychosis is a psychological disorder in which a person loses contact with reality, experiencing irrational ideas and distorted perceptions o Schizophrenia is a prime example of psychosis Disorganized Thinking - Delusions are false beliefs, often of persecution or grandeur, that may accompany psychotic disorders - Paranoid tendencies are particularly prone to delusions of persecution o Even within sentences, jumbled ideas may create what is called word salad o E.g. a man begged for “a little more allegro in the treatment” - Disorganized thoughts may result from a breakdown in selective attention o Those with schizophrenia cannot give undivided attention to one set of sensory stimuli while filtering out others o Thus, irrelevant stimuli may distract their attention from a bigger event or a speaker’s meaning Disturbed perceptions - A person with schizophrenia may have hallucinations - sensory experiences without sensory stimulation o They may see, feel, taste, or smell things that are not there o They are often auditory, hearing voices making insults or giving orders Inappropriate emotions and actions - The expressed emotions of schizophrenia are often utterly inappropriate, split off from reality o E.g. Maxine laughed after recalling her grandmother’s death o E.g. crying for no reason - Other schizophrenia lapse into an emotionless state of flat affect - Most also have difficulty perceiving facial emotions and reading other’s state of mind - Motor behavior may also be inappropriate o E.g. continually rocking or rubbing an arm - Others who exhibit catatonia may remain motionless for hours and then become agitated 50-2: Onset and development of schizophrenia - Schizophrenia typically strikes as young people are maturing into adulthood - Affects both males and females, though men tend to be struck earlier and more severely o Studies show that thin young men and those who were not breast-fed are more vulnerable - For some, schizophrenia will appear suddenly, seemingly as a reaction to stress - For others, it develops gradually, emerging from a long history of social inadequacy and poor school performance - Schizophrenia is actually a cluster of disorders o Subtypes share some common features but also have distinguishing symptoms o Positive symptom patients may experience hallucinations, talk in disorganized ways, exhibit inappropriate emotion o Negative symptom patients have toneless voices, expressionless faces, or mute and rigid bodies o Thus, positive symptoms are the presence of inappropriate behaviours and negative symptoms are the absence of appropriate behaviours - One rule is when schizophrenia is a slow-developing process (chronic or process schizophrenia) recovery is doubtful - When previously self-adjusted people develop schizophrenia rapidly (acute or reactive schizophrenia), recovery is much more likely 50-3: Brain abnormalities Dopamine overactivity - One key researchers found when examining schizophrenia patients’ brains after death is an excess of receptors for the neurotransmitter dopamine o It is a six-fold excess for the so-called D4 dopamine receptor - Hyper-responsive dopamine system may intensify brain signals in schizophrenia, creating positive symptoms such as hallucinations and paranoia - Drugs that block dopamine receptors may lessen symptoms and drugs that increase dopamine levels may intensify them Abnormal brain activity and anatomy - Modern brain-scanning techniques reveal that many people with chronic schizophrenia have abnormal activity in multiple brain areas o Also often display a noticeable decline in the brain waves that reflect synchronized neural firing in the frontal lobes o Out-of-sync neurons may disrupt the integrated functioning of neural networks, possibly contributing to schizophrenia symptoms - Many studies have found enlarged, fluid-filled areas and a corresponding shrinkage and thinning of cerebral tissue in people with schizophrenia - The bottom line of various studies is that schizophrenia involves not one isolated brain abnormality but problems with several brain regions and their interconnections Maternal virus during mid-pregnancy - Another possible culprit is a mid-pregnancy viral infection that impairs fetal brain development Scientists have asked the following: - Are people at increased risk of schizophrenia if, during middle of fetal development, their country experienced a flu epidemic? - Are people born in densely populated areas at greater risk for schizophrenia? - Are those born during winter and spring months, after flu season, at increased risk? - Are mothers who report being sick with influenza during pregnancy more likely to bear a child with schizophrenia? 