chapter 13+14 Flashcards
Defining Psychological Disorders
the phrase psycholgical disorder conjures up the image of some whose psycholgical functioning is abrnomal
however if u think abt it, many things that ppl think, feel, and do may be abrnomal without necessarily being a symptom of disorder
in covid, the experience of troubling levels of anxiety and depression became more common
if abnromal behaviours arent awlays a sign of psychopathology and if normal behaviours can be signs of psychopathology we need to ask: what is a psychological dirodeR?
the most commonly accepted definition of psychological disorder is the one provided by the APA in DSM 5: psychological disorders are syndromes, or clusters of symptoms that tend to occur simultanously
a symptom is a physcial or mental feature that may be regarded as an idnciation of a particlaular condition or pyschological disorder
according to DSM5 a psychologcial disroder is a clinically signficant disturbance in an indivduals cognition, emotion regulation or behaviour that is usually associated with signfiicnat distress or disability in social, occupational or other imporant actvities
many diff mental health profensioals will use DSM5 to diagnose mental disorders
psychopatholgy is the scientfic study of psycholgical disorders or the disorders themselves
two closely related terms are abronal psych which seeks to characterize the natrue and origins of psycholgical disordes and clinical psych which refers to the assessment and tretament of psych disorders
to qualify as a psych disorder, a syndrome must not be a) an expectable rsponse to a common stressor and losses, b) a cultrually approved response to a particular event, or c) a simple devicence form social nroms
the last is crucial
socially accpetbale behaviour varies across cultures and over time which makes it important to take social context into account when assesing whether an individuals thoughts, feelings and behaviours are the resuly of a psycholgical disorder
in thinking abt psycholgical disorders, its useful to imagine a continuum of cognitive, emotional and behavioural responses ranging from normal to severly disordered
at one end the continuum we see relatievly normal resposnes, in the middle we see mild to moderately disordered responses and ta the far end of the continuum we see a severely disordeed response
using DSM5 definition, how common are psycholgical disorders?
prevalnce refers to how widepread a disorder is and researchers condier two types
point prevalence is the percentage of ppl in a population that have a given pscyh disorder at a partciular time
lifetime prevalence is the percentage of ppl in a populatoon who will have a psych disorder atany point in their lives
nearly half of us will have one psych disorder and more than a quarter wil have two or more
an even larger number of ppl are affected by these disorders indirectly (ex. family)
from a global perspective, the total costs associated with psych disorders are staggering
its estimated nearly half billion ppl in world suffer from a psych disorder and psych disorders rep five of the tend leading causes of disability and prematrue death worldwide
if u consider all known diseases, disabilities and disorders and calc their total impact on human health and well being, its estimated that psych disorders are responsible for 7-13% of total disbaility related impact on human health and well being wordlwide
if u zoom in on impact of psych disorder on human health and well being, mood disorder account for 41% of impact wordlwide: anxiety account for 15% and schizophrenia account for 7%
Assessing psych disorders
in addition to offering a genral definition of psych disorder, DSM5 provides specific deifnitions ofr eahdc of the diff psychological disorders
these deifnitions mkae it possible to decide which disorder, if any, a particular client has
each deifnition conisst of lists of specific criteria, a certain number which need to be met for the disorderto be diagnosed
diagnoses are improtant bc they are the first step in unrdertsanding why clients are suffering and how they can be helped
a clinical assessment is a procedure for gathering the info that is needed to evaluate a clients psych functioning and to determine whether a diasgnosis is warranted
clinical assemnets often begin witha clincial inetrview in which a clinician asks the clinet to describe theri probelms and concerns
the goal is to explore the clinets current mentakl state, life circumstances and history
some questions are open eneded and felixble with no script follow; the clinician asks questions and simply listens to response
the clincial may also employ a structured interview asking specific questions in a specific sequence with attention to certain types of content
ex. the clinician might use the strcutured clinical inetrview for DSM5 which asks questions firectly pertinent to a certain diagsnotic categroy ex. anixty related disorders
throughout the clinical interviews, clinicans pay attention to what the clients say concerns are
at the same time they also look for any behvaiours that might hint at difficulties the client isnt reporting
clinicalsn are aslo alert to discepancies between what they observe and probelms that the clients report
ex. them saying they dont know why ppl are cocnernedbut also havent been able to leave the house in weeks or spend horus washing their hands etc
the full pattern of a clients problems, together iwth their onset and course, usually allows the clinican to form an opinion as to whetehr the client has a psychoclaigl disorder
