Lecture 24: Models And Therapy Of Psychopathology

Question 0

What is Freud’s contribution to psychopathological therapies?

Answer 0

Recognised conscious preconscious and unconscious processes,
Developmental stages
Oedipal crisis
Drive theory
Psychoanalysis, psychodynamic theory
Ongoing contribution to psychotherapies today.

Question 1

What is the brief history of treatment for Psychopathological disorders?

Answer 1

1970s- the beginnings of asylum care
1780s- mesmer, trance states
1793- pinel- moral therapy
Charcot- use of hypnosis in hysteria
Schopeneur, Nietzshce, Jewish mystics talk of the unconscius, understanding that we are irrational beings who hide things from ourselves

Question 2

What are the forms of psychodynamic therapy?

Answer 2

Psychoanalysis

Psychodynamic psychotherapy

Question 3

What is psygchoanalysis?

Answer 3

Patient lies on a couch with therapist seated behind them. Patients are encouraged to free associate

Question 4

What is psychodynamic psychotherapy?

Answer 4

Patient and therapist are face to face
The techniques used are more goal directed than those used in psychoanalysis
Many styles: therapies in children, art therapies, skills, used in indivudals, couples, families and groups

Question 5

What is the psychodynamic approach?

Answer 5

Mental symptoms are a reflection of unconscious conflicts which induce anxiety
The goal of therapy is to gain insight into these conflicts

Question 6

What is insight?

Answer 6

It refers to the situation in a person coming to understand their unconscious conflicts

Question 7

What does psychodynamic therapy require?

Answer 7

An alliance (relationship) between the patient and therapist

Question 8

What are psychodynamic techniques?

Answer 8

Relaxed atmosphere
Free association
Resistance, dream analysis and parapraxis
Interpretation
Analysis of transference

Question 9

What is free association?

Answer 9

Technique in which the patient is encouraged to say whatever comes to mind to reveal the unconscious processes of the patient

Question 10

What is interpretation?

Answer 10

The therapist interprets the thoughts and feelings of the patient in order to reveal the hidden conflicts and motivations

Question 11

What is analysis of transference?

Answer 11

Patients bring into therapy their past troubled relationships, these ar transferred to the therapist

Question 12

What is behaviourism?

Answer 12

A more scientific approach based on observation.

Question 13

Who contributed to behaviourism?

Answer 13

Ivan Pavlov - conditioning reflex in dogs, pairing of stimuli
BF skinner - operant comditiojijg, reward and punishment shape behaviour
Watson- behaviour can be studied without consideration of learning etates

These contributions remain highly relevant to learning theory and shaping behaviour

Question 14

What are behavioural approaches to treat psychopathology

Answer 14

Desensitisation- classical conditioning in the treatment of phobias

Contingency management- positive reinforcement strategies promote repetition of behaviour e.g. Praise, and
Extinction strategies diminish dysfunctional behaviours e.g. Dog training, disruptive behaviour management in classrooms

Question 15

What is cognitive behavioural therapy?

Answer 15

When behavioural therapies are blended with cognitive psychology

Question 16

What is cognitive psychology?

Answer 16

Attention
Language use
Memory
Perception
Problem solving
Thinking

Question 17

What is the cognitive behavioural perspective?

Answer 17

Bech- 1970
Proposed that thoughts are connected to feelings

Many psychological disorders reflect thinking errors such as dysfunctional attitudes, faulty thinking and cognitive distortions

Thinking errors can lead to psychopathology

Question 18

What is CBT like?

Answer 18

Usually short term and focused in the current behaviours of a person and careful analysis of thinking and feeling associated with this

Therapists are more directive
Solid evidence base exists based on RCT for depression, anxiety, eating disorder, chronic fatigue, psychotic disorders

Now CBT can be computerised, group delivery also available

Question 19

What is the focus of cognitive therapies?

Answer 19

Changing dysfunctional thought patterns (automatic thoughts) through rational approaches such as looking for evidence and challenging this

Question 20

What does rational emotive therapy focus on?

Answer 20

The irrational thought patterns of the patient (rational thinking is the key to eliminating symptoms)

Question 21

What does Beck’s cognitive therapy focus on?

Answer 21

Changing patent’s cognitive distortions

Question 22

What are family therapies?