50-4: genetic factors - Fetal-virus infections do appear to increase the odds that a child will develop schizophrenia - Evidence strongly suggest that some people also inherit a predisposition to this disorder - Identical twins also share a prenatal environment o About 2/3 also share a placenta and blood it supplies o If an identical twin has schizophrenia, the co-twin’s chances of being similarly afflicted are 6/10 if they shared a placenta o If they had separate placentas like fraternal twins, the chances are only 1/10 - Adoption studies however confirm that the genetic link is real o Children adopted by someone who develops schizophrenia seldom “catch” the disorder o Rather, adopted children have an elevated risk if a biological parent is diagnosed with schizophrenia Psychological factors - If prenatal viruses and genetic predispositions do not, by themselves, cause schizophrenia, neither do family or social factors Some possible early warning signs are: - A mother whose schizophrenia was severe and long-lasting - Birth complications, often involving oxygen deprivation and low birth weight - Separation from parents - Short attention span and poor muscle coordination - Disruptive or withdrawn behavior - Emotional unpredictability - Poor peer relations Module 51 Dissociative, Personality, and Eating Disorders 51-1: Dissociative disorders - Dissociative disorders are disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings Dissociative identity disorder (DID) - DID is a rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities o Formerly called multiple personality disorder - Each personality has its own voice and mannerisms o Typically the original personality denies any awareness of the other(s) - People diagnosed with DID are usually not violent, but cases have been reported of dissociations into a “good” and “bad” personality Understanding DID - Skeptics question whether DID is a genuine disorder or an extension of our normal capacity for personality shifts - For instance, they find it suspicious that the disorder is so localized in time and space o Outside North America, the disorder is much less prevalent  Some in Britain consider it a “wacky American fad” o In India and Japan, it is essentially nonexistent or unreported - Such findings point to a cultural phenomenon, a disorder created by therapists in a particular social context o Rather than being provoked by trauma, dissociative symptoms tend to be exhibited by suggestible, fantasy-prone people - Other researchers believe that DID is a real disorder o Ophthalmologists have detected shifting visual acuity and eye-muscle balance as patients switched personalities  Changes that did not occur among control group members trying to simulate DID o They also have exhibited heightened activity in brain areas associated with the control and inhibition of traumatic memories - Other clinicians include Dissociative disorders under the umbrella of post-traumatic disorders - a natural protective response to “histories of childhood trauma” 51-2: Personality disorders - Personality disorders are psychological disorders characterized by inflexible and enduring behavior patterns that impair social functioning o Anxiety is a feature of one cluster of these disorders, such as a fearful sensitivity to rejection that predisposes the withdrawn avoidant personality disorder o A second cluster expresses eccentric or odd behaviours, such as the emotionless disengagement of the schizoid personality disorder o Third cluster exhibits dramatic or impulsive behaviours, such as the attention- getting histrionic personality disorder and the self-inflating narcissistic personality disorder Antisocial personality disorder - This is the most troubling and heavily researched personality disorder - The person (sometimes called a sociopath or psychopath) is typically a male whose lack of conscience becomes plain before age 15, as he begins to lie, steal, fight, or display unrestrained sexual behavior o About half the children become antisocial adults - Despite their remorseless and sometimes criminal behavior, criminality is not an essential component of antisocial behavior o This is because criminals actually show responsible concern for their friends and family members o Antisocial personalities behave impulsively and feel and fear little Understanding antisocial personality disorder - It is a disorder woven of both biological and psychological strands - Twin and adoption studies reveal that biological relatives of those with antisocial and unemotional tendencies are at increased risk for antisocial behaviour - Genetic influences, often in combination with child abuse, help wire the brain o Studies found reduced activity in the murderers’ frontal lobes, an area of the cortex that helps control impulses o Also found that violent repeat offenders had 11% less frontal lobe tissue than normal - Studies show that two combined factors - childhood maltreatment and a gene that altered neurotransmitter balance - predicted antisocial problems o Neither “bad” genes alone nor a “bad environment” alone predisposed later antisocial behavior 51-3: Eating disorders - Anorexia nervosa is an eating disorder in which a person (usually female) maintains a starvation diet despite being significantly underweight o About half of those with anorexia