this provisional clincial diagnosis isnt set in stone
rather it serves as the initial judgement abtteh clients current state
clinicians may revise the diagnosis as they gain new info abt the clients current life circusmances and history, family and cultrual bakcgorund and even how the client responds to a paticular form of treatment
in additon to the clincal inetrview, a clinical will often administer self report measures
these standarized measures consist of a fixed set of questions that teh client asnwers
some self report measures are breif and target a certain well defined set of symptoms
other self report measures are broader and longer
ex. the minsota multiphasic personality inventory (MMPI) was developed and then revised as MMPI 2 with an impsing 567 items
the most recent variant, the MMPI 2 RF has been trimmed by 40% to 338 true false items
in adidtion to being used in clincal assesments, the MMPI in its various forms is used toa ssess a clinets suitibality for high risk jobs like a police officer or air traffic controller
some clincialns also use projective tests in which client resposds to unstructerd or ambigous stimuli
the idea is that repsonding to these stimuli, clients cant helop but impose a structure of their own
in the process of descriviing this strcutrue, tehy are thoiught to provide isniht abt unconsocus wishes and conflicts
in the Thematic Apperceptuon Test, the clinet makes up a story. to describe whats going on in a pic - repsonses to the pic are seen as revealing implict or otehrwise hidden motives
another projective test, the Rorschach inkblot test has clients descirbe what they see in inkblots
projective test have been hsitrocally popular - in mid 1990s, 8 in 10 clincians would use them
today tehres an agreement that the popularity of tehse tests outweight their demonstarted usefulness partciaulrly given how much time it takes toa dmisniter these tetsst and the mixed evidence regarding their validity
the consensu has tranlated to decreases use in the test in grad training programs
nonenthelss they remian inthe use of clinicians and proponents of more specific projective tests like the adult attachment prpjective picture system whihc asssess atatchment styles have been presented evidence for the reliablilty and validity of tehse tests
Benefits and Costs of Diagnostic Labels
having a label for something makes it possible to think abt, discuss and exmine that thing more easily
in the case of psychological disorders, however, diagnostic labels carry very real costs as well as beenfits
an imprtant beenift of diagnostic labels is imprved treatment of psych disroders
having specific labels for diff disorders helps to ensure that clients get the appropriate ttreatement
withoutt diagnostic labels, it would be difficult to konw hwihc treatment to provide
diagnostic labels also help to create a uniform framework for descriving the diffuclties a client is having allowing many diff healthcare rpoviders who work iwth the same lcinet to coordinate treatments
form the client pov having a label may provide relefi and motivate the client to seek treatment
in addition, doagnosti labels faciliatte research on psycholgical disorders
without specific diagnoses, we would have no way to know whetehr ppl with a specific disorder studies in one hospital had the same illness as cleints who received same diagnsois in another hospiytal
we wouldnt know whetehr u could legtimtely compare the results of diff studies or pool results across studies
we alos wouldnt have any way of konwing how common any given disorder is and thus we wouldnt be able to make rational decisons abt how to allocate the finite resoucres thta are availbale for resaerch purposes
the development of an inc reliable and valid st of diagnostic categories has inc the possobility of integrating veyr diff approachss to psychopathology, bringing togetehr neuroscinetifc findings with clinical and frist person accounts
ath the same time labesl can have drawbacks
stigma is attached to disorder; ppl with psych disorder and their family are often view negtavely
labels can have a bad effect on how ppl are eprceived and how they perceive themselves
self defeating and destrctive attidtudes are in many cases reinforced by media portyaals of ppl with psycholgical disorders as violnt criminals
the fffort to destigmize psych disorders has received a bost from the willingness of some high rpoifle celebs like gymast simone biles etc to talk abt imortance of mental health and theri own disorders
psycholgcists are also working on combattings terotypes
they humanize disorders by speaking of a first with person first language and say stuff like someone sufffering from depression, neerving losing trakc of the fact that ppl not matter their diagnosis have an identity, value and dignity
from research tehre is also drabakc with labels
one is that labels encourage reserchers to think of each disorder as fixed and enduring diagnsois
ex. in a study ppl wnet to the hospital and said they heard bvoices and were diagnosed with schorzprhenia - after they went on nromally with their life - the hospital never discareded the diagnosis, the label remained - label had staying power
psychitatric labels also encourgae the view that each disorder is seperate from all other disorders
if a reseracher focuses on one disorder, develps reserch programs on it and publishes and reads paper only abt that disorder it would make the real overlap hard to see, hindeirng the serach for common underlying mechnaisms that might provide common tretament targets
