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Chapter 15: Abnormal Behavior and Therapy: Defining Abnormality What is a mental disorder?

A variety of cognitive, emotional, and behavioral symptoms that: o Deviate from the norm (uncommon, abnormal) Culturally-determined ORthe APAs definition: o Creates significant distress o Impairs functioning (disability) o Or leads to significant risk of harm (danger) What is considered abnormal? It is hard to draw the line b/t normal and abnormal o Based on cultural practices (which change with time) o Based on what is determined by various health care organizations Are these behaviors abnormal? Scenario 1: Imagine you see a man raising his hands to the sky, shaking his fists, and shouting. He claims that beings from outer space speak to him and that he can to them. o Occurs in churches everyday Scenario 2: A person you know begins crying excessively, withdraws socially, and is not acting like him/herself at all. For two weeks, this person does not leave the house except to go to work and stops talking to friends. o Could be a reaction to death of a loved one Scenario 3: Imagine you see a person in the grocery store. In the middle of the aisle, this person drops his pants, takes off his shirt, and begins running around laughing hysterically. o You wouldnt bat an eye if it was a 3 year old boy Its All about Context

Individuals with mental disorders are different from others in degree, not in kind What causes mental disorders? Demonic model: evil spirits in the body Medical model: mental illness is a physical disorder requiring medical treatment o Insane asylums, surgeries, drugs Diathesis-stress model o Must have both a biological predisposition to develop a certain disorder (diathesis) and significant environmental stressors Biopsychosocial Model Abnormal Behavior has 3 major aspects: o Biological (genes, anatomy, neurotransmitters) o Psychological (learning history, stress) o Social (cultural context, society) DSM-IV (Diagnostic and Statistical Manual of Mental Disorders 4 ed.) Axis I: Disorders Axis II: Personality Disorders and MR(mental retardation) Axis III: Medical Conditions Axis IV: Psychosocial/environmental stressors
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Axis V: Level of functioning within the past year o GAF: (0-100) DSM-IV Designates lists of observable symptoms needed to warrant a particular disorder o How to differentiate between disorders o Prevalence, course, onset Adopts a categorical (present/absent) model Does not explain causes of disorder Criticized for classifying so many human behaviors as disordered Comorbidity Presence of more than one psychological disorder Why does this occur? o Criteria for various disorders overlap? o Having one disorder increases vulnerability for another? o Common diathesis for different disorders? o Common stressors for different disorders? Overview of Psychotherapy An American History of Psychological Treatment 1700s o

Prior to construction of mental hospitals in America, patients were often: Taken care of by family Placed in jail Placed in a poorhouse Separated from society in some other way Or left to wander the streets

The First Hospital: Williamsburg VA (1773 Mission: provide short term care to court referrd patients Diagnosis were poor o Mania: violent, restless behavior (get rest of this point from Brit) Terrible Treatments Drugs to sedate patients Water baths Bleeding instruments o To drain the body of harmful fluids, reduce inflammation, and focus attention Restraining devices o Shackles (1700s), straightjackets (early 1800s), and confining chairs Electricity machines to shock patients Patients were to be afraid of their doctors to change their ways Moral management Early to mid-1800s, mental health reform was initiated o Began in France in 1792 when patients were unshackled at the hospitals Focus was being kind to patients and improving living conditions to facilitate change

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Patients left their rooms more, but many were still isolated Some worked in a garden or on farms Games and other equipment were purchased for patients

