DO NOW:
•Describe what a person with a mental
disorder might be and act like
CRITICAL QUESTIONS:
•How do we define disorders?
•How can we understand them (sicknesses or natural responses)?
•How can we classify without stigmatizing?
•Definition: a pattern of thoughts, feelings or behaviors that is:
•Deviant
•Distressful
•Dysfunctional
•What do you mean deviant, distressful and dysfunctional?
DO NOW:
•What are two interesting things you learned
about mental disorders that you didn’t know
before? (From your own presentation or
others) Be prepared to share
MEDICAL MODEL
•Psychological disorders
have physical causes
that can be diagnosed
and treated, often
cured.
•Biopsychosocial model
SOME INTERESTING POINTS:
•Mental “disorders” differ by culture
•Eating disorders occur mostly in western cultures
•“Amok” is a Malaysian term that means an
outburst of violent behavior
•Susto exists in Latin America
•Taijin—kyofusho exists in Japan
•Others, like schizophrenia, are worldwide
DIAGNOSTIC AND STATISTICAL MANUAL
(DSM) CLASSIFICATION PURPOSES:
•Describe
•Diagnose
•Predict
•Treat
•Research
•Does Not explain causes
DSM CRITERIA:
Must Be:
•Disturbing
(violates cultural
standards)
•Maladaptive
(harmful)
Atypical
Unjustifiable
(irrational)
•
•
One, none or more of 16 Clinical Syndromes
•
•
•
•
•
•
Disorders usually diagnosed
in infancy through
adolescence
Delirium, dementia, and
other cognitive disorders
Due to a general medical
condition (organic)
Substance-related disorders
Schizophrenia and related
psychosis
Mood disorders
•
•
•
•
•
•
•
•
•
Anxiety disorders
Eating disorders
Somatoform disorders
Factitious disorders (faked)
Dissociative disorders
Sexual/gender identity
disorders
Sleep Disorders
Impulse control disorders
Personality disorders
THE “UN-DSM”
•Peterson and Seligman (2004) The positive Psychology movement
•Values in Action Classification of strengths
•Six clusters of 24 strengths:
•Wisdom & Knowledge
•Courage (overcoming opposition)
•Humanity
•Justice
•Temperance
•Transcendence
•See yours at www.viastrengths.org!!!
CRITICISMS OF LABELING:
•Activity!!!
•We use labels to classify complexities
•Labels can stigmatize
•Labels bias perceptions AND change Reality
•Labels can become self-fulfilling prophecies
LABELING PSYCHOLOGICAL DISORDERS
•Rosenhan’s study
•Power of labels
•Preconception can stigmatize
•Insanity label
•Stereotypes of the mentally ill
•Self-fulfilling prophecy
MENTAL DISORDERS: REVIEW!!!
•Anxiety disorders
•Generalized anxiety disorder
•Panic disorder
•Phobia
•Obsessive-compulsive disorder
•Post-traumatic stress disorder
UNDERSTANDING ANXIETY DISORDERS
THE LEARNING PERSPECTIVE
•Fear conditioning
•Stimulus generalization
•Reinforcement
•Observational learning
UNDERSTANDING ANXIETY DISORDERS
THE BIOLOGICAL PERSPECTIVE
•Natural selection
•Genes
•Anxiety gene
•Glutamate
•The Brain
•Anterior cingulate cortex
SOMATOFORM DISORDER
•Somatic (body)
•Conversion disorder (Freud’s view)
•Hypochondriasis
•Changed in DSM V to Somatic Symptom
Disorder (SSD)
DISSOCIATIVE DISORDERS
•Dissociative disorders
•Fugue state (time is lost; person may show
up elsewhere)
•Dissociate (become separated)
DISSOCIATIVE IDENTITY DISORDER
•Multiple personality disorder
•Genuine disorder or not?
•Therapist’s creation?
•Review!
UNDERSTANDING DISSOCIATIVE IDENTITY
DISORDER
•Genuine disorder or not?
