Lecture 24: Models And Therapy Of Psychopathology Flashcards
What is Freud’s contribution to psychopathological therapies?
Recognised conscious preconscious and unconscious processes,
Developmental stages
Oedipal crisis
Drive theory
Psychoanalysis, psychodynamic theory
Ongoing contribution to psychotherapies today.
What is the brief history of treatment for Psychopathological disorders?
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
What are the forms of psychodynamic therapy?
Psychoanalysis
Psychodynamic psychotherapy
What is psygchoanalysis?
Patient lies on a couch with therapist seated behind them. Patients are encouraged to free associate
What is psychodynamic psychotherapy?
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
What is the psychodynamic approach?
Mental symptoms are a reflection of unconscious conflicts which induce anxiety
The goal of therapy is to gain insight into these conflicts
What is insight?
It refers to the situation in a person coming to understand their unconscious conflicts
What does psychodynamic therapy require?
An alliance (relationship) between the patient and therapist
What are psychodynamic techniques?
Relaxed atmosphere Free association Resistance, dream analysis and parapraxis Interpretation Analysis of transference
What is free association?
Technique in which the patient is encouraged to say whatever comes to mind to reveal the unconscious processes of the patient
What is interpretation?
The therapist interprets the thoughts and feelings of the patient in order to reveal the hidden conflicts and motivations
What is analysis of transference?
Patients bring into therapy their past troubled relationships, these ar transferred to the therapist
What is behaviourism?
A more scientific approach based on observation.
Who contributed to behaviourism?
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
What are behavioural approaches to treat psychopathology
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
What is cognitive behavioural therapy?
When behavioural therapies are blended with cognitive psychology
What is cognitive psychology?
Attention Language use Memory Perception Problem solving Thinking
What is the cognitive behavioural perspective?
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
What is CBT like?
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
What is the focus of cognitive therapies?
Changing dysfunctional thought patterns (automatic thoughts) through rational approaches such as looking for evidence and challenging this
What does rational emotive therapy focus on?
The irrational thought patterns of the patient (rational thinking is the key to eliminating symptoms)
What does Beck’s cognitive therapy focus on?
Changing patent’s cognitive distortions
What are family therapies?
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.
What is the biological perspective on psychopathology.
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
What are some biological treatments?
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
What is psychopharmacology?
The use of drugs to treat symptoms of mental illness
Drugs predictably alter symptoms in a particular mental disorder or illness
What are psychotropic medications?
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
What are neurotransmitters.
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.
What are some common neurotransmitters and their effects?
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
What are antipsychotic medicines?
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
What are antidepressant medications?
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
What antianxiety meds are used?
Benzodiazepines increase the activity GABA to dampen the neural activity of the brain
Antianxiety medications can result in physical and psychological dependence
How are treatments evaluated?
Drug treatments are evaluated by randomised controlled trials with blinding, and measured against placebo.
What is a difficulty in evaluating psychological treatments?
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.
What do efficacy studies do?
They assess treatment outcomes under controlled experimental conditions
What do effectiveness studies do?
They assess treatments as practiced by clinicians
What are the genetics like in mental illness?
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.
What is the Diathesis stress model for mood disorders.
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
