Unit 5 Abnormal Behavior Flashcards
HOW DO WE DEFINE BEHAVIOR AS ABNORMAL?
A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual that is ASSOCIATED WITH PRESENT DISTRESS or disability or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom
WHAT ARE THE CRITERIA FOR DEFINING A PSYCHOLOGICAL DISORDER.
- Uncommon behavior
- Unacceptable behavior
- Displays faulty perception (e.g. hallucinations)
- Displays faulty interpretation of reality (e.g. delusions)
- Displays self-defeating behavior
- Displays dangerous behavior
- Displays extreme personal distress
“…there is more to a disorder than being ___.”
atypical
What is the most common type of hallucination?
auditory
Give an example of a delusion or faulty perception of reality.
“I know you’re all aliens. You don’t look like aliens. But I know you’re aliens.”
“I’m king of the world.”
Give an example of a self-defeating behavior.
heroin addiction, other additions (alcohol, other drugs)
What types of faulty perceptions or hallucinations might one have?
auditory, visual, tactile
HOW DID SOCIETY APPROACH ABNORMAL BEHAVIOR BEFORE THE “MEDICAL MODEL” BECAME COMMONLY ACCEPTED?
Through the 18th century abnormal behavior was most often attributed to “evil” influences.
Depending on the cosmology of the times the aberrant actions were managed, punished or exorcised.
The typical response called for protecting the public by isolating the abnormal individual.
These asylums were initially intended to contain and isolate the insane.
What was the number one function of an asylum?
to protect the public (the non-abnormal)
Asylums perpetuated the belief about people with mental illness being ___.
evil
WHAT CHANGE OCCURRED IN THE 18TH CENTURY AND WHO WAS PHILIPPE PINEL?
In the 18th century a dramatic change occurred in the management of those with psychological disorders.
In 1793, Philippe Pinel was appointed médecin des infirmeries of the Hospice de Bicêtre, and he implemented his ideas on the humane treatment of the insane.
At the Bicêtre Pinel had the chains removed from his patients.
WHAT ARE THE BENEFITS OF USING A DIAGNOSTIC SYSTEM?
- treatment
- cause
- efficient communication about the patient’s condition
- it makes it possible for the mental health profession to function
WHAT IS THE MINIMUM THAT A DIAGNOSIS SHOULD ACCOMPLISH?
at a minimum, the diagnostic system should be able to discriminate between normal and abnormal
WHAT WAS ROSENHAN’S PROCEDURE AND WHAT WERE HIS FINDINGS?
(1972) The pseudopatient arrived at the admissions office complaining that he had been hearing voices saying “empty,” “hollow,” and “thud.“
Beyond claiming to hear voices and falsifying name, vocation, and employment, everything else was true and accurate.
The pseudopatients were never detected.
Admitted, except in one case, with a diagnosis of schizophrenia, each was discharged with a diagnosis of schizophrenia “in remission.”
If the pseudopatient was to be discharged, he must naturally be “in remission” but be was not sane, nor, in the institution’s view, had he ever been sane. Staff did not view patients as people.
IS THERE ANY COUNTER ARGUMENT FOR ROSENHAN’S POSITION?
Robert Spitzer responded:
First, the primary reason the pseudopatients were admitted was the request to be admitted when there was no obvious benefit, other than treatment, to be gained from admission.
They entered a hospital in personal distress, seeking help.
In order to be admitted the patients had to be diagnosed and Spitzer points out that the diagnostic system responded appropriately in identifying schizophrenia.
Specifically:
-There was no indication of substance abuse
-The patients were normal in memory and attention thus the symptom wasn’t due to neurological trauma
-There was no recent emotional trauma to produce a transient psychosis
-There was no evidence of significant mood disorder
-Thus, the remaining diagnosis that matched the symptom was schizophrenia.
WERE THE PSEUDOPATIENT’S DETECTABLE AS SANE PEOPLE?
Yes, other patients, real patients detected them.
It was quite common for the patients to “detect” the pseudopatients’ sanity. “You’re not crazy. You’re a journalist, or a professor [referring to the continual note-taking]. You’re checking up on the hospital.
IS THERE A “BIAS” IN THE DIAGNOSTIC SYSTEM?
Rosenhan (1972) went to a new hospital and made sure the staff had heard about his findings.
