Psychopathology:
Abnormality
• In psychology individual differences involves the
study of the ways that individuals differ in terms of
their psychological characteristics.
• People differ in many ways: in their intelligence,
aggressiveness, willingness to conform, masculinity
and femininity, etc.
• An important individual difference is in the degree
to which a person is mentally healthy.
• This is Psychopathology and it is this area of
individual differences we study in AS Psychology.
• In order to protect and/or treat people with an
abnormality psychologists need to be able to define
them as having abnormal psychopathology.
• So how do we define someone as being abnormal?
What parameters do we use?
• In groups of 2 or 3 use the paper provided to write
down a list of things that may make a person
appear abnormal. What would you look for as an
1
indication of abnormal behaviour?
• You have five minutes ……
What makes someone abnormal?
Your Ideas…… on board
So do these ideas fit into one of the four following categories?
Statistically rare,
Going against social norms,
Mentally ill
Or
Inability to function safely (danger
to self or others)
2
Can you define the
following behaviour as
abnormal using all four
definitions?
3
4
L2
A very unusual
behaviour or trait
will be more than 2
standard deviations
from the mean. i.e.
over 130 or under
70 IQ score.
This statistically
‘rare’ behaviour or
trait is likely to be
seen as being
abnormal.
5
Statistical Infrequency ~
Is all rare behaviour abnormal
and if not how do we decide
what is ~ is this?
6
Why is context so important when
defining behaviour as abnormal?
7
Statistical Infrequency: Limitations/Criticisms
• Mental Health By this definition all rare behaviour would be
seen as abnormal however, depression and anxiety are not
rare but clinical depression is rare (but is only diagnosed if
patient attends the doctors – so how do we know how rare it
is?)
• Gender Issues (Females are more likely than males to
consult a GP). (In our culture females can wear makeup and
skirts without seeming abnormal …… males ??? Well David
Beckham manages it!)
• Cultural Issues (Jewish people mourn by tearing their
clothes and wailing in public.) (In India mentally ill people are
thought to be cursed) (In china being mentally ill carries such
a stigma that it is rarely diagnosed) (Some cultures walk
around naked and you are in the minority if you are clothed!)
(In the USA 48% of people were treated for psychological
disorders at some point – by this definition that would make
them normal!)
• Age Thumb sucking and bed wetting may be considered
statistically normal at 2 years old but not at 20!
• Desirability of behaviour Many behaviours are rare but
considered highly desirable (High IQ, Great athletic ability).
It is difficult to know how far you have to deviate from the 8
average to be considered abnormal?
Advantages of this approach
• Statistical Infrequency is an obvious and
relatively quick and easy way to define
abnormality.
• It has face validity that odd or rare behaviour
is seen as abnormal
• Applications of statistical definitions: It is
relatively easy to determine abnormality
using psychometric tests developed using
statistical methods.
E.g. there is a test for O.C.D. – Obsessive
compulsive disorder.
• You can have a go at the test if you like –
could you be a potential sufferer?
• First watch an O.C.D. sufferer in action! 9
10
L3
• Society sets up rules for behaviour based on a set of moral
standards which become social norms (V.I.M.). Any deviation
is seen as abnormal (Szasz 1972)
• This suggests that madness is a term manufactured in order to
label the people in society who do not conform to the rules of
society.
• These unwritten social rules are culturally relative (i.e. you
cannot judge behaviour properly unless it is viewed in the
context from which it originates as different cultures have
different social norms and behaviour may differ across
cultures). A lack of cultural relativism can lead to
ethnocentrism, where only the perspective of your own culture
is taken. Social norms can also be era-dependent.
• For example, homosexuality was once illegal and considered to
be a mental disorder because it deviated from the social norm.
Now there are campaigns for gay marriages to be recognized
and afforded the same benefits as heterosexual marriages
• This shows the extent to which this definition of abnormality is
subject to change.
11
AO2: Deviation from Social Norms Limitations / Issues
Historical Issues:
Cultural Issues:
/
Expected Behaviour:
Hello!
Context:
!
Until early 20th century, unmarried women who
became pregnant were interred in mental institutions.
Until 1960's in the UK homosexual acts were criminal
offences
Until 1973 in USA homosexuality was a mental disorder!
Russia - a diagnosis of insanity was used to detain
political dissidents.
Japan - You are deemed insane if you do not want to
work!
Western Societies - you can plead insanity as a defence Lorena Bobbit cut of her husband's penis - pleaded
temporary insanity!
African/Indian cultures consider it normal
to talk to the dead.
Nakedness normal in some cultures.
Singing in park understood if you see the film crew!
SUMMARY:
• Social norms is a subjective measurement of abnormality as norms change over
time and differ between cultures.
• This approach has been used as a form of social control.
• Social norms are necessary and specific to each society to enable members of
12
each society to know the ‘rules’ in order to get along together!
• Anti-Social Behaviour can be viewed as abnormal under this definition e.g.
