Psychological Dysfunction and Treatment

Download Report

Transcript Psychological Dysfunction and Treatment

Psychological Dysfunction and
Disorders are given psychological
labels and listed in the DSM
Source of Psychological Disorders
• Nurture or Nature
• Biological or Learned
• Culture invested in biological model but
evidence is growing that learning is a
significant contributor
Neural Development that results from
Excessive Stress
• Stress axis involves the hypothalamus which alerts
the pituitary gland which in turn alerts the adrenal
• This stress axis is sensitized to over-react to stimuli
• Organisms under stress less open to learning
experiences. Why?
Need to survive and protect reduce
ability to learn
• If overly concerned about threats, can’t be
curious and open to experiences
• Reduced learning results in under-developed
cerebral cortex and hippocampus
• Children under stress do show cognitive
Experiences shape genes, brain
anatomy and then behaviors
• Classical Conditioning with Aplysia
• Classical conditioning with Howard Hughes
• Classical conditioning with David Helfgot
• Anxiety Disorders result, including
How can children learn to become anxious:
Raised in Stressful Environment
• Overly protective, intrusive &/or demanding
• Very unstable and unpredictable early
• Parents model excessive number of anxieties
and fears, as Mrs. Hughes did for Howard
toward germs
Classical Conditioning Paradigm
• How Howard Hughes develop phobia toward
David Helfgot and volitile,
demanding & abusive father
Woman with OCD and
Authoritarian Father
Anxiety Disorders
General Anxiety Disorder
Panic Disorder: Anxiety Levels can
result in Panic Attacks
Racing heart
Feel faint and/or dizzy
Tingling or numbness in hands or arms
Sense of impending doom
Chest pains
Difficulty with breathing
Feel a loss of control
Treatment of Panic Disorder
• People with this disorder often will avoid
leaving the house
• Initially will go to ER at nearby hospitals
• Behavioral treatment involves the person
intentionally start a panic episode and then
demonstrate to self not a serious event
Social Anxiety Disorder
Behavioral Clinic that teaches socially
phobic people to learn how to reach out
• Model and rehearse simple and appropriate
ways to initiate a social interaction
• Give weekly assignments that start very
simple and move forward step-by-step
• Report back to group every week on successes
the previous week
Obsessive Compulsive Disorder
Common Thoughts or Obsessions
• Fear of dirt or contamination by germs
• Fear of doing harm to another
• Obsess if proper order and neatness has not been maintained
• Excessive doubt and need for constant reassurances
• Fear of thinking evil or sinful thoughts
Common Compulsions
• Repeatedly showering or washing hands
• Refuse to shake hands or touch door knobs
• Repeatedly checking things, as locks
• Constantly arranging things in certain order
• Collecting or hoarding items of no value
Aviator: Life Howard Hughes
Childhood of Howard Hughes
1) He grew up with a mother who forced him to endure odd cleaning rituals,
as dousing himself with mineral oil daily.
2) She disapproved of him making friends as believed they were carriers of
disease, resulting in him spending much of his childhood alone or with his mother.
3) Mother insisted on giving Howard hand baths until he reached his teens.
4) She watched for slightest changed in physical condition, sniffles, a cough as well
as any abnormality in his feet, teeth or digestion and then would whisk to a doctor,
in the process lavishing much attention and sympathy.
5) Observers were amazed at the extreme closeness between Howard and his
mother and how often they would kiss and hug.
Hughes also developed life-long
obsession with germs
• Not like anyone touching him
• Over-react to people around him to be messy or
dirty, especially when under stress
• Wash his hands many times every day
• Become more and more reclusive through the years
Last 20 years live alone in hotel room
Cognitive therapy for anxiety: challenge a
person’s inaccurate perceptions
• Will touching doorknobs cause contamination & then serious illness?
• What will be the dire consequences of not washing your hands more than
5 times a day?
• Are people really watching and judging you when you walk into a
restaurant or library?
• Are you really having a heart attack during a panic episode?
• So what if not do a job perfectly?! So what if not get an A on every tests?!
• Can control habitual anxious thinking & so reduce anxious feelings
Behavioral Therapy: Can learn behaviors that
effectively reduce anxiety
• Meditation
Causes of Depression: operant
• Child receive much extinction &/or lots of
discouraging feedback
• Receive very little positive, encouraging feedback
• Not encouraged to become independent—or
develop a sense of autonomy
• Given sense that they are not valued, lovable or
How do depressed people think?
• Learn have very little control over environment so learn
feelings of helplessness and hopelessness
• Learn selective perception: focus on what did wrong, not
what did right as what parents did
• Develop pessimistic attitude and low self-esteem
• When experience loss or set-backs, over-react and become
depressed and blame self
Cognitive Behavioral Therapy
• Structured therapy where analyze ways think
and behave that are causing anxiety and/or
• Use role playing and homework assignments
to practice new ways of thinking and behaving
Cure for Depression—Become
active and productive