This staff reported that such an error would not occur in their hospital.
He waned them that at some time during the following 3 months he would send pseudopatients to the hospital.
Each staff member was asked to rate each patient according to the likelihood that the patient was a pseudopatient.
Judgments were obtained on 193 patients
Forty-one patients were alleged, with high confidence, to be pseudopatients by at least one member of the staff.
Twenty-three were considered suspect by at least one psychiatrist.
Nineteen were suspected by one psychiatrist and one other staff member.
Actually, no pseudopatient were sent to the hospital.
The conclusion was that there had to be a comprehensive revision of the diagnostic system.
DEFINE AND ILLUSTRATE THE ANXIETY DISORDERS (5).
Anxiety disorders are characterized by fear, feelings of dread and over arousal of the sympathetic nervous system. Anxiety disorders are psychological disorders characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety. The anxiety disorders are -Phobic disorder -Panic disorder -Generalized anxiety disorder -Obsessive-Compulsive disorder -Post Traumatic Stress Disorder
PHOBIC DISORDER
excessive, irrational fear of an object or activity
PANIC DISORDER
intermittent episode of severe fear or terror
GENERALIZED ANXIETY DISORDER
continuous fear or anxiety that is not associated with an identifiable object or activity
This disorder certainly includes a non-specific over arousal of the sympathetic nervous system.
The person displays
-Hyper vigilance and scanning
-Motor tension and hyperactivity
-Apprehension and expectation
OBSESSIVE-COMPULSIVE DISORDER
-recurring thoughts or images (obsessions)
-irresistible urges to act (compulsions)
To cope with the fear the person may engage in highly ritualized behavior.
When these mental or behavioral rituals begin to disrupt daily function the disorder is fully pathological.
Intrusive (logical..not necessarily healthy) Thoughts.
HOW IS PTSD LIKE THE ANXIETY DISORDERS?
POST-TRAUMATIC STRESS DISORDER, while not considered part of the Anxiety Disorders, includes vigilance, anxiety, partial memories of the trauma, and social withdrawal.
PTSD also seems to potentiate addiction.
DEFINE AND ILLUSTRATE THE MOOD DISORDERS.
Major depressive disorder
Dysthmic disorder
Mania
Bipolar disorder
The MAJOR DEPRESSIVE DISORDER, and the closely related DYSTHMIC DISORDER are both forms of ___ ____, and they are the most common disorder seen in today’s culture
clinical depression
All depression includes… (5)
lethargy, loss of motivation, change in appetite, changes in sleeping, and changes in self-care
A ___ episode is less severe but persistent and may last for two years or more.
Dysthmic
A ___ ___ ___ is severe, rapid in onset and typically lasts two weeks or more without obvious environmental origin (e.g. grief) or drug use.
Major Depressive episode
Major depression can be so severe that the person looses contact with reality. This ___ ___ is debilitating and can lead to suicidal thoughts and actual suicide.
PSYCHOTIC DEPRESSION
Major Depression is a recognizable and treatable disorder; a ___ fraction of suicides with Major Depression received adequate antidepressant treatment prior to their deaths
small
most depressed suicide attempters receive inadequate ____ treatment
antidepressant
Women tend to seek medical care (including therapeutic care) ____ than men.
sooner
Men kill themselves at about ___ times the rate for women.
four
Suicide is ___ leading cause of death in the US.
eighth
The largest increase in suicide in the last 30 years has been among people between 15-24 years old, but the highest rates are still among the ___.
elderly
You are ___ as likely to kill yourself than be killed by someone else.
twice
Those who succeed at suicide generally use lethal methods (guns, hanging, drowning, jumping) and are disproportionately older and ___.
male
Almost a ___ fully intend to kill themselves; fewer than half of these succeed.
third
One third clearly do not want to die.
Their “suicidal gesture” is…
a cry for help or attention.
One third of suicidal people are tossing the dice.
They don’t much care if they live or die, as long as the pain stops.
They tend to be…
impulsive, not plan carefully (if at all), and leave their survival to chance.
Teenagers ATTEMPT suicide roughly __ times more frequently than adults, but their fatality rate is about the same.
10
Suicide is the ___ leading cause of death among 15-19 year-olds.
third
MANIA
euphoria,
hyperactivity and
wildly unreasonable optimism
If the Mania appears without periods of depression the person is simply ___
manic
WHAT IS “FLIGHT OF IDEAS?”