Early therapies for psych disorders
psych disorders have been with us sicne the dawn of recorded histroy
so too have efforts to alleviate the suffering and probelmatic behaviours associated with tehse disorders
hundreds of tehrpies exists for disorders, rangng from behavioural tehrapy to brain surgery, from psychoanalsyi to durg teratements
we need to consider early treatments
looking at tehrapies now considered obsolete empajsizes the important fact that treatment depedsn on how one thinks abt the factors that cause and sustain a disorder
as we will see, even good and well intentioned tteratment providers can do harm if they have an incomplete or incocrect undertsanidng of the probelm they are trying to adress
early therapies were based on the idea that evil spirits causes psycholgical disorders
in a process called trephination, treatment providers cut large holes in a patients skull, apprently so the demons could be driven out
other treatments sought to calm demons iwth music, chase them away with prayer, or purge them with vomit inducing potions
anotehr approach was to make the spirits unfoctbale in the body so they would flee - patients were starvevd, flogger or immerised in boiling water
no tretament worked
in 16th centrury a number of special hsopitals for the insane were establshed in europe
most wrre hosipitals in name only
their real function was to isolate social undesirbales from the rest of humanity
criminal,s incurables etc instituonalized and treated alongside teh psychologically disturbed
an uathor describd the barbaric conditions in the mental hospital for parisian women at end of 1700s “madwomen seized by fit of violcen are charined like dogs at theri cell door,s and seprated from keepers and visitors alike by a long corridoer prietcd by an iron grille; through this their food is passdd and the straw on which their sleep; by means of rakes, part of the filth that surorudns them is cleaned”
in england, patients wre put on display at the hosiptal of bethlem in london and mebrs of public paid addimisin to wonder among the patients
scene was chaotic that we owe the word belamd - a noisy and confused state- to the hospita
gradually, reformers suceeded in elmating the worst of the pratcies
ex. Pinel was put in charge of Parison hospital in 1793 and he wanted to remove the patients shakcles and chains and give them exercise and fesh air - french gov perimited the chnages grudingly
in the US similar reform effrots had uneven results
Rush, one of signers of declartion of indepndecne and the father of american psych, subemrged patients in hot or cold water until they were short of drowing or twiled them on devices at high speeds until they were unconcious
suhc methods were belived to restablish balnce between bodily and mentak functions
they almost certnaly had no pos effects but they terrfied the pateints which kept them ordered
in mid 19th century, retired schoolteacher Dix became a pasisonate advoctae for approp tretament for those suffering from psych disoders
in the resprt to massacheusetts legislature in 1843, Dix said: “I come as the advocate of helpless, forgotten, insane, and idiotic men and women; of beings, sunk to a condition from which the most unconcerned would start with a real horror. . . . I proceed, Gentlemen, briefly to call your attention to the present state of Insane Persons confined within this Commonwealth, in cages, closets, cellars, stalls, pens! Chained, nmaked, beaten iwth rods and lashed into obedicne”
her report is a pwoerful indictment of the tretament of psycholgcially disorder perosn in 19th centruy NA and fortnetly it acheived the intended effect
She worked on behalf of those with psych disorders eventual;;ly led to the dramtic growth of state-supported institutions for psych care in both the US and Canada during the later part of ninetetnth centryy
other devlopments in mid to late 19th century also profoundly shaped how ppl thought abt and tried to treat psych diroders
one triumph was the sucesful tretament of general paresis, a disorder charcetrized by a broad decline in psychal and psycholgicla functioning, culminating in marked personality abnormalities that include delusions conreinrg ones imprtance or imment demise
without treatment, the dirder progresses to point of paralysis and death occrus within a few years
the breakthrough in undertsnaidng paresis came in 1897 when Ebing disoverd that it was a conseqeunce of infection with syphilis
this disocevry lead to dveeloment of antibiotics that cured ithe infection and if adminsitered early could preventthe symptoms of genral pareisis altogetehr
the disocervy was imprtant for itws own sake but also understood as the leading edge of a much larger trend
across the following decades, a medical perpective regardng psych disorder became more common
in many cases, thi approch ment tretament via meds, a trend that laid the basis for many of todays biological tehrapies
another dvelopment at end of 19th centruy was Freuds taling cure
this tretament became the first in a long line of psych tehrapies that drew attenton to envrinmentla and social dimensiosn of psych diroders and led to the pwoerful new tools for tretaing psych disorders used today
Contemporary Therapy Providers
today many professionals and nonprofessionals provide therapies for psych disorders
some offer psych therapies; others offer biological therapies
some offer both types
who are these tehrapy providerS?
