Abnormal Flashcards
Models of Abnormality - Supernatural Influences
- cause of psychological abnormality was that you were possessed by evil demon / spirits
Treatments:
- flogging - makes spirit / demon uncomfortable
- psychosurgery - drilling holes into the brain (frontal lobe) which gave the spirit / demon an exit route
- most people didn’t survive or it had an impact on cognitive functioning
- prayer / exorcism
What is “abnormal” behaviour?
*difficult concept to define
- people who have thought / perceptions that may be unrealistic or different to other people
- inappropriate emotions
- harmful / unpredictable behaviour
- psychological stress can result in physiological symptoms
- behaviour that is personally distressing, personally dysfunctional and/or so culturally deviant that other people judge it to be inappropriate or maladaptive
Models of Abnormality - Biological Factors
medical or neurobiological model
- cause = a result of some kind of physical illness or an imbalance in bodily processes
- view that psychological disorde are just like physical illnesses - they can be categorised and treated
- Hippocrates - theory of humours
- treatments - medical treatments
- 18th century - asylums
- 20th century - psychosurgery, electro convulsive therapy, drugs
Successes of the Medical Model
Dementia - loss of intellectual functioning
Caused by - age, lots of strokes, lots of alcohol, certain viruses or bacteria
Identified certain biological features that can help you diagnose certain disorders therefore you can treat them :)
Problems with the Medical Model
- no good biological markers for diagnosis
- diagnoses are largely based on P’s own account of behaviour and the practitioner’s observations of the P’s behaviour - subjective?
- few new treatments have been developed in recent history compared to the previously large increase in research into the area
- some medications don’t actually cure the problem, they just mask the underlying problem eg depression?
- doesn’t explain all abnormalities:
- there are certain environmental factors / reasons that can explain psychological disorders eg loss of a parent in childhood p, traumatic experiences
Models of Abnormality - Psychological Model
Cause = manifestations of psychological problems are a result of psychological processes eg inner conflicts, childhood experiences etc
3 different theories within:
1) Psychodynamic Theory
2) Humanistic / Phenomenological Theories
3) Cogntive-Behavioural Theory
Psychological Model - Psychodynamic Theory
Freud - late 1800s
- cause = unconscious conflicts and desires
- these desires aren’t admitted in public as they are unacceptable - produces anxiety to talk about them
- kept down by defences in the unconscious which causes conflict
- instinctual impulses cannot stay hidden forever - will eventually break through defences into the consciousness
Treatment:
- psychotherapy - looking for slips to gain an insight into the unconscious to make the person aware of these unconscious desires
Psychological Model - Humanistic / Phenomological Model
Developed by Carl Rogers
- cause = self-actualisation has been blocked
- this can be by parents, society, the environment etc
Treatment = therapy - work with a councillor
Psychological Model - Cognitive-Behaviour Therapy (CBT)
Combination of 2 models:
1) Behavioural / Learning Model
- eg Watson or Skinner
- cause = abnormal behaviour has been learned
- eg phobia - little Albert
2) Cognitive Model
- eg Beck
- cause = negative, maladaptive perceptions of the world & self
- focus on internal dialogue - how they understand the world & self
Treatment - Cognitive Behavioural Therapy
- behaviour aspect - trained to be relaxed
- cognitive aspect - challenge the irrational cognitions
Models of Abnormality - Sociocultural Context
- the effect of the environment in which someone develops a disorder and the effect of the sociocultural context on the disorder
2 factors affect:
1) the way the disorder is expressed
- culture specific disorders
- gender differences
- social expectations
2) the way abnormality is viewed
- biases in diagnosis
Models of Abnormality - Diasthesis-Stress Model
Integrated model - aspects of previous models into one another
Vulnerability factors can predispose people to stressors which lead to psychological disorders
Name the three criteria for defining abnormality
1) Statistical infrequency
2) Norm violation
3) Personal suffering
Defining Abnormality - Statistical Infrequency
Normal = average
Abnormal = deviations from the average
Problem - average is not always desirable or healthy and deviations from the average can actually be beneficial or desirable (high IQ)
Defining Abnormality - Social Norms / Norm Violation
- behaviour is seen to be abnormal if behaviour is seen to violate cultural norms
- eg wearing a bikini in public etc
- problem - social norms vary across cultures and historical cues
Cultures - eg Draguns (1986) Amish communities describe different manifestations of affective disorders compared to typical American cultural manifestations
Historical era - views on women & homosexuality
Defining Abnormality - Personal Suffering
- a feature of many abnormal conditions
- problem - not a reliable measure as it’s subjective and not a feature of all conditions
Defining Abnormality - Behavioural Abnormality
3 criteria
Distress:
- excessive anxiety, depression, dissatisfaction or extremely sadness about oneself or life circumstances may be viewed a disturbed behaviour if the individual has little control over these reactions
- but it’s not a feature of all mental health problems however
Dysfunction:
- behaviours can be seen as maladaptive and self-defeating if they interfere with a person’s ability to work or to form / experience satisfying relationships with others
- some behaviours are labelled as abnormal because they interfere with the well-being of society BUT this is a difficult issue eg terrorists or freedom fighters?
