Abnormal Psych 3331 Midterm 2
Popular in Abnormal Psychology
Popular in Psychlogy
verified elite notetaker
verified elite notetaker
verified elite notetaker
PSYC 2012 Social Psychology
verified elite notetaker
verified elite notetaker
verified elite notetaker
This 163 page Bundle was uploaded by Nicole Rossetti on Tuesday November 3, 2015. The Bundle belongs to 3331 at a university taught by Stephanie Fountain-Zaragoza in Fall 2015. Since its upload, it has received 51 views.
Reviews for Abnormal Psych 3331 Midterm 2
These were really helpful...I'll be checking back regularly for these
Report this Material
What is Karma?
Karma is the currency of StudySoup.
You can buy or earn more Karma at anytime and redeem it for class notes, study guides, flashcards, and more!
Date Created: 11/03/15
Stress Disorders Psych 3331 Example Case: Bob • http://www.pbs. org/thisemotionallife/video/lingering- war Stress • Two components of stress: 1. Stressor: an event that creates a demand on the body • physical, psychological, environmental – Daily hassles – Important events – Chronic stressors – Traumatic events – large number of stressors → more likely to develop anxiety disorders and/or a stress disorder. Stress Response 2. Stress response: a person’s reactions to the demands • Influenced by the way we judge events and our ability to react to them • sympathetic nervous system activated • Activation of organs, release of epinephrine and norepinephrine • HPA axis activated • Release of corticosteroids like cortisol Hypothalamic-Pituitary-Adrenal Axis Hypothalamic-Pituitary-Adrenal Axis Stress Response Stressor Hypothalamus Sympathetic NS Release of ACTH Release of corticosteroids Activation of Organs Release of epi and norepinephrine Various organs Arousal and Fear Activation of Organs Reaction Arousal and Fear Reaction Arousal and Fear Trauma and Stress-Related Disorders • New Term for DSM-5 • During and after trauma we may temporarily experience levels of arousal, anxiety and depression – Problem: symptoms that persist well after the upsetting situation is over • Acute Stress Disorder • Posttraumatic Stress Disorder • Arise in reaction to a psychologically traumatic events – Would be traumatic to anyone (unlike) other anxiety disorders) Traumatic Stress • Traumatic stress: involves actual or threatened death or serious injury to self or others – Creates intense feelings of fear, helplessness, or horror • Examples: – Natural Disasters – Rape, physical assault – Combat and war-related trauma Common Traumatic Situations • Combat • “shell shock” •Afghanistan conflictss affects 20% of veterans of Iraq & • Multiple deployments increase risk of PTSD • Abuse / Victimization • especially rape • terrorism • torture • Natural Disaster or Severe Accident • Floods, earthquakes, tornadoes, fires, airplane crashes, serious car accidents Posttraumatic Stress Disorder DSM-5 Checklist: PTSD 1. Exposure to a traumatic event --- actual or threatened death, serious injury or sexual violence 2. One or more intrusive symptoms 3. Persistent avoidance of stimuli associated with the event(s) 4. Negative changes in cognitions and moods 5. Marked changes in arousal and reactivity 6. Significant distress or impairment (with symptoms lasting more than 1 month) PTSD vs. Acute Stress Disorder • Acute Stress Disorder – Symptoms last less than 1 month – Symptoms begin within 4 weeks of the trauma – 80% of cases of acute stress disorder develop into PTSD • PTSD – Symptoms last more than 1 month PTSD: Intrusive Symptoms • re experiencing the traumatic event – Recurrent, involuntary, and distressing memories – Recurrent distressing dreams – dissociative reactions, such as flashbacks PTSD: Avoidant Behaviors • Examples: – Avoid activities that remind them of traumatic event – Avoid thoughts or feelings or conversations related to the traumatic event PTSD: Reduced Responsiveness • May feel detached from other people • May lose interest in activities that once brought enjoyment • May experience symptoms of dissociation: – Feel dazed have trouble remembering things or have a sense of derealization PTSD: Increased Arousal and Negative Emotions • Hyperarousal: – Overly alert – Easily startled – Trouble concentrating – sleep difficulties • Negative emotions – anxiety, anger, depression or guilt Etiology of Stress Disorders: Biological Factors • Biological consequences of stress may perpetuate symptoms • Abnormal levels of norepinephrine • Found in urine, blood, and saliva survivors of trauma Etiology of Stress Disorders: Biological Factors • Dysfunctional activity in the amygdala and hippocampus • Hippocampus: memory, regulation of stress hormones • Abnormal functioning → intrusive memories and increase arousal • Amygdala: works with the hippocampus to produce emotional component of memory • Abnormal functioning → emotional symptoms