The patient is speaking faster than the average person can follow, so only a select few of the ideas come through. They are not disconnected from reality.
BIPOLAR DISORDER
alternating pattern between depression and mania
WHAT DIFFERENT INTERVENTIONS ARE LOGICALLY RELATED TO THE VARIOUS COMPONENTS OF DEPRESSION?
COGNITIVE THERAPY
PHARMACOLOGICAL THERAPY
BEHAVIORAL THERAPY
If a person has a negative explanatory style, what would the therapy seek to do for the person? What type of therapy is this?
Changing the individual’s “way of thinking” is the goal of COGNITIVE THERAPY.
If the person is actually depressed and serotonin levels are low then the logical intervention would be ____ with drugs to elevate serotonin levels. These drugs (SSRIs such as Paxil, Zoloft, etc.) now represent more than ___% of the pharmacological intervention for depression.
PHARMACOLOGICAL THERAPY; 80
If the person is “acting depressed” with low levels of activity, sleeplessness, poor appetite, and flat affect then ____ can change the person’s actions. If an individual is reinforced for activity then what happens to activity levels?
BEHAVIORAL THERAPY; They go up!
WHAT IS SCHIZOPHRENIA?
which means “split mind,” is a severe mental illness characterized by some or all of the following:
- Bizarre behavior.
- Disorganized thinking.
- Disorganized speech.
- Decreased emotional expressiveness.
- Diminished or loss of contact with reality.
- Diminished to total social withdrawal.
The prevalence of schizophrenia is ___ ___ ___ ___ sex, race, and culture.
the same regardless of
Schizophrenia afflicts approximately __% of the world’s population.
1
____ experience less severe disruptions due to the illness and are less likely to be hospitalized and maintain better social functioning.
Women
In the United States, ___ of all beds in psychiatric hospitals are occupied by schizophrenic patients.
one-third
people with schizophrenia account for at least __% of the homeless population in the United States
10
Schizophrenia is progressive as evidenced by:
- Have a history of bizarre thoughts, speech, or viewpoints in childhood.
- Have a hard time keeping up at school.
- Have a history of being disliked at school
- Have a history of social isolation.
- Are less likely to marry and more likely to divorce.
- Have a hard time keeping a job, perform poorly at work and miss work frequently.
- More prone to attempt suicide.
Schizophrenia is progressive or sudden?
progressive
The illness usually develops slowly over months or years.
Schizophrenia usually develops between the ages of __ and __
15 and 30
Once people develop schizophrenia, they usually suffer from the illness for the rest of their lives.
T/F
True
Is there a cure for schizophrenia?
Although there is no cure, treatment can help many people with schizophrenia lead productive lives.
Positive symptoms of schizophrenia
include exaggeration or distortions of normal thoughts,emotions,and behavior. (e.g. delusions, hallucinations,or thought disorders).
Negative symptoms of schizophrenia
include a reduction or absence ofnormal thoughts,emotions,and behavior.Includes flattened affect,alogia (loss of speech or non speech),or avolition (loss of motivation or goal seeking).
Schizophrenia is characterized by ___ and ____ symptoms.
positive; negative
In this context positive and negative do not mean good and bad.
LIST THE SYMPTOMS OF SCHIZOPHRENIA.
delusions, hallucinations, bizarre behavior, Disorganized Thinking and Speech, social withdrawal
Illustrate delusions.
A schizophrenic may believe that he is Alexander the Great
Illustrate hallucinations.
People with schizophrenia may feel “things” moving under their skin
Illustrate bizarre behavior as related to schizophrenia.
A schizophrenic may suddenly begin laughing without obvious emotional content or explanation
Illustrate Disorganized Thinking and Speech.
People with schizophrenia might tell you that because so many people live on the west coast the United States has tilted down on one side and that lifts the east higher into colder air and we are going to freeze to death if Los Angeles gets any bigger.
A schizophrenic might jump between thoughts without connection. For example, “Birds flying south and chemical plants with loneliness is so bad.” (NOTE the ease of confusion with “flight of ideas?”)
Illustrate Disorganized Thinking and Speech (verbigeration).
