Psychological Psychological DisordersDisordersSome statistics:

– 1 in 6 Americans suffers clinically significant mental disorders

– The incidences of mental disorders doubles for those below the poverty line

– Over 75% of all sufferers experience their first symptoms by the age of 24

Psychological Psychological TherapiesTherapies

– With the development of drugs With the development of drugs in the 1950’s, the major push in the 1950’s, the major push was to localize therapy and to was to localize therapy and to deinstitutionalize patients patients

Preventative Efforts offer therapy at the onset offer therapy at the onset

of a disorderof a disorder

Primary Prevention hopes hopes to minimize societal incidents to minimize societal incidents of unemployment or of unemployment or homelessness as the result of homelessness as the result of having a disorder.having a disorder.

Secondary Prevention deals deals with helping at risk patients, such with helping at risk patients, such as those who living in a war zone. as those who living in a war zone.

Tertiary Prevention aims at aims at helping those already with a helping those already with a disorder avoid situations that may disorder avoid situations that may add to their already complicated add to their already complicated lives.lives.

There are over 250 identifiable types of There are over 250 identifiable types of psychotherapy, though the most influential psychotherapy, though the most influential are:are:

–Psychodynamic Therapies–Humanistic Therapies–Behavior Therapies–Cognitive Therapies–Group and Family Therapies–Bio-Medical TherapiesAny therapist who uses a combination

of therapies is said to be using an “eclectic” approach to therapy

PsychoanalysiPsychoanalysiss

Aims:Aims:–Psychoanalysis Psychoanalysis assumes that assumes that many many psychological psychological problems are problems are fueled by the fueled by the childhood childhood repression of repression of impulses and impulses and conflictsconflicts

It is the job of a psychoanalyst It is the job of a psychoanalyst toto::

– bring repressed feelings into bring repressed feelings into conscious awarenessconscious awareness– have the have the

patient “work patient “work through” the through” the feelings feelings

– release the release the negative, negative, repressed repressed energyenergy

MethodsMethods::–Free Association is a method is a method of exploring the unconscious, of exploring the unconscious, in which a person relaxes and in which a person relaxes and says whatever comes to mind, says whatever comes to mind, no matter how trivial or no matter how trivial or embarrassingembarrassing

Free Association:During free association, though, During free association, though, patients almost instinctively patients almost instinctively begin to edit themselves, feeling begin to edit themselves, feeling that some information is too that some information is too trivial, irrelevant, or shameful. trivial, irrelevant, or shameful. - - These blocks in the flow of free These blocks in the flow of free association are called association are called resistance

Resistance:– Resistance hints at anxiety and the Resistance hints at anxiety and the

repression of sensitive material. A repression of sensitive material. A psychotherapist wants to first make a psychotherapist wants to first make a patient aware of these areas, and then patient aware of these areas, and then explore their underlying meanings explore their underlying meanings further. further. The notation of hidden meanings in The notation of hidden meanings in resistance and later, dreams, and the resistance and later, dreams, and the insights provided, is called insights provided, is called interpretation

Interpretation:Interpretation:

– Interpretation = recognition by Interpretation = recognition by therapist and patient of therapist and patient of repressed issues to deal repressed issues to deal with….and then begins the with….and then begins the suggestions of underlying suggestions of underlying wishes, feelings, desires, or wishes, feelings, desires, or conflicts.conflicts.

–How do those underlying issues How do those underlying issues further fit into the larger further fit into the larger picture of the patient’s disorderpicture of the patient’s disorder

Methods:Methods:–Dream Interpretation is a is a psychotherapist’s psychotherapist’s understanding of the understanding of the latent content of a patient’s dream. of a patient’s dream.

Latent content Latent content refers to the refers to the underlying, but underlying, but censored, censored, real real meaning of a meaning of a dream.dream.

Methods:Methods:

–While revealing their secrets, their While revealing their secrets, their desires, and their repressed desires, and their repressed feelings, patients may begin to feelings, patients may begin to experience strong feelings experience strong feelings (positive or negative), towards (positive or negative), towards their therapists. their therapists.