displays a binge-purse-depression cycle - Bulimia nervosa is an eating disorder in which a person alternates binge eating (usually high-calorie foods) with purging (vomiting or laxative use) or fasting o Experience depression and anxiety during and following binges o Marked by weight fluctuations within or above normal ranges unlike anorexia - Binge-eating disorder is significant binge-eating episodes, followed by distress, disgust, or guilt, but without the compensatory purging or fasting that marks bulimia nervosa - Those with eating disorders often have low self-evaluations, set perfectionist standards, fret about falling short of expectations and are intensely concerned with how others perceive them - Genetics also influence susceptibility to eating disorders o Twins are more likely to share the disorder if they are identical rather than fraternal - These disorders also have cultural and gender components o Ideal shapes vary across culture and time o E.g. in Africa, plumpness means prosperity so bigger seems better Therapy Module 52 –The Psychological Therapies Treating Psychological disorders  Today’s therapies can be classified into two main categories 1. In psychotherapy a trained therapist uses psychological techniques to assist someone seeking to overcome difficulties or achieve personal growth. 2. Biomedical therapy offers medication or other biological treatments  Some therapists combine techniques  Half of all psychotherapists describe themselves as taking an eclectic approach, using a blend of psychotherapies  Many patients can receive psychotherapy combined with medication  Psychoanalysis and Psychodynamic Therapy  Sigmund Freud’s psychoanalysis was the first psychological therapies  Few clinicians today practice therapy as Freud did Psychoanalysis: Goals  Psychoanalytical theory presumes that healthier, less anxious living becomes possible when people release the energy they had previous devoted to id-ego-superego conflicts  Freud assumed we do not fully know ourselves  There are threatening things that we seem to want not to know that we disavow or deny  Freud’s therapy aimed to bring patients repressed or disowned feelings into conscious awareness  By helping them reclaim their unconscious thoughts and feelings and giving them insight into the origins of their disorders, he aimed to help them reduce growth-impeding inner conflicts Techniques  Psychoanalysis is historical reconstruction  It emphasizes the formative power of childhood experiences and their ability to mold the adult  It hopes to unearth the past to unmask the present  Freud used free association  Psychoanalyst sits well the patient says whatever comes to mind  The analyst recognizes resistance to speak about certain topics and provides insight into their meaning  This interpretation proving might illuminate the underlying wishes, feelings and conflicts you are avoiding  The analyst may also offer an explanations of how this resistances fits with other pieces of your psychological puzzle including those based on analysis of your dream content  Through many sessions the analysis may suggest you are transferring feelings that you experience in earlier relationships with family members or other important people. By exposing such feelings, you may gain insight into your current relationship  Relatively few US therapists now offer tradition psychoanalysis; much of its underlying theory is not supported by scientific research Psychodynamic Therapy-try to help people understand their current symptoms  Focus on themes across important relations including childhood experiences and the therapists relationship  Patients meet with their therapists face to face, once or twice a week and often for only a few weeks or months (different than psychotherapy)  In these meetings, patients explore and gain perspective into defended-against thoughts and feelings  Psychodynamic therapists may also help reveal past relationship troubles as the origin of current difficulties  Interpersonal psychotherapy, a brief (12 to 16 sessions) variation of psychodynamic therapy has effectively treated depression  Although interpersonal psychotherapy aims to help people gain insight into the roots of their difficulties its goal is symptom relief in the here and now  Rather than focusing on undoing past hurts and offering interpretations the therapist concentrates primarily on current relationship and on helping people improve their relationship skills Humanistic Therapies  Humanistic perspective has emphasized peoples inherence potential for self-fulfillment  Like psychodynamic therapies, humanistic therapies have attempted to reduce growth- impeding inner conflicts by providing clients with new insights  Psychodynamic and humanistic therapies are often referred to as insight therapies  Humanist therapist different form psychoanalytic therapies in many other ways:  Humanistic therapists aim to boost people’s self-fulfillment by helping them grow in self- awareness and self-acceptance  Promoting