A schizophrenic might warn you about “pseudocerebrocybersubliminal messages,” or repeat “Must wash your hands before returning to work.” over and over (NOTE the ease of confusion with autistic behavior.) He is combining words and phrases in meaningless ways.
Illustrate Disorganized Thinking and Speech (“poverty of speech”).
You ask a schizophrenic woman how she feels and she answers “Yes.” She will only use the word “yes.”
Illustrate social withdrawal.
In a conversation with a schizophrenic man he indicates that you are not present. He talks to you but tells you that you don’t exist (deny the existence of others).
How do you determine if behavior is truly bizarre for a schizophrenic?
Is this behavior bizarre or is it logical within the context of the delusion?
HOW IS SCHIZOPHRENIA DIAGNOSED?
ONE
one month or more, in which a significant portion of time is taken up by
-bizarre delusions
-hallucinations consisting of two or more voices conversing with each other
-a voice affecting a person’s behaviors or thoughts.
–(Voices that issue commands are referred to as command hallucination)
OR at least two of the following for less time:
-Delusions (delusions are false beliefs that appear obviously untrue to other people)
-Hallucinations.
-Grossly disorganized Behavior.
-Catatonic Behavior.
-Negative symptoms.
TWO
-The disturbance produces a significant impairment in academics, interpersonal relations, self-care, work, or any other major area of functioning
THREE
-Symptoms are continuous and persist for at least six months.
FOUR
There is no
-Pervasive Developmental Disorder,
-substance issue disorder,
-general medical condition,
-or another mental disorder.
+PROCESS OF ELIMINATION
ARE THESE SYMPTOMS ALWAYS SCHIZOPHRENIA?
When the symptoms have a very rapid onset, less than four weeks, the diagnosis will probably be schizophreniform disorder
schizophreniform disorder
When the symptoms have a very rapid onset, less than four weeks
Unlike schizophrenia, this disorder has a good prognosis if:
-onset of psychotic symptoms was within 4 weeks of the first noticeable change in behavior
-at the height of the psychotic episode the patient is confused or perplexed
-before the illness the person had good social and occupational function
-the person does not show absence of or flat affect
WHAT ARE THE SUBTYPES OF SCHIZOPHRENIA (5)?
PARANOID TYPE DISORGANIZED TYPE (Hebephrenic) CATATONIC TYPE UNDIFFERENTIATED TYPE RESIDUAL TYPE
Schizophrenia: CATATONIC TYPE
(dominated by negative symptoms) characterized by marked psychomotor active, a variety of catatonic symptoms such as
- Cataplexy (periods of muscular weakness).
- Increased motor movement with no stimuli.
- Mutism (apraxia) or extreme negativism.
- Echolalia or echopraxia
- Posturing,grimacing,or stereotyped movement (waxy rigidity–patient chooses not to move–will take on forced new positions).
Schizophrenia: DISORGANIZED TYPE (Hebephrenic)
characterized by a disorganized behavior, disorganized speech,and flat affect.Involving a disturbance in behavior,communication,and thought. There is a lacking of any consistent theme.
Schizophrenia: PARANOID TYPE
characterized by a preoccupation of bizarre delusion(s) of being persecuted or harassed.Auditory hallucinations that are related to the delusions’ theme.
Schizophrenia: UNDIFFERENTIATED TYPE
characterized by a number of schizophrenic symptoms such as delusion(s),disorganized behavior,disorganized speech, flat affect,or hallucinations but does not meet the criteria for any other type of schizophrenia.
Schizophrenia: RESIDUAL TYPE
characterized by a previous diagnoses of schizophrenia, but no longer having any of the prominent psychotic symptoms.There are some remaining symptoms of the disorder however,such as eccentric behavior, emotional blunting,illogical thinking,or social withdrawal
What is the most problematic type of hallucination?
Voices that issue commands are referred to as command hallucination
DO SCHIZOPHRENICS SHOW BRAIN ABNORMALITIES?
Schizophrenic patients lose 20% of their cortex/cortical mass in 5 years. The average adolescent loses 5%.
Schizophrenia has an imbalance of the neurotransmitter ____ in certain parts of the brain and an abnormal sensitivity to ___(same)____.
dopamine
What are possible contributing factors for schizophrenia?