Answer 22

This began in 1950s with the central notion that an individuals symptoms were not pathology but rather symptoms of dysfunction in the family.

This theory was reinforced by the cybernetics and systems theory which states that causality can be non-linear e.g. Child’s symptoms may function to keep the two parents together, who are otherwise in conflict.

Question 23

What is the biological perspective on psychopathology.

Answer 23

Seeks roots of abnormal behaviour within the brain.

Can be due to neurotransmitter dysfunction
-depression due to low levels of serotonin

Can be due to abnormality of brain structures
-frontal lobe differences in schizophrenia

Can be due to disrupted neural pathways
- e.g. OCD

Can be due to genetics

Question 24

What are some biological treatments?

Answer 24

These have arisen from the view that psychological disorders reflect pathology of the brain

Treatments include
Pharmacotherapy
Electroconvulsive therapy
Psychosurgery

These can only be administered by physicians

Question 25

What is psychopharmacology?

Answer 25

The use of drugs to treat symptoms of mental illness

Drugs predictably alter symptoms in a particular mental disorder or illness

Question 26

What are psychotropic medications?

Answer 26

Drugs that act on the brain to alter mental function

Before 1956, schizophrenia was virtually untreatable with many patients confined for life in mental hospitals

Chlorpromazine was found to reduce the severity of psychotic thought, allowing people to live outside of mental institutions

Question 27

What are neurotransmitters.

Answer 27

These are chemicals which transmit information from one cell to another

They are stored in the vesicles of the presynaptic cell
Released in response to the action potential from the presynaptic membrane
Molecules diffuse across the synaptic cleft and bind to post synaptic receptors.

Question 28

What are some common neurotransmitters and their effects?

Answer 28

Glutamate - excitation of neurons throughout the nervous system
GABA - inhibition of neurons in the brain
Glycine - inhibition of neurons in the spinal cord and lower brain
Dopamine - emotional arousal, pleasure and reward, voluntary movement, attention
Serotonin - sleep and emotional arousal, aggression, pain regulation, mood regulation
Acetylcholine - learning and memory
Endorphins and Encephalins - pain relief and elevation of mood
Epinephrine and norepinephrine - emotional arousal, anxiety and fear

Question 29

What are antipsychotic medicines?

Answer 29

These refer to drugs that alleviate schizophrenia

They inhibit dopamine which has been implicated in the positive symptoms of schizophrenia
However, can result in side effects like tardis dyskinesia, which is involuntary movements such as tics and twitching

Question 30

What are antidepressant medications?

Answer 30

Drugs which reduce depression by correcting for the depletion of norepinephrine and serotonin

E.g. Monoamine oxidase inhibitors allow the neurotransmitter to work for longer periods

Selective serotonin reuptake inhibitors block the reuptake of each serotonin

Question 31

What antianxiety meds are used?

Answer 31

Benzodiazepines increase the activity GABA to dampen the neural activity of the brain

Antianxiety medications can result in physical and psychological dependence

Question 32

How are treatments evaluated?

Answer 32

Drug treatments are evaluated by randomised controlled trials with blinding, and measured against placebo.

Question 33

What is a difficulty in evaluating psychological treatments?

Answer 33

The difficulty lies in the definition of success and variability in the disorder.

Research needs to consider the length of treatment, cost, symptom reduction and relapse rates.

Question 34

What do efficacy studies do?

Answer 34

They assess treatment outcomes under controlled experimental conditions

Question 35

What do effectiveness studies do?

Answer 35

They assess treatments as practiced by clinicians

Question 36

What are the genetics like in mental illness?

Answer 36

Research has shown that:

Autism, schizophrenia and biopolar disorder have 60% concordance in identical twins and 5% in fraternal twins

Coronary artery disease have a 40% concordance in identical twins and 10% in fraternal twins

Depression has a 50% concordance in identical twins and 15% in fraternal twins.

Question 37

What is the Diathesis stress model for mood disorders.

Answer 37

Diathesia- hereditary with or without early environmental experiences, along with
Stress- precipitating event like a death in the family

In combination, can contribute biologically to low serotonin/norepinephrine levels,
This in turn results in psychological negative cognitions- learned helplessness.

Which causes the symptoms like depressed mood/energy