Books Cognitive Behavioral Therapy
Cognitive Behavioral Books focused on
specific problems
Sociopath: Anti-social Personality
No conscience
Inability to feel remorse
Lacking structure or restraints in childhood
Lacking loving and affectionate care in
• Serial killers, cheaters, liars
• Hurt others with no concern: very selfabsorbed
Treatments for Anti-Social
• How determine that a person has this
• Why do they not go for treatment?
• What could the treatment be if they did?
• Sigmund
Freud use
intuition to
develop theory
of role of
Believe essential to explore traumas
repressed in unconscious mind
• Free association: lie on couch and talk about
whatever enters ones mind
Use Dream Analysis as believed they
were road to unconscious
Psychoanalytic Therapy
• Wish to delve into traumas stored in
unconscious psyche
• Initially Freud use free-association
• Later therapists started to use hypnosis to get
patients to remember early traumas
Problems with foundation of
Psychoanalytic Therapy
• Are childhood traumas really “repressed?”
• Is it really of value to dig into our childhood in
order to relive and gain insight into our early
• Does hypnosis really improve our memories of
childhood or encourage the development of
false memories?
Humanistic Theory: Believe Conscious
Mind is in charge
• Carl Rogers
Humanistic School: Client-centered
• We control our own destiny & are
autonomous: conscious mind is in control
• We have the ability to solve our own problems
with clarification and support
• Role of therapist is to reflect and clarify, not to
give advice
Questions about Client-Centered
• Can we solve our own problems simply by a therapist
providing us support and clarification?
• For which type of issues would we need so direct
• Panic attacks? Serious depression? Constant
concerns about germs and contamination?
Cognitive Behavioral Therapy
• Practice new ways of thinking and behaving as
opposed to “talking” about problems
• For anxiety disorders, determine habitual thinking
patterns that make you anxious
• Learn to STOP! obsessive worrying
• Learn to start using calming self-statements
Behavioral Changes for Anxiety
• Practice the “relaxation response:" Starts with
the mind which, in turn, relaxes the body
• Learn deep muscle relaxation exercises: Starts
with the body which, in turn, relaxes the mind
Cognitive-behavioral therapy for
• Identify thinking patterns that are common
among people who are depressed
• Practice keeping a journal of every positive
event that occurred during the day
• Practice positive self-statements about an
event or interaction you handled well
Feeling Good Handbook
• All or nothing thinking
• Discounting the positive
• Believe need to be perfect or have failed
• Buy into view ‘am a loser,’ no matter what
Behaviors to reduce depression
• Step-by-step increase in level of exercise do on
daily basis: start at 250 steps per day & week
by week increase up to 10,000
• Increase social network: create one social
interaction during a week
• Join new social groups via
Increase One’s Productivity
• Establish goals for each day that are realistic
• Give oneself credit for accomplishing each
• Slowly increase level of productivity plan for
each day
Schizophrenia is most serious
psychological dysfunction
• Diathesis-Stress Model: Born with genetic
defect that predisposes them to overreact to
• Early severe stressful events cause abnormal
neurodevelopment that has caused nervous
system to be hyper sensitive to stressors
Abnormalities found in
• Over-reactivity of hypothalamic-pituitaryadrenal axis
• Structural brain changes, including
hippocampus damage and cerebral atrophy
• Elevation of release of cortisol and dopamine
when exposed to stress
What could these neurological
abnormalities explain?
• Oversensitivity to stress
• Cognitive impairments
• Relationship between psychotic and
hallucinations, delusions and paranoia
Problem with biological model
• Impede adequate consideration of relevance
of stress, trauma, neglect and loss in early
• Diathesis-stress model only measure stressors
a few weeks or months prior to outbreak so
not consider early life events
• Gross imbalance in examining biological
psychological and social factors
“Genotype-environment interaction in
schizophrenic-spectrum disorder”
• British Journal of Psychiatry (2004)
• 36% of high-genetic risk adoptees raised in
dysfunctional families develop symptoms
• 5.8% of high-genetic risk adoptees raised in
healthy families
• Demonstrates protective effect of family
Factors in Environment: High Degree
of Stress Early in Life
• Genetic risk
combined with
volatile, hostile
and/or overly
Healthy Families
• Have good sense of humor and can laugh at
• Respect each other’s need for privacy and not
engage in mind reading
• Negotiate and compromise
Findings of Adoptee studies
• Genes do not operate alone
• Environmental factors play a significant role
• Much of environmental influences are result
of family environment
• Developing brain vulnerable early in life
Traits of Healthy Families
• Speak clearly and are not rigid nor confusing
• Friendly environment & able to disagree
without upsetting other members
• Can express happiness or sadness to each
Treatment for Schizophrenia:
Limited to Biological Treatments
Biological Treatments
• Medications
Thorazine one popular anti-psychotic
medication: very strong sedative
Action of Antidepressants
ECT: Electro-convulsive therapy
Deep Stimulation of the
Reward Centers in the Brain
Trans-cranial Magnetic Stimulation