- Transferring emotions from one - Transferring emotions from one experience to the therapist is experience to the therapist is called called transference.transference.

Methods:Methods:– A modern variation of psychoanalysis is A modern variation of psychoanalysis is

called called interpersonal psychotherapyinterpersonal psychotherapy.. – Helps people gain insight into the roots Helps people gain insight into the roots

of their difficulties by focusing on of their difficulties by focusing on currentcurrent relationships, rather than past or relationships, rather than past or repressed feelings. repressed feelings.

– especially effective with those patients especially effective with those patients suffering from depression.suffering from depression.

Humanistic Humanistic TherapiesTherapies

Aims:Aims:–The humanistic therapist’s The humanistic therapist’s goal is to boost goal is to boost self-fulfillment by helping by helping people grow in self-people grow in self-awareness and self-awareness and self-acceptance.acceptance.

Methods:Methods:–Humanists hope to accomplish their Humanists hope to accomplish their goals by:goals by:Focusing on the Focusing on the present and the futurepresent and the future, , rather than the pastrather than the past

Exploring feelings as they occur, rather Exploring feelings as they occur, rather than repressed, past feelingsthan repressed, past feelings

Dealing with Dealing with consciousconscious thoughts, thoughts, rather than the unconsciousrather than the unconscious

Methods:Methods:–Humanists hope to Humanists hope to accomplish their goals by:accomplish their goals by:

Having patients take Having patients take immediate responsibility immediate responsibility for their thoughts and for their thoughts and actions, rather than hiding actions, rather than hiding themthem

Promoting growth, rather Promoting growth, rather than dwelling on a “cure” than dwelling on a “cure” for an illnessfor an illness

Methods:Methods:– Re-enforce the idea of Re-enforce the idea of free willfree will, or the , or the realization that people realization that people are capable of controlling are capable of controlling their own destiny (as their own destiny (as opposed to opposed to determinism))

Methods:Methods:– Carl Rogers’ Carl Rogers’ ““Client-

Centered Therapy” is a is a widely used humanistic widely used humanistic technique.technique.

HI! Remembe

r Me?

Focuses on a therapist’s Focuses on a therapist’s ability to exhibit genuineness, ability to exhibit genuineness, acceptance, and empathy for acceptance, and empathy for their clients. their clients.

The deeper understanding a The deeper understanding a therapist portrays, the more therapist portrays, the more open a client will be (this open a client will be (this empathy is also called empathy is also called unconditional positive regard).).

Methods:Methods:– A key aspect of a client-centered A key aspect of a client-centered

therapy session is what Rogers called therapy session is what Rogers called “active listening”“active listening” involves a therapists technique of involves a therapists technique of listening intently, echoing, restarting and listening intently, echoing, restarting and seeking clarification, and seeking clarification, and acknowledgement of a clients expressed acknowledgement of a clients expressed verbal and non-verbal emotionsverbal and non-verbal emotions

Behavior Behavior TherapiesTherapies

Aims:Aims:

–Behaviorists believe that Behaviorists believe that problem behaviorsproblem behaviors areare the problem, and the goal the problem, and the goal is not to figure out the is not to figure out the meanings behind them, meanings behind them, but instead to simply but instead to simply eliminate or eliminate or unlearn the the problem behaviorproblem behavior

Methods:Methods:– Behaviorists believe that we learn Behaviorists believe that we learn

various behaviors and emotions through various behaviors and emotions through classical and operant conditioningclassical and operant conditioning , , so it’s a good assumption that so it’s a good assumption that maladaptive behaviors (disorders) are maladaptive behaviors (disorders) are learned behaviors as well. learned behaviors as well.

– If so, behaviorists believe that disorders If so, behaviorists believe that disorders can be can be unlearnedunlearned..

– a young child has a a young child has a bedwetting problem.bedwetting problem.

– A behaviorist would A behaviorist would have the child sleep on have the child sleep on a moisture-sensitive a moisture-sensitive mattress hooked up to mattress hooked up to an alarm. an alarm.