this growth, not curing illness, is the focus of therapy. This, those in therapy become “client” or just “persons” rather than “patients” (a chance many other therapists have adopted)  Path to growth is taking immediate responsibility for one’s feelings and actions, rather than uncovering hidden determinates  Conscious thoughts are more important than the unconscious  Present and future are more important than the past. The goal is to explore feelings as they occur rather than achieve insights into the childhood origins of the feelings  Carl Rogers developed the widely used humanistic technique he called client-centered therapy which focuses on the person’s conscious self-perceptions  In this nondirective therapy, the therapist listens , without judging or interpreting and seeks to regain from direction the client toward certain insights  Believes most people possess the resources from growth, Rogers encouraged therapists to exhibit acceptance and empathy  When therapists drop their facades and genuinely express their true feelings and enable their clients to feel unconditionally accepted the clients may deepen heir self- understanding and self-acceptance  Rogers technique of active listening-echoing, restating and seeking clarification of what the person expresses (verbally or nonverbally) and acknowledging the expressed feelings  Active listening is now an accepted part of therapeutic counsel practice  Counselor listens attentively and interrupts only to restate and confirm feelings, to accept what is being expressed or to seek clarification  Rogers conceded that one cannot be totally nondirective  He believed that the therapist’s most important contribution is accept and understand the client  Given a nonjudgmental grace-filled environment that provides unconditional positive regard, people may accept even their worst traits and feel valued and whole Behavior Therapies  Insight therapies assume that many psychological problems diminishes as self-awareness grows  Psychodynamic therapists expect problems to subside as people gain insight into their unresolved and unconscious tensions  Humanistic therapist expect problems to diminish as people get in touch with their feelings  Proponents of behavior therapy however doubt the healing power of self-awareness  They assume that problem behaviors are the problems and the application of learning principles can illuminate them  Rather delving deeply below the surface looking for inner causes, behavior therapists view maladaptive symptoms as learned behaviors that can be replaced by constructive behaviors Classical Conditioning Techniques  We learn various behaviors and emotions through classical conditioning  Counter conditioning pairs the trigger stimulus with a new response that is incompatible with fear  Behavior therapists have successfully counter conditioned people with such fears  Two specific counterconditiong techniques-exposure therapy and aversive condition replace unwanted responses Exposure Therapies  Expose people to what they normally avoid or escape (behaviors that get reinforced by avoidance).  Exposed therapies have them face their fear and thus overcome their fear of the fear response itself  One widely used exposure therapy is systematic desensitization  If you can repeatedly relax when facing anxiety-provoking stimuli, you an gradually eliminate your anxiety  Next, using progressive relaxation, the therapist would train you to relax one muscle group after another, until you achieve a blissful state of complete relaxation and comfort  The therapist would profess up to the constructed anxiety hierarchy, using the relaxed state to desensitize  After several sessions you move to actual situations and practice what you had only imagined before, beginning with relatively easy tasks and gradually moving to more anxiety-filled ones  Conquering your anxiety in an actual situations, not just in your imagination raises your self-confidence  Virtual reality exposure therapy-wearing a head-mounted display until that projects a three-dimensional virtual world, you would view a lifelike series of scenes that would be tailored to your particular fear and shift as your head turned Aversive Conditioning  In systematic desensitization, the goal is substituting a positive response for a negative response to a harmless stimulus  In aversive conditioning, the goal is for substituting a negative response for a positive response to a harmful stimulus  Thus, aversive conditioning is the reverse of systematic desensitization it seeks to condition an aversion to something the person should avoid  It associates the unwanted behavior with unpleasant feelings  The issue is that in therapy, cognition influences conditioning  Therapist often use aversive condition in combination with other treatments Operant Conditioning  Voluntary behaviors are strong influences by their consequences  Knowing this, behavior therapists can practice behavior modification-reinforcing desired behaviors and withholding