Individual Differences: Abnormality
5Appropriate for treating severely depressed / suicidal
patients. 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 MOAPerform
about 20,000 per year in the U.K.May cause brain damage as..
Substantial memory loss (especially short term memory).
Electroconvulsive Therapy (ECT)
L2
556The 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.Effectiveness >70% improveE.C.T.
663Psychosurgery SummaryModern methodsStereotactic neurosurgery
(most common method today)much more accurate and do less
damageEffectiveness Effective if performed precisely and on the
appropriate patient i.e. severely depressed/suicidal as last
resortResearch shows: 33% high effectiveness, 33% moderate effect,
33% minimal or no effectAppropriatenessOnly 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.
334Electroconvulsive Therapy (ECT)
2Video Clip ECT (Trust me Im a Dr.)44Electroconvulsive Therapy
(ECT) Commonly called "shock therapy," this treatment is used for
severely depressed individuals; it causes a seizure to occur in the
brain. 7Drug (Chemo) TherapyMost 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%.
8Types 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 effectCommon 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 re-absorption of serotonin,
creating high levels (brain arousal).Common Side Effects:
dizziness, dry mouth, nausea.Anti Psychotic Drugs:
NeurolepticsMajor 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, drowsiness, dry
mouth, nasal congestion
9Strengths & LimitationsStrengths 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 symptomsDrugs 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%.
10Psychodynamic 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)
1011Activity: Psychoanalytical TechniquesNow 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.12Freuds
Dream AnalysisMale genitals, especially penisFemale genitals,
especially vaginaSexual intercourseParentsUmbrellas, knives, poles,
swords, airplanes, guns, serpents, necktiesBoxes, caves, pockets,
pouches, the mouth, jewel cases, ovens, closetsClimbing, swimming,
flying, riding (a horse, an elevator, a roller coaster)Kings,
queens, emperors, empressesSiblingsLittle animalsLatent
ContentManifest Content of Dream121213Bergin (1971) : Meta-analysis
(Effectiveness) 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 groupLuborksy and Spence (1978) (Appropriateness) Useful in
the treatment of anxiety disorders, depression, sexual disorders,
but not schizophreniaUseful with patients who are better
educatedStrengths & 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 and behaviour, so may aid prevention of
mental illnesses.
Appropriateness, Effectiveness, Evidence &Strenths &
Limitations1313141.Behavioural Therapies Based on Classical
ConditioningMOA; Re-learning adaptive new behaviours to replace the
maladaptive behaviour.Flooding or Implosion TherapyExposure to the
feared stimulus = 70% effective!Systematic desensitisationWolpe
(1958)Based on counter-conditioning (gradually learning to
re-associate the stimulus with a more positive response).Aversion
therapyAssociate unwanted behaviour with a very unpleasant
unconditioned stimulus:-
141415Behaviour TherapiesAll these Learning techniques are used
to alter behaviours; these techniques include using:Classical
conditioning as inAversion therapy e.g.
Systematic desensitization e.g. Driving phobia?!!!!
151516Systematic Desensitization
161617Appropriateness & EffectivenessAppropriate 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
18- 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)Limitations /
Criticisms181819COGNITIVE THERAPIESCognitive Behavioural
TherapyCognitive Restructuring TherapyRational Emotive
TherapyStress Inoculation & Hardiness Training.
1920Cognitive Behavioural TherapyAppropriateness: Cognitive
behavioural therapy (CBT) isused to help solve problems in people's
lives, such as anxiety, depression, post-traumatic stress disorder
(PTSD) or drug misuse. CBTwas developed fromtwo 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 toit.
Video Clip (Trust me I am a Dr.)2021Effectiveness of CBTCBT 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 relapseKeller (2001)
combination of CBT and drug therapy more effective than either
therapy aloneButler (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 effectively.22Strengths and LimitationsTreatment
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.23The Therapy GameYou will be put in groups of either
Psychiatrists, Psychotherapists, Behavioural Therapists or
Cognitive TherapistsYou 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!
2324Patient No. 1You 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?
2425Patient No. 2You 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?
2526Patient No. 3You 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?
2627Patient No. 4You 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?
2728Patient No. 5You 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?
2829The End
2930Key Term: AbnormalityBehaviour 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 3031Key Term: Anorexia nervosaAn 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 3132Key Term: Bulimia nervosaAn 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 3233Key Term: Cultural
relativismThe 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 ones own culture is taken
3334Key Term: Deviation from ideal mental health Deviation from
optimal psychological well-being (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 3435Key Term: Eating disorder A
dysfunctional relationship with food. The dysfunction may be gross
under-eating (anorexia), bingepurging (bulimia), over-eating
(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 3536Key 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) 3637Factors Important to Mental
Health
The factors that drive or motivate individuals, according to
Maslow (1954)37