and Etiology of Stress Disorders: Genetic Factors • Propensity for developing stress disorders may be inherited • Example: Twin studies, where both have served in the military • If one twin develops stress symptoms after combat, an to develop symptoms than aely fraternal twin Etiology of Stress Disorders: Personality • More likely to develop a stress disorder if: – More anxious or had other psychological problems before trauma – Feels a lack of control over negative events – Less able to find positive outcomes in an unpleasant situation Etiology of Stress Disorders: Childhood Experiences • More likely to develop a stress disorder if… • child poverty • Family members suffer from psychological disorders • Experience assault or abuse at an early age • Younger than 10 when parents separated/divorced Etiology of Stress Disorders: Other factors • Social support – More likely to develop if weak family or social support • Severity of trauma – More severe, more direct exposure to trauma, greater likelihood of developing a stress disorder • E.g., traumas involving witnessing the injury or death of others Treatment for Stress Disorders • Drug therapy • Anxiolytic medications: helps control muscle tension (psychological) • Antidepressant medications: reduce nightmares, flashbacks, panic attacks and depressive symptoms (cognitive) • Behavioral exposure techniques • Prolonged imaginal exposure (PE) • Cognitive Therapy • Cognitive processing therapy (CPT) • Eye Movement Desensitization Retraining (EMDR) Treatments for Stress Disorders • General goals: – End lingering stress reactions – Gain perspective on painful experiences – Return to constructive living • Duration of PTSD shortened with treatment – No therapy: symptoms last average 5 years – Therapy: symptoms last average 3 years Prolonged Imaginal Exposure • flooding and systematic desensitization • approach , rather than avoid trauma-related thoughts, feelings, and situations • Components of PE • psychoeducation • relaxation • i• E.g., virtual reality, software • Imaginal exposure: Learn that do not need to be afraid of memories • Talk through the trauma with the therapist repeatedly Cognitive Processing Therapy • Educate about PTSD • Process trauma – Modify excessively negative appraisals of the trauma • Increase awareness of link between thoughts and emotions • Identify “stuck points” • Learn to question thoughts • Learn to have a more balanced view Processing the Trauma Example • “Write a full account of the most traumatic incident of abuse and include as many sensory details (sights, sounds, smells, etc.) as possible. Also, include as many of your thoughts and feelings as you recall having during the event. Pick a time and place to write so you have privacy and enough time. Do not stop yourself from feeling your emotions. If you need to stop writing at some point, please draw a line on the paper where you stop. Begin writing again when you can and continue to write the account even if it takes you several occasions. Read the whole account to yourself at least once before the next individual session. Allow yourself to feel your feelings. Bring your account to the next individual session.” Discovering/Modifying Negative Thoughts Example • Below is a list of questions to be used in helping you challenge your problematic beliefs or rules. Not all questions will be appropriate for the belief you choose to challenge. Answer as many questions as you can for the belief you have chosen to challenge below. • 1. What is the evidence for and against this belief? • 2. In what ways does this belief confuse a habit with a fact?(consider whether you have just said this belief to yourself so many times that it seems like fact) • 3. In what ways does your belief distort what really happened?(e.g., blaming yourself, denying the seriousness of the abuse, excusing the perpetrator, etc.) • 4. In what ways might you be thinking in all-or-none terms? (e.g., either-or, black-white, right-wrong, good-bad) Eye-Movement Desensitization & Reprocessing (EMDR) • Clients move eyes in a saccadic manner while flooding mind with images of stimuli they avoid – Facilitates processing of traumatic event – Eye movement stimulates orienting response that naturally arises to generate attention_ towards new stimulus – Orienting response hypothesized to activate integration of memories into semantic memory • Controversy over mechanism (and efficacy) •__________ showed a larger effect, tended to do so faster, and resulted in more people no longer meeting PTSD criteria From Taylor et al. (2003) JCCP Psychological Debriefing • Crisis intervention directly after trauma – Victims talk extensively about feelings and reactions within days of the trauma – Help the patient see reactions as normal – Goal: prevent or reduce stress reactions before they start • Efficacy has been