reinforcement for undesired behaviors  Operant conditioning is used to solve specific behavior problems  Combination of positively reinforcing desired behaviors and ignoring or punishing aggressive and self-abusive behaviors works well for some  Rewards used to modify behavior vary; for some people reinforcing power of attention or praise is sufficient well others require concrete rewards  In institutional settings, therapists may create a token economy  When people display appropriate behavior they receive a token as positive reinforce, later exchange their accumulated tokens for various rewards  Critics of behavior modification express two concerns: First is practice: How durable are the behaviors? Second is ethnical: Is it right for one human to control another’s behavior? Cognitive Therapies  Assume that our thinking effects our feelings  Between the event and our response lies the mind  Self-blaming and over-generalized explanations of bad events are often an integral part of the vicious cycle of depression  Cognitive therapists try in various ways to teach people new, more constructive ways of thinking Aim of Technique Technique Therapists Directions Reveal Beliefs Question your interpretations Explore your believes, revealing faulty assumptions Rank thoughts & emotions’ Gain perspective by ranking your thoughts and emotions from mildly to extremely upsetting Test Beliefs Examine consequences Explore difficult situations, assessing possible consequences and challenging faulty resonating Decatastrophize thinking Work through actual worst case consequences of situation you face. The determine how to cope with real situation you face Change beliefs Take appropriate responsibility Challenge total self-blame and negative thinking, noting aspects for which you may be truly responsible, as well as aspects that aren’t your responsibility Resist extremes Develop new ways of thinking & feeling to replace maladaptive habits Rational Emotive Behavior Therapy (REBT)  Albert Ellis creator of REBT believed many problems arise from irrational thinking  Change people’s thinking by revealing the “absurdity” of their self-defeating ideas and you will change their self-defeating feelings and enable healthier behavior, Ellis believed Aaron Beck’s Therapy for Depression  Aaron Beck as believes that changing people’s thinking can change their function  With Cognitive Therapy Beck and colleagues have sought to reverse client’s catastrophizing beliefs about themselves, their situations and their futures  Gentle questioning seeks to revel irrational thinking and then to persuade people to remove the dark glasses through which they view life  Getting people to change what they say to themselves is an effective way to change their thinking  Donald Meichenbaum offered stress inoculation training: teaching people to restructure their thinking in stressful situations Selected Cognitive Therapy Techniques  Cognitive Behavioral Therapy, a widely practiced integrative therapy aims not only to alter the way people think (cognitive therapy), but also to alter the way they act (behavioral therapy)  Seeks to make people aware of their irrational negative thinking to replace it with new ways of thinking and to practice the more positive approach in everyday settings  Behavioral change is typically addressed first followed by session of cognitive change therapy concluded with a focus on maintaining both and preventing relates  Anxiety and mood disorders share a common problem: emotion regulation  An effective treatment program for these emotional disorders constrains people both to replace their catastrophizing thinking with more realistic appraisals  Many studies confirm cognitive behavioral therapy effectiveness for those suffering anxiety, depression or anorexia nervosa Group and Family Therapies  Except for traditional psychoanalysis most therapies may also occur in small groups  Group therapy does not provide the same degree of therapists involvement with each client  Some benefits: save therapists time and clients money  Offers a social laboratory for exploring social behaviors and developing social skills  Enables people to see that others share their problems  It provides feedback as clients try out new ways of behaving Family Therapy  One special type of group interaction, family assumes that no persons an island  Family therapists work with multiple family members to heal relations and mobilize family resources  View family as a system in which each person’s actions triggered reactions from other and they help family members discover their roles within their family’s social system  Therapists also attempt to open up communication within the family or to help family  members discover new ways of preventing or resolving conflicts Self-Help Groups  Many people also participate in self-help and support groups  Most support groups focus on stigmatized or hard to discuss illness Therapy Presumed Problem Therapy Aim Therapy Technique Psychodynamic Unconscious conflicts Reduce anxiety Interpret patients’ from childhood through self-insight memories and feelings experiences Client-centered Barriers to self- Enable growth via Listen actively and understanding and unconditional positive reflect self-acceptance regard, genuineness, and empathy Behavior Dysfunctional Relearn adaptive Use classical behaviors behaviors; extinguish condition (via problem ones exposure or aversion therapy) or operant condition (as in toke economies) Cognitive Negative, self- Promote healthier Train people to defeating thinking thinking and self-talk dispute negative thoughts and attributions Cognitive-behavioral Self-harmful thoughts Promote healthier Train people to & behaviors thinking & adaptive counter self-harmful behaviors thoughts & behaviors Group & family Stressful relationships Heal relationships Develop an understanding of gamily and other social systems, explore roles & improve communication Module 53: Evaluating Psychotherapies Psychotherapy: treatment involving psychological techniques; consists of interactions between a trained therapist and someone seeking to overcome psychological difficulties or achieve personal growth 53.1 Is psychotherapy effective? Clients Perceptions  We should not dismiss testimonials lightly  For several reasons, client testimonials do not persuade psychotherapy’s skeptics: 1. People often enter therapy in crisis 2. Clients may need to believe the therapy was worth the effect 3. Clients generally speak kindly of their therapists  As research findings continue to document, we are prone to selective and biased recall and making judgments that confirm our beliefs Clinicians Perceptions  Most therapists testify their success stories  Clients’ and therapists’ perceptions of therapy’s’ effectiveness are vulnerable to inflation from two phenomenon  One is placebo effect-the power of belief in a treatment  The second is regression toward the mean- the tendency for extreme or unusual scores to fall back (regress) toward their average  We sometimes attribute what may be a normal regression (the expected return to normal) to something we have done Outcome Research  The opening challenge to the effectiveness of psychotherapy was issued by British psychologist Hans Eysenck (1952) launching a spirited debate, he summarized studies showing that two-thirds of those receiving psychotherapy for nonpsychotic disorders improved markedly  Eysenck also reported similar improvement among untreated persons  With or without psychotherapy, he said, roughly two-thirds improved noticeably  According to him time was a great healer Meta-analysis: a procedure for statistically combining the results of many different research studies  Simply said, meta-analyses give us the bottom-line results of lots of studies  Those not undergoing therapy often improve, but those undergoing therapy are more likely to improve more quickly, and with less risk of relapse 53.2 The Relative Effectiveness of Different Psychotherapies  Consumer reports concluded, clients seemed equally satisfied whether treated by a psychiatrist, psychologist or a social worker; whether seen in a group or individual context; whether the therapist had extensive or limited training and experience  Other studies concur, there is little if any connection between clinicians’ experience, training, supervision, and licensing and their clients’ outcomes  Therapy is most effective when the problem is clear-cut  The more specific the problem, the greater the hope Evidence-based practice: clinical decision making that integrates the best available research with clinical expertise and patient characteristics and preferences 53.3 Evaluating Alternative Therapies Eye Movement Desensitizing and Reprocessing (EMDR)  Francine Shapiro (1889, 2007) developed EMDR while walking in a park and observing that anxious thoughts vanished as her eyes spontaneously darted about  Offering her novel anxiety treatment to others, she had people imagine traumatic scenes while she triggered eye movements by waving her finger in front of their eyes, supposedly enabling them to unlock and reprocess previously frozen memories  Franz Anton Mesmer introduced animal magnetism (hypnosis)  Some argue that eye movements server to relax and distract patients, thus allowing the memory-associated emotions to extinguish  Others believe that eye movements themselves are not the therapeutic ingredient Light Exposure Therapy  Seasonal affective disorder- SAD: wintertime blahs constitute a form of depression  To counteract these dark spirits, National Institute of Mental Health researchers in the early 1980s had an idea: give SAD people a timed daily dose of intense light  The effects are clear in brain scans; light therapy sparks activity in a brain region that influences the body’s arousal and hormones 53.4 Commonalities among Psychotherapies  According to Jerome Frank (1982), Marvin Goldfried, Hans Strupp, and Bruce Wampold have studied the common ingredients of various therapies  They suggest they all