- genetics
- non-genetic structural brain abnormalities
- abnormalities in the prenatal environment (teratogens)
- stressful life events
The ___-____ ____ block dopamine receptors for schizophrenics.
anti-psychotic drugs
DOES GENETIC RELATEDNESS PREDICT SCHIZOPHRENIA?
Yes
A person with no schizophrenic relatives has a ____ percent chance of developing the illness
1
If one parent has schizophrenia the children have a ____ percent chance of developing the illness
6
If an older brother or sister has schizophrenia the other children have a ____ percent chance of developing the illness
9
If a fraternal twin has schizophrenia the other twin has a ____ percent chance of developing the illness
17
If an identical twin has schizophrenia the other twin has a ____ percent chance of developing the illness
48
Most prominent among the functional differences is abnormally low activity in the ___ ___ of the schizophrenic brain.
frontal lobe
IS THERE A TERATOGENIC FACTOR IN SCHIZOPHRENIA?
Yes, Pregnant women who have been exposed to the influenza virus or who have poor nutrition have a slightly increased chance of giving birth to a child who later develops schizophrenia.
Pregnant women who have been exposed to the ___ ___ or who have ___ ___ have a slightly increased chance of giving birth to a child who later develops schizophrenia.
influenza virus; poor nutrition
ARE THERE ENVIRONMENTAL CAUSES OF SCHIZOPHRENIA?
CAN THEY PRODUCE SCHIZOPHRENIA IN ANYONE?
Generally these factors [stress] will only precipitate schizophrenia in a person already biologically predisposed to the disease.
therapeutic intervention for schizophrenics should target ___ ____
stress management
Why should therapeutic intervention for schizophrenics target stress management?
Stressful environmental factors can trigger a relapse of symptoms.
HOW IS SCHIZOPHRENIA TREATED?
Treatment of schizophrenia usually involves a combination of medication, rehabilitation, and treatment of other problems the person may have.
However, rehabilitation and other therapies to improve cognitive and social functioning should wait for management of the major psychosis.
Antipsychotic medications are indicated for nearly all acute psychotic episodes in patients with schizophrenia.
What are the two main types of medication prescribed for schizophrenia?
-The traditional antipsychotic medications, a.k.a neuroleptics, (Haldol, etc.) block various dopamine receptors in the brain.
lower dopamine levels also affect the motor system muscle-related side effects are called Extra-Pyramidal Side effects, or EPS.
-The atypical neuroleptics target specific dopamine receptors and/or may block or inhibit re-uptake of serotonin.
atypical drugs more effectively treat the negative symptoms of schizophrenia
Atypical neuroleptics have fewer muscle-related side effects (EPS) and there will be a lower risk of developing tardive dyskinesia.
tardive dyskinesia
neurological syndrome characterized by repetitive, involuntary, purposeless movements. grimacing, tongue protrusion, lip smacking, puckering and pursing, and rapid eye blinking. Rapid movements of the arms, legs, and trunk
Involuntary movements of the fingers may appear as though the patient is playing an invisible guitar or piano.
There is no standard treatment for tardive dyskinesia…first step… stop or minimize the use of the neuroleptic drug…for patients with a severe underlying condition this may not be a feasible option
Symptoms of tardive dyskinesia may remain long after discontinuation of neuroleptic drugs
Once the major schizophrenic psychosis is under control the primary goal is to insure ___ ____.
medication compliance
Schizophrenia: Skills training
establishes specific behaviors for functioning in society
Schizophrenia: behavioral training methods
teach self-care skills such as personal hygiene, money management, and proper nutrition
Schizophrenia: cognitive-behavioral therapy
a type of psychotherapy, can help reduce persistent hallucinations, delusions, and unusual social behavior
schizophrenics experience employment problems with high levels of ____
homelessness
With schizophrenia a common associated problem is ____ ____.
substance abuse
WHAT IS THERAPY?
Therapy is an interaction between a therapist and a patient, guided by the perspective of the therapist and intended to improve the quality of life for the patient.
DEFINE PSYCHOLOGICAL THERAPY
Psychological therapy is a structured interaction between the therapist and the client.
DEFINE BIOMEDICAL THERAPY
Biomedical therapy is a procedure that acts directly on the patient’s nervous system.
DO THERAPISTS WHO USE PSYCHOLOGICAL THERAPIES FOLLOW SPECIFIC PROCEDURES?