13
Short Answer Exam Questions
(SAQs)
Deviation from social norms is one definition of
abnormality: You may use your handouts to
help you with this. (feed back to class later)
(a) What is a ‘social norm’?
(b) Give one example of how breaking a social
norm might lead to the behaviour being
defined as abnormal.
(c) Outline one other way of defining abnormality
14
L4
Starter
• Complete the recap exercise:
– Problems with diagnosis: Social norms,
social control and personal freedom.
15
Deviation from Ideal Mental Health:
Six Categories that Clinicians Typically
Relate to Mental Health
PRAISE Marie Jahoda (1958)
1. Personal growth (Self Actualisation: should reach
your potential)
2. Reality perception (should know what’s real)
3. Autonomy (should be independent)
4. Integration (should ‘fit in’ with society and be able to
cope with stressful situations)
5. Self-attitudes (should be positive: high self esteem)
6. Environmental mastery (should cope in your
environment, be able to function at work and in
relationships, adjust to new situations and solve
problems)
16
Deviation from Ideal Mental Health Limitations/Criticisms
•
•
•
•
•
•
•
Jahoda 1958 said that it was better to focus on positive aspects of mental health
rather than the negative – so this is seen as a positive attempt to define
abnormality.
Positive self attitude (Many people have a negative self image due to such things as
– Bullying, Persecution of gender and/or race etc – but are they abnormal?)
Growth to one’s potential or ‘self actualisation’ ( Very few people reach their full
potential due to such things as – Family commitments, Money, Social / peer
pressure, Gender OR Culture: some countries women are not allowed to work! – are
they abnormal? CULTURAL RELATIVISIM!)
Resistance to stress (Integration) Should ‘fit in’ without suffering stress. Some
people thrive on stress, Personality may make you more susceptible, Some people
crack under enormous amounts of stress – prisoner of war camps – are they
abnormal?)
Autonomy (independence)– ability to make our own decisions (Some people cannot
– due to disability – illness – age – culture e.g. arranged marriages, collectivist
societies ‘WE not ME’ – prisoners – poverty – are they abnormal?)
Perception of reality (Other things than mental illness affect our perception of
reality e.g. Alcohol, drugs/LSD, illness/diabetes – are they abnormal?)
Adapting to the environment (More difficult if you are poor, black, female, disabled
etc. but are they abnormal?)
SUMMARY
Criteria are so demanding that almost everyone is bound to fall into the category
17 of
mental ill health!
Failure to function adequately
• A definition of abnormality
based on an inability to
cope with day-to-day life
caused by psychological
distress or discomfort
which may lead to harm of
self or others.
18
Failure to Function Adequately
This is seen as a humane way of addressing psychological problems as it allows the
individual to decide if they need or wish to seek help.
However it does have some limitations as a method of defining abnormality such as:
•
•
•
•
•
•
•
•
•
•
Labelling – a label gives a stigma that may stick around long after the problem has
gone. Can affect employment prospects and personal relationships.
Gender issues – Bennett 1995 found that societies have created masculine
stereotypes that alienate men from seeking help for psychological problems.
Enforced detaining in mental institutions –
If behaviour appears abnormal there is no institutionalisation providing the individual
can function adequately and is not harming self or others.
Before 1983 people could be detained in mental institutions against their will on the
authority of a health professional guardian or husband. (NOTE: Wives could not have
husbands detained!)
Psychiatric prison is the only place in the UK that people can be detained against
their will.
Care in the community – means that there are not enough hospital places for those
who want residential care. So health professionals leave people alone unless there
is severe dysfunction.
SUMMARY
Leaves power with the individual.
Not functioning adequately is not seen as serious in mental disorder terms.
Individuals may be aware or unaware of their own dysfunction – so how can
psychiatrists be sure of a diagnosis – and how can they know for sure when a 19
patient is ‘cured’?
We are now going to watch a video about
two people with mental illness. ‘Louisa and
Darryl’.
As you are watching decide if Louisa and
Darryl fit all 4 definitions of Abnormality.
Then write down any issues that the
program raises regarding difficulties in
defining abnormality and any ethical issues
you notice, for discussion afterwards.
20
Summary Activity
• Use notes and handouts to complete a
summary mind map / poster entitled DEFINING
ABNORMALITY. Include a concise definition,
explanation, and example of each method and
then list as many as possible but at least two
limitations associated with each method of
definition – e.g. – can be era dependent – can
be ethnocentric (cultural relativism) – labelling &
stereotyping – desirable behaviour…. etc.
• Try also to include one Strength
• Then: Say how each of these definitions would
define Anorexia as being abnormal, and what the
problems defining Anorexia using each definition
21
would be.
L5
Models of Abnormality
• Definitions tell you if a person is abnormal
(mentally ill) or not.
• A model is a way of describing why they
are ill, i.e. what is the cause of their mental
illness.
• You need to ensure that you can
distinguish between models and
definitions.
• Definitions answer “are they or aren’t
they?” questions, Models try to answer the
“why are they?” question.
