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Chapter 14

PSY100H1 Chapter Notes - Chapter 14: Personality Disorder, Panic Disorder

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Chapter 14Treating Disorders of Mind and Body
Psychodynamic therapy focuses on INSIGHT:
-Psychotherapy: changing the patterns of thought and behaviour
-Freud was the first to develop psychological treatment for mental illness, he believed mental
disorders were caused by prior experiences, particularly early traumatic experiences
-Breuer, developed the method of psychoanalysis, in which the patient typically lay on a couch with
the therapist sitting out of view, in order to reduce the patient’s inhabitations and allow freer access
of unconscious thought processes
- Treatment was based on uncovering unconscious feelings and drives believed to give rise to
maladaptive thoughts and behaviours
- Techniques included free association, in which the patient says whatever comes to mind, and dream
analysis, in which the therapist interprets the hidden meaning of dreams
-Focus on insight (understanding his or her own psychological processes)
- Modified versions used today, however more focus on today’s relationships
-Short-term therapy useful for depression, eating disorders, substance abuse
Humanistic Therapies focus on THE WHOLE PERSON:
- Treat the person as a whole, not as a collection of behaviours or a repository of repressed and
unconscious thoughts
-Client-centered therapy - fulfill individual potentials for personal growth through greater self-
-Need to be empathic
-Use reflective listening: repeating client’s concerns to help clarify his or her feelings
-Motivational interviewing: good treatment for drug and alcohol abuse
Behavioural Therapy focus on OBSERVABLE BEHAVIOR.
- Consider maladaptive behavior to be the problem itself and not result of underlying problem
- Basic premise is that the behavior can be unlearned
- Reflect the medical approach to illness and disease. A limitation is that although they are often effect
in the short term, long-term success requires the person to continue treatment, sometimes
-Behaviour modification, based on operant conditioning, rewards desired behaviours and ignores or
punishes unwanted behaviours.
-Social-skills training is an effective way to elicit desired behaviour
-Modeling in which the therapist acts out appropriate behaviour
oThe client is encouraged to imitate this behaviour, rehearse it in therapy, and later apply the
learned behaviour to real-world situations
-An approach that integrates insight therapy with behavioural therapy is interpersonal therapy,
which focuses on relationships that the patient attempts to avoid
oTreatment is focused on helping patients express their emotions and explore interpersonal
-Exposure: therapy for phobia, repeatedly expose, based on classical conditioning
oGradual form of exposure is systematic desensitization, uses relaxation
oTechniques to allow client to imagine anxiety producing situation while maintaining relaxation
Cognitive-Behavioural therapy focuses on FAULTY COGNITIONS
- Based on the theory that distorted thoughts can produce maladaptive behaviors and emotions.
Modifying these thoughts can be used as treatments
-Cognitive restructuring, in which clinicians help their parents recognize maladaptive thought
patterns and replace them with ways of viewing the world that are more in tune with reality
-Rational-emotive therapy, introduced by Albert Ellis, in which therapists act as teachers who
explain and demonstrate more adaptive ways of thinking and behaving
-Cognitive-behavioural therapy (CBT), is perhaps the most widely used version of cognitive
therapy, it incorporates techniques from behavioural therapy and cognitive therapy. CBT tries both to
correct faulty cognitions and to train clients to engage in new behaviours
oHas proven to be on the of most effect forms of psychotherapy for many types of mental
illness, especially anxiety disorders and mood disorders
Group Therapy builds SOCIAL SUPPORT:
-Benefits include improving social skills and learning from others, and providing support
Family Therapy focuses on the family context
-Systems approach: an individual is part of a larger context, and any chance in individual behaviour
will affect the whole system
-Family plays a big role in treatment of patient
-Expressed emotion: a pattern of interactions that includes emotional over-involvement, critical
comments, and hostility directed toward a patient by family members
- Relapse rates vary significantly
- Those with families with a lot of EE need medication much more than those with low EE.
oA family’s level of negative expressed emotion correspond to the relapse rate for patients with
Biological Therapies are necessary for some disorders
-Psychotropic medications: drugs that affect mental processes, change brain neurochemistry
-Anti-anxiety drugs: tranquilizers. Short-term treatment of anxiety - increase activity of GABA
(inhibitory). These drugs (benzodiazepines) induce drowsiness and are addictive. Some drugs don’t
have this (buspirone)
- Antidepressants: MAO (Monoamine oxidase) inhibitors were the first antidepressants to be discovered
-MAO inhibitors: a category of anti-depressant drugs that inhibit the action of monoamine oxidase
(an enzyme that converts serotonin into another chemical form). These drugs also up dopamine and
-Tricylic antidepressants: inhibit the reuptake of a number of different neurotransmitters, e.g.
-Selective serotonin reuptake inhibitors (SSRIS): a category of antidepressant medications that
prolong the effects of serotonin in the synapse
-Antipsychotics (neuroleptics): a class of drugs used to treat schizophrenia and other disorders
that involve psychosis. Reduce symptoms such as delusions and hallucinations. Inhibit dopamine
-Have irreversible side effects like tardive dyskinesia: involuntary twitching of muscles. Also not useful
for treating negative symptoms of schizo
-Clozapine acts both on dopamine and serotonin, norepinephrine, acetylcholine, and histamine
-Lithium is used for bipolar disorder.