Most therapists are either eclectic, shifting between therapeutic techniques as needed, or integrated, mixing elements into a deliberate structured approach.
Thus, a clinician might talk with a patient, listening in a supportive attitude most of the time (Client centered) then suggest that the patient consider thinking about a stressful situation in a different way (Cognitive) and arranging specific consequences for healthier actions (Behavioral).
eclectic therapist
shifting between therapeutic techniques as needed
integrated therapist
mixing elements into a deliberate structured approach
client centered therapy
a clinician might talk with a patient, listening in a supportive attitude most of the time
cognitive therapy
suggest that the patient consider thinking about a stressful situation in a different way
behavioral therapy
arranging specific consequences for healthier actions
WHAT ARE THE DIFFERENCES BETWEEN PSYCHOLOGICAL THERAPIES?
Is there an emphasis on thinking and feeling?
Is there an emphasis on past experiences and repressed memories of past events or current thinking and future experiences?
psychodynamic (and psychoanalytic) therapy
client-centered and cognitive all emphasize thinking
emphasizes past experiences
emphasize current and future thinking
client-centered and cognitive therapy
emphasize current and future thinking
Behavioral therapy
does not emphasize thinking or feeling
WHAT IS THE GOAL OF PSYCHODYNAMIC THERAPY?
The therapist’s task is to reveal hidden conflicts to the patient.
The therapist will use techniques that circumvent our defensive barriers.
Freudian perspective
past conflicts and past anxieties are hidden outside the patient’s awareness and express themselves through inappropriate or abnormal behavior
We construct defensive mechanisms and barriers to acknowledging these anxieties [hidden conflicts], we cannot bring these anxieties into our awareness.
WHAT IS FREE ASSOCIATION?
“compulsion to utter” we want to speak of our anxiety but we actively inhibit these statements as part of our defensive barrier
the psychoanalyst will present a series of words and encourage a patient to say the very first thing that comes to mind
if the patient speaks quickly enough, should allow the anxiety to be expressed.
Of course the expression is often coded or tangential.
WHAT IS LATENT CONTENT IN DREAM ANALYSIS?
Dreams satisfy repressed desires and allow us to release our urges.
Of course the release had to be symbolic
the manifest content, or actual images, of the dream is not important
the censored, symbolic or latent content really matters
HOW CAN WE EVALUATE THE PSYCHODYNAMIC PERSPECTIVE?
Patients who are left alone get better faster than those enduring psychodynamic therapy
WHAT IS THE GOAL OF CLIENT-CENTERED THERAPY?
Client-Centered Therapy (CCT) is explicitly non-directive.
the therapist should never steer the client toward a goal or conclusion
A directive approach implies that the therapist knows what is right, healthy, or normal. What if the patient wants to grow in a different direction?
a non-directive approach appeals to many clients.
They maintain control over the content, pace, and goal of the therapy.
But what is CCT if the therapist isn’t “treating” the patient?
To be unconditionally positively responsive
The therapist provides safety.
The path is in the patient.
The therapist doesn’t know the answer, the client does.
The therapist repeats what the client says back to him/her.
CCT: How is a human being like a potato?
They will inherently root in an effort to find the light, grow toward health.
a foundational belief of CCT is that people tend to move toward growth and healing. Thus, left to their own devices a client will naturally grow toward health.
WHAT HAPPENS IN CLIENT-CENTERED THERAPY?
- Listen and try to understand how things are from the client’s point of view
- Check that understanding with the client if unsure
- Treat the client with the utmost respect and regard
- There is also a mandate for the therapist to be “congruent”, or “transparent” - which means being self-aware, self-accepting, and having no mask between oneself and the client.
HOW CAN A CCT WORK WITH CLIENTS WHO DID OR DO VERY BAD THINGS?
To be unconditionally responsive to the experiencing person does not mean accepting all of their behavior and certainly does not imply condoning everything they do.
HOW DOES BEHAVIORAL THERAPY WORK?
“…problem behaviors are the problem.”
Like the behavioral theory of personality, you are what you do.
The assertion is that we learn inappropriate or poorly adjusted behaviors through the processes of respondent and operant conditioning.
WHAT ARE CRITICISMS OF BEHAVIORAL THERAPY?