Deviance:
- concerned with the deviance of a given behaviour
- conduct within every society is regulated by norms - behavioural rules that specify how people are expected to think, feel & behave
- some are explicitly codified as laws and violations of these norms defines criminal behaviours
- others however aren’t explicit but are expected eg making eye contact on public transport / an elevator
- people are likely to be viewed as psychologically disturbed if they violate these norms especially if the violations make others uncomfortable and cannot be attributed to environmental causes
Describe research into the prevalence of mental abnormality
Srole et al - 1500 participants:
- 25% marked degree of psychological problem
- 55% mildly impaired psychologically
- 20% psychologically healthy / unimpaired
- so it is actually normal to have had a mental health issue*
National Institute of Mental Health (USA) 1984
- 20,000 participants, 3 cities
- 29-38% experienced at least one psychiatric disorder
Üstün & Satorius (1995) - 14 countries
- 24% had a diagnosable disorder, 9% experienced severe symptoms of a disorder, 31% were symptomatic & 36% were well
What are the 2 classification systems for diagnosing mental health?
ICD-10 and DSM-IV-TR
Describe the ICD-10
World Health Organisation International Classification of Diseases
- covers mental health problems & other disorders
- more of a complete diagnostic classification system
Describe the DSM-IV-TR
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision
- only covers mental health problems
- very widely used around the world
Describe the DSM axes
Axis 1 - Clinical Syndromes / Primary diagnosis
Axis 2 - Personality Disorders & Mental Retardation
Axis 3 - General / Relevant Medical Conditions
Axis 4 - Psychosocial & Environmental Problems
Axis 5 - Global Assessment of Functioning Scale
Problems of classification
Reliability:
- clinicians using the system should show high levels of agreement in their diagnostic decisions
- this means that the classification systems should be couched in terms of observable behaviours that can be reliably detected in order to minimise subjective judgements
- inter-rater reliability?
Validity:
- the diagnostic categories should accurately capture the essential features of the various disorders
- the categories should allow us to differentiate one psychological disorder from another
- overlap between conditions? co-morbidity?
Criticisms of Classification - Not a mental illness
Szasz
Szasz - there is no such thing as mental illness
- diseases of the brain rather than diseases of the mind - mental illnesses are no different from other diseases
- the term is widely used to describe something very different than a disease of the brain; it’s a name for problems in living
- mental illness is regarded as the cause of human disharmony as living is now taken for granted as being an arduous process
Eg schizophrenia in different cultures - hearing voices????
Criticisms of Classification - Labelling
Effects of labelling - Rosenhan (1973)
- reduces responsibility
- self-fulfilling prophecy
- stigmas that come along with it - clinicians hold predisposed views, society views people differently and the patient themselves
What are anxiety disorders?
- disorders where the frequency and intensity of the anxiety responses are out of proportion to the situations that trigger them and the anxiety interferes with daily life
What are the symptoms of anxiety disorders?
