12 and 13 Flashcards
By studying abnormal psychology, the hope is
to gain a better understanding of normal psychology.
All cultures have
depression and schizophrenia.
450 million people have disorders, which vary by
culture
this is a ___ _____ between normal and abnormal
gray area
patterns of thoughts, feelings, and behaviors that are deviant, distressful, and dysfunctional
psych disorders
This means the behavior strays from what is normal. The norms of a society are determined by different things…
Culture – one culture’s norms may be another’s deviance.
Time period – what used to be odd may now be normal, or vice versa.
deviant
Just straying from the normal doesn’t make a disorder. They must also be bothered by what they do or see it as problematic.
distress
The abnormal behavior must also create problems in the person’s life. Whereas distress is on the inside, dysfunction sees the problem carried out in real life.
dysfunction
“Therapies” for psychological disorders have been very crude in the past. Things were done like
caging the insane, or beating/burning/mutilating them in some way.
The normal thinking was either that the person was possessed by an evil spirit or simply acting that way for attention.
were reformers who tried to replace brutality with care and loving treatment.
Philippe Pinel and Dorothea Dix
By the 1800s, it was learned that _______ affects the mind. This started the movement towards hospitals and away from jail cells. It also started two new approaches to psychological disorders…
syphalis
a movement that looks for biological causes of mental disorders. It believes:
Mental disorders are diagnosed based on their symptoms.
Mental disorders are cured through a therapy.
medical model
believes ALL behavior comes from the interaction of the body/genetics and one’s background/experiences as well as our thoughts.
The “bio” and the “social” parts of the name simply refer to nature and nurture.
The “psycho” part of the name is what we think about things. All three dance together.
Different cultures tend to have different disorders.
biopsychosocial
the current “disorder bible.” It’s the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The DSM-5 came out in 2013 and replaced the DSM-IV-TR (which came out in 2000).
DSM-5
The DSM-5 includes
a diagnostic process and 16 clinical syndromes.
It does not try to explain _______ but tries to describe the disorder.
causes
The DSM gets good and bad marks…
The DSM has been praised for being rather reliable in diagnoses.
The DSM has been criticized for being too broad.
Almost any behavior could be stretched into being some type of “disorder.”
The number of categories has increased from 60 in the 1950s to 400 today.
Also, the number of people diagnosed with something has increased substantially.
What used to be the regular “ups and downs of life” is now “bipolar disorder.”
What used to be sassiness is now “oppositional defiance disorder.”
What used to be fidgety is now “ADHD.”
did a study in 1973 on labels. He and other normal people lied and said they heard voices talking to them. They were diagnosed with disorders.
The initial fact they were diagnosed might be okay. But later, the “causes” of their supposed problems were also pinpointed.
David Rohsana
In another experiment, people watched others on TV. The watchers
were shown different labels for the people they were watching. Thus, the watchers drew different conclusions about the people on TV.
tends to perpetuate stereotypes too of mental disorders. A person is usually either funny, freaky, or a psychotic killer.
People with mental disorders are rarely violent, but often the victims.
hollywood
Labels can also lead to the ________ _______ _______ where a person’s expectations cause the expected result.
For instance, if a teacher is told a student is “gifted” the teacher may grade more forgivingly on an essay. Thus, the student gets better grades and acts as though he or she really is gifted.
Or if student A speaks to student B and labels a teacher as “mean”, student B might be disrespectful to the teacher, see the teacher come down hard on student B, and thus verify student B’s perception of a mean teacher.
_self-fulfilling prophecy
Everyone feels ______ (worrying) at some point, like being nervous before giving a speech. But, for most people, anxiety is temporary. If it’s persistent, an anxiety disorder may be present.
anxiety
There are five basic anxieties
(1) generalized anxiety disorder, (2) panic disorder, (3) phobias, (4) obsessive-compulsive disorder, and (5) post-traumatic stress disorder.
worry that does not have a specific reason or a physical cause for the anxiety., The focus of the worry may change. The person cannot explain why he/she is so edgy.
generalized anxiety disorder
eneralized anxiety disorder often goes with_____ and can lead to high blood pressure.
DEPRESSION
GAS It tends to decline by about age
It tends to decline by about age 50.