22
Each model is based on a Psychological
Approach or Perspective (point of view)
• Psychological Perspectives or Approaches
refer the different types of psychologists,
and how they view things differently from
each other
• Each approach will give different
explanations for the same behaviour.
• The four approaches we are going to look
at are the Biological, Behavioural,
Psychodynamic and Cognitive. Can you
remember the differences between
these?
• For example how would each approach
explain violent behaviour differently?
23
A1
Approaches/Perspectives in Psychology
Biological Approach
Learned
from violent
parents or
peers
It is due to your
Physiology i.e.
your Hormones
Genetics
Evolution
Brain Damage
Behavioural Approach
Psychodynamic Approach
You have
distorted
thinking or have
reasoned that it
will get you what
you want
Cognitive Approach
Unconscious
need to
release
aggression
24
KISSING
HOW WOULD THE DIFFERENT APPROACHES
IN PSYCHOLOGY EXPLAIN IT?
Write down a quick note of your ideas
For how the Biological, Behavioural,
Psychodynamic and Cognitive approaches 25
would explain it!
Biological Model of Abnormality
KEY FEATURES OF THE
BIOLOGICAL APPROACH TO
PSYCHOPATHOLOGY (Abnormality) (TO LEARN)
• Assumption 1: The Biological or Medical Model of
abnormality assumes that mental abnormality has
physiological causes. These abnormalities may be caused
by chemical malfunctions in the brain or by genetic
disorders. For example, too much dopamine in the brain
is linked with the mental illness called schizophrenia. It
is also clear that the eating disorder called anorexia
nervosa has a genetic component.
• Assumption 2: The Medical Model also assumes that
mental disorders can be treated in ways similar to
physical disorders. In other words, we can cure the
patient by using medical treatments. Treatments include
26
medication (drugs), ECT and psychosurgery.
BIOLOGICAL CAUSES OF PSYCHOPATHOLOGY
Genetic factors
• inherited predispositions to certain mental illnesses (Anorexia
Nervosa, Tourettes & Down’s Syndrome)
– Biochemistry
• excessive or low amounts of certain biochemicals in the brain
(Dopamine – Schizophrenia, Serotonin - Depression)
– Neuroanatomy
• brain damage or inherited
structural/organisational defects (Autism)
– Treatment (acts on physiology)
•
•
•
•
Drugs (chemotherapy)
Genetic counselling / gene therapy possibly to come
Electroconvulsive therapy (ECT)
Psychosurgery
27
Best explanations......
• Work in pairs and decide which would be
the best biological explanation/s for the
following disorders. Justify your thoughts.
–
–
–
–
–
–
–
Anorexia
Tourettes Syndrome
Dementia
Depression
Schizophrenia
Phobic Disorders
OCD
28
• Strength 1: The main strength of the Medical Model is that it is scientific.
The results of treatment can be measured and manipulated until we have a
satisfactory outcome. For example, we can vary the dosage of Prozac until
the depressed patient is able to function adequately.
• Strength 2: A second strength is that the patient is seen as being ‘ill’ and
therefore not responsible (to blame) for their behaviour. Although the
label of mental illness still carries a stigma in our society. It is reassuring
to most people to learn that their behaviour has an organic/medical cause
that can be corrected by medical treatment.
• Limitation 1: The main limitation of the Medical Model is that it may be
useful in dealing with the symptoms of mental illness but it may not be
effective in resolving the underlying causes. Mental illness may have
multiple causes, including cognitive and behavioural causes. The MM
does not take these into consideration. It is always dangerous to reduce a
complex phenomenon to a single explanation (reductionism).
• Limitation 2: A second limitation is that medical intervention may have
undesirable side effects. Very few drugs can be used without negative side
effects. For example, prolonged use of Prozac is associated with suicidal
thoughts. Drugs may also encourage addiction and dependency similar to
nicotine addiction. In addition, techniques such as ECT and psychosurgery
are invasive, unpredictable and often irreversible.
29
Defining Abnormality
Tourettes Syndrome
•
•
1.
2.
3.
4.
5.
L5
When watching the video make notes on the behaviour seen.
First write down the four definitions of abnormality and
Rosenhan & Seligman’s seven elements of abnormality. Note
down when behaviour seen falls into each definition or element
i.e.
Statistical Infrequency
Deviation from Social Norms
Deviation from ideal mental health (use handout)
Failure to function adequately (Maladaptiveness)
The 7 of the elements of abnormality defined by Rosenhan &
Seligman – illustrate with examples from the video.
Consider the limitations of each definition and explanations.
Then consider the evidence that Tourette’s Syndrome
is a biological illness?
Write down the main pieces of evidence for this.
Make sure you make notes for discussion afterwards.
30
L7
The Psychological Models
of Abnormality
(there are three of these)
• Psychodynamic
• Behavioural
• Cognitive
31
Psychodynamic Approach
Main Assumptions:
• Assumption 1: The Psychodynamic Model assumes that
experiences in our earlier years can affect our emotions, attitudes
and behaviour in later years without us being aware that it is
happening. Freud suggested that abnormal behaviour is caused
by unresolved conflicts in the Unconscious. These conflicts create
anxiety, and we use defence mechanisms such as repression and
denial to protect our Ego against this anxiety. However, if defence
mechanisms are over-used, they can lead to disturbed abnormal
behaviour.