providers who are licensed to offer pychological therapies include clinical pschhologists (assessment and psych treatment); psychiatrists (assesment and biological treatment); psychiatric nurses; marriage, family and child counsellors (psych treatment with focus on respective ppl) ;school and vocational cousnsellors (assesment and counseling with a focus on vocation and adjustment); mental health counselors (assessmment and counselling); and clincial social workers (psych treatment and assistance with housing, healh care and treatment)
other biilogical treaters include practiontors, neurologists and psychiatric nurse
some therpaist practice without a license, meaning they havnt competed a course of training or passsed an offcial licensigng exam
these ppl can offer psych therapies without a license bc the titles therapist and counselor arent protected in most jurisdictions
in practice this means a lot of ppl can legally call themselves a tehrapist or counselor whether or not theyve had trainng
suprisinly, reserach has shown that neitehr profesional credentials nor years of experience are hgood predictors of a persons success in providing psych therapies
these findings suggest that who tehrapists are, what they do and how well therpies match cloents may be more important than the therapists level of experience or degrees they have earned
working with trained profesionals however has some clear advanatges
these include professionals knowledge regarding specific treatments, their awarness of and relationships with other health care professionals, their ability to detetc and handle emergencies when a client poses a seirous danger to themsleves or someone else and their sensitivty to the many complex legal and ethical issues associated with treating psych disorders
ex. psycholohissts adhere to a set of ethical pricniples that include: striving to benefit the ppl they work with; estbalishing relationshps thta are based on trust; showing integrity by being accurate, honest and truthful; being vigilant abt potential baises; and showing respect for the dignity and worth of all ppl
unlike the adminsitration of psych tehrapies, the administartin of recognized biological tehrpaies requires a license
there are many diff providers including psychiayrists, general medical practioniers and psychitaric nurses
one area of active debate regarding biological tehrapies is who should be allowed to prescribe medictaions to treat psych disorders
in the US five sttaes permit limited preciription privleges for clinical psychologists who have compeklted additional training
this issue is contentious with strong feleings on both sides
proponents of prescription privileges for psychologists point to the high level of demand for pharmacological tehrpay, a demand that traditionally trained medical profeisonalls cannot meet
opponents counter this by saying that ppl who are interested in rpescriving meds can follow an existing educational path to become a medical doctor, a registered nurse pratcitoner or a phsyicnas assistant
they aregue that such medical triaing is necessary for treatment providers to safely prescribe meds and udnerstand potentially fatal inetractions among meds (which is more likley when ppl like elderly are taking many meds at once)
psychiatrists are the only mental health profrsonal that can prescribe meds for psych disorders in all states of america
Contemporary tehrapy recipients
psychological disorders cause pain and suffering both for nearly a billion indivduals wordlide who suffer from disorders and for their family and friends
in addition to the emotiona cosost tehre is also signficant financial costs associated with psych disorders
WHO survey of 19 countries found that across countries, respondents with serious psych illness earned on average a third less than the median earnings
just the two disorders of anxeity and depression alone are thoughht to cost the world economy a trillion dollars a year and by 2030 poor mental health and the decreased productvity it entails are expected to cost the world economy 6 trillion a year
its likley that even these alarming estimates understate the true cost of psych disorders
this is bc many projections leave out a number of impritant factors including the full costs of prodcutivty loss due to the early death, incarceration or instiutionalization of those with pscyh disorders
alos missing from tehse estimates are costs of the far more prevalent less serious psych disorders and subsyndrmal disorders- verison of psych disorders that dont meet the critier of DSM5 of diagonsis but still cause signifacnt probelms
an ex. is depresive symptoms that dont reahc tehrshold for official diagnsosi but still cause deep suffering and dysfunction
given these emotionala nd fincanial costs, its no wonder that many ppl seek tehrapy, not only for psych disorders and subsyndromal disorders, but also bc they need help coping with feelings of loss, grief or anxiety; want to improve their relationships; or simply want to live happier and more fufilling lives
in 2014, 33.5 mil adults inUS received mental health care
although many ppl seek tehrpay and numbers inc each year, many who might beenfit from tehrpay dont obtain it
survey reveal that in US more than half of tose with clinically signficnat disorders dont receive mental health treatment
even though men and women beenfit equally from tehrapy, women are more likleier than men to seek etehrapy
tehre are also ethnic differences in who seek tehrapy
ex. among young adults, European americans are more likely than otehr ethnic groups to seek therapy
how can we explain why so few ppl who might beenfit from tehrapy obtain it?