– Every time the child wet Every time the child wet the bed, an alarm would the bed, an alarm would go off. go off.

– Eventually the child will Eventually the child will learn to awaken learn to awaken themselves at the onset themselves at the onset of a full-bladder feeling.of a full-bladder feeling.

If a claustrophobic fear of elevators is a learned If a claustrophobic fear of elevators is a learned aversion to confined spaces, then a behaviorist would aversion to confined spaces, then a behaviorist would put something relaxing in the elevator to alleviate the put something relaxing in the elevator to alleviate the fear response (soothing, classical music?).fear response (soothing, classical music?).

Associating the trigger (Associating the trigger (enclosed spacesenclosed spaces) ) with a new, less fearful response with a new, less fearful response ((relaxationrelaxation) is called ) is called counter conditioning..

Methods:Methods:– For example, if a young child cries For example, if a young child cries

hysterically as soon as he enters hysterically as soon as he enters the doctors office, his mother may the doctors office, his mother may bring along some of his favorite bring along some of his favorite toys when they go to the office. toys when they go to the office. Associating the trigger with a new, Associating the trigger with a new, less fearful response is called less fearful response is called counter-conditioning..

Methods:Methods:–There are three types of There are three types of classical counter classical counter conditioning.conditioning.Systematic DesensitizationSystematic DesensitizationImplosive TherapyImplosive TherapyAversive ConditioningAversive Conditioning

Systematic Desensitization:– IE. Billy is afraid of rabbits and other IE. Billy is afraid of rabbits and other

furry creatures. furry creatures. Rabbits = FearRabbits = Fear. . – Billy enjoys eating. Billy enjoys eating. Eating = HappyEating = Happy..– Billy’s therapist wants to eliminate Billy’s therapist wants to eliminate

Billy’s fear of rabbits. His therapist Billy’s fear of rabbits. His therapist will attempt to will attempt to associateassociate the fear- the fear-inducing rabbits with something that inducing rabbits with something that makes Billy happy, like dinner time.makes Billy happy, like dinner time.

Systematic Desensitization:– IE. When Billy sits down for dinner, his IE. When Billy sits down for dinner, his

therapist puts a rabbit in the room, in a far therapist puts a rabbit in the room, in a far away corner. Billy hardly notices. away corner. Billy hardly notices.

– On succeeding days, his therapist gradually On succeeding days, his therapist gradually moves the rabbit closer and closer during moves the rabbit closer and closer during dinner time. dinner time.

– Within two months, Billy is able to hold the Within two months, Billy is able to hold the rabbit in his lap during dinner time. His fear of rabbit in his lap during dinner time. His fear of rabbits has been countered.rabbits has been countered.

Systematic Desensitization is also known as is also known as exposure exposure therapytherapy. A therapist is . A therapist is attempting to attempting to gradually substitute a positive response substitute a positive response for a negative response to a for a negative response to a harmless stimulus.harmless stimulus.

US = URUS = UR US = URUS = UR

Rabbit = FearRabbit = Fear Dinner = Dinner = RelaxedRelaxed

A therapist wants to eliminate A therapist wants to eliminate the fear response to rabbits.the fear response to rabbits.

Systematic Desensitization

US + CS = URUS + CS = URDinner + Rabbit = RelaxedDinner + Rabbit = Relaxed

After Counter-Conditioning:After Counter-Conditioning:

CS = CRCS = CRRabbit = RelaxedRabbit = Relaxed

Implosive Therapy floods patients with their floods patients with their worst fears first, in hopes worst fears first, in hopes that by confronting their that by confronting their worst fears, they’ll learn worst fears, they’ll learn how to not back downhow to not back down

Aversive Conditioning:–In aversive In aversive

conditioning, a conditioning, a therapist tries to therapist tries to replace a replace a positive response positive response to a harmful to a harmful stimulus with a stimulus with a negative negative response.response.

