Gen Psych Abnormality

Lecture Outline • • • •

Definitions of Psychological Abnormality. Diagnostic Systems. Psychotherapy. Other considerations.

What is Psychological Abnormality? • The American Psychiatric Association defines abnormal behaviors as those which lead to: – Disrupted functioning. – Distress in the person or in others. – Danger to the person or to others.

• Abnormality may also involve problems with thoughts or emotions, even without abnormal behavior. – For example, severe depression or anxiety.

Beware Medical Student’s Disease • Upon hearing the symptoms of a disorder, the tendency for people to believe that they or someone they know shares those symptoms. • Only a trained professional can diagnose a psychological disorder.

College Students with Symptoms • A 2007 University of Michigan survey found that more than half of U-M college students with significant symptoms of anxiety or depression do not seek help. – The incidence of mental illness on college campuses is increasing. – Rutgers students can visit one of the RU Counseling and Psychological Services locations.

The Biopsychosocial Model • Biological factors. – Damaged, over-reactive or under-reactive brain structures. – Imbalance of neurotransmitters. • Psychological factors. – Conditioning history. •

For example: classically conditioned fear responses.

– Beliefs and thoughts. •

For example: low self-efficacy, pessimistic interpretation of events.

– Poor social skills.

• Social structures and cultural norms. – Treatment by others and expectations held by others.

Diathesis-Stress Model Genetic and environmental contributions to psychopathology

Threshold for psychopathology

Genetically above threshold

Genetically near threshold

Genetically Not genetically at risk predisposed

Environmental component Genetic vulnerability

DSM-IV • The Diagnostic and Statistical Manual of Mental Disorders. • Published by the American Psychiatric Association in an attempt to establish uniform criteria for diagnosis. – The current edition is termed the DSM-IV. • Uses a multi-axial system of diagnosis.

The Axes of DSM-IV Axis I II III IV V

Description Clinical disorders – distress, dysfunction Personality disorders and mental retardation. Medical conditions that may influence mood or behavior. Psychosocial and environmental problems. Global assessment of functioning (1-90)

Some Criticisms of DSM-IV • The DSM-IV includes too many minor disorders. • Disorders do not cleanly fall into one of the DSM-IV categories as opposed to the others. • To what extent is the situation the problem, rather than the person?

Prevalence of Psychological Disorders • There is a stigma associated with receiving a mental health diagnosis. • Yet about 50% of people in the U. S. will have a psychological (DSM-IV) disorder at some point in their lives.

Psychotherapy • Psychotherapy is a treatment of psychological disorders involving an ongoing relationship between a trained therapist and a client. – Medical and biological interventions for specific disorders will be discussed in the next lecture.

• There are many techniques of psychotherapy, but all of them seem to depend on the client’s motivation to improve.

Psychoanalysis (Freudian) • Mental symptoms reflect unconscious conflicts that induce anxiety. • Insight. – Therapeutic change requires the understandings of the internal workings of one’s own mind.

• The relationship between the patient and therapist is critical.

Psychoanalytic Techniques • Free Association. – The patient is encouraged to say whatever comes to mind to reveal unconscious processes. – Responses to projective tests (e.g., TAT) are analyzed.

• Interpretation. – The therapist interprets the dreams, associations, and feelings of the patient in order to reveal the hidden conflicts and motivations.

• Analysis of transference. – Patients bring into therapy their past troubled relationships; these are transferred to the therapist.

Cognitive-Behavioral Therapies • Behavioral, cognitive, and cognitive-behavioral therapies focus on a person’s specific observable problem behaviors or on a person’s currently experienced mental distress, such as depression and anxiety. – The emphasis is on the present rather than on the past. – The therapist can be very directive. – Duration is relatively short-term.

Behavior Therapies • Techniques based on classical conditioning. – For example: Systematic desensitization.

• Therapist teaches relaxation techniques to the patient. • While in a relaxed state, the patient is encouraged to imagine situations involving the feared object, starting with the least fearful image and progressing through the more fearful.

Cognitive Therapies • Attempt to change dysfunctional beliefs and thought patterns. • Albert Ellis’ Rational Emotive Therapy: – Pathology results when persons have illogical beliefs guiding their responses to life situations. Activating Conditions  Beliefs  Emotional Consequences – Therapist teaches alternative thinking that promotes rational thought.

Beck’s Cognitive Therapy • Cognitive restructuring. • Client keeps a daily record of dysfunctional beliefs. • Client reviews daily record and: – Identifies automatic thoughts. – Generates rational responses.

Humanistic Therapies • Carl Rogers’ Client Centered Therapy. – Psychological problems result when self-concept differs from actual feelings or experience. • Incongruence between the ideal self and the real self. – Assumes that growth and maturity are natural if allowed to happen. • Unconditional positive regard from the therapist creates the necessary conditions. • Therapy is based on empathy: Understanding the client’s feelings without judgment.

Modalities of Therapy • Individual therapy. • Group therapy. – Different groups have different: • Therapeutic objectives. • Composition. • Therapeutic perspectives.

• Family therapy. • Systems therapy. • Self-help groups.

Which Therapy Works Best? • Difficult to know, because different questions can be asked: – – – –

What percentage of patients are helped? Of those who are helped, how much of the problem goes away? Of those who are helped, how long do they go before the problems come back? How many people drop out of therapy?

• A therapy may be better or worse than others on each of these questions.

Therapeutic Effectiveness Research • A meta-analysis of 475 experiments found that receiving therapy was better than being on a waiting list. • A large Consumer Reports study found outcomes were similar with treatment by psychiatrists, psychologists, or social workers; less satisfactory with marriage counselors or medical doctors. • Different approaches produce similar results. • Most improvement is seen in the first 25 sessions and subsequently continues at a slower rate.

Common Factors among All Psychotherapies • All forms of therapy share the following characteristics: – A positive, cooperative relationship between the therapist and client (therapeutic alliance). • The therapist provides empathy and acceptance. • Therapy involves an opportunity for and the encouragement of emotional disclosure. • The client makes a commitment to change.

– The client acquires new ways of thinking about problems and new social skills. – The therapeutic situation provides hope. • Therefore, there is a strong potential for expectancy (placebo) effects.

Eclecticism in Psychotherapy • A single therapist may use different psychotherapeutic techniques: – Depending on the problem. – If the client doesn’t improve with the first technique.

• 68-98% of therapists use an eclectic approach.