one barrier is access
in many places the relevant health care privoders arent available
according to WHO, the majority of idnivduals who have psych disorders live in developing countries where 90% of tehse ppl have no access to treatments
A second barrier is financial
many psych disorders are common in those with low income but ppl with low income are less likely to have insurance coverage, a factor that sometiems not always leads to lower rates of psych tretament
a thrid barrier is recognition
before u can get help with disorder, u must reocgnize tehres a treatable condition; they must also belive that seeking treatmet is a good idea
sadly even though stigmatziation is less, a high level of stigma is still aosicated with psych disorders in many places
this stigma is thought to be one of the key reaosn for ethnic diffeences in sekeing tehrapy
of the ppl who do seek tehrpay, may are helped
however tehrapy doesnt always work
in fact. a certain proportion of ppl like betwen 5-10% actually get worse as a rsult of tehrapy
for may years, reserachers thoyht therpay was most likley to succeed with ppl who are young, pshycally atrarcive, high in verbal ability, intelligent and succesful in otehr domains; however these qualities arent key factors in tehrpauetic success
instead, tehrapy seems to have roughly equal beenifts for ppl from a wide range of tehnic and socioeconomic backgrounds
what matters mya not be who the client is as much as whetehr the client feels a strong sense of rapport with the tehrapist, is strongly motoavted to partciapte actievly in tehrpay and has a psych disorder or tretament target that can be tereated effectly with the type of tehrapy being offered
Cognitive Behvaioural Apporahces
over time the success of both behavoural and cognitive approaches has led to the emergence of a hybrid cognitive behavioural therapy that is now mroe common than eitehr pure behaviorual therapy or pure cognitive tehrapy
cognitive behavoural thearpy (CBT) - a hybrid form of psychotherapy focused on changing the patients habitual interpretations of the world and ways of behaving; it combines cognitive and behavoural approaches to therapy
there is now a shared professional organization for behavoural, cognitive and cognitive behavrual tehrapists - the association of behavoiral and cognitive tehrapies, whose mission statement says that it is commited to the advancement of health and well being by advancing the sicnetfici understanding, asssessment, prevention and treatment of human probs through behavoural, cognitive and bioloical evdience based rpicniples
many variants of cognitive bhevaiorual tehrapy now exist
tehse therapies differ in imprtant ways but as a general rule, cognitive behavioural therapists are present focused
they are concerned with idenitifying and solving probelms that theri clients wish to address
therapy sessions are typically hoghly strcutured and clients are often expected to do hoemwork between sessions
hoemwork may consist of pratcicing new skills or new ways of thinking learned during the tehrapy sessions
therpaists are usually fully transparent with theri clients abt the treatement goals whihc are typically set collabretvly
therapists and clients also discuss how well clients are progressing towards theri goals
one interesting new twsist on cignitive behavoural terapy is the development of thrid wave tehrapies (first wave was behavoural tehrapies, and the seocnd wave was cognitive therpaies)
third wave therapies retain the behavoural and coginitive therapists goals of addressong unhelpful patterns of thinking, feeling and behaviour
however, third wave tehrapists dont attempt to directly mdoify either thoughts or behvaiours but rather seek to mdofiy the hold that thoughts have on us, allowing us to acheve values goals
ex. instead of working to change irrational beliefs, third wave tehrapists might cocnentrate on teaching clients that they can act in valued ways (such as seeking out new oprotnuties at work or tryting to make new friends at a social gather) despite feeling anxious
one prominent third wave tehrapy is acceptance and commitment tehrapy
this therapy aims to decrease psych rigidity and inc psych felxbility by heloing the client acheive a greater awarness and acceptance of thoughts and feelings
the therapeutic goal is to make it clear that clients can puruse values goals despite having unwanted thoughts and feelings
anotehr prominent third wave tehrapy is minduflness - based stress reduction
this therpay which draws on eatern meditative traditions, was initially used to help ppl manage chronic pain