questioned – Patients’ symptoms may get worse Physical Stress Disorders • Psychological factors affecting other medical conditions—bring about actual physical damage DSM-5 Checklist 1. The presence of a general medical condition 2. Psychological factors adversely affect the general medical condition in one of the following ways a. influence the course of the medical condition b. Interfere with the treatment of the medical condition c. pose additional health risks d. Influence underlying pathological physiology, triggering or worsening the medical condition Psychophysiological Disorders • Interaction of stress factors (e.g., ) and physiological factors (e.g., ) leads to: • Ulcers • Asthma • Insomnia • Chronic headaches (tension headaches, migraines) • Hypertension • Coronary heart disease Etiology: Biological Factors • Defects in the autonomic nervous • Displays of biological may increase chances – E.g., experiencing temporary rises in blood pressure in response to stress may put you at risk for hypertension Etiology: Psychological Factors • Certain attitudes, emotions or coping styles may cause people to overreact repeatedly to stressors → psychophysiological disorder • “Type A” : consistently angry, cynical, driven, impatient, competitive, and ambitious • Associated with coronary heart disease Etiology: Sociocultural Factors • Adverse social conditions may make one vulnerable to psychophysiological disorders – Produce ongoing stressors that trigger and interact with biological and personality factors • Examples of adverse social conditions – poverty – discrimination Biopsychosocial Perspective • Biological, psychological and sociocultural factors combine to produce psychophysiological disorders Stress and Health • The greater the amount of life stress, the greater the likelihood of illness • Most stressful events: • Most stressful events for students: -death of a spouse • death of a family/friend -divorce -marital separation • have a lot of test -jail term • finals week -death of a family member • applying to grad school • victim of crime Psychoneuroimmunology • Explains the link between stress and health • Immune system protects us from antigens • Lymphocytes, when stimulated, spring into action to help the body fight antigens • Helper T cells • Natural killer T cells • B-cells • Stress interferes with the activity of , increasing the susceptibility to viral and bacterial infections • contribute to poorer immune system functioning (________________________) Stress and Immunity • Behavioral changes can slow down the immune system • Stress→ change in health behaviors → slow down immunity • Personality: those with a general sense of hopelessness are more susceptible to illness • Social Support: those with few social supports and feel onel display poorer immune funcitoning in the face of stress Psychological Treatments for Physical Disorders • Relaxation training: •effective for headaches, insomnia, asthma, diabetes surgical pain and cancer treatments • Biofeedback: •Effective for headaches, muscular disabilities after strokes or accidents, asthma, high blood pressure, stuttering and pain • Meditation (esp. mindfulness Psychological Treatments for Physical Disorders • Hypnosis: somewhat effective for pain, insomnia, high blood pressure • Cognitive Interventions: identify and appraise negative illness-related self statements • Emotion Expression (writing down emotions) and Support Groups: • Effective for asthma, arthritis, HIV and cancer patients • Combination approaches DISSOCIATIVE & SOMATIFORM DISORDERS Guided Notes Today’s Agenda • Dissociative Disorders – Four Types – Etiology – Treatment • Somatoform Disorders MEMORY AND DISSOCIATIVE DISORDERS • Memory is key to one’s identity – Memories of past experiences guide our reactions in present/decisions for future • People sometimes experience a major disruption of their memory, identity, or consciousness – When these experiences lack a clear physical cause, they are called “dissociative” disorders WHAT IS DISSOCIATION? • A process in which different parts of an individual’s identity, memories, or consciousness become split off from one another. DISSOCIATIVE DISORDERS • Four types: – Dissociative Amnesia – Dissociative Fugue – Dissociative Identity Disorder – Depersonalization Disorder DISSOCIATIVE AMNESIA • One or more episodes of : – Inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary f• Episodic, not semantic memory, is affected. • No organic cause for the memory loss • Higher incidence following trauma Types of Dissociative Amnesia • Types of amnesia that can be experienced: – Localized- losing all memory from limited time period – Selective- losing only some memories from limited time period – Generalized- losing all memory from the past – Continuous- not able to remember new memories/current experiences and losing all