•DID rates
•Therapist’s creation
•Differences are too great
•DID and other disorders
MOOD DISORDERS
•Major depressive disorder
• “Common cold” of mental disorders
• Feelings of lethargy and worthlessness
• Loss of interest in family, activities
• Lasts longer than two weeks with no medical or drug-related cause
• Women are twice as vulnerable
• But men commit suicide more often
• Most episodes end on their own (therapy helps accelerate recovery)
• It can happen to teens (Psychologists didn’t used to believe this
Major Depressive Disorder
BIPOLAR DISORDER
•Mania (manic)
•Overtalkative, overactive, elated, little
need for sleep, etc. (And sometimes just
irritable)
•Bipolar disorder and creativity
UNDERSTANDING MOOD DISORDERS
• The Biological Perspective
• Genetic Influences
• Mood disorders run in families
• Heritability of depression is 35-40 percent
• Linkage analysis (DNA examination to find “chromosome neighborhood”)
• The depressed brain shows less activity in the left frontal lobe
• The manic brain shows more activity in PET scans
• Biochemical influences
• Norepinephrine scared during depression; overabundant in mania
• Serotonin scarce during depression
• Drugs (SSRIs) block re-uptake of these, or block their chemical breakdown
UNDERSTANDING MOOD DISORDERS
• The Social-Cognitive Perspective
• Negative Thoughts and Moods Interact
• Self-defeating beliefs
• Learned helplessness
• Overthinking
• Explanatory style
• Stable, global, internal explanations
• NIB: Traits of optimism: temporary, circumstantial, localized
• Cause versus indictor of depression?
Understanding Mood Disorders
Explanatory Style
Understanding Mood Disorders
The Vicious Cycle of Depression
Biopsychosocial Approach to Depression
SCHIZOPHRENIA
•Means split mind = cannot distinguish real from unreal
•Does not mean multiple personalities
•Disorganized thinking
•Delusions
•Delusions of persecution (paranoid)
•Word Salad
•Breakdown in selective attention
•Disturbed perceptions
•Hallucinations
•Often auditory
•Inappropriate emotions and actions
•Laughing in sad situations and vice
versa
•Flat affect
•Catatonia
Types of Schizophrenia
ONSET AND DEVELOPMENT
•Affects 1 in 100; men slightly more than women
•May appear suddenly or gradually
•Positive symptoms = hallucinations, disorganized talk,
delusions and inappropriate behavior
Negative symptoms = tonelessness, rigidity, expressionlessness,
mutism
•Chronic (process) schizophrenia
Acute (reactive) schizophrenia
•
•
SCHIZOPHRENIA: BRAIN ABNORMALITIES
•Dopamine Overactivity
•Dopamine – D4 dopamine receptor
•Dopamine blocking drugs
•Impaired Glutamate activity
•Low activity in frontal lobes
•Decline in brain waves that reflect neural firing in frontal lobes
•PET scan evidence of vigorous activity in thalamus and
amygdala when hallucinating
SCHIZOPHRENIA: BRAIN ABNORMALITIES
•Fluid filled areas of the brain
•Risk factors? Low birth weight and oxygen
deprivation during delivery
SCHIZOPHRENIA: OTHER FACTORS
•Maternal Virus During Pregnancy
•Genetic predisposition
SCHIZOPHRENIA: WARNING SIGNS
•Mother severely schizophrenic
•Separation from parents
•Short attention span
•Poor muscle coordination
•Disruptive or withdrawn behavior
•Emotional unpredictability
•Poor peer relations and solo play
PERSONALITY DISORDERS
•Anxiety cluster
•Avoidant personality disorder
•Eccentric cluster
•Schizoid personality disorder
•Dramatic/impulsive cluster
•Histrionic personality disorder (attention-getting)
•Narcissistic personality disorder (self-focused, self-inflating)
ANTISOCIAL PERSONALITY DISORDER
•Formerly known as sociopath or psychopath
•Lower levels of stress hormones
•Impulsive, uninhibited, unconcerned with social
rewards
Lack of conscience or remorse
•Genes put them at risk for substance abuse, too
•Reduced activity and 11% less tissue in frontal
lobes
•
RATES OF DISORDER
•Genetics
•Environment
•Influence of poverty
•See book, p. 600 for risk
and protective factors
WHAT ABOUT TREATMENT?
• Do Now: Is too much unconditional positive
•
•
•
regard a problem or not?
How could it lead to unwarranted self-esteem?
Why would people in therapy benefit most from
Philippe Pinel (France) & Dorthea Dix (US,
Canada, Scotland) – advocates for more
humane treatment
Eclectic approach
PAST… AND PRESENT:
•Chained & beaten
•Exhibited as zoo animals
•Dunked in cold water
•Kept in dungeons
•Often unclothed and
unheated
•Lobotomies for varied
disorders
•More humane hospitals
•Less hospitalization
•More mentally disordered
people in prisons than
hospitals.
•Many homeless
PSYCHOANALYSIS
• Bring repressed motivations into
•
•
consciousness
Work through buried feelings to take
responsibility
Methods:
Free association
Noticing resistance
Interpretation of resistance
Dream analysis
Transference
•
•
•
•
•
PSYCHODYNAMIC THERAPY
•Influenced by Psychoanalysis
•Focus on themes or patterns across
relationships, including childhood
•Face-to-Face; once a week (generally)
INTERPERSONAL PSYCHOTHERAPY (IPT)
•Short-term & effective for treating depression
•Focuses on (NOT IN YOUR BOOK):
•Interpersonal disputes and conflicts
•Role transitions
•Grief that goes beyond normal bereavement
•Deficits in starting and maintaining relationships
HUMANISTIC THERAPIES
•Focus on present & future
•Focus on conscious (rather than unconscious)
•Focus on taking personal responsibility
•Focus on promoting growth (rather than cure)
•Client vs. patient
CLIENT-CENTERED THERAPY
• Carl Rogers
• Non-directive
• People possess their own tools for growth
• Therapists: genuineness, acceptance, empathy
• Listen without judgment & Active Listening
• Paraphrase
• Invite clarification
• Reflect feelings
• Unconditional Positive Regard
BEHAVIOR THERAPIES
• Applied learning can eliminate problem behaviors
• Reconditioning (ex. Bedwetting, p. 611)
• Counterconditioning (pairs trigger with new response)
• Exposure therapy
Term NOT IN YOUR BOOK:
• Systematic desensitization
Flooding – a controversial technique
• Progressive relaxation
where a person is immersed in the
object or situation they fear.
• Aversive conditioning
• Operant conditioning (voluntary behaviors)
• Behavior modification
• Token Economy
SYSTEMATIC DESENSITIZATION
AVERSION
THERAPY:
ALCOHOL
BEHAVIOR THERAPY CRITICISM
•Aversive: Results may not last because of cognition
•Operant conditioning:
•Dependence on extrinsic rewards
•Ethical concerns over “controlling” behavior
COGNITIVE THERAPIES
•Premise: Our thoughts
color our feelings
•Learning to think
differently will help
COGNITIVE THERAPIES
•Beck’s Therapy for Depression:
•Attempt to reverse catastrophizing
•Gentle questioning to reveal irrational
thought
•Persuasion to remove “dark glasses”
•Stress inoculation training
COGNITIVE-BEHAVIORAL THERAPY
Integrated therapy that combines:
Altering negative thinking patterns (Cognitive
therapy) (changing self-defeating thinking) and
Altering ways of acting (Behavior therapy)

GROUP & FAMILY THERAPY
Group therapy:
Not as much individual attention
Awareness that one is not alone in the struggle
Family therapy:
Treats the family as a system
Views an individual’s unwanted behaviors as influenced by or directed at
other family members
Attempts to guide family members toward positive relationships and
improved communication

EVALUATING PSYCHOTHERAPIES
To whom do people
turn for help for
psychological
difficulties?
EVALUATING PSYCHOTHERAPIES: DO THEY WORK?
Client and Clinician perceptions both show that clients enter unhappy and
leave when they have a better sense of well-being. Reliable?
Confounding factors:
The placebo effect (people expect to get better)
Regression toward the mean (tendency for extremes of emotions to
return to normal)
Meta-analysis : procedure for statistically combining the results of many
different research studies
Bottom line: Whether undergoing therapy or not, all people are likely to
improve, but those undergoing therapy are MORE likely to improve.
EVALUATING PSYCHOTHERAPIES
Number of
persons
Average
untreated
person
Poor outcome
80% of untreated people have poorer
outcomes than average treated person
Average
psychotherapy
client
Good outcome
WELL, WHAT WORKS?
• Summaries don’t show one particular type of therapy as superior
• Behavioral training has good results with particular behavior problems
(phobias, bedwetting, etc.)
• Therapy is most effective when problem is clear-cut
• Three elements shared by all psychotherapies:
• A sense of hope [NIB: Hope = goals (challenging & attainable),
agency (belief in abilities), and pathways (multiple ways to get
there), (Snyder)
• A new perspective
An empathetic, trusting, caring relationship
•
RATIONAL-EMOTIVE BEHAVIORAL THERAPY
•Albert Ellis: It’s not events but interpretation of event that
causes trouble
•Steps:
1. Identifying the underlying irrational thought patterns and beliefs.
2.
3.
(often expressed as “I should,” “I must,” “I can’t”
Challenging the irrational beliefs. (sometimes aggressively)
Gaining Insight and Recognizing Irrational Thought Patterns
UNSUPPORTED THERAPIES:
•Energy therapies
•Recovered-memory therapies
•Rebirthing therapies
•Facilitated communication
•Crisis debriefing
•Psychological civil war: art & intuition vs. science.
•Evidence-based practice (p. 623)
ALTERNATIVE THERAPIES
•No clear evidence for or against many of them
•EMDR
•Light Exposure Therapy
BIOMEDICAL THERAPIES
Psychopharmacology
study of the effects of drugs on mind and behavior
Double-blind procedure (review from Chapter 2)
Antipsychotic drugs block dopamine activity
Side effects – tardive dyskinesia and symptoms like Parkinson’s Disease
(older); obesity & diabetes (newer)
BIOMEDICAL THERAPIES
The emptying of U.S. mental hospitals
DRUGS FOR THIS AND THAT
• Antianxiety:
• Xanax, Ativan and (new kid) D-cycloserine (an antibiotic)
• Psychological dependence
• Physiological dependence
DRUGS FOR THIS AND THAT
• Antidepressants (also used for OCD and anxiety):
• Increase available serotonin and norepinephrine
• Prozac (blocks reabsorption and removal from synapses)
• Zoloft and Paxil (SSRIs) slow the uptake of S&E from synapses
• Multiple side effects not listed in your book
• Can take 4 weeks to be effective (neurogenesis)
• Not that effective: “No reason to prescribe except to most severely
•
depressed!”(Kirsch, 2008)
Question about whether they increase the risk of suicide (see p. 632)
BIOMEDICAL THERAPIES
BIOMEDICAL THERAPIES
DRUGS FOR THIS AND THAT
•Mood Disorders:
•Lithium carbonate (used for bipolar)
•Depakote
BIOMEDICAL THERAPIES
Electroconvulsive Therapy (ECT)
 For severely depressed patients--a brief electric current is
sent through the brain of an anesthetized patient
 Works, but 4 in 10 relapse within 6 months
 Side effects
rTMS – Magnetic stimulation
 Only reaches surface
 No memory loss, convulsions or seizures
 Deep Brain Stimulation
 Targets area of cortex that bridges frontal lobes to limbic
system
 Implanted electrodes and a pacemaker stimulator
 In an early trial brought relief to 8 of 12 participants
BIOMEDICAL THERAPIES
Psychosurgery -- Surgery that removes or destroys brain tissue in an effort to change
behavior
Lobotomy
Cutting nerves connecting frontal lobes with emotion-controlling center
(limbic system)
Early procedure used icepick-like tools hammered into eye sockets
Used to calm uncontrollably emotional or violent patients
MRI-guided precision surgery is used in severe OCD
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MIND-BODY INTERACTION