• Assumption 2: The Psychodynamic Model assumes that if
repressed memories can be recovered from the Unconscious
through psychotherapy, and if the patient experiences the
emotional pain of these repressed memories, the conflicts will be
resolved and the patient will be cured (catharsis & closure i.e.
lancing the psychological boil) . Modern psychoanalysis suggests
patients must also come to understand these memories
32
cognitively.
(Inner child ~ I want
It & I want it NOW!)
(Self ~ Protector
Voice of reason)
(Inner parent the
Conscience)
Recap: Freud’s Theory
of Personality
Complete Activity Sheet :
The Psychodynamic Model
(Item A) Question (a) & (b)
33
Recap: Psychosexual Stages of
Development
34
EVALUATION OF THE PSYCHODYNAMIC APPROACH
• Strength 1: One strength of the Psychodynamic Model is that it reminds
us that experiences in childhood can affect us throughout our lives. It
accepts that everybody can suffer mental conflicts and neuroses through
no fault of their own.
• Strength 2: The model also suggests there is no need for medical
intervention such as drugs, ECT or psychotherapy, and that the patient,
with the help of a psychoanalyst, can find a cure through his own
resources. (which empowers the individual & discourages helplessness)
• Weakness 1: The main limitation of the Psychodynamic Model is that it
cannot be scientifically observed or tested. There is no way of
demonstrating if the Unconscious actually exists. There is no way of
verifying if a repressed memory is a real or false memory unless
independent evidence is available. In other words, most of the theory
must be taken on faith.
• Weakness 2: Any evidence recovered from a patient must be analysed
and interpreted by a therapist. This leaves open the possibility of serious
misinterpretation or bias because two therapists may interpret the same
evidence in entirely different ways. Psychoanalysis is time-consuming
and expensive. It may not even work: in a comprehensive view of 7000
35
cases, Eysenck (1952) claimed that psychodynamic therapy does more
harm than good.
Activity: Fairy Tale Psychoanalysis
• How can you explain the behaviour of the
Fairy tale characters using the
Psychodynamic model.
• Match up the correct example with the
most likely explanation.
• Use the ego defence mechanism sheet to
help you with this.
• You can cut them out and move them
about if it helps!
36
L8
The Behavioural Model
37
KEY FEATURES OF THE BEHAVIOURAL APPROACH TO
PSYCHOPATHOLOGY (Abnormality)
• Assumption 1: The Behavioural Model of Abnormality
assumes that all behaviour is learned through experience. All
behaviour, including abnormal behaviour, is learned through
the processes of classical and/or operant conditioning.
Classical Conditioning involves learning through association.
Operant conditioning involves learning through rewards
(positive and negative reinforcement) and punishment. Or
through modelling and Social Learning Theory. (as in
Bandura’s ‘BoBo’ doll study)
Assumption 2: The model assumes that what has been
learned/acquired can be unlearned through the processes of
conditioning, classical or operant. Undesirable or maladaptive
behaviour can be replaced by desirable or adaptive behaviour.
For example, we can use behavioural therapies such as
38
Desensitization and token economies.
CLASSICAL CONDITIONING
Classical Conditioning was one of the first types
of learning to be discovered. It was studied by
Ivan Pavlov using his dogs.
Ivan Pavlov
39
How this can cause a phobia…..
•
•
•
•
•
•
•
•
•
Classical Conditioning:
We learn to associate one thing with another e.g.
Child on mum’s knee
Child sees spider (NS) – unafraid – doesn’t know
what spider is!
Mum sees spider
Mum screams and drops baby!
Baby associates spider with fear and lump on head
(UCS)!
Baby sees spider
Baby cries! (CR)
40
Operant conditioning
• A behaviour that has a positive effect is more
likely to be repeated
• Positive and negative reinforcement (escape
from aversive stimulus) are agreeable
• Punishment is disagreeable
• Therefore treatment is by positive & negative
reinforcement and punishment (used in schools
to treat disruptive children – and in treatment of
disorders such as anorexia)
41
OPERANT CONDITIONING
Reinforcement of
Behaviour (by reward)
Results in the
behaviour being
repeated
Behaviour can then be
SHAPED to give a
desired response.
B. F. Skinner (1904-1990)
Operant Conditioning
The PIGEON & The Skinner Box 42
How can this cause abnormal
behaviour?
• We can learn to associate and action with a
reward or sanction e.g.
• Boy sees sweets at checkout
• Boy wants sweets but mum says No!
• Boy screams and shouts and has a tantrum
• Mum gives boy sweets reinforcing the bad
behaviour
• Boy learns that tantrums = getting what
he wants!
• So next time boy wants sweets…..