(GAD) - symptoms
The symptoms are things such as dizziness, sweating palms, heart palpitations, ringing in the ears, edginess, lack of sleep, and “the shakes.”
a sudden and paralyzing fear that something terrible is about to happen.
It strikes suddenly and out-of-the blue to about 1 in 75 people. It lasts minutes.
panic disorder
PD - symptoms
Symptoms include heart palpitations, shortness of breath, choking feelings, trembling, sweating, and dizziness.
are irrational fears that cause a person to avoid an object, activity, or situation.
There are many, many phobias. There are phobias for nearly anything you can imagine.
Some phobias have a natural cause, like fear of heights or snakes.
Other phobias have irrational causes, like fear of the number 13.
Social phobias include the fears of being evaluated by others. For instance, the fear of speaking publicly or going to parties.
phobias
fear of going into public places where a panic attack might begin.
Agoraphobia
an anxiety disorder with unwanted repetitive thoughts and/or actions. Everyone can become picky over certain things. But, with OCD, the pickiness begins to interfere with the person’s life.
OCD can become paralyzing to the point that normal living becomes impossible.
OCD is more common among teens and young adults.
OCD
an anxiety disorder with haunting memories, nightmares, social withdrawal, jumpiness, and/or insomnia that lasts weeks after a traumatic experience.
PTSD often hits soldiers after they return from the battlefield. It can also hit accident, disaster, or attack survivors.
PTSD among veterans seems to be at about 1 in 6 vets showing symptoms.
PTSD
system that may cause ptsd
A limbic system that’s sensitive
Identical twin studies suggest that _____ can pre-dispose a person to PTSD.
Identical twin studies suggest that genetics can pre-dispose a person to PTSD.
Among non-soldiers who experience a tragic event, about 5-10% show signs of PTSD
(90-95% do not).
a new love or appreciation for things due to an extremely challenging situation. It’s like the cancer patient who says he loves his family and friends even more, whereas before, he took them for granted.
Understanding anxiety disorders
post-traumatic growth
suggests that we learn to be anxious from past experiences.
learning persect
says that our bodies may pre-dispose people to anxiety disorders.
biological perspective
ould agree that any animal could be taught to fear anything, as long as something negative went along with it.
It’s likely that a person’s anxiety has been conditioned to go along with an unpleasant (or traumatic) experience.
ivan pavlow
Remember concepts from Pavlov and conditioning…
Stimulus generalization” is where we broaden things. A fierce dog can be generalized to a fear of all dogs.
“Reinforcement” is where our fear gets supported. Maybe we see a movie with a mean dog—this reinforces our fear of dogs. Reinforcement works two ways to avoid our anxiety…
We may stop doing something, like going to a park where dogs might be.
We may do something, like taking an alternate walking route to avoid a home with a dog in the yard.
can also play a part in our anxieties because we can learn worry or fear from watching others.
In one case, baby monkeys were not afraid of snakes, until they watched adult monkeys who were scared of snakes.
observational learning
holds the theory that people naturally hold onto the fears that helped our ancestors survive. Things such as a fear of heights or spiders help keep us safe.
natural sleection
lay a role too. Some people seem genetically prone to anxiety disorders. This has been shown in monkeys and in identical twin humans who may develop similar phobias although raised separately.
One team identified 17 genes associated with anxiety disorders.
Genes can also impact neurotransmitters that impact anxiety disorders.
genetics
play a role too. Anxiety disorders are overly active brain areas that deal with impulse control and habitual behavior. Brain scans show an active area among people with OCD while going through certain repetitive actions.
brains
symptoms that take a physical or bodily form but without a physical cause – it’s like thinking yourself sick.
Although the cause may be “in your head,” the physical effects are real.
somatoform
ssumes that anxiety is converted into physical symptoms. This is usually associated with Freud’s time and thinking. A person might have a numb hand, but no physical cause for it to be numb.
conversion disorder
occurs when people take small “symptoms” and imagine dreaded diseases. A person with this goes from doctor to doctor, symptom and disease to symptom and disease.
illness anxiety disorder
mean there’s a break with a person’s consciousness, memory, or identity. A person often can’t tell what’s real and what’s not.
disassosciate disorder
two or more distinct personalities that control his or her behavior.
The personalities are totally independent – they may have their own “flavor” and even their own accent when speaking.