Emotional - feelings of tension & apprehension
Cognitive - worry & thoughts about inability to cope
Behavioural - avoidance of feared situations, decreased task performances & increased startle response
Physiological - increased heart rate, muscle tension & other autonomic arousal symptoms
Anxiety Disorders - Prevalence - Alonso et al (2004)
Wanted to describe the 12-month and lifetime prevalence rates of mood, anxiety and alcohol disorders in 6 European countries
14% reported an anxiety disorder
Anxiety Disorders - Phobic Disorders
- intense, irrational fear of objectively non-dangerous situations or things
- lead to disruptions of behaviour
- Magee et al (1996) - more than 10% of people have a phobia at some point in their lives
Phobic Disorders - Types
Social - excessive fear of situations in which the person might be evaluated and possibly embarrassed
Specific - fear & avoidance of specific things
- eg dogs, snakes, spiders, aeroplanes, lifts, enclosed spaces, water, injections or germs
Agoraphobia - fear of open or public spaces from which escape would be difficult
Anxiety Disorders - Generalised Anxiety Disorder (GAD)
- is a chronic state of diffuse or free-floating anxiety that is not attached to specific situations or objects
- excessive anxiety not focused on a specific situation or object
- Weissman (1994) - affects around 6% of the US population in any year
- can markedly interfere with daily functioning even if the symptoms aren’t continually present for the 6 months required for a formal diagnosis - difficulty in concentration, making decisions & remembering commitments
Anxiety Disorders - Obsessive-Compulsive Disorder
Persistent ideas or worries accompanied by ritualistic behaviours performed to neutralise the anxiety-driven thoughts
- obsessions = repetitive & unwelcome thoughts, images or impulses that invade the consciousness and are often abhorrent to the person and are very difficult to dismiss or control
- compulsions = repetitive behavioural responses that can be resisted only with great difficulty
- can greatly interfere with daily functioning
- compulsions are strengthened through a process of negative reinforcement because they allow the person to avoid anxiety
- Torres et al (2006) prevalence of OCD approx 1.1%
- significant co-morbidity with other problems
- found that it was as high as 62% in those they found with OCD
Anxiety Disorders - Panic Disorder
- repeated attacks of intense fear involving physical symptoms such as faintness, dizziness and nausea
- occur suddenly and unpredictability
- more intense than GAD
- likely to develop agoraphobia because they fear that they will have an attack in public
- American Psychiatric Association (1994) - affects around 2-3% of women and 1% of men
Anxiety Disorders - Biological Causes?
Genetic predisposition - Jang (2005)
- may make a person vulnerable to anxiety disorders
Twin Studies - Carey & Gottesman (1981)
- MZ twins have a concordance rate of about 40% for anxiety disorders compared with a concordance rate of 4% in DZ twins
- far from 100% therefore there are psychological & environmental factors that could be considered?
Abnormal neurotransmitter activity - Bremner (2000)
- abnormally low levels of inhibitory GABA activity in the amygdala and other brain areas involved in emotional arousal may cause some people to have highly reactive nervous system that quickly produce anxiety responses to stressors
- Twin studies
- Oversensitive Autonomic Nervous System
- Abnormal neurotransmitter activity
Anxiety Disorders - Psychological Causes?
Cognitive:
Catastrophising - anticipate that the worst will happen & feel powerless to cope effectively
- Beck - give greater weight to the worst possible outcome, however unlikely, or experiencing a situation as unbearable or impossible when it is just uncomfortable.
Behavioural / Learning:
- Rachman (1988) some fears acquired as a result of traumatic experiences produce a classically conditioned fear response
- operant conditioning - learn behaviours that are successful in reducing anxiety through negative reinforcement
- eg agoraphobia - remaining at home serves as the fear reducing behaviour
Environment - Social & Cultural factors
- traumatic childhood experiences or abuse
- cultures - anorexia has obsessive-compulsive elements & it is found almost exclusively in Western, developed countries where being thin is a cultural obsession (Becker et al 1999)
Anxiety Disorders - Psychodynamic Theories?
Anxiety is a central concept in psychoanalytic conceptions of abnormal behaviour
Freud:
- neurotic anxiety = when unacceptable impulses threaten to overwhelm the ego’s defences & explode I to consciousness or action
- in phobic disorders neurotic anxiety is displaced onto some external stimulus that has symbolic significance in relation to an underlying conflict
- eg Little Hans
- psychoanalysts believe that obsessions & compulsions are also ways of handling anxiety
- the obsession is symbolically related to the underlying impulse
- a compulsion is a way of taking back or undoing one’s unacceptable urges
- eg thoughts about dirt & hand washing techniques are used to deal with one’s ‘dirty’ sexual impulses
Anxiety Disorder - Post-traumatic Stress Disorder
Severe anxiety disorder that can occur in people who have been exposed to traumatic life events
Four major symptoms:
1) experience severe symptoms of anxiety, arousal & distress that weren’t present before the trauma
2) relive the trauma recurrently in flashbacks, dreams & in fantasy
3) person becomes numb to the world & avoids stimuli that serve as reminders of the trauma
4) individual experiences intense survivor guilt in instances where others were killed & the individual was somehow spared
What are dissociative disorders?