memory from the past DISSOCIATIVE FUGUE • Forgetting personal identity and details from the past, fleeing to a different location ● Confusion about one’s identity or, in more severe cases, take a new name and start a new life ● Fugue state lasts from hours to months, and typically ends suddenly ● Once the fugue is over, people generally regain most or all of their memories and do not experience a recurrence. ● Onset often related to trauma DISSOCIATIVE IDENTITY DISORDER • 1) The presence of two or more distinct identities or personality states • Formerly: multiple personality disorder • Alternate identities (sub-personalities or alters) may have different names, genders, ages, personal characteristics, abilities, and physiological responses • Difficulty integrating different parts of personality “United States of Tara” COMMON ALTER TYPES • Child type: alters that are young, who do not age as the individual ages, appear to be the most common type of alter. • Persecutor type: alters that inflict pain or punishment on the other alters by engaging in self-mutilating acts. • Helper typealters that protect the weaker alters or control the switching between the alters. DISSOCIATIVE IDENTITY DISORDER • • • • • Chris Sizemore DISSOCIATIVE IDENTITY DISORDER • • • CONTROVERSY • Limited data on prevalence • prevalence unknown • Higher in US than elsewhere • 3:1 ratio women:men • Some noteworthy cases (e.g., ‘Sybil’) have been discredited years later DEPERSONALIZATION DISORDER • Frequent episodes of feeling detached from own mental processes or body, as if you were an outside observer of yourself • Occasional experiences can occur due to sleep deprivation or life-threatening event • More common in adolescents/young adults • Derealization can also occur: the feeling that the external world is unreal and strange EXPLAINING DISSOCIATION • Psychodynamic View • Dissociative disorders caused by excessive repression • Assign impulses to other personalities • Self-hypnosis: goal is to repress or avoid difficult memories, attitudes, events • Behavioral View • Dissociation has been reinforced: decreases anxiety • Rigid State-dependent Learning: may struggle to remember things when not in the same emotional state ETIOLOGY OF DID: TWO COMPETING MODELS • Post-traumatic Model • DID arises from a history of severe physical or sexual abuse in childhood (often dissociative coping is involved) • Sociocognitive Model • DID is socially constructed; it results from inadvertent therapist cueing, media influences, and broader sociocultural expectations. • Iatrogenic: disorder unintentionally caused by therapist EVIDENCE CONSISTENT WITH EACH MODEL OF DID • Post-Traumatic Model – Most individuals with DID have a history of childhood physical and sexual abuse – Children who were physically or sexually abused demonstrate symptoms of dissociation • Sociocognitive Model – Most patients don’t show clear signs prior to treatment – Practitioners who use hypnosis tend to have more DID cases – Most DID cases come from small number of practitioners TREATMENTS FOR DISSOCIATIVE DISORDERS* • Psychodynamic therapy: uncover repressed memories • Hypnotic therapy: uncover forgotten memories through hypnosis • Drug therapy (Sodium Amobarbital): regain lost memories • Barbiturates sedate so can uncover anxiety-provoking thoughts • Used in combination with therapy • For DID in particular: • 1. integrate sub-personalities, 2. recover memories, 3. integrating the sub-personalities, 4. teach coping styles * most data is from case studies, not well controlled trials CONCLUSIONS • Dissociative disorders differ in their symptom presentation, but the general consensus is that these disorders stem from: • Disturbance in integration of sense of self • Reaction to extremely stressful or traumatic experiences • Due to the rarity of these disorders (2-3% estimated lifetime prevalence), not much is known about specific etiology or effective treatments. next couple slides are not on exam!!! SOMATOFORM DISORDERS • ________________________are the primary features • Factitious disorder (Munchausen syndrome/by proxy) – Patients _____________________________ physical symptoms DSM-5 Criteria Imposed on self (or others) • Deceptive _________ of physical or psychological symptoms, or deceptive __________ of injury or disease, even in the absence of __________ • Presentation of oneself as ____________________ – Common in those who receive _________________, SOMATOFORM DISORDERS • Conversion disorder: • Patients experience ______________ physical symptoms that affect their voluntary ____________ functioning DSM-5 Criteria • Presence of one or more symptoms or deficits that affect ______________ function • Symptoms are found to be inconsistent or incompatible with known _______________________ • Significant distress or impairment SOMATOFORM DISORDERS • Somatic symptom disorder: • concerned, distressed, and disrupted by _______________ SOMATOFORM DISORDERS • Illness anxiety disorder (hypochondriasis): • Health-anxious individuals become preoccupied with the notion that ________________________ DSM-5 Criteria • Preoccupation with having or acquiring a _______________ • Somatic symptoms are ____________________________________ • _______, easily triggered alarm about one’s health • Performance of excessive health-related _________ • Preoccupation with health is ____________________________ Etiology • Behavioral: – Physical symptoms ____________to sufferers • Learn to display more prominantly – People who are __________________more likely to adopt its symptoms • Cognitive: – Disorders forms of communication, provide means for people to express emotion – ___________→_____________ • Biological: Treatment • Believe problems are ____________, so often take a long time to seek psychological treatment • Focus on causes – _____________tied to physical symptoms • Psychoeducation • Exposure to features of ___________ that first triggered physical symptoms • Drug therapies: Today’s Agenda • Unipolar Depression & Bipolar Disorder – Symptoms – Classification – Epidemiology • Emotion – subjective feelings – E.g. sadness, anger, disgust • Affect – observable behavior that goes with emotion – E.g. facial expression • Mood – pervasive and sustained emotional response – E.g. depression and elation • Clinical depression is: – Pervasive pervasive across situations – Persistent persistent over time • Clinical depression is characterized by: – Absence of expected mood changes that you would expect to result in response to situational cues – Additional signs and symptoms – Subjective quality – doesn’t feel like ‘normal sadness’ • May feel like: being engulfed, being numb or nothing at all … • Mood disorders – Involve discrete periods of time dominated by depressed and or manic mood – reflected in a person’s behavior – Cause clinically significant distress, impairment and or possibility of harm Unipolar vs. Bipolar Disorders Depression _________ Depression Mania ________ • Unipolar Disorders – Major Depressive Disorder – Dysthymic Disorder – Premenstrual Dysphoric Disorder • Bipolar Disorders – Bipolar I Disorder – Bipolar II Disorder – Cyclothymia • 19% of adults will experience an episode of severe unipolar depression • Median onset: age 26 • twice in women than men – 26% of women – 12% of men • 40% will have at least one other episode • Emotional – depressed or down most of the day, nearly everyday – Anhedonia: • loss of pleasure in activities once enjoyed • anger, irritability agitation • Motivational – lack of desire to pursue usual activities • may have to force self to engage in activities • Behavioral – Decreased activity • Psychomotor retardation: move more slowly than usual – Increased time in bed • Cognitive – negative views of the self (e.g., inadequate, undesirable) – self-blame, criticism, pessimism, helplessness – difficulty concentrating, confusion • Physical – Physical symptoms: headaches, indigestion, constipation, pain – Sleep and appetite disturbances – Increased fatigue • • • 1. The presence of five or more of the following symptoms during a two-week period: • Daily – depressed for most of the day – Diminished interest in almost all activities for most of the day – Change in appetite significant weight loss or gain – Insomnia or hypersomnia – Psychomotor agitation or retardation – fatigue or loss of energy – Feelings of worthlessness or excessive guilty – Reduced ability to think or concentrate or indecisiveness – Recurrent thoughts of death/suicide , an attempt or plan 2. Significant distress or impairment 1. The presence of a major depressive episode 2. No history of manic or hypomanic episode Specifier Definition 1. Recurrent current episode preceded by previous episodes 2. Seasonal changes with the seasons 3. Catatonic either immobility or excessive activity 4. Postpartum occurs within 4 weeks of giving birth 5. Melancholic almost totally unaffected by pleasurable events • Depressed or dysphoric mood • A case of chronic unipolar depression • Can take two forms: – Experience major depressive episodes – Experience less severe and less disabling symptoms 1. Depressed mood for most of the day, for more days than not, for at least two years 2. Presence while depressed of at least two of the following 1. poor appetite or overeating 2. insomnia or hypersomnia 3. low energy or fatigue 4. low self-esteem 5. poor concentration or difficulty making decisions 6. feelings of hopelessness 3. During the two-year period, never without symptoms for >2 months 4. No history of manic or hypomanic episode 5. Significant distress or impairment 1. Premenstrual Dysphoric Disorder (PMDD) – Women experiencing clinically significant depressive symptoms