Aversive Conditioning:Aversive Conditioning:–IE. Dave enjoys sucking his thumb IE. Dave enjoys sucking his thumb at night. This is a bad habit. A at night. This is a bad habit. A therapist would cover Dave’s therapist would cover Dave’s thumb with hot pepper before bed thumb with hot pepper before bed time. Dave does not like the taste time. Dave does not like the taste of hot peppers, and therefore he of hot peppers, and therefore he will stop sucking his thumbwill stop sucking his thumb..

US US = UR = URThumb Sucking = EnjoymentThumb Sucking = Enjoyment

US = URUS = URHot Peppers = SicknessHot Peppers = Sickness

A therapist wants to eliminate A therapist wants to eliminate the enjoyment derived from the enjoyment derived from thumb sucking.thumb sucking.

Aversive ConditioningAversive Conditioning

US + CS = URUS + CS = URHot Peppers + Thumb = SicknessHot Peppers + Thumb = Sickness

After ReconditioningAfter Reconditioning

CS = CRCS = CRThumb Sucking = SicknessThumb Sucking = Sickness

Methods:Methods:– Behavior therapists who use Behavior therapists who use operant counter conditioning:Use Use positive reinforcers to shape behavior in a reinforcers to shape behavior in a step-by-step manner by rewarding closer and step-by-step manner by rewarding closer and closer approximations of the desired behaviorcloser approximations of the desired behavior

Withhold reinforcement, or punish, for Withhold reinforcement, or punish, for undesired behaviorsundesired behaviors

Deter negative behaviors by simply ignoring Deter negative behaviors by simply ignoring them, and only acknowledging closer them, and only acknowledging closer approximations of the desired behavior approximations of the desired behavior (shaping)(shaping)

Methods:Methods:–The rewards The rewards used to modify used to modify behavior vary, behavior vary, from praise to from praise to food, depending food, depending on the on the individual, their individual, their disorder, and disorder, and the therapistthe therapist

Methods:Methods:– In some cases, a In some cases, a token economy is set up. A token economy is one is set up. A token economy is one in which a therapist rewards in which a therapist rewards patients for displaying appropriate patients for displaying appropriate behaviors by giving them a token, behaviors by giving them a token, such as a ticket or a plastic coin, such as a ticket or a plastic coin, that they can later exchange for that they can later exchange for prizes or gifts.prizes or gifts.

Cognitive Cognitive TherapiesTherapies

Aims:Aims:–Generally used for depression and anxiety disorders

–Cognitive therapists attempt to teach people new, more adaptive ways of thinking and acting

Aims:Aims:–The belief is that our The belief is that our thinking and and interpretation of external events is of external events is what causes depression and anxiety, what causes depression and anxiety, notnot the events themselves. A the events themselves. A therapist wants to therapist wants to change the thought processes of patients from of patients from negative to positive to alleviate negative to positive to alleviate disorder symptoms.disorder symptoms.

IE. People with depression or anxiety IE. People with depression or anxiety disorders will interpret disorders will interpret suggestions as suggestions as criticismcriticism, , disagreements as dislikedisagreements as dislike, , friendliness as pityfriendliness as pity. If a sufferer loses . If a sufferer loses their job, they their job, they think “I’m worthless and “I’m worthless and it’s hopeless that I’ll find another job”. it’s hopeless that I’ll find another job”.

A therapist wants to change these A therapist wants to change these negative interpretations to positive negative interpretations to positive thoughts and actions.thoughts and actions.

IE. A student has anxiety IE. A student has anxiety over a test. “I’m going to over a test. “I’m going to fail. I always fail. The test fail. I always fail. The test is hard, everyone is is hard, everyone is prepared, and I’ll probably prepared, and I’ll probably forget everything forget everything anyway.” anyway.” A therapist may counter this with, “I A therapist may counter this with, “I didn’t do very well in that subject either, didn’t do very well in that subject either, but I still passed and look where I am but I still passed and look where I am now. And you’re much brighter than I now. And you’re much brighter than I was at your age. The test will be difficult was at your age. The test will be difficult for everyone. Besides, you don’t need a for everyone. Besides, you don’t need a perfectperfect score to pass the exam.” score to pass the exam.”