The person claims to be unaware of each one.
DID used to be called “multiple personalities” or “split personalities.”
DID
Some psychologists question whether DID is legit or is made up. Nicholas Spanos led this research.
They say we all act differently in different situations. That’s normal.
They point out that the frequency of DID cases has shot up since the DSM first recognized it in the 1980s.
Diagnoses went from 2 to 20,000.
The number of personalities went from 3 to 12.
Other cultures have much less DID than America where it’s a bit of a fad.
The idea is that some psychologists actively seek out other personalities, and thus, they “find” them.
Other psychologists say DID is indeed legit. They cite…
Distinct brain activity with different identities.
Handedness can switch (right & left handedness).
Visual acuity and eye muscles can change.
Others debate the cause of DID…
Psychoanalysts say it’s to combat unacceptable impulses.
Learning psychologists say it’s been learned to reduce anxiety.
Some say it’s a response to traumatic experiences in the past.
There are two main mood disorders, they are
1) major depressive disorder and (2) bipolar disorder.
where a person who has two or more weeks of significantly depressed moods or feelings and a lack of interest or pleasure in most activities. It’s being depressed for 2+ weeks.
major depress
Depression can be . It stops us, makes us look inward, makes us assess what’s important, and urges us to get back up and move forward.
constructive
a chronic depression that’s less severe than major depressive disorder.
Dysthymic disorder, or dysthymia
alternating between mania and depression.
bipolar disorder
simply being very, very happy. It’s euphoric, hyper, and very optimistic.
mania
During mania, a person might…
Talk a lot and not like it when interrupted.
Not sleep.
Be sexually promiscuous.
Not want to take advice from others, though they really need it for judgment, spending, and sex. Basically, they’re in a great mood, are going to “run with it”, and just don’t care what you say about it.
does seem to produce creativity and free-flowing thoughts. Thus people in the arts seem more prone to bipolar disorder.
mania
is less common than major depressive disorder, but it seems more paralyzing and disruptive.
bipolar
summarized facts on depression…
Peter Lewinshon
depression facts
Depressed folks almost look at the negative (imagine that!). They’re also more likely to abuse substances.
Depression is common.
Women are twice as likely as men to become depressed.
Causes for this are genes, child abuse, self-esteem, relationship issues.
Whereas women’s disorders are more on the inside (depression), men’s disorders are more on the outside (like alcohol abuse).
Major depressive conditions usually end on their own.
It’s likely to come back within two years though.
Stress often comes before depression.
Things like the death of the loved one, losing a job, relationship issues, etc. can trigger depression.
Depression seems to be hitting earlier with each new generation.
In North America today, teens are 3 times more likely to have depression than their parents.
The biological perspective of depression
This theory believes that some folks are genetically pre-disposed to depression, genetics
As always with genetics, we turn to identical twin and adoption studies.
If one twin gets depression, the chances are 1 in 2 that the other will.
If one twin is bipolar, the chances are 7 in 10 that the other is. This is true even for identical twins reared apart.
Heritability is estimated at 35 – 40%.
Adopted people with depression usually have a biological relative with depression.
The lesson here: genetics seem to matter with mood disorders.
may be pre-disposed to depression.
New technology reveals brain activity during manic and depressed moods.
the brain
seems active when in a good mood.
The left-front lobe
which deals with emotions, can be changed by stress and affect moods.
The hippocampus,
boosts arousal and mood – it’s there when you’re happy, absent when you’re down.
Norepinephrine
the “happy neurotransmitter” – is absent when you’re down.
Serotonin
can affect moods
chemical balence
Drugs to combat depression, like ______, either block reuptake or prevent neurotransmitter breakdown.
prozac
can also boost serotonin and help stop depression.
excercise/jogging
There’s more to depression than just biology. How we feel and think about it also matters
social-cog perspecti
so-co facts depression
Negative thoughts spawn more depression, which spawns more negative thoughts.
Learned helplessness can play a part too. A person has effectively concluded he/she cannot do anything about the situation, so why try?
Women are more inclined to “feel overwhelmed” than men.
People who explain their failures outside of themselves are less likely to become depressed. Someone prone to depression usually approaches things this way…
Stable – “The situation is stable and won’t change.”
Global – “If affects everything.”