The Shift to Custodial Care Understanding of psychopathology improved little Asylums began to view their role as custodians of people who could not be cured o Search for a cure was not the primary goal o Williamsburg Hospital housed over 400 people before it burned down in 1885 Humane practices were preached, but not always practiced o Newer restraining devices were developed Other Developments Phrenology o Brain shape= personality Lobotomies defective nerves would reform as nor) o Dr. Walter Freemans lobotomobile o 50,000 people in total Today, treatments have improved considerably o They are more humane and based on scientific research Modern Psychological Treatments Two Major Groups: Insight-oriented Therapies (psychodynamic and client-centered) o Psychological problems are caused by emotional forces o Gaining insight into the forces is necessary Cognitive and Behavioral Therapies o Psychological problems are caused by maladaptive thinking or behavior patterns Insight-Oriented Therapies Sigmund Freud Psychodynamic and Psychoanalytic (longer) o Problems arise b/c of unconscious conflicts o Goal: achieve insight into unconscious motivations o Techniques: Free association, dream analysis, interpretation, identifying defense mechanisms and resistance, analyzing transference Person-Centered Therapy Problems arise b/c of incongruence b/t real self and ideal self Goal: decrease this incongruence Techniques: Unconditional positive regard (nonjudgmental acceptance), genuineness, empathy and warmth, reflective listening o Most imp. For therapist to provide a warm and open environment for patient Action-Oriented Approaches Behavior Therapy Joseph Wolpe, B.F. Skinner

Problems caused by maladaptive behavior patterns Goal: change behaviors by learning new ones (changing behaviors changes thoughts and feelings) Techniques: Exposure therapies (systematic desensitization, flooding, virtual reality exposure), relaxation, skills training, modeling (assertiveness training, social skills training, role plays), token economics, homework Cognitive Therapy Albert Ellis, Aaron Beck Problems are a function of maladaptive thinking patterns Goal: replace maladaptive thoughts with more rational ones (changing thoughts changes behaviors and feelings) Techniques: identify cognitive distortions, cognitive restructuring (changing maladaptive thoughts) thought records CBT CBT= Cognitive behavioral therapy o Many psychologists use both cognitive and behavioral approaches in treating patients o CBT is the most widely researched and supported treatment for most psychological disorders o Better than or equal to medication for many disorders The Dodo Bird Verdict Some argue that all psychotherapies are equally effective o Because they share 4 common features o And not because of specific techniques This is heavily debated o Common Features of Psychotherapy 4 features shared by all forms of psychotherapy: Relationship Locale is place of healing Therapeutic rationale Task or procedure prescribed by the theory o Therapist are NOT Paid Friends Therapists are highly trained professionals who treat disorders Treatment is confidential; relationship is one-way Much more than just talking Strong evidence backs its effectiveness Patients in therapy do better than 75% of those NOT in therapy Empirically Supported Treatments ESTs are treatments for specific disorders that are backed by high quality scientific evidence o The same way new medications are tested Most are cognitive behavioral therapies o Equal to or better than medication Without side effects! With longer maintenance of gains! o Www.apa.org/divisions/div12/cppi.html Some therapies dont work or are harmful o DARE, Scared Straight, CISD Be skeptical of extraordinary claims and treatments not backed by research evidence Psychological Disorders and their Treatment Anxiety Disorders

Most common class of disorders (29%) Most anxiety disorders involve: o Fear of an object, situation, or event o Avoidance of the feared stimulus Some anxiety disorders include panic attacks Almost twice as common in women Often have early age of onset (11 years) Origins of Anxiety Disorders Classical conditioning o Environmental cues become CSs for fear Claustrophobia: elevator(CS) then trapped(US)= fear(UR) Eventually we have fear just to the CS (elevator) Observational learning o Modeling(monkeys to snakes)-if a lab monkey who is unafraid of snakes watches a wild monkey that is afraid, he will slowly develop this fear himself Information transfer Preparedness o We are prepared to learn some fears easily The Role of Avoidance Avoidance is the whole problem!!! Avoidance behavior is negatively reinforcing o Reduces exposure to aversive CSs o But prevents you from new learning That the object is in fact not dangerous You can only get over your fear if you stop your avoidance Social Phobia The most common anxiety disorder o 13% lifetime prevalence Fear of social or performance situations o Afraid of being judged negatively by others o Afraid of doing something embarrassing Public speaking, public restrooms Panic Disorder History of recurrent, unexpected panic attacks o Worry about having more attacks o Worry about the consequences/implications of the attacks o Significant change in behavior as a result Agoraphobia o Fear of situations where escape may be difficult if an attack occurs o These feared situations are usually avoided GAD Excessive anxiