Abnormal Psych and Psychotherapy Notes
Abnormal Psych and Psychotherapy Notes PSY 110
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Date Created: 12/07/15
ABNORMAL PSYCHOLOGY I. Approaches to Understanding Abnormal Behavior A. Statistical Approach B. Sociological Approach C. Psychoanalytical Approach D. Behavioral Approach E. Cognitive Approach F. Biological Approach **G. Interactionist Approach II. Diagnosing Psychological Disorders DSM-II (Neurotic and Psychotic) DSM-5 III. Some of the Main Categories A. Anxiety Disorders B. Neurodevelopmental Disorders C. Obsessive-Compulsive & Related Disorders D. Trauma and Stress Related Disorders E. Somatic Symptom & Related Disorders F. Feeding and Eating Disorders G. Dissociative Disorders H. Paraphilic Disorders (Psychosexual) I. Personality Disorders J. Mood Disorders in the DSM-IV K. Schizophrenia Spectrum Disorders L. Substance-Related & Addictive Disorders A. Anxiety Disorders 1. Generalized Anxiety Disorder 2. Panic Disorder 3. Specific Phobia 4. Separation Anxiety 5. Social Anxiety (Social Phobia) 6. Agoraphobia B. Neurodevelopmental Disorders 1. Intellectual Disability (Retarded) 2. Autism 3. Attention-Deficit/Hyperactivity Disorder 4. Specific Learning Disorders C. Obsessive-Compulsive and Related Disorders 1. Obsessive-Compulsive Disorder 2. Hoarding Disorder D. Trauma and Stress-related Disorders 1. Posttraumatic Stress Disorder (PTSD) Shell Shock Battle Fatigue E. Somatic Symptom & Related Disorders (Not Psychosomatic) 1. Conversion Disorder (formerly Hysteria) a. Glove anesthesia b. Hysterical deafness c. Hysterical blindness F. Feeding and Eating Disorders - Anorexia - Bulimia G. Dissociative Disorders 1. Dissociative Amnesia with Dissociative Fugue 2. Dissociative Identity Disorder (was Multiple Personality Disorder) The Corruption of Reality: A unified Theory of Religion, Hypnosis and Psychopathology: book by Schumaker (1995) World is a dangerous place Theory of religion helps us cope with reality Need a mechanism (such as religion) to dissociate from reality o i.e God’s plan (helps us cope with death) Psychopathology- all mental illnesses have a mental dissociates from reality H. Paraphilic Disorders Paraphilia- non normal love - Fetishism (Fetishistic Disorder)- sexual attraction to objects or body parts - Transvestite (Transvestic Disorder)- enjoy dressing as opposite sex - Exhibitionism (Exibitionistic Disorder)- enjoys showing off sexually - Voyeurism (Voyeuristic Disorder)- enjoys watching others in a sexual context - Sexual Sadism Disorder- gets pleasure from hurting or humiliating others - Sexual Masochism Disorder- gets pleasure from being hurt of humiliated - Pedophilia (Pedophlic Disorder)- addicted to having sex with minors (children) Under Sexual Dysfunctions - Gender Dysphoria also called Gender Identity Disorder (or Transexuality)- people who want to have a sex change I. Personality Disorders: personality is corrupted 1) Odd or eccentric - Paranoid Personality Disorder= pervasive suspiciousness/distrust of others (cold, aloof) - Schizoid Personality Disorder= loaners, hermits, want to be left alone - Schizotypal Personality Disorder= people who manifest oddities of thought, perception, speech and behavior including magical thinking 2) Dramatic or Emotional - Histrionic Personality Disorder= overly dramatic, flamboyant, given to exaggeration (Robin Williams); more common among women than men; often associated with homosexuals (Cam from Modern Family) - Narcissistic Personality Disorder= grandiose sense of self-importance (Donald Trump) - *Antisocial (formerly sociopath, psychopath, or morally insane)= chronic antisocial behavior, which violated the rights of others; con-men; don’t have normal moral codes (Ted Bundy); don’t care about others* - Borderline Personality Disorder= instability in behavior, mood and self-image; start out intensely burn out quickly; rapid switching 3) Anxious or Fearful - Avoidant Personality Disorder= want close intimate relationships but repeatedly withdraw from relationships to avoid rejection, shame, or humiliation (set impossible standards); not to be confused with the Schizoid - Dependent Personality Disorder= overly dependent on other