IE. In addition, have the student IE. In addition, have the student look at their past, good grades to look at their past, good grades to prove to them that they are prove to them that they are capable. capable.

The goal is to dispute the The goal is to dispute the negative thoughts, diffuse the negative thoughts, diffuse the stress, and enter positive stress, and enter positive thoughts and encouragement.thoughts and encouragement.

Methods:Methods:–A variation of this therapy is A variation of this therapy is called called cognitive-behavior therapy. This therapy . This therapy aims to alter the way aims to alter the way people act people act andand to alter the to alter the way they think. way they think.

IE. A client has an obsessive compulsive IE. A client has an obsessive compulsive disorder, which included ritually washing their disorder, which included ritually washing their hands again and again. A cognitive-behavior hands again and again. A cognitive-behavior therapist would show the client a PET scan therapist would show the client a PET scan that rationally explained the behavior as that rationally explained the behavior as abnormal, not the fault of the client. abnormal, not the fault of the client.

Next, through behavior therapy, a therapist Next, through behavior therapy, a therapist would counter condition the disorder by would counter condition the disorder by having the client pick up their favorite having the client pick up their favorite instrument and play until the compulsion instrument and play until the compulsion passed.passed.

Group and Group and Family Family

TherapiesTherapies

Benefits:Benefits: others have others have same disordersame disorder

share therapy share therapy ideasideas

receive feedback receive feedback you are not aloneyou are not alone

Aims:Aims:– Group therapy is generally for Group therapy is generally for

people experiencing family conflicts people experiencing family conflicts or those whose behavior is or those whose behavior is distressing to others.distressing to others.

Aims:Aims:–Provide a sense of Provide a sense of community, safety, and community, safety, and connectednessconnectedness

–Support and friendshipSupport and friendship

Methods:Methods:– Usually groups of six to ten Usually groups of six to ten

individualsindividuals– Averaging up to 90 minutes per Averaging up to 90 minutes per

weekweek –Family Therapy promotes the idea promotes the idea that families are a that families are a unit that depends unit that depends on each member on each member to be positive and to be positive and to communicateto communicate

Alternative Alternative TherapiesTherapies

A practitioner A practitioner moves their moves their hands a few hands a few inches from a inches from a patient’s body, patient’s body, purportedly purportedly “pushing “pushing energy energy fieldsfields into into balance”balance”

Therapeutic Touch:Therapeutic Touch:

Eye Movement Eye Movement Desensitization Desensitization

Reprocessing (EMDR):Reprocessing (EMDR):– Usually for disorders Usually for disorders associated with trauma and associated with trauma and anxiety. anxiety.

– A patient is asked to close A patient is asked to close their eyes and to think their eyes and to think about a traumatic scene about a traumatic scene from their life. from their life.

– A therapist waves their A therapist waves their hand in front of their eyes hand in front of their eyes as they are thinking, as they are thinking, causing causing rapid eye rapid eye movementmovement

Does this Does this resemble the resemble the

stress-less stress-less REM of sleep?REM of sleep?

–Especially for seasonal affective disorder, or depression brought on seasonal changes from summer to winter (less light). The therapy includes timed doses of intense light in “light boxes”.

Light Exposure Therapy:Light Exposure Therapy:

Electroconvulsive Electroconvulsive Therapy:Therapy:

– Patients are given Patients are given an anesthetic so an anesthetic so that they are not that they are not conscious, and a conscious, and a muscle relaxant to muscle relaxant to prevent any injuries prevent any injuries that may occur that may occur from convulsions.from convulsions.

–Patient’s brains are given Patient’s brains are given momentary shock treatments, momentary shock treatments, generally for about 30 seconds.generally for about 30 seconds.

Electroconvulsive Therapy:Electroconvulsive Therapy:– Especially used in cases of deep Especially used in cases of deep

depression, but historically/barbarically depression, but historically/barbarically used for almost anything determined to be used for almost anything determined to be abnormal behavior.abnormal behavior.

– May work by helping the release of May work by helping the release of norepinephrine in the brain, which is in the brain, which is responsible for elevating arousal and mode.responsible for elevating arousal and mode.