43
Social Learning Theory – Imitation of
role models & Reinforcement can also
lead to abnormal behaviour:• Girl watches mother (role model) who
has OCD washing ritualistically every
item in house daily.
• Girl cleans own things in same way –
copying mum!
Evidence:
Bandura’s
BoBo Doll exp. ~>
44
Advantages & Limitations
•
Advantage 1: Behavioural approaches, especially when combined with
cognitive approaches, have proved very effective in treating clients with
phobias and other neurotic disorders, such as obsessive-compulsive
disorders. They are less successful with more serious disorders such as
schizophrenia and psychosis.
•
Advantage 2: There is also the advantage that therapy can focus directly on the
client’s maladaptive behaviour. There is no need to refer to the client’s
previous history or to his medical history. Behaviourists believe that changing
the behaviour from maladaptive to adaptive is sufficient for a ‘cure’.
•
Limitation 1: One limitation of the BM is that only behaviour is considered. The
thoughts and feelings of cognition are not taken into consideration. However, a
human being is much more than a bundle of behaviours, and thinking and
feelings need to be considered. Behavioural therapy may change the behaviour
without resolving the underlying causes of that behaviour.
•
Limitation 2: The BM ignores possible medical causes of abnormal behaviour.
For example, we know that there is a genetic element in anorexia, that the lack
of glucose can deepen depression, and that excessive dopamine is linked with
several mental disorders. It is likely that the Behavioural Model takes too
narrow a focus of what constitutes human psychology. Humans are more45
than
rats in Skinner boxes.
Activity: Explaining mental illness
using the behavioural model
• Anorexia Nervosa is an eating disorder
where sufferers gradually starve
themselves sometimes with fatal
consequences.
• Work in Pairs and Use Classical
conditioning, Operant conditioning, and
Social learning theory (modelling) to
explain the development of Anorexia
Nervosa. (write down your explanations)
• You will have 10 minutes and will then
feedback to the class.
46
The Cognitive Model: Main
Assumptions
Assumption 1: The Cognitive Model of Abnormality assumes
that how we think influences how we feel and how we
behave. The ways in which we process information
(cognition) directly affect the ways we behave. The
Cognitive Model suggests that disordered thinking can
cause disordered or abnormal behaviour. Disordered
thinking includes irrational assumptions and negative views
about the self, the world and the future.
Assumption 2: The Cognitive Model assumes that cognitive
disorders are the result of negative or disorganised thinking
and, therefore, they can be made positive or organised.
Thoughts can be monitored, evaluated and altered.
Individuals can modify their thinking, challenge their
irrational cognitions and self-defeating thoughts. So the
model assumes cognitive change will lead to behavioural
change.
47
Beck’s (1976) cognitive triad
• negative (irrational) thoughts that depressed
individuals have about...
– Themselves: “I am helpless and inadequate”
– The world: “The world is full of insuperable
obstacles”
– The future: “I am worthless, so there’s no
chance that the future will be any better than
the present”
48
EVALUATION OF THE COGNITIVE APPROACH
Strength 1: A major strength of the Cognitive Model is that it concentrates in current
thought processes. It does not depend on the past history of the client, for example,
recovering repressed memories from the Unconscious. This is an advantage because
details about a person’s past are often unclear, irrelevant, misleading and
misremembered.
Strength 2: A second strength is that Cognitive Therapies, especially when used together
with Behavioural Therapy, have a good success rate in helping clients. It is a popular and
much-used approach. It also empowers the individual to take responsibility for his own
thinking processes by monitoring, evaluating and altering self-defeating thought
processes.
Weakness 1: Like all other approaches, psychological and medical, the Cognitive Model
rarely supplies the complete solution to abnormal behaviour by itself. There may be
medical and environmental influences affecting a person’s behaviour. Focussing only on
a person’s cognition may be too narrow an approach.
Weakness 2: The Cognitive Model sometimes places the blame for any disorder unfairly
on the individual – “It’s your disordered thinking, so you are at fault”. For example, a
person suffering from depression may be living in awful circumstances where depression
is a perfectly valid and rationale response to the situation. It will hardly be surprising if
he perceives the world and his future as a negative and grim.
49
L9
TREATMENT METHODS
• Behavioural Approach (Aversion Therapy (counter
conditioning), Systematic Desensitisation Therapy,
Flooding & Token Economy)
• Psychodynamic Approach
(Psychotherapy which
may include: Dream Analysis, Projective Therapy – ink
blot/pictures, Hypnosis, Free & Word Association)
• Biological Approach (Drug (chemo) Therapy (anti
anxiety /anti depressant and sedatives etc.) – ECT,
Psychosurgery)
• Cognitive Approach (Cognitive Behavioural Therapy
– (CBT))
50
Biological
Therapies
Psychosurgery
Antonio Egas Moniz
• MOA: Removes brain tissue
in an effort to change
behaviour. (unsure of how!)
• Lobotomy (Moniz - Nobel
Prize).
– Calmed violent patients,
but produced lethargy &
could destroy patients
personalities (zombies).