people - Obsessive/Compulsive Personality Disorder (OCPD)= excessively preoccupied with order, rules, details, and trivial; may be good for studying, editing, book keeping, or housekeeping (jobs), but may interfere with relationships. J. Mood Disorders in DSM-V: Now 2 separate categories: 1. Bipolar and Related Disorders (Formerly called Manic-Depression) - Most recent episode Manic- believe they can do anything (go to Europe impregnate a woman in every country) - Most recent episode Depressed - Lithium(carbonate) o Long periods of depression o Depression more common from lack of religious beliefs; and distance on family relationships 2. Depressive Disorder - Major Depressive Disorder- (common cold) - Prozac 3. (Seasonal Affective Disorder)- depression in a season o People eat more in the winter; stock up- shortest time with daylight o Remedy= going away for a little K. Schizophrenia Spectrum and other Psychotic Disorders 1. Schizotypal (Personality) Disorder- magical, oddities, speak in tongues, weird 2. Schizophrenia- suffering from separations with reality Not SPLIT PERSONALITY Common features: - Hallucinations- problems with perceptions; visual; auditory; tactile Delusions of: - Grandeur- think they’re more important than they are - Persecution- - Reference- think random things are meaningful meant for them (signs) - Control- where you think other people are controlling your thoughts (brain) Four types in DSM-IV 1. Catatonic: someone who becomes somewhat unconscious, unaware of what’s going on around them - Waxy Flexible= can take shape of chair; take care of them (sit them down) - Rigid= can’t take shape; won’t sit - only dangerous to themselves 2. Paranoid - most not but can be dangerous to others (esp. when not taking medication) if they think someone is out to get them etc. 3. Disorganized - have trouble coping with what they’re doing; often homeless (shopping carts) hoard things - trouble speaking (word salad= have sentence in head, get all the words, put them in random order) 4. Undifferentiated - have symptoms that aren’t one or the other L. Substance-Related and Addictive Disorders (Includes many classes of drugs and also gambling, but not sex, pornography or internet addiction) 1) Warning signs according to AA: - Daily use- if it effects relationships (disruptive) - Using to cope- if you NEED it; different than just using it - Using when alone or secret use- lying about it - Impaired Social or Occupational Functioning- interfering with life (friends, school, etc.) - Black-outs- can deny - Physical Dependence including- - Fear of withdrawal- may have tried to stop; caffeine headache 2) Genetic component: It may involve the ability to get pleasure from ordinary events (like a sunset.) –something clicked and they never felt same after; heavy weights dangerous 3) Is the Problem the Drug or the Person?- lots people blame the drug (treat the person) 4) AA and the 12 step programs Psychotherapy Any method of working with an individual to improve their psychological functioning Techniques: talking therapies (Freud); listening; suggesting; role playing; medications; journal writing I. Psychoanalytic Therapy (Freud)- some sexual development- early childhood experiences/trauma - therapist centered= therapist figures out problem and fixes it over time A. A Hydraulic Model B. Focus on the Unconscious mind & early experience C. Highly directive. Extensive interpretation D. Unresolved conflicts F. Free Association & Dream Analysis G. Important concepts: Transference- relating to the therapist in a way that reproduces an important past relationship (ex. Woman without husband, see therapist and man she never found; etc.)