in the week before menstruation Disruptive mood dysregulation disorder – Emerges during mid-childhood or adolescence – Combination of persistent symptoms and recurrent outbursts of severe temper • Reactive (exogenous) depression: – Depression following clear-cut stressful events • Endogenous depression: – Depression occurring as a response to internal factors • Not easy to differentiate – Look to both external and internal factors to explain onset of depression • Biochemical Factors – Low activity of norepinephrine (stress hormone. normal level helps, when it’s too high you get stressed, when it’s too low you can get depressed) and serotonin • Medications lowering norepinephrine and serotonin linked to depression • Medications increasing norepinephrine or serotonin relieve depression • • Genetic factors – Some people inherit a predisposition to unipolar depression • family studies • twin studies (concordance rates) • adoption studies – May be tied to genes on chromosomes (1, 4, 9, 10, 11, 12, 13, 14, 17, 18, 20, 21, 22, and X) • Abnormality of 5-HTP gene on chromosome 17 responsible for production of serotonin transporters (_____________________________________________) • Brain Anatomy and Brain circuits – Circuit involves • Prefrontal cortex – Mood, attention, immune functioning • Hippocampus: reduced size/decreased neurogenesis in depression – Regulate body’s response to stress – Aid formation and recall of emotional memories • Amygdala: increased activity in depression – expression of negative emotions and memories • Brodmann Area 25: smaller and more active in depression – Inhibition, decision making – Circuit filled with serotonin transporters • Psychodynamic view – Experience real or imagined loss • Unable to accept the loss, regress to earlier developmental stage • Introjection: direct feelings about the loss (e.g.,sadness, anger) toward themselves – Some support that losses may set the stage for later depression – BUT view not strongly supported by research • Only 10% of people experiencing major losses become depressed • Peter Lewinsohn • Cognitive View – Individuals with depression consistently view life negatively – Perceptions lead to disorder • Two main explanations – Beck’s: theory of negative thinking – Seligman’s: theory of learned helplessness Beck’s Theory of Negative Thinking • Negative thoughts influence how we feel and act • Depression characterized by the cognitive triad: – negative thinking about the self, the world and the future Aaron Beck • Depression also characterized by errors in thinking. – E.g., draw negative conclusions based on little evidence Beck’s Theory of Negative Thinking • Automatic Thoughts: negative thoughts that occur automatically in response to a situation – Maintain depression • Schemas/maladaptive attitudes: enduring, organized representations of prior experience that guide the way people perceive and interpret environmental events Beck’s Theory of Negative Thinking Formation of: dysfunctional schemas Father leaves family “He left because he “I am unlovable” when client was a childdoes not love me” Beck’s Theory of Negative Thinking “I am unlovable” “He left because he Significant other didn’t love me, breaks up with client nobody could love me” Depressed Both covert (self-talk) and overt (to others) Beck’s Theory of Negative Thinking • – – – • Seligman’s Learned Helplessness • Seligman’s Learned helplessness – People become depressed when: • No control over reward/punishment in life • Feel responsible for feeling helpless Marty Seligman Seligman’s Learned Helplessness 1. – – Seligman’s Learned Helplessness • Dogs learned that they had no control over unpleasant events in their lives when they received inescapable shocks – Learned they were helpless to do anything to change the situation • When later placed in a new situation they could control, they were generally helpless -resembles depression • The effects of learned helplessness resemble ___________ Learned Helplessness Revised: Attribution-Helplessness Theory • When people believe events are beyond their control, they ask themselves “why?” • Following a negative life event, the probability that the person will become depressed depends on the explanations and importance ascribed to events___ • Causal Attributions – internal vs external – global vs specific – stable vs unstable Attribution-Helplessness Theory Example Example Event: You fail your Abnormal Psychology exam. • External vs. Internal • “The test was difficult” vs “I’m stupid” • Specific vs. Global • “i mess this one up” vs “im a failure “ • Unstable vs. Stable • “ • internal, global, stable • – • – • – • – • – • • • • – – – – – – – – • • – • • – • • • • • • • – – – • • • • • • • – • – • – • – – – • – – • • • – – – • • • – • Symptom Pattern of Bipolar II • • – – • – – • • – – → – → • – • • • – • – • • • – – Treatments