-Anticonvulsants used to regulate moods and prevent seizures
Common factors enhance treatment
- Those who received both drugs and psychotherapy reported the best outcomes, followed by those
receiving only psychotherapy and the those receiving only drugs
- Therapy helps, but the type does not matter
- Common factors in therapy might facilitate positive outcomes regardless of the type of therapy used
A caring therapist
- One factor known to affect the outcomes of therapy is the relationship between the therapist and
Confessions is good for the spirit
- Aristotle coined the term catharsis, to describe the way certain messages evoke powerful emotional
reactions and subsequent relief
- Freud used incorporated the idea of catharsis into his treatment of mental disorders. He believed that
uncovering unconscious material and talking about it would bring about catharsis and therefore relief
from symptoms
- Pennebaker finds that when people reveal intimate and highly emotional material, they go into an
almost trancelike state
- Talking or writing about emotionally charged events reduces blood pressure, muscle tension, and skin
conduction during the disclosure and immediately after
What are the most effective treatment
- David Barlow points out that findings from medical studies often lead to dramatic changes in
treatment practice
- Increasing importance of evidence-based treatments in medicine
- Psychological treatments to distinguish evidence-based treatment from more generic talk
- Vary according to the particular mental disorder
- Treatments should be tailored specifically to the specific psychological symptoms of a client. Second,
the techniques used in these treatments have been developed in the laboratory by psychological
scientists, especially behavioural, cognitive, and social psychologists. Finally, no overall grand theory
guides treatment, but rather it is based on evidence of its effectiveness
- Good evidence that confessing, writing and talking about emotional events and traumas is very
beneficial for health. Improves immune function in HIV patients
Specific phobias
- Characterized by fear and avoidance of particular stimuli
- Fears are acquired either though experiencing a traumatic personal encounter or by observing similar
fear in others
- In systematic desensitization therapy, the client first makes a fear hierarchy, a list of situations in
which fear is aroused, in ascending order. The next step is relaxation training, in which clients learn
to contrast muscular tension with muscular relaxation and to use relaxation techniques. Once the
client has learned to relax, exposure therapy is often the next step.
- One way to expose people without putting them in danger is to use virtual environments, sometimes
called virtual realities, i.e. computer simulations
- Brain-imaging date indicate that successful treatment with cognitive-behavioural therapy alters how
the fear stimulus is processed in the brain
- Those whose treatment had been successful shoed decreased activation in a frontal brain region
involved with emotional regulation
- Psychotherapy effectively rewires the brain
- Tranquilizers can help people handle immediate fear
- Researchers found that both Prozac and cognitive-behavioural therapy were effective in treating
social phobia
Panic Disorder
- Imipramine, a tricyclic antidepressant, prevents panic attacks but does nothing to reduce the
anticipatory anxiety that clients have when they fear they might have a panic attack
- In order to break the learned association between the physical symptoms and the feelings of
impending doom, cognitive-behavioural therapy can be effective
- Cognitive-behavioral perspective: the panic attacks continue because of a conditioned response to
the trigger, goal is to break the connection between the trigger symptom and the resulting panic. This
can be done by exposure treatment, which induces feelings of panic
- Those who received psychotherapy were less likely to relapse than those who had taken medication
- These findings indicate that cognitive behavioural therapy is the treatment of choice for panic
- For those who have panic disorder with agoraphobia, the combination of CBT and drugs is better than
either treatment alone
Obsessive-Compulsive disorder
- OCD is at least in part genetic and appears to be related to Tourette’s syndrome, a neurological
disorder characterized by motor and vocal ties, convinced that many that OCD was a biological
disorder that should respond to a biological treatment
- When SSRIs began to be used to treat depression, it was found that they were particularly effective in
reducing the obsessional components of some depressions, such as constant feelings of
worthlessness, proved to also be effective for OCD
- The drug of choice for OCD is the potent serotonin reuptake inhibitor clomipramine
oHowever, clinical studies have shown that 40-60% of patients with OCD do not improve when
treated with these medications
- For some, combining SSRIs with dopamine receptor blockers has been effective
-Interesting to note that the patients who benefit from this combination are those who also suffer from
tics, such as Tourette’s syndrome
- Tic disorders are related to dopamine dysfunction
- Genetic studies have hinted at a link between OCD and Tourette’s patients also have OCD symptoms.
Thus, this suggests dopamine plays a role in OCD
- Other studies implicate high levels of the hormone oxytocin in people with OCD
- There may be two distinct types of OCD: one tic related and one non-tic related
- Cognitive-behavioural therapy is also effective for OCD and is especially valuable for those who do
not benefit from or who do not want to rely on medication.
- The two most important components of behavioural therapy for OCD are exposure and response
- Clients are directly exposed to the stimuli that trigger compulsive behaviour, but are prevented from
engaging in the behaviour. This treatment is based on the theory that a particular stimulus triggers
anxiety, and that performing the compulsive behaviour reduces that anxiety
- As with exposure therapy for panic disorders, the goal is to break the conditioned link between
particular stimuli and compulsive behaviour.