- no therapy will occur unless you can project those needs on the therapist (necessary for therapy) Resistance – any effort on the part of the patient to prevent the therapist from uncovering the true source of the problem; (ex. of resisting therapy= quitting therapy, bottling up, anger, forgetting) Catharsis- sudden release of pressure caused by reliving a traumatic experience; crying screaming emotional outbursts; emotional release; breakthrough II. Humanistic Therapies Encourage self examination & growth. Focus on conscious thought & present & future A. Client-Centered Therapy (Carl Rogers) -Didn’t think they knew you more than you know you o Unconditional Positive Regard= if everyone was raised with this no negativity everyone would reach full potential; but therapists provide this (more genuine) o Real-Self vs. Ideal-Self= describe characteristics of where you are right now (should have goals; but reachable otherwise delusional) o Non-directive= wont tell you what to do; guide you to figure out own answers o Necessary conditions: Empathy, Acceptance, & Genuineness o Active listening= reflect, don’t probe, don’t add own ideas (ex. “what do you think I should do?” “So you think I should tell you what to do?”) B. Gestalt Therapy (Fritz Perls) More directive and confrontational but still places responsibility for change on client o Try to challenge client, sometimes need an emotional slap in the face, wake you up a little C. Transactional Analysis (I’m OK You’re OK, by Thomas Harris, M.D., 1967) - Two good people even on important issues and still be good people (don’t always have to agree) - Looking at people’s interactions - Everyone has an inner: Child: spoiled, self-centered, whining, brat that’s in all of us: need to suppress it Parent: little tape recorded messages, every little saying you’ve heard (say to yourself I would never say that to my kid) years later you might say it to your kid Adult: strive for; talking to another adult (even child) on an adult level III. Behavioral Therapies (Behavior Modification)- (learning theory to improve function) A. Classical Conditioning 1. Systematic Desensitization= associating fear stimulus with relaxation - Virtual Reality Therapy (exposing to recreated 3D traumatic event) - Exposure Therapy - Behavior Therapy 2. Aversive Conditioning= associating addictive substance with negative thoughts B. Operant Conditioning 1. Token Economy= setting up rewards and punishments for specific behaviors 2. Extinction and Punishment 3. Time out C. Modeling (Cognitive Behavior Therapy) Social Learning and Albert Bandura - Bo Bo dolls study= vicarious rewards and punishments; had to think about what the kids thought why they did or didn’t beat up the doll after different examples of what was good or bad behavior Encourage constructive “Self-Talk” Self-Efficacy Donald Meichenbaum: Distinguished Visiting Professor, U.M. School of Education. Nov 6, 2006 IV. Cognitive Therapies Thoughts are main source of abnormal behavior. A. Rational-Emotive Therapy (Albert Ellis) - Irrational and Self-Defeating Beliefs. (doesn’t follow everything I say so doesn’t love me) B. Cognitive Therapy (Aaron Beck) - Identify distorted “self-labels” (I’m no good) - famous depression researcher (BDI) - teach you to replace it with more rational thoughts (not easy) V. Biomedical Therapies A. Anti-Anxiety Drugs: Anxiolytics (Librium, Miltown, Valium, Xanax) B. Anti Psychotic Drugs: (Thorazine= Chlorpromazine in 1950’s and 60’s) (also Haldol) C. Antidepressant Drugs: (Prozac, Zoloft, Paxil all SSRI’s) (also Elavil, Effexor, Wellbutrin, Celexa & Lithium Carbonate) D. Electro Convulsive Treatment (ECT): For severe depression -Side effect: memory loss (memory hole) - need several treatments; not one time and then fixed E. Psychosurgery: any brain surgery to improve psychological functioning (removing tumor) (split brain surgery) (frontal lobotomy- originally used to treat aggression- before thorazine available) VI. Group Therapies- method of delivering therapy -Less expensive -Sometimes more effective - Good Ideas - Good role models - Less pressure - You’re not alone -What works for others? -But seek qualified leaders VII. Miscellaneous points 1.Deinstitutionalization= letting them out of an institution, lie of deinstitutionalization- did this to mental hospitals (suspended services, closed them all down) not a lot of options when people stop taking meds and go to jail (more mental places in jails than mental hospitals) 2. Which approach is beststall approaches can get good results with a good therapist, therapist is 1 approach is secondary 3. False memory Syndrome= people recovering memories in therapy that never actually happened
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