Internal – “The problem is because of me.”
Optimism matters. If you’re optimistic, you’re less likely to get depressed.
Depression is more common in Western cultures where individualism is valued (your performance or failure is your own doing).
It’s a chicken-and-egg thing: which comes first, negative thoughts then depression, or depression which gives you negative thoughts?
Depression makes up a vicious cycle of feeling down, acting sluggish, performing poorly, getting poor reviews, withdrawal from others, etc. which returns to feeling down again. The cycle can be labeled as…
Stressful experiences Negative explanatory style Depressed mood Cognitive and behavioral changes The bottom line: negative thoughts make up a disease that feeds itself.
break the cycl
his cycle can be broken! Some tips…
Move to a new environment (literally put yourself in a new place)
Turn your attention from inside to outside (don’t be so arrogant as to blame yourself for everything – you’re frankly not that important!).
Do something that you’re good at, no matter how small.
Remember, many very famous and very successful people suffered from depression, and overcame it.
how many people get schizophrenia
1/100
split mind, not split personalitiea split between reality and what a person thinks is real.
schizophrenia
3 ways schizophrenia shows itself
Disorganized thinking
Thoughts and words come out in no logical order. Schizophrenics often speak in “word salad” – a jumble of words thrown together like tossed salad..
Schizophrenics cannot use “selective attention” – our normal ability to focus on the task-at-hand. Thus, they think and speak in a very scattered manner.
Disturbed perceptions
Schizophrenics often hallucinate - sensory perception without sensory input. They can perceive with all 5 senses something that isn’t there.
Usually, this comes out with them speaking out loud to no one. Often, what they say is negative, insulting, or bossy.
Delusions of grandeur can occur where the person thinks he or she alone knows something big, like some type of huge conspiracy that’s going on and no one else realizes it.
Inappropriate emotions and actions
Schizophrenics often react emotionally in a totally wrong way. For instance, they may find someone’s death just hilarious.
Some schizophrenics go into a no-emotion state called the “flat affect.”
Some schizophrenics go into repetitive motions like rocking.
Some schizophrenics go into “catatonia” where they remain motionless for hours, then they get agitated.
Needless to say, schizophrenia causes huge problems with maintaining relationships and a job.
There are some trends in schizophrenia’s beginnings…
Schizophrenia often begins to emerge as adulthood comes on.
It hits both genders, but slightly more so to men.
It can come on gradually, and often hits lower socio-economic groups hardest.
There are actually 5 subtypes of schizophrenia. They are…
Paranoid schizophrenic – The person thinks there’s some grand conspiracy going on. Often they think someone is “out to get them.”
Disorganized schizophrenic – The person’s speech and behavior is disorganized, or their emotions are flat or inappropriate.
Catatonic schizophrenic – The person remains motionless for long periods, is very negative, and speaks parrot-like.
Undifferentiated schizophrenic – The person has many of these symptoms.
Residual schizophrenic – The person just withdraws socially after delusions and hallucinations go away.
When schizophrenia comes on slowly, it’s called either
chronic schizophrenia or process schizophrenia.
The chances of recovering from this type of schizophrenia are not good at all.
When schizophrenia comes on quickly, it’s called
acute schizophrenia.
The chances of recovering from this type of schizophrenia are much better.
Psychologists look to the brain in attempt to figure out schizophrenia. They seem to have more ______ in the brain
dopamine receptors, drugs that slow it down seem to help, but don’t stop withdraw
Brain scans show schizophrenics brains work differently from normal folks.
While hallucinating, PET scans showed an increased action in…
The thalamus that handles incoming sensations.
The amygdala that handles fear.
Schizophrenics’ brains show signs of shrinkage in places.
The cavities between the folds of the brain become filled with fluid and thus the brain itself is smaller.
Some risk factors for schizophrenia seem to be:
low birth weight, decreased oxygen at birth, and famine.
If a mother has a viral infection during pregnancy, the chances ______ that the child might develop schizophrenia. Even something common like the flu ups the risk.
This is another reason pregnant women are urged to get a flu shot.
The second trimester seems to be the especially important time period.
rise
If you have a family member who’s had schizophrenia, your odds
go up
As always when studying the impact of genetics, we look to twins and adoption studies.
The conclusions with twins are that genetics matter in a big way. If one identical twin has schizophrenia, the other has about a 1 in 2 chance of getting it.
For fraternal twins, it’s much lower, at around a 15% chance. Lower, but still much higher than two random people. This also supports the impact of genetics.
Adoptions studies show that genetics are a major factor in schizophrenia, rather than the environment in which people grow up.
The Genain quadruplets (identical DNA) all have schizophrenia. The odds of four random people getting it is 1 in 100,000,000. Genetics matter!
Psychological factors or “warning signs” seem to precede schizophrenia. They are…
A mother with serious schizophrenia.
Complications at birth, especially oxygen deprivation and low birth weight.
Separation from parents.
Short attention span and poor muscle coordination.
Disruptive or withdrawn behavior.
Emotionally unpredictable.
Poor interactions with others.
a behavior that occurs in a continuous pattern, is disruptive, stubborn, and impairs a person’s interactions with others.
personality disorder
Symptoms here are a lack of stable relationships, emotional outbursts, impulsiveness, fear of abandonment, and suicidal behaviors.
borderline pers
Narcissism is exaggerating your own importance. A narcissist thinks he/she has done great things, hates any criticism, wants to be in the limelight, is very arrogant, but has no empathy for others. It’s me-first and me-only.
narcissistic personality disorder
used to be called a “sociopath” or a “psychopath.” This person is usually a male, usually starts to show signs before age 15, and begins to lie, steal, fight, or display unrestrained sexual behavior.
It’s a person who cannot live within the bounds of normal rules of life, and doesn’t care either.
An antisocial person doesn’t feel sorrow or any bit of remorse or wrongdoing.
These folks have no sense of conscience—no sense of right and wrong.
antisocial personality disorder
understanding anitsocial personality
Both nature and nurture influence a person’s antisocial behavior.
Men who were antisocial often had these characteristics as boys: they were impulsive, uninhibited, not concerned with social rewards, and had little worries.
An antisocial person’s brain operates differently too. Their frontal lobes (which halt impulsive and aggressive behavior) show less activity on a PET scan than a normal person.
Several factors go into increasing a person’s chances for becoming a violent criminal. These support the all-encompassing biopsychosocial approach…
Genetics
Risk factors at birth
Poverty
Childhood upbringing
attacks learning-related disorders, like fears. Here, a trained psychologist uses psychological techniques to try to overcome the disorder.
psychotherapy
here are four main approaches within psychotherapy…
Psychoanalysis
Humanism
Behaviorism
Cognitive
involve medication. They’re used for things like schizophrenia.
biomedical th
Psychologists in the biopsychosocial perspective may try both psychotherapy and medication. This is called an
eclectic approach.
Sigmund Freud’s ideas brought us the first psychotherapy. His techniques are used by almost no one today. Some of his ideas still exist in the
psychodynamic thera
A quick review of psychoanalysis…
We are constantly in a struggle with ourselves. Our struggles hearken back to a childhood struggle with our parents.
We do things as “grown ups” because we have repressed memories and desires and our unconscious drives us to do them.
tries to dig down into a person’s unconscious (the part of the iceberg below the water) and root out the causes of the struggles. Then the struggles can be relieved.
psychoanalyti
people speak freely and quickly. The idea is that they’ll speak their unconscious and a psychoanalyst will be able to decipher it.
free assosi
the person is suppressing something they don’t want to surface.
resistance
Patients may feel strong emotions and ______ those onto the analyst.
transfer
start with Freud’s ideas.
They agree that a person’s childhood experiences are critical as well as the patient-therapist relationship.
They agree that it’s important to explore the patient’s underlying thoughts and feelings.
They differ from Freud in that they (a) may speak face-to-face, (b) meet less frequently, and (c) for a shorter time period.
psychdynamic
a 12-16 session treatment that has been successful with treating depression.
It tries to dig up the cause of their depression. But the real goal is to cut back the symptoms of depression.
Whereas a psychodynamic therapist focuses on finding the root cause of the problem, the interpersonal psychotherapist tries to do this too, but really wants a more real result. Often the real result is improving relationships with others.
interpersoanl therapy
believe that people are good-at-heart and try to help people grow to reach their full potential.
humanist
The humanist approach and psychoanalysis are called _____ therapies because they both have the person look inside to figure things out.
insight
Humanist therapies differ from psychoanalysis in that humanism
(1) focuses on the present instead of the past, (2) the conscious instead of the unconscious, (3) holds a person accountable for his actions instead of the unconscious, and (4) it promotes growth rather than a cure.
innovated client-centered therapy where the patient speaks and, through self-awareness, moves himself toward his own conclusion. It’s “self-help”. The therapist listens without judgment and with as little input as possible.
carl rogers
cct racts
Rogers encouraged therapists to show genuineness, acceptance, and empathy. In other words, be real, don’t judge, and feel their pain.
Rogers thought this encouraged the patients to “open up” and seek to grow and move on.
Rogers spoke of active listening where the listener echoes what’s heard, restates it, then seeks clarification.
Rogers #1 thing was that a therapist use unconditional positive regard – that they listen without judging. The hints to listening…
Paraphrase what you hear.
Seek clarification to see if you got it right.
Reflect the feelings that you’re hearing/sensing.
disagree that resolving unconscious conflicts or getting to know yourself will solve your mental issues. Behaviorists say you’ve learned these things through rewards and punishments. But, just as you’ve learned them, you can unlearn them too.
behaviorists (dogs)
where we “unlearn” something by conditioning or pairing a trigger stimulus with a new response.
For example, suppose a person has acrophobia—fear of heights.
counterconditioni
exposure therapy
exposes people to what they try to avoid. It tries to associate the bad thing (heights) with a good thing (like eating). Slowly, the person is moved closer to the ledge or higher up. Eventually, the height is associated with the eating.
Systematic desensitization says you can’t be worried and relaxed at the same time. So, while relaxed, you “face your fears” in small baby steps and work up to the “big fear.”
The therapist trains you to use “progressive relaxation” to keep calm when you feel the first hints of anxiety.
The trick here is to take it very slowly, in baby steps.
Virtual reality exposure therapy puts the person in virtual world where they can “face-their-fears”. Results have been promising at facing fears and interacting in social virtual worlds.
adverse conditioning
ries to condition a person to not do something. It pairs a negative result with an unwanted stimulus. Two examples…
To stop nail biting, use nasty tasting nail polish. This pairs a yucky taste with nail biting.
To stop drinking alcohol, put a nausea inducing drug in the drink. This pairs nausea with drinking alcohol.
Aversive conditioning works, but it may be only temporary. The pairing or association may wear off. This is because cognition (thinking) steps in. We know when we’ve put on the nasty nail polish, we know when the drink has been drugged.
techniques can be used too. This is where the person’s actions interplay with the stimulus and results (it’s not just biological or automatic, as in classical conditioning).
B. F. Skinner and his Skinner box pioneered this. The rat interacted with his environment—what he did as a stimulus affected the results.
Essentially, “behavior modification” techniques withhold rewards until a desired behavior is done. Or, punishments are given out when an unwanted behavior is done.
Rewards might be food or a “token economy”. This is receiving tokens which can be spent for things like candy, TV time, etc. It’s like earning points in a video game which can be used for various things.
Critics say behavior modification means the behaviors are done just to get silly things like plastic tokens. Behaviorists say they slowly take a person off the tokens, and ask, “Their behavior is better, so where’s the harm?”
operant conditioning
start with the belief that what we think influences what we feel.
In other words, what we think about a situation impacts what we feel in response to a situation.
If we blame ourselves for something bad, we’re likely to feel depressed. If we think it through and see something else as the cause, we don’t.
cognative therapies (beck) donald - negative words
ries to change the way people think and act. It’s widely practiced. Its goals are to…
Get folks to recognize their negative thinking.
Change the negativity into positive thinking.
Get folks to act on the new positive thoughts.
Techniques included…
Relabeling the bad into something else. Instead of labeling the bad thing and then dwelling on it, they re-name it and move forward.
Doing something else. This re-directs the brain into other areas. PET scans support that these techniques woryk.
cBT
the most common type of therapy—it saves therapist time and patient money.
It shows patients that they are not alone and that others share their problems.
Family therapy is a type of group therapy. It stresses the importance of being an individual and a member of a family.
Family therapy sees a person not solely as an individual but as a component. It’s like a spark plug as a part of an engine—both individual yet part of the whole.