its use has now been expanded to a wide range of conditions including anxiety and mood disorders
this tehrapy teaches ppl to be fully present in the moment and to observe tehri thoughts, feelings and sensations nonjudgementally, veiiwng them as teh ever changing products of their mind ratehr than something of greater substance
the tehrapist might enocurage clients to regard their neg thoughts and painful feelings as clouds passing in the sky or as bubbles floating by on a stream
this perspetive whihc highlights the insubstantial and feleting nature of thoughts may help clinets pursue valued goals despite the presence of irrational thoughts and feelings of anxiety
Physical activty and natural envrinments
there is a gread dela to celebrate in the many successes of pharmacological treatment as well as those of modern day neurosurgcial techniques, electoconvulsive treatments for medictaion-resistnat disorders and newer teratemnts such as vagal nerve stimulation, deep brain stimulation and transcranial magentic stimulation
however some wonder whether there might be simpler ways to restore healthy patterns of brain fucntioning, relying on behavour change ratehr than invasive procedures
one back to basics apporahc focuses on the role of phsyical activty
physical activty is important for both mental health and physical health and correlational studeis dating back two decades have documented that lower levels of regular phsycial activty are associated with higheer levels of mood and anxiety disorders among US adults
levels of phsyicla activty are alos lower in indivduals with severe psychlogical illlenesses inlcuding shcizophernia and BP disorder
nationally represnetative studies in Sctland and Norway etc document similar relationships between physical activty and psychological distress with less actvity being associated with higher levels of stress
a small but hrowing literature suggest similar relationships between leevls of physical atcivty and mental health in children and adolescents
these correlational findings have motivated reserachers to examine interventions that systematically manipulate activty levels
in one early study, adults with shizopehrnia, bp disorder, major depression and other psychological disorders were enrolled in an indivdually tailored health promotion program that emphasized healthy eating as well as exercise
the prorgam icnluded weekly meetings with a health advisor
this inetrventon led to inc phsycial activty, decreased severity of neg symptoms and inc leveels of oevrall psychological health
subseqeunt meta-analyses have confirmed that phsyical acivty interventions reduce symptoms of depression and shizophernia in idnivduals with mental illness
importantly, physical activty can also be effective for indivduals with sublcinal distress
one meta-meta-analzes examined fidnings from8 meta analysises of randomized trials examining the effects of phsycial activty on depression and anxiety
findings indicated that physical acitvy had clear effects on depressive symptoms and reliable but smaller efefcts on anxiety
a second back to basics approahc focuses on exposure to natural envrinments
it has long been thought that exposure to nature can lead to inc levels of well-being
this idea motivated early conservationisst such as John Muir who played an instrumental role in svaing wilderness land in the SU
this idea is also relfected in the long-stndidng practcive of creating courtyards in public buildings and hospitals
in recent years, the idea that exposure to nature is good for us has gained solid empircl backing
for ex. in a panel study over 10k idniduals, ready access to green space was associated with higher levels of well-being and lower levels of distress
our appreciation of the value of nature experiences sits uneasily alongside the worlds increasing level of uranization
more than half of the wolrds pooulation now resides in urban envrinments and its estimated that by 2050 more than two of eveyr three indivduals will be living in urban areas
of course, tehre are many wonderful things abt lviing in a city
however, the prveelance of modd and anxiety disorders is higehr in urban residents than in rurual residents
also rates of shcizopherina are greater among those born in cities than in the country
for tehse reasons, the debate abt the role of exposure to nature has taken on inc urgency
indeed, one authro has agrued that todays chidlren have nature deficit disorder
but why might a persons exposure to nature be linked to a risk of developing disorder?