offer at least three benefits: 1. Hope for demoralized people- what any therapy offers is the expectation that, with commitment from the therapy seeker, things can and will get better 2. A new perspective- every therapy also offers people a plausible explanation of their symptoms and an alternative way of looking at themselves or responding to their world 3. An empathic, trusting, caring relationship  These three common elements are also part of what the growing numbers of self-help and support groups offer their members Therapeutic Alliance: a bond of trust and mutual understanding between a therapist and client, who work together constructively to overcome the clients’ problem 53.5 Culture, Gender, and Values in Psychotherapy  All therapies offer hope, and nearly all therapists attempt to enhance their clients’ sensitivity, openness, personal responsibility, and sense of purpose  But in matters of diversity, therapists differ from one another and may differ from their clients  In North America, Europe, and Australia, for example most therapists reflect their culture’s individualism which often gives priority to personal desires and identity, particularly for men  Clients who are immigrants from Asia would have a hard time thinking of just themselves when they are mindful of others expectations  Such differences help explain minority populations’ reluctance to use mental health services and tendency to prematurely terminate therapy 53.7 Preventing Psychological Disorders  Psychological research has shown that lifestyle change can help reverse some of the symptoms of psychological disorders  Might such change also prevent some disorders by building individuals’ resilience Resilience: the personal strength that helps most people cope with stress and recover from adversity and even trauma  We could interpret psychological disorders as understandable responses to a disturbing and stressful society  According to this view, it is not just the person who needs treatment, but also the person’s social context  Intervention efforts often based on cognitive-behavioral therapy principles significantly boost child and adolescent flourishing  Through such preventive efforts and healthy lifestyles, fewer of us will fall into the rushing river of psychological disorders Module 54: The Biomedical Therapies - Psychotherapy – trained therapist uses psychological techniques psychological disorders - Biomedical therapy – physically changing the brain’s function by altering its chemistry with drugs, or affecting its circuitry with electroconvulsive shock, magnetic impulses, or psychosurgery o Only offered by psychiatrists (medical doctors) with few exceptions Drug Therapies - Most widely used biomedical treatments - Psychopharmacology – study of drug effects on mind and behaviour - resident population of mental hospitals is a small fraction of what it used to be o because of drug therapy, efforts to minimize involuntary hospitalization, and efforts to support people (with community mental health programs) - most drug therapies are met with enthusiasm, but are diminished when researchers subtract: o 1) normal recovery rates among untreated persons o 2) recovery rates due to the placebo effect (from positive expectations) - Double blind procedure – researchers give half the patients the drug and the other half a similar looking placebo; neither the staff nor the patients know who gets which Antipsychotic Drugs - Psychoses – disorders in which hallucinations or delusions indicates some loss of contact with reality - Anti-psychotic drugs – dampen responsiveness to irrelevant stimuli o Provided most help to patients experiencing positive signs of schizophrenia o Molecules of most conventional anti-psychotic drugs are similar enough to the molecules of the neurotransmitter dopamine to occupy its receptor sites and block its activity  Reinforces idea that overactive dopamine contributes to schizophrenia - Side effects: sluggishness, tremors and twitches (like in Parkinson’s disease) o Long term side effects: tardive dyskinesia (involuntary movements of facial muscles, tongue, and limbs o Many newer-generation antipsychotics have fewer of these effects o Can increase the risk of obesity and diabetes Antianxiety Drugs - Antianxiety drugs – depress central nervous system activity (should not be used in combination with alcohol - Often used in combination with psychological therapy - Reduce symptoms without resolving underlying problems o Can produce psychological dependence and physiological dependence - New standard drug treatment for anxiety disorders  antidepressants Antidepressant Drugs - Named for ability to life people from a state of depression - Also used now to treat anxiety disorders (like OCD) - Works by increasing the availability of norepinephrine or serotonin – neurotransmitters that elevate mood (scarce during depression) o Fluoxetine (Prozac) blocks the reabsorption and removal of serotonin from
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