Disorders that are characterised by temporary alterations or disruptions in consciousness, memory, identity or perception
Involve a breakdown of normal personality integration resulting in significant alterations in memory & identity
Dissociative Disorders - Dissociate Amnesia
- Sudden, unexpected loss of memory
- short term
Dissociative Disorders - Dissociative Fugue
- Sudden, unexpected loss of memory
- May result in relocation and start of new life
- American Psychiatric Association (1994) - affects around 2% of people
Dissociate Disorders - Dissociative Identity Disorder
- two or more separate personalities coexist in the same person
- each personality has its own unique way of thinking & behaving
- the personalities may or may not know about the existence of the other personalities
- prevalence is debatable
Dissociative Disorders - possible causes
Psychological - psychodynamic, unconscious motives? Eve White?
Environmental stressors - extreme trauma, especially child sex abuse
Biological - genetic readiness to dissociate?
Sociocultural factors?
What are somatoform disorders?
- involve physical complaints or disabilities that suggest a medical problem but that have no known biological cause and are not produced voluntarily by the person
Somatoform Disorders - Hypochondriasis
When people become unduly alarmed about any physical symptom they detect and are convinced that they have or are about to have a serious illness
Somatoform Disorders - Pain Disorder
When people experience intense pain that is either out of proportion to whatever medical condition they might have or for which no physical basis can be found
Somatoform Disorders - Conversion Disorder
Where serious neurological symptoms such as paralysis, loss of sensation or blindness suddenly occur
Eg glove anaesthesia - where a person loses all sensation below the wrist
Somatoform Disorders - Possible Causes
Biological - can’t be traced back to any biological factors
Psychodynamic - according to Freud, conversion symptoms are a symbolic expression of an underlying conflict that aroused so much anxiety that the ego kept the conflict in the unconscious by converting the anxiety into a physical symptom
- Freud (1935) a woman who was forced to take care of her hostile, verbally abusive & unappreciative father suddenly developed paralysis in her arm
- occurred when her repressed hostile impulses threatened to breakthrough & cause her to strike him using that arm
- Phillips (2001) showed that current psychodynamic theories continue to accept Freud’s original explanations
Sociocultural:
Tanaka-Matsumi & Draguns (1997) found that the incidence of somatoform disorders tends to be much higher in cultures that discourage open discussion of emotions or that stigmatise psychological disorders
Describe the history behind the term of Schizophrenia
Kraepelin & Bleuler
Kraepelin (1896) - first to realise that schizophrenia is different from other disorders
Bleuler (1911) - coined the term ‘schizophrenia’ as a loss of harmony between various groups of mental functions
Describe the epidemiology of Schizophrenia
Incidence is about 1-2%
Equally men & women
Onset is later for women
International pilot study of schizophrenia found that:
- it occurs all over the world
- approximately equal frequency
- many of the same manifestations
- follow up showed differences in outcomes - better developed societies have higher outcomes
Describe Schizophrenia’s comorbidity link with Suicide
Approx 10% of patients die via suicide
20-40% attempt it whilst 60-80% think about it
Risk is higher for males in social isolation
Normally committed early on in the illness
Define Schizophrenia
Includes severe disturbances in thinking, speech, perception, emotion & behaviour
Describe Paranoid Schizophrenia
Most prominent features are:
- delusions of persecution - believe that others are meant to harm them
- delusions of grandeur - believe that they are enormously important
- suspicion, anxiety or anger may accompany the delusions
- hallucinations may also occur
Describe Disorganised Schizophrenia
- central features are confusion & incoherence
- also have a severe deterioration of adaptive behaviour such as personal hygiene, social skills & self-care
- thought disorganisation is often so extreme that it’s difficult to communicate with sufferers
- behaviour is often silly & childlike
- emotional responses are highly inappropriate
- usually unable to function on their own
Describe Catatonic Schizophrenia
- characterised by striking motor disturbances ranging from muscular rigidity to random or repetitive movements
- sometimes alternate between:
1) stuporous states - oblivious to reality
- may exhibit waxy flexibility in which their limbs can be moulded by another person into grotesque positions that they will maintain for hours
2) agitated excitement (can be dangerous to others)
Describe Undifferentiated Schizophrenia
- a category assigned to people who exhibit some of the symptoms and thought disorders of the other categories of schizophrenia but who do not have enough of the specific criteria to be diagnosed in those categories
Describe Residual Schizophrenia
Where positive symptoms are present at a low intensity only
What are the diagnostic criteria for Schizophrenia?