What happens to the learned behavior when the therapist is no longer around to deliver reinforcement?
Should anyone have this control or power over another person’s behavior?
Behavioral Therapy: What should happens to the patient and the learned behavior when the therapist is no longer around to deliver reinforcement?
Do you ever experience “pride,” or “satisfaction?” These are internal sources of reinforcement for successful behaviors.
Self-reinforcing is an action and, like all other actions, it can be taught through reinforcement.
HOW DOES COGNITIVE THERAPY WORK?
The situation alone cannot determine our emotional or psychological state.
We are centrally and actively involved in creating our “state” by interpreting or thinking about the situation.
Challenge the thinking.
In 1955 Dr. Albert Ellis developed Rational Emotive Behavior Therapy (REBT) (a.k.a. Rational Emotive Therapy, RET)which stimulates emotional growth by teaching people to replace their self-defeating thoughts, feelings and actions with new and more effective thoughts.
Rational beliefs (RBs) lead to functional consequences, while irrational beliefs (IBs) lead to dysfunctional consequences.
Clients who engage in RET are encouraged to actively dispute their IBs and to develop more RBs, which should have a positive impact on their emotional, cognitive, and behavioral responses
WHAT IS THE SEROTONIN THEORY OF DEPRESSION AND HOW DOES IT RELATE TO ANTIDEPRESSANTS?
depression is due to a decrease in serotonin
SSRIs are prescriped
What does SSRI stand for?
selective serotonin reuptake inhibitor
What evidence suggests depression is due to a decrease in serotonin?
What is the problem for this model?
- Drugs that reduce 5-HT in the neurons cause the user to feel and act depressed
- All antidepressants (SSRIs) increase 5-HT levels
The antidepressants all require several weeks to become effective.
This doesn’t fit the drug action implied by the monoamine theory
tolerance and adaptation would follow elevated 5-HT levels
The SSRIs would become less effective over time.
Yet, antidepressants seem effective after an extended period of use?
WHAT IS THE NEUROGENIC THEORY OF DEPRESSION?
The neurogenic theory of depression suggests that stress and depression are neurodegenerative and that unless neurogenic signals stimulate repair there will be a significant loss of function
When is cortisol released?
when you’re stressed
How is cortisol related to depression?
“Normal” people have lower cortisol levels at night while sleeping. They’re recovering.
Depressed people’s cortisol levels do not decrease at night.
What does cortisol do to your brain? How is this related to depression?
destroys your brain
depressed people have physically smaller brains
Neurogenesis
is a process leading to new neurons
neurogenesis requires some signals to start
How are SSRIs and neurogenesis related?
the time course of the effectiveness of antidepressants and effective neurogenesis are the same
“Antidepressants relieve depression by acting at the cellular level to promote neuronal survival and reverse stress-induced neuronal damage…[antidepressants’] ultimate targets are the intracellular molecules responsible for maintaining neuronal health and plasticity”
antidepressants are healing tissue damaged by cortisol
WHAT ARE THE COMMON ANTI-ANXIETY DRUGS AND HOW DO THEY REDUCE ANXIETY?
Valium, Xanax, Halcion, Versed, Klonopin
(Benzodiazepines - BZDs)
Remember that we have chemically gated channels on our neurons. The BZDs open these channels and the result is an increase in GABA function.
GABA is the global inhibitor in the brain.
More GABA function = less brain activity, less activity = less anxiety
BZDs help GABA do its job better
What is Adderall, really?
amphetamine
What do Adderall and Ritalin do?
make you release dopamine and leave it out there, help you assign importance so you know what to concentrate on
What is ADHD?
an importance deficit
patient thinks everything in the world is equally important
looks like they don’t have an attention span
Is Adderall addictive?
yes
creates tolerance and dependence
Are BZDs addictive?
yes
create dependence
Are SSRIs addictive?
no
do not create tolerance
WHAT IS ELECTROCONVULSIVE THERAPY AND HOW DOES IT WORK?
old type: induces grand mal seizure
-memory loss
now: induces seizure-like moment in brain
- elevates serotonin levels enough to trigger neurogenesis (healing and recovery)
WHAT IS PSYCHOSURGERY AND HOW DOES IT WORK?
surgical modification of a (physically) healthy brain to change behavior
lobotomy
Monese discovered on baboons, then used on violent criminals