Usually, family-therapy seeks to help a relationship issue.
Support or self-help groups usually hit on things that are hard to talk about, like alcoholism or eating disorders.
The most famous support group is AA (Alcoholics Anonymous).
AA uses a 12-step program. It starts with admitting dependence and seeking more help.
AA’s success rate is high, but so are other treatments like cognitive-behavior therapy or “motivational therapy”.
group therap
It’s hard to measure the effectiveness of psychotherapy. But, three ways seem to stand out…
How the patient feels about its success.
The patient, or client, almost always feels that psychotherapy is effective.
Still, skeptics say (1) people enter therapy in a crisis and once it’s over, they feel better naturally, (2) no one wants to admit the time and money was a waste, and (3) clients tend to like their therapists on a personal level.
Also, selective recall and confirmation bias means people tend to pull out the facts that support their thinking, while ignoring facts that don’t.
How the therapist feels about its success.
Therapists, or clinicians, tend to report success too.
The problem here is that the (1) feedback is usually only received from “successful” cases, and (2) patients usually leave happier than when they entered, but the cause of the improvement isn’t necessarily the therapy.
How much the behavior has changed.
The two views above are purely subjective (patient and therapist opinions). To get an objective view, we look at behaviors.
To do this, we need an experiment with control and experimental groups.
In one study, a group was “treated” with psychotherapy and a control group got nothing. Both groups healed. The lesson—time is a great healer.
A meta-analysis (a summary study of many studies to determine the bottom-line) determined that the average treated person winds up being better-off than 80% of the non-treated group. The bottom line: people not getting treatment are likely to improve, but those who get treatment are more likely to improve.
Psychotherapy also cuts costs. It cuts down on more-expensive medical treatment.
best for specific problems, like phobias, bed-wetting, compulsions, and marital problems.
behavorial
best for depression and suicide issues.
cognative
There are some “voodoo therapies” to avoid…
Energy therapies – dealing with supposed invisible energy fields around a person.
Recovered memory therapy – try to dig up supposed “suppressed memories.”
Rebirthing therapy – to re-enact the supposed trauma of birth.
Facilitated communication – where an assistant touches the typing hand of an autistic child.
Crisis debriefing – which forces people to re-live and verbalize traumatic events.
Some people argue that if the patient said the therapy worked, then it worked.
The key is to rely on evidence that the therapy worked. This is called
evidence based therapy
EMDR was developed by Francine Shapiro. It’s having your eyes dart to and fro and is supposed to relieve anxiety.
The person thinks of a traumatic experience, then darts his/her eyes back and forth. Shapiro reports 84% to 100% success.
Skeptics say the eye movement really does nothing except that it magnifies the placebo effect. Thus, EMDR is effective. But, it could also be effective doing any other task that aids the placebo effect—it doesn’t have to be eye movement.
EMDR – Eye Movement Desensitization and Reprocessing
People tend to be depressed in the dark winter months. This is called “seasonal affective disorder” (SAD).
As a treatment, patients were put under bright lights for a while—they tended to feel better!
An experiment was done…
Experimental group A got light in the morning – they had a 50+% success rate.
Experimental group B got light in the evening – they had a 33% success rate.
The control group got a fake “treatment” (a placebo) – they had a 30% success rate.
The conclusion – morning light helps fight depression.
The light exposure therapy was as effective as anti-depressant drugs or cognitive-behavioral therapy.
Brain scans supported these findings as well.
Light exposure therapy
is the study of how drugs affect the mind and behavior.
This means far fewer people are now in mental hospitals.
It also means many who’ve been released, yet are unable to care for themselves, wind up homeless.
psychopharmology
The typical antipsychotic drug is chlorpromazine (brand name “Thorazine”).
The molecules of this drug were like the neurotransmitter dopamine. The drug molecules occupy, and thus block, dopamine’s receptor sites.
There can be side-effects like (a) sluggishness, (b) “the shakes” like Parkinson’s where too little dopamine is the case, and in long-term use, (c) tardive dyskinesia where facial muscles move involuntarily.
Schizophrenics with apathy or withdrawal usually don’t respond to Thorazine. Another drug, clozapine, affects both dopamine AND serotonin receptors. They have some positive effects in these cases.
Newer drugs are trying to achieve the beneficial results without the side-effects.
Antianxiety drugs
Antianxiety drugs depress the central nervous system (as does alcohol). A common drug is Xanax.
The good—the drug may aid the effects of exposure therapy and cut down on effects of PTSD and OCD.
The bad—the drug can lead to psychologically dependence and physiological dependence. Then when the person stops taking it, symptoms can be even worse.
antidepressantss
Antidepressants boost a person’s mood by increasing neurotransmitters serotonin or norepinephrine.
A typical drug is Prozac (or Paxil or Zoloft).
The good—Prozac blocks reuptake of the serotonin neurotransmitter molecule so more of them “stay in play” rather than get reabsorbed by the sending axon.
The bad—side-effects can be dry mouth, weight gain, hypertension, or dizziness.
Cognitive therapy helps people out of depression too. It helps to get them thinking in a new way.
Aerobic exercise boosts mood too.
It usually takes a month for the effects of antidepressants to kick in. But then, the question comes back up, was it just a matter of time and/or placebo?
A double-blind study showed the “drug’s effect” was actually 75% the “placebo effect.”
The medication was helpful for severely depressed, not so much for moderate depression.
used to level the emotional roller-coaster of people with bipolar disorder.
7 in 10 people seem to have their moods stabilized.
lithium
better known as “shock therapy” or “shock treatment.”
In the early days (1938), the patient was strapped down then jolted with 100 volts to the brain. Convulsions and unconsciousness followed.
Nowadays, the patient is given an anesthetic and muscle relaxant, then 30 to 60 seconds of electricity. They awaken 30 minutes later, remember nothing of the treatment.
ECT seems successful.
80% of depressed people who did not respond to drug therapy see significant improvement.
ECT reduces thoughts of suicide.
Although 4 in 10 return to depression after treatment is over, the results seem very good.
Alternative neurostimulation therapies
Magnetic stimulation
Magnetic energy pulses are sent into the person’s brain. They stimulate or dampen certain areas of the brain.
This is called repetitive transcranial magnetic stimulation (rTMS).
The person remains awake, it’s painless, and there’s no memory loss or side effects.
A double-blind study saw the rTMS group do 50% better than the placebo control group.
Deep-brain stimulation
Helen Mayberg has located a spot in the cortex that links the thinking frontal lobes with the limbic system. It’s overly active in a depressed person.
She implanted electrodes to stimulate these areas.
8 in 12 people that tried this seemed to have positive results.
etc
removes or destroys part of the brain and is therefore irreversible, rare, and usually the last thing tried.
psychosurgery
Egas Moniz came up with the most common procedure,The surgery took only 10 minutes and involved shocking the person into a coma, driving “icepicks” throught the eye sockets, then wiggling them to cut the connections from the frontal to emotional parts of the brain.
The goal was to calm people who were uncontrollably emotional and violent.
It usually did cut down on the violent emotions.
It also often left the person lethargic, immature, and uncreative.
Since the 1950s, drugs have replaced lobotomies.
Today, psychosurgery is very rare. It’s still used to stop seizures by cutting the nerves that cause them, or in precision MRI-guided surgery to halt extreme OCD.
lobotomy
This simply means that to change the way you feel, change the way you live. He says…
People seem built for physical exercise, to be engaged with others, to be in the sunlight, and get lots of sleep (think of an Amish community). These people show little depression.
But many today live on the couch, alone, in a dark room, and stay up late (think of the “gamer geek”).
Ilardi suggests…
Aerobic exercise – 30 minutes three times a week.
Adequate sleep – about 7 to 8 hours per night.
Light exposure – about 30 minutes each morning.
Social connection – interact with others at least twice a week.
Anti-rumination – don’t dwell on negative thoughts.
Nutritional supplements – including daily fish oil with omega-3 fatty acids.
In an experiment, 77% of the people improved from depression; only 19% of control group did.
thauraputic lifestyl
preventing psych disorders
What’s better than treating a psychological disorder is to prevent from getting one.
A person can build resilience which is strength to deal with stress and recover from adversity and thus helps fend off psychological disorders.
The idea is to change the root causes of the disorders (rather than try to fix them).
George Albee noted that improving a person’s condition helps ward off psychological disorders. This includes anything that can help the person: finances, self-esteem, strengthening the family, etc.