– May work by calming areas of the brain that May work by calming areas of the brain that are overactive during depressed periods.are overactive during depressed periods.

Psychosurgery:Psychosurgery:– Surgery that removes or destroys brain Surgery that removes or destroys brain

tissue in an effort to change behavior.tissue in an effort to change behavior.– Once popular, but no more, a Once popular, but no more, a lobotomy

cuts the nerves that connect the frontal cuts the nerves that connect the frontal lobe to the emotion-controlling centers in lobe to the emotion-controlling centers in the inner-brain. the inner-brain.

Psychopharmacology:Psychopharmacology:

– The study of the effects of drugs on the The study of the effects of drugs on the mind and behaviormind and behavior

– Introduced in the 1950’sIntroduced in the 1950’s

– Greatly reduced those confined to a Greatly reduced those confined to a hospitalhospital

– currently applied to just about anythingcurrently applied to just about anything

Careful…Careful…– The normal recovery rate from drug The normal recovery rate from drug

therapy isn’t 100%therapy isn’t 100%

– The The placebo effect may skew results – may skew results – meaning, patients assume that because meaning, patients assume that because they are taking a pill, they must be they are taking a pill, they must be getting bettergetting better

……so the pill isn’t necessarily effective, but the so the pill isn’t necessarily effective, but the belief in it isbelief in it is

Antipsychotic Drugs:Antipsychotic Drugs:– Drugs used for the purpose of calming Drugs used for the purpose of calming

psychotic patients; those patients with psychotic patients; those patients with fundamental mental derangement fundamental mental derangement (such as schizophrenia) characterized (such as schizophrenia) characterized by defective or lost contact with reality by defective or lost contact with reality (ie. hallucinations, paranoia, apathy, (ie. hallucinations, paranoia, apathy, withdrawal)withdrawal)

– IE. Thorazine, Clozaril, HaldolIE. Thorazine, Clozaril, Haldol

Antipsychotic drugs work by Antipsychotic drugs work by attaching themselves to attaching themselves to receptor sites for receptor sites for dopaminedopamine, , thus blocking their transmission thus blocking their transmission from neuron to neuron. from neuron to neuron. Excessive dopamine in the Excessive dopamine in the body’s system is linked to body’s system is linked to schizophrenia.schizophrenia.

Antianxiety DrugsAntianxiety Drugs – Are used for the purpose of Are used for the purpose of alleviating the symptoms alleviating the symptoms stemming from frightening stemming from frightening situations and fear-inducing situations and fear-inducing stimulistimuli

– IE. Xanax, ValiumIE. Xanax, Valium

Antianxiety drugs Antianxiety drugs work by work by depressingdepressing the central nervous the central nervous system activitysystem activity

Antidepressant DrugsAntidepressant Drugs–The purpose is to lift The purpose is to lift people up from a state people up from a state of depressionof depression

–IE. Prozac, Paxil, ZoloftIE. Prozac, Paxil, Zoloft

Antidepressant drugs Antidepressant drugs work by increasing the work by increasing the availability of availability of norepinephrinenorepinephrine and/or and/or serotoninserotonin, which elevate , which elevate arousal and moodarousal and mood

–These drugs are often called These drugs are often called reuptake-inhibitorsreuptake-inhibitors

–They block the reuptake of They block the reuptake of neurotransmittersneurotransmitters

– Therefore more of the Therefore more of the neurotransmitter is left in the neurotransmitter is left in the synapse and its effects are synapse and its effects are felt for longer periods of timefelt for longer periods of time

LithiumLithium is an anti- is an anti-depressant used depressant used mainly for manic-mainly for manic-depressives depressives (bipolar)(bipolar)

Some Criticisms of Drug Some Criticisms of Drug Therapy:Therapy:

–Doesn’t address the root Doesn’t address the root causes of behavior causes of behavior disordersdisorders

– May cause addictionMay cause addiction

– Increased risks for suicide Increased risks for suicide with some drugs?with some drugs?

– May cause other symptoms, May cause other symptoms, disorders or diseasesdisorders or diseases