2 or more symptoms
Must have been present for more than 1 month
Positive symptoms of schizophrenia - Delusions
- false beliefs that are sustained in the face of evidence that normally would be sufficient to destroy them
- delusions of thought - insertion, broadcast, withdrawal & control
- paranoia eg aliens landing
- reference - random events, objects, have a particular & unusual significance to oneself
- delusions of grandeur
Positive symptoms of Schizophrenia - Hallucinations
False perceptions that have a compelling sense of reality
Auditory - voice speaking to a client
- most common
- parroting, arguing, commenting
Visual
Taste
Describe other form of positive symptoms of schizophrenia
“Bizarre” / disorganised behaviour
- eg silly, rude, sexually explicit/inappropriate
Disorganised speech
- word salad
- difficulty suppressing irrelevant thoughts
Describe the negative symptoms of Schizophrenia
Alogia - poverty of speech content
Behavioural seclusiveness, impaired social interactions
Apathy: lack of interest in routine behaviours
- often a result of antipsychotic meds
What are positive symptoms of schizophrenia?
Represent a change in behaviour or thoughts
What are negative symptoms of schizophrenia?
Represent a withdrawal or lack of function which you would usually expect to see in a healthy person
Theories of Schizophrenia - Heredity
Gottesman & Shields (1987) - concordance rates for MZ twins = 44.3% whilst DZ twins = 12.08%
Heston (1966)
- 47 offspring with schizophrenic mothers and 50 control children
- 35 years later - 5 of the kids with schizophrenic mothers had schizophrenia whilst 0 of the control kids had schizophrenia
- offspring of mothers with schizophrenia were more prone to psychopathy & neuroticism
Tienari et al (1994)
- compared adopted kids of schizophrenic mothers with kids of healthy mothers
- first group were more likely to have a diagnosis
Theories of Schizophrenia - Neurological
Dopamine hypothesis - Randrup & Munkvand (1966)
- schizophrenia = too much dopamine
- gave rates L-dopa to increase dopamine levels
- exhibited symptoms of schizophrenia
- gave them anti-psychotic meds - symptoms of schizophrenia reduced
Prefrontal cortex
- MRI scans show reduced grey matter
- Berman et Al’s PET study
- card sorting task - P’s with schizophrenia showed reduced activity in the prefrontal cortex
Enlarged ventricles especially in males - overall smaller brain vol
Crow:
+ve symptoms are related to dopamine hypothesis
-ve symptoms are related to structural changes
Research on auditory hallucinations
McGuire et al (1993) and Giesel et al (2012)
McGuire - fMRI scans revealed increased activity in Broca’s area during auditory hallucinations
Giesel - TMS stimulation to left superior temporal gyrus
- fMRI before TMS - activation in gyrus of Heschl
- fMRI after TMS - no activation in gyrus of Heschl
- effect was not long-term, hallucinations returned to baseline one week after treatment
Theories of Schizophrenia - Stress Vulnerability Model
- the interaction of a vulnerable hereditary predisposition with triggers in the environment
- people with schizophrenia demonstrate differences in their stress & coping responses - they are more sensitive
Reulbach et al (2007)
- investigated onset of schizophrenia after the Holocaust
- significantly associated with the highest category of persecution
- late onset of schizophrenia correlated with stress exposure?
Horan et al (2006) - responses to 1994 CA earthquake
- schizophrenia, bipolar & controls
- S & BD had higher avidoance than controls
- S had lower approach coping than controls
- S’s had lowest social support & self-esteem (controls had most)
Theories of Schizophrenia - Sociopsychological
Social class
- lower classes have higher prevelance?
- Hollingsched & Redlich (1954) - study in Connecticut showed that S was 2x higher in lowest social class than second lowest class
New culture
- Afro-Caribbean’s in London have more reported cases of S than those in native country - new culture, diagnosis, pressure?
Relapse
High expressed emotion in family factors
- Brown (1966) - P’s with S living with higher expressed emotion had a significantly higher relapse rate 9 months after discharge than those who had relatives with low EE
Life events
- Leff & Vaughn (1980) P’s from low EE families who relapse are much more likely to have experienced an undesirable life event
Theories of Schziohrenia - Psychological
Schizophrenia is a retreat from unbearable stress & conflict
Freud - an extreme example of regression
- a defence mechanism where a person retreats to an earlier and more secure (even infantile) stage of psychological development I’m the face of overwhelming anxiety
Cognitive theorists
- a defect in the attentional mechanism that filters out irrelevant stimuli so they become overwhelmed with internal & external stimuli
- sensory input then becomes a chaotic flood and irrelevant thoughts and irrelevant thoughts & images flood the consciousness
- stimulus overload produces distract-ability, thought disorganisation and the sense of being overwhelmed by disconnected thoughts & ideas
How can schizophrenia & bipolar be differentiated?
- share some of the same medications
- positive symptoms of schizophrenia can look like the symptoms in about 50% of the manic episodes (eg delusions)
- negative symptoms of schizophrenia can closely resemble the symptoms of a depressive episode
- normally the initial symptoms are predictive of the resulting disorder
Give examples of Anxiety Disorders
Phobic Disorders
Generalised Anxiety Disorder
Panic Disorder
Give examples of Dissociative Disorders
Dissociative Amnesia
Dissociative Fuge
Dissociative Identity Disorder
Give examples of Somatoform Disorders
Hypochondriasis
Pain Disorder
Conversion Disorder
Give examples of Mood Disorders
Depressive Disorders:
- Major Depressive Disorder and Dysthymic Disorder
Bipolar Disorders:
- Bipolar Disorders and Cyclothymic Disorder
What are the general characteristics of Major Depressive Disorder?
1) Profoundly sad mood over weeks or months
2) Loss of interest in activities & relationships
- antiedonia - blunted response in the things you used to enjoy, loss or lack of interest
3) Disturbance of appetite, weight, sleep & activity
- trouble of getting to sleep or waking up early and unable to get back to sleep
4) Suicidal thoughts
- usually quite high
5) Possible delusions?
- not unusual to experience these, can be part of the symptoms
What can Major Depression be co-morbid with?
- Anxiety (very common) - lots of medications are design to deal with both depression and anxiety
- Panic attacks
- Self-harm
- Suicidal behaviour (1 out of 10 attempt)
- Substance abuse - a way to take away the pain eg a bottle a night
- Personality disorders
- Somatic symptoms eg back pain
Describe the epidemiology of Major Depression
Women report more than men - 21/22% compared to 13%
- reasons - biological make up? women think over things more?
Consistent across many cultures
More common in low SE classes & young adults
80% of depressives will experience a 2nd episode aka RELAPSE
- average number of episodes in a lifetime = 4
Adolescents - approx 28% have an episode by 19 years of age
DSM-IV criteria for Major Depression
2 or more weeks of depressed mood
Presence of 4 additional symptoms
Define Major Depression
An intense depressed state that leaves an individual unable to function effectively in their lives
Define Dysthymic Disorder
A less intense form of depression that has less dramatic effects on personal and occupational functioning
Describe the characteristics of Dysthymic Disorder
2-3% more likely in females
Feeling depressed, pessimistic
Fewer symptoms but a longer duration of symptoms
Define mania
A state of highly excited mood and behaviour that is quite the opposite of depression
Describe the general characteristics of Bipolar Disorder
Depression alternating with periods of mania - slide between the two extremes
- Depression
- Elation (polar opposite of depression)
- Hyperactivity
- Impractical flight of ideas/grandiose plans
- Distract-ability
- Sometimes inappropriate / intrusive to others
Describe the epidemiology of Bipolar Disorder
- 1% of the population
- average onset is early 20’s
- equal in both males & females - females experience more depression and less mania
- tendency to recur - average number if episodes in a lifetime = 4
Can be misdiagnosed with schizophrenia!!!
- eg in manic episodes you can experience delusions - need to investigate more to prevent a misdiagnosis
Describe the DSM-IV requirements for Bipolar Disorder
Symptoms of both mania & depression
Mania:
- abnormally elevated mood with the presence of 3 additional symptoms
- sufficient enough to impair social & occupational functioning
- eg inflated self-esteem, less need for sleep, talkative, flight of ideas, distract-ability, increase in goal-directed behaviour and excessive involvement in activities with potentially bad consequences
Describe Cyclothymic Disorder
Little sister of Bipolar
Frequent periods of depressed mood or hypomania mixed with normal mood
Frequent periods but not to the extent of bipolar diagnosis
What are the psychodynamic therapies for psychological disorders?
Psychoanalysis and Brief psychodynamic therapies
What are the humanistic therapies for psychological disorders?
Client-centred therapy (Rogers) and Gestalt therapy (Perls)
What are the cognitive therapies for psychological disorders?
Rational-Emotive therapy (Ellis) and Cognitive therapy (Beck)
What are the behavioural therapies for psychological disorders?
Classical Conditioning
- Exposure, Systematic Desensitisation, Aversion Therapy
Operant Conditioning
- Positive Reinforcement, Punishment
Modelling
- Social Skills Training
What are the biological therapies for psychological disorders?
Drug therapy, ECT and Psychosurgery
Describe Psychoanalysis
Goals:
- to gain insight into unconscious conflicts
- to resolve conflicts
- to reconstruct personality
Techniques:
- Hypnosis
- Free Association - relate thoughts out loud
- Dream Analysis - underlying meaning of dreams sought out through analysis of surface descriptions
Reactions to therapy:
- Resistance - attempts to avoid facing thoughts, memories, desires etc as they are painful
- Transference - when the client responds irrationally to the analyst as if they were an important figure from the client’s past
Describe Brief Psychodynamic Therapies
- briefer & more economical approach
- utilise basic concepts from psychoanalysis (insight & interpretation) but employed in a more focused and active fashion
- seen once or twice a week rather than daily
- limited to helping the P deal with specific life problems rather than attempting a complete rebuilding of the P’s personality
Describe Interpersonal Theory
Focuses almost exclusively on the clients’ current relationships with important people in their lives
Describe Client-Centred Therapy
Developed by Rogers - thought the relationship between the analyst and patient was very important
Goals:
- congruence between experience and self-concept
- acceptance of real self
- personal growth
Techniques:
- no goals set in therapy - client takes the lead
- empathy - understanding, acceptance, recognition & clarification of feelings
- advanced accurate empathy - interprets what is said over a number of sessions & infers what is troubling client / the source of distress
- unconditional positive regard - value the client
- reflecting back to client - leads to increased awareness but the goal is to change phenomenology, not just reflect it back
Describe Gestalt Therapy
Perls
- concentrates on the whole person, what makes the person whole
- aim of this therapy is to bring together important feelings, wishes and thoughts that were blocked from ordinary awareness (as they evoked anxiety) into immediate awareness so the client can be wholes again
- Empty Chair Technique - project feelings, objects or situations onto an empty chair then talk to it
- can evoke powerful feelings & make clients aware of unresolved issues that affect other relationships in a person’s life
Evaluation of Humanistic therapies
Eysenck (1952) - ineffective after a review of studies
Later studies refuted this & found that they have some effect and these were relatively long lasting
Why are they effective?
- common factors - emotional support/empathy/bring problems into the open/change behaviour
- different processes - may be procedures due to specific therapy
Describe Systematic Desensitisation
Wolpe - learning based treatment for anxiety disorders
- used to reduce phobic anxiety
- anxious behaviour is learned through classical conditioning
- therefore counter conditioning is used
- P produces a hierarchy of anxiety (least to most anxiety producing stimuli)
- work through hierarchy whilst staying relaxed
- stop when too anxious - relax and then move on until little or no anxiety is produced by the stimuli
Describe Social Skills Training / Behaviour Modification
- interpersonal problems are the root of psychological problems
- social skills acquired through learning - some don’t learn and this leads to anxiety/other disorders
- use social skills training to increase social ability
- uses operant conditioning & observational learning techniques
- modelling / shaping / role-play / token system / contingency contracting
Eg autism, social anxiety, schizophrenia
Describe Aversion Therapy
- aversive stimulus is paired with a stimulus which lead to an undesirable response
- can break down unwanted habits
- not commonly used - controversial & difficult
- usually part of a wider range of treatments in a programme
Eg alcohol abuse, drug abuse, smoking, overeating, gambling, sexual deviance