to find out one reserach team selected healthy german patypants who lived in cities with more than 100k inhabitants, towns with fewer than 100k inhabvitants, or in rural areas
after subjecting particpnats to a social stress test, the researchers examined their stress responses using functional magentic resonance imaging
their findings idnicated that urban living was associated witha ctviation in teh amygdala which is thought to play a key role in stress resposnes
these findings are consitent with teh notion that urban lviing magniifies responses to stressful situations and tehse researchers hypotehsized that this enhanced reactivty may play a role in placing urban dwellers at greater risk of dveloping a psych disorder
not suprisngly, clicnians and researchers are beggining to test whetehr exposure to nature plays a casual role in psych functioning
their findings are encouragning green exercise, outdoor exercise that brings one into contact with nature
one metanalysis of 10 UK studies suggest a psotive relationship between green exercise and self-esteem/mood with greater exercise being associated with greater self-esteem and improved mood
as is the case with the exerise lietrature, caution is required bc tehre is not yet compelling evdience that exposure to natrue can help treat psych disorders
Do psychological therapies rlly work? if so, which is best?
one of the earliest formal studies of whether psychoanalysis and simialr insight therpaies work was conducted by Eysenck
his conclusion based on smaller number of studies, was pessimistic
he found that threpay actually seemed to dec the spontaneous improvment evident in ppl who did not receive therapy
this initial suprising finding galvanized the field and it led to a flurry of research activty
hundreds of studies were conducted over the next few decades with widely divergent findings
to make sense of a large number of findings on related topics, its useful to conduct a metaanalysis whcih combines the results of may diff studies
in one of the ealriest metanalyses, 475 studiesi were reveiwed
each studies compared pateints who received some kidn of psychotehrpay with a similar group of patients who didnt receive any psycholtehrpay
the study concluded that the average person who receives therapy is better off at the end of it than 80% of the persons who do not
sibsequent studies have domonstated that patients who beenift from tehrapy still show tehse imrpovements months or even years after treatment
more recent meta-analyses have used diff criteria in selecting studies for includsion but hav eyielded similar results across diff populations and disorders
these meta-analytcs results suggest that Eysencks initial gloomy conclusins werent correct
tehrapyy is generally efeftcive
however, when we are seeking help for ourselves or for a loved one, the quetsion we rlly want to answer is not whetehr tehrapy works in generaly, bt which therapy works best for a given problem
interest in evaluating treatments for specific disorders have been fueled by a worldwide moevemnt toward idnetfiying empically uspported treatments, or teratmets that reserach has shown to be effective
his moevemnt began in medicine but led to similar moevemnt iwthin eductaion, social work and psych
the conclusin of this reserach is suprisng: despite the many obvious differences among diff tehrapies for psych disorders and the strong partisan claims for the superiority of one type of therapy over others, many studies indicate that even apprently wildly differnt interventions are equally effective
this assesment has led some reserachers to offer the dodo bird verdict after the dodo bird in Alice in Wondeland, who organized a race among various Wonderland createus and concluded “everybody has won and all must have prizes”
others have taken strong issue with teh dodo bird verdict, pointing to studoies that examine the efefcts of specific modes of tehrpay for diff clinical disorders
thus for ex. behavoural tehrpay seems especially effective in treating anxiety disorder,s particularly the phobias but is rarely used for say personality disorders
cognitive tehrapy is efefctive in treating mood disorders and may be just as effectiove as drug treatement (but with longer lasting imapct and without side effects); it is also useful for otehr diagnsoses, such as panic disorder and bulimia nervosa
however, cognitive tehrapy may be less efefctive with other problems, including phobias
evidence likewise sugegsts that the experiential therapies can alleviate depression and anxiety disorders but these therpaies too have their limits and are less effective for schizophernia
the evidence is least compelling for the earliest form of tehrapy - freuds psychonalytic technqiue
however, the more modern psychodnyamic therapies, especially interperosnal tehrapy, do seem to be effective, especially for depression