– Side-effects also included:
apathy, diminished
intellectual powers,
impaired judgements,
coma, and even death
51
Psychosurgery Summary
• Modern methods
– Stereotactic neurosurgery (most common method
today)
• much more accurate and do less damage
• Effectiveness
– Effective if performed precisely and on the
appropriate patient i.e. severely depressed/suicidal
as ‘last resort’
– Research shows: 33% high effectiveness, 33%
moderate effect, 33% minimal or no effect
• Appropriateness
– Only appropriate in severely depressed or
compulsive and suicidal patients who have not
responded to other therapies.
– Only appropriate under BMA rules if have patients
fully informed consent.
52
2
Electroconvulsive Therapy (ECT)
Video Clip – ECT (Trust me I’m a Dr.)
53
Electroconvulsive Therapy
• Appropriate for treating severely
(ECT)
depressed / suicidal patients.
L2
Sometimes given without
their consent (if sectioned).
• Introduced during the late 1930s
(Ugo Cerletti).
• Effective in lifting mood. Can
stop suicidal thoughts rapidly –
therefore can save lives.
• MOA: Increases norepinephrine
(neurotransmitter that elevates
mood) but not sure of MOA
• Perform about 20,000 per year in
the U.K.
• May cause brain damage as…..
• Substantial memory loss
(especially short term memory).
54
E.C.T.
• The guidelines for the
administration of ECT. In general
are:
– Patient is anesthetized.
– Given muscle relaxant.
– Shocked with about 100 volts
for a half to 3-4 seconds.
– Patient experiences slight
seizures that last from 30
seconds to 1 minute.
– 3-6 treatments per week for
several weeks (Though this
protocol varies).
– Entire session (from prep. time
to recovery time) takes between
1 to 2 hours.
55
– Effectiveness >70% improve
Drug (Chemo) Therapy
• Most widely used Biomedical Therapy, as it is cheap,
relatively fast acting and ‘easy’ to give.
• Appropriateness: treatment when taken responsibly,
and with the close supervision of a doctor. Drugs are
given appropriate to a ‘specific’ symptom e.g. anti (anxiety, depressive and psychotic drugs).
• Effectiveness: they are generally extremely effective at
treating symptoms. (but many have side effects such
as addiction). Drugs have liberated many people from
mental hospitals – deinstitutionalization (a big +).
Since the mid 50's, 70% of persons diagnosed with
schizophrenia lived in mental hospitals - today, less
than 5%.
56
Types of drugs:
•
Anti Anxiety Drugs: Benzodiazepines (BZs)
– Reduce tension and anxiety. (downers) e.g. (Valium)
– MOA : Enhance the action of neurotransmitter GABA resulting in
reduction in activity of brain – calming effect
•
•
– Common Side Effects : drowsiness, fatigue, weight gain,
interactions with other medications.
Anti Depressive Drugs:
– Opposite of anti-anxiety drugs (uppers).
– MOA: Increase of serotonin etc. (arousal-inducing
neurotransmitters). SSRI (e.g., Prozac) interferes with reabsorption of serotonin, creating high levels (brain arousal).
– Common Side Effects: dizziness, dry mouth, nausea.
Anti Psychotic Drugs: Neuroleptics
– Major Tranquilizers.
– MOA: Decrease production of the neurotransmitter Dopamine.
– Relieves hallucinations, hostility.
– Requires very close supervision by a physician/psychiatrist.
– Most popular: Thorazine.
– Common Side Effects: Weight gain, constipation, dizziness,
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drowsiness, dry mouth, nasal congestion
Strengths & Limitations
Strengths of drug treatment:
• Research (Kahn) showed that compared to a placebo, BZs were
more effective at reducing anxiety.
• Drugs are generally extremely effective at treating symptoms
• Drugs are easy, relatively fast acting and cheap to use.
Weaknesses of drug treatment:
• Addiction: BZs create a physiological dependence creating
marked withdrawal symptoms when stopped. Should be limited to
4 weeks use because of this.
• Side Effects: General (see individual drugs) In BZs they can be
paradoxical (opposite to that expected) i.e. can cause
aggressiveness. Also memory problems – storage difficulty.
• Sticking Plaster: Treats the symptoms not the problem so when
drugs are stopped the symptoms return. So best paired with
psychological therapies that address the problems.
• Drugs have liberated many people from mental hospitals –
deinstitutionalization (a big +). Since the mid 50's, 70% of persons
diagnosed with schizophrenia lived in mental hospitals - today,
less than 5%.
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Psychodynamic Therapies
• Psychoanalysis – MOA: treatments concentrate
on making the unconscious conscious (gaining
INSIGHT – discovering the reasons for their
problems). Then the mind can be cleansed of
maladaptive thoughts and emotions (lancing the
psychological boil – release of negative energy or
CATHARSIS) This is accomplished by using
interviews to ask about past, early experiences,
parents, and siblings, inner fears and innate
drives. It may include: Dream analysis –
interpretation of symbolism in dreams. Projective
tasks and/or Free and word association – saying
whatever enters your head!
• Catharsis can then lead to healing (CLOSURE)59
Activity: Psychoanalytical
Techniques
• Now we are going to have a go at two
Psychoanalytical treatment techniques:
• Word Association &
• Projective Task (Ink blots)
• Be prepared to criticise this techniques
after we have completed them.
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Freud’s Dream Analysis
Latent Content
Male genitals,
especially penis
Manifest Content of Dream
Umbrellas, knives, poles, swords,
airplanes, guns, serpents, neckties
Female genitals, Boxes, caves, pockets, pouches, the mouth,
especially vagina jewel cases, ovens, closets
Sexual
intercourse
Climbing, swimming, flying, riding (a horse,
an elevator, a roller coaster)
Parents
Kings, queens, emperors, empresses
Siblings
Little animals
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80
70
Percent improved
Appropriateness,
Effectiveness, Evidence &
Strenths & Limitations
60
50
40
30
20
10
• Bergin (1971) : Meta-analysis (Effectiveness)
0
Psychotheapy
Placebo
No treatment
– Psychoanalysis produced an 73% success rate and was better than a placebo or
no treatment.
• H.J. Eysenck (1952)
– Psychoanalysis is bad for you!
• Sloane et al. (1975)
•
– Behaviour therapy and Psychoanalysis both had 80% improvement rate vs
48% control group
Luborksy and Spence (1978) (Appropriateness)
– Useful in the treatment of anxiety disorders, depression, sexual disorders, but
not schizophrenia
– Useful with patients who are better educated
• Strengths & Limitations:
– Unscientific, un-falsifiable, unqualified therapists, expensive and time
consuming, techniques require subjective interpretation and rely on the
memory of the client, making them unreliable.
– Good for treating Sexual Problems.
– Recognises the importance of early childhood in development of personality
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and behaviour, so may aid prevention of mental illnesses.
1.Behavioural Therapies
Based on Classical Conditioning
• MOA; Re-learning adaptive new behaviours
to replace the maladaptive behaviour.
• Flooding or Implosion Therapy
– Exposure to the feared stimulus = 70%
effective!
• Systematic desensitisation
– Wolpe (1958)
– Based on counter-conditioning (gradually
learning to re-associate the stimulus with a more
positive response).
• Aversion therapy
– Associate unwanted behaviour with a very
unpleasant unconditioned stimulus:-
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Behaviour Therapies
• All these Learning techniques are used to alter
behaviours; these techniques include using:
– Classical conditioning as in
•Aversion therapy… e.g.
•Systematic desensitization… e.g. Driving
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phobia?!!!!
Systematic Desensitization
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Appropriateness & Effectiveness
• Appropriate ONLY for behaviour that has been
learned.
• Behaviour therapy is as effective as other forms of
therapy (Smith et al., 1980)
• It is very effective with:
– Anxiety disorders (Ost, 1989)
– Obsessive-compulsive disorder (van Oppen et al.,
1995)
– Specific phobia (Ost, 1989) ( i.e. flooding 70%
effective)
• Not very effective with disorders with a genetic
component, such as schizophrenia
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Limitations / Criticisms
- Simplistic and Deterministic – limits all behaviour to
simple cause and effect.
- Mechanical in its application – do this and this will happen
- There are ethical questions relating to both research and
treatment methods. (Little Albert – Treating Gay Men)
- Treats only the behaviour not the causes of the
behaviour.
- Does not consider individual differences (blank slate?) –
we may all learn differently.
+ Scientific approach with good supporting evidence &
easy to research.
+ Therapies are successful for phobias, OCD and anxiety
disorders etc
? New learning or re-education is it always possible?
? What is unwanted behaviour? How is it defined and who
by? Used for punishment/social control (gay men) 67
COGNITIVE
THERAPIES
•
•
•
•
Cognitive Behavioural Therapy
Cognitive Restructuring Therapy
Rational Emotive Therapy
Stress Inoculation & Hardiness
Training.
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Cognitive Behavioural Therapy
Appropriateness: Cognitive behavioural therapy (CBT) is used to help solve
problems in people's lives, such as anxiety, depression, post-traumatic stress
disorder (PTSD) or drug misuse. CBT was developed from two earlier types
of psychotherapy:
•Cognitive therapy, designed to change people's thoughts, beliefs, attitudes
and expectations. (i.e. Changing negative thoughts to positive) Includes
Stress Innoculation and Hardiness training (both cognitive methods)
•Behavioural therapy (designed to change how people acted/behaved).
American psychotherapist Aaron Beck developed CBT believing that the
way we think about a situation affects how we act but also that our
actions/behaviours can affect how we think and feel.
MOA: It is therefore necessary to change both the act of thinking (cognition)
and behaviour at the same time. This is known as cognitive behavioural
therapy. CBT says that your problems are often created by you. It is not the
situation itself that is making you unhappy, but how you think about it and
how you react to it. Video Clip (Trust me I am a Dr.)
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Effectiveness of CBT
• CBT is often favoured over other therapies
because it aims to get rid of the problem not
just the symptoms.
• Evans (1992) CBT is at least as good as
drug therapy in preventing a relapse
• Keller (2001) combination of CBT and drug
therapy more effective than either therapy
alone
• Butler (2006) effectiveness depends on the
disorder. When the problem is severe, a
combination of drugs and CBT is best. E.g.
Drugs may reduce disturbed thoughts of
Schizophrenics allowing CBT to be used
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effectively.
Strengths and Limitations
• Treatment very effective, especially when
combined with drug therapy.
• Patient has a certain amount of control
over their treatment and can use the
techniques taught to them to deal with
future problems and situations.
• Assumption is that patient is to ‘blame’ for
their problems. This is the only therapy
that assumes that the patient is at fault.
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The Therapy Game
• You will be put in groups of either Psychiatrists,
Psychotherapists, Behavioural Therapists or
Cognitive Therapists
• You are now the potential therapists of the following
patients.
• Can you explain their abnormal behaviour?
• Can you suggest an appropriate treatment?
• You must stick strictly to the model/approach of your
particular group when answering these questions.
• The team with the most appropriate explanation and
treatment will win the patient.
• The team with the most patients wins the game! 72
Patient No. 1
• You have 2 minutes to discuss the case with
your fellow therapists and decide:
• What is the likely cause of the patients
abnormal behaviour?
• Which treatment is the most suitable and why? 73
Patient No. 2
• You have 2 minutes to discuss the case with your
fellow therapists and decide:
• What is the likely cause of the patients abnormal
behaviour?
• Which treatment is the most suitable and why? 74
Patient No. 3
• You have 2 minutes to discuss the case with your
fellow therapists and decide:
• What is the likely cause of the patients abnormal
behaviour?
• Which treatment is the most suitable and why? 75
Patient No. 4
• You have 2 minutes to discuss the case with your
fellow therapists and decide:
• What is the likely cause of the patients abnormal
behaviour?
• Which treatment is the most suitable and why? 76
Patient No. 5
• You have 2 minutes to discuss the case with your
fellow therapists and decide:
• What is the likely cause of the patients abnormal
behaviour?
• Which treatment is the most suitable and why? 77
The End
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Key Term: Abnormality
• Behaviour that is considered to deviate from
the norm (statistical or social), or ideal mental
health. It is dysfunctional because it is harmful
or causes distress to the individual or others
and so is considered to be a failure to function
adequately. Abnormality is characterised by
the fact that it is an undesirable state that
causes severe impairment in the personal and
social functioning of the individual, and often
causes the person great anguish depending
on how much insight they have into their
illness
79
Key Term: Anorexia nervosa
• An eating disorder characterised by the
individual being severely underweight; 85%
or less than expected for size and height.
There is also anxiety, as the anorexic has
an intense fear of becoming fat and a
distorted body image. The individual does
not have an accurate perception of their
body size, seeing themselves as “normal”,
when they are in fact significantly
underweight, and they may minimise the
dangers of being severely underweight
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Key Term: Bulimia nervosa
• An eating disorder in which excessive
(binge) eating is followed by compensatory
behaviour such as self-induced vomiting or
misuse of laxatives. It is often experienced
as an unbreakable cycle where the bulimic
impulsively overeats and then has to purge
to reduce anxiety and feelings of guilt about
the amount of food consumed, which can be
thousands of calories at a time. This
disorder is not associated with excessive
weight loss
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Key Term: Cultural relativism
• The view that one cannot judge behaviour
properly unless it is viewed in the context from
which it originates. This is because different
cultures have different constructions of
behaviour and so interpretations of behaviour
may differ across cultures. A lack of cultural
relativism can lead to ethnocentrism, where
only the perspective of one’s own culture is
taken
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Key Term:
Deviation from ideal mental health
• Deviation from optimal psychological wellbeing (a state of contentment that we all strive
to achieve). Deviation is characterised by a
lack of positive self-attitudes, personal growth,
autonomy, accurate view of reality,
environmental mastery, and resistance to
stress; all of which prevent the individual from
accessing their potential, which is known as
self-actualisation
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Key Term: Eating disorder
• A dysfunctional relationship with food. The
dysfunction may be gross under-eating
(anorexia), binge–purging (bulimia), overeating (obesity), or healthy eating (orthorexia).
These disorders may be characterised by faulty
cognition and emotional responses to food,
maladaptive conditioning, dysfunctional family
relationships, early childhood conflicts, or a
biological and genetic basis, but the nature and
expression of eating disorders show great
individual variation
84
Key Term: Statistical
infrequency/deviation from
statistical norms
• Behaviours that are statistically rare or
deviate from the average/statistical norm as
illustrated by the normal distribution curve,
are classed as abnormal. Thus, any
behaviour that is atypical of the majority
would be statistically infrequent, and so
abnormal (e.g., schizophrenia is suffered by
1 in 100 people and so is statistically rare)
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Factors Important to Mental Health
The factors that
drive or motivate
individuals,
according to
Maslow (1954)
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