of Mood Disorders Treatments of Depression • Biological Treatment • Psychodynamic Treatment • Behavioral Treatment • Cognitive Treatment • Sociocultural Treatment Biological Treatments • Antidepressant Medications : – Monoamine Oxidase Inhibitors (MAOIs) • Monoamine Oxidase: breaks down neurotransmitters in the synapse • MAO Inhibitors: block destruction of neurotransmitters, leads to rise in activity (goal: increase serotonin in synapse for depression) – Side effects • Possible dangerous rise in blood pressure if eat foods containing tyramine like cheeses, bananas, and certain wines Biological Treatments • Antidepressant Medications: – Tricyclic Antidepressants (Tricyclics)— 3 ring structure • Reduce depression by blocking reuptake of neurotransmitters • Effective in 60-65% of patients • Chance or relapse decreases with continuation with continuation of therapy Biological Treatments • Second-generation antidepressants: – Selective Serotonin Reuptake Inhibitors (SSRIs) • Increase serotonin levels without affecting other neurotransmitters • Prozac, Zoloft, Lexapro – Selective Norepinephrine Reuptake Inhibitors (SNRIs) • Increase norepinephrine levels without affecting other neurotransmitters – Strattera – Serotonin-Norepinephrine Reuptake Inhibitors • Increase both serotonin and norepinephrine levels – effexor Biological Treatments • Antidepressant Medications: – Second-generation antidepressants • Efficacy similar to tricyclics • Preferred over others because harder to overdose – Side effects: • weight gain • reduced libido Biological Treatments • Electroconvulsive Therapy (ECT) – 6-12 treatments over 2-4 weeks – Given muscle relaxants and anesthesia to reduce side effects – Two electrodes placed on the head and 64-140 volts of electricity passed through the brain – 60-80% of patients improve – Effective with severe depression • Side Effects: – Memory Loss of events immediately before the procedure, which may be permanent Biological Treatments • Brain stimulation – Transcranial magnetic stimulation (TMS) • Electromagnetic coil placed on or above the head • The coal sends a current into the prefrontal cortex – Increases activity in the PFC • See reductions in depression when administered daily for 2-4 weeks • Helpful for recurrent/treatment resistant depression Biological Treatments • Brain stimulation – Vagus Nerve Stimulation • 2 vagus nerves: primary channel of communication between the major organs • Pulse generator implanted under the skin of the chest connected to the vagus nerve • Stimulated every 5 minutes for 30 seconds • Approved for recurrent/treatment depression • As many as 40% see improvements Biological Treatments • Brain stimulation – Deep brain stimulation • Electrodes implanted in Brodmann Area 25 • Electrodes connected to a pacemaker sending a steady stream of low-voltage electricity to the area • Goal: to calibrate and regulate the depression circuit • Study of 6 patients: – quality of life. in mood, short term memory and – http://www.cbsnews.com/video/watch/? id=2054120n&tag=contentBody;storyMediaBox Psychodynamic Therapy • Depression results from unconscious grief over real or imaged loss on others • Goal: bring awareness to losses to consciousness, become less dependent on others, and cope more effectively • free association • Interpret patient’s dreams displays of resistance • Help the person interpret events and feelings Behavioral Treatment • Behavioral therapy – Reintroduce patients to patients to pleasurable events – Appropriately reinforce non depressive behaviors – Improve social skills Behavioral Treatment • Behavioral Activation (BA) – Select activities that the client considers pleasurable – Encourage the person to set up a weekly schedule for the activities Behavioral Treatment • BA increases rewards • Negative behaviors keep others at a distance, reducing the chances for rewarding experiences • Goal of BA: Monitor negative behaviors and try new, more positive ones • Contingency management: • Ignore a client’s depressive behaviors while praising or rewarding constructive statements/behaviors Activity Log Cognitive Treatments Beck’s Cognitive Therapy • maladaptive lead people to view themselves, their world and their future negatively • biased views combine with illogical thinkingon Beck to produce automatic thoughts Cognitive Treatments • Primary Aim: attend to and correct distorted thinking • Also includes behavioral techniques • 4 phases 1) Increasing activities and elevating mood 2) Identifying negative thinking and biases 3) Challenging automatic thoughts 4) Changing primary attitudes Cognitive Treatments 1. Increasing activities and elevating mood • Encourage individuals to become more active and confident • Use behavioral techniques • activity scheduling • Reinforcement Cognitive Treatments 2. Identifying negative thinking and biases • Show how illogical thinking processes contribute to the thoughts • Guide patients to recognize that interpretations of events are negatively bias • Goal: change the style of interpretation Cognitive Treatments 3. Challenging Automatic Thoughts • Educate about negative automatic thoughts • Recognize and record automatic thoughts as they occur • Test the validity of the thoughts • Often conclude that the thoughts are not realistic Cognitive Treatments 4. Changing Primary Attitudes • Change the maladaptive attitudes that set the stage for the depression in the first place (schemas) • Test the attitudes via behavioral experiments • 50-60% of individuals show near total elimination of symptoms Sociocultural Perspective: Interpersonal Psychotherapy • Focused on problems in current relationships • Four interpersonal problem areas may lead to depression and must be addressed: 1. Interpersonal loss: grief over lost of a loved one • explore the relationship and express emotions, develop new ways to remember the person 2. Role dispute: two people have different expectations of their relationship • examine and try to solve them Sociocultural Perspective: Interpersonal Psychotherapy 3. Role transition: brought on by major life changes like divorce or the birth of a child • Help develop social supports, foster skills the new roles require 4. Interpersonal deficits: unable to have intimate relationships • Help recognize deficits and teach social skills to improve social effectiveness Treatments for Bipolar Disorder Biological Treatments • Pharmacotherapy – Lithium carbonate ←know this name for bipolar • Need to find correct dosage: – Mood stabilizing drugs • E.g., Tegretol, Depakene (antiseizure drugs) – Effective for treating manic episodes • >60% of patients with mania see improvements and have fewer new episodes • Less powerful impact on depressive symptoms—may augment with antidepressant medications • manic episodes can be under control with bipolar medicine but you can still get depressed so antidepressants can be prescribed if discussed with doctor Psychological Considerations ● Negative life events increase time to recovery (not due to medication non-compliance). ● Life events involving goal attainment or disruption increase manic symptoms. ● social support exerts a stronger influence on symptoms of depression than symptoms of mania. Psychological Treatments • Psychotherapy alone is rarely helpful for bipolar disorder • BUT mood stabilizing drugs alone are not always sufficient – 30% or more may not respond to lithium or other drug, may relapse, may not receive the correct dosage – Patients may stop taking drugs because of side effects Psychological Treatments • Family-Focused Therapy – Identify conflicts within the family that may contribute to patient/family stress – Help the family find ways to resolve the conflicts – Reduce “expressed emotion” – Critical, hostile, or over-involved attitudes and behaviors towards individual with disorder – Improve Psychological Treatment • Interpersonal Social Rhythm Therapy – Based on the recognition that a repeated episode of either mania or depression is often precipitated by: • stressful life events • disruptions in social rhythms • failure to take medications – Regulate sleep-wake cycles – Resolve interpersonal problems effectively Conclusions • medications are an effective treatment for bipolar disorders • psychotherpay may be useful as an adjunct treatment to medication Effectiveness of Treatments Post-treatment HRSD Scores for Severely Depressed Patients (Intake HRSD > 20) DeRubeis (From DeRubeis et al., 1999, Am J of Psychiatry) Sustained Improvement for All Assigned to Treatment Mindfulness-Based Cognitive Therapy (MBCT) • Teasdale et al. (2001) study – Used MBCT for continuation therapy for recovered patients • Train patients to disengage from depresogenic thinking – Randomized to continue treatment as usual or treatment + MBCT • MBCT reduced risk for relapse in patients with 3 or more previous episodes of depression ( depression) Behavioral Activation • behavioral therapy have shown lessstrictly improvement than those who receive cognitive, cognitive-behavioral, interpersonal or biological therapy • BUT behavioral activation still better than a placebo • Better for individuals with mild/moderate depression in comparison to severe Conclusions -Cognitive therapy (CT) is effective as ADM even more for severely depressed out patients -CT has enduring effect (comparable to keeping patients on medications) -MBCT and BA appear to be promising treatments -Benefits of combination treatment
Are you sure you want to buy this material for
You're already Subscribed!
Looks like you've already subscribed to StudySoup, you won't need to purchase another subscription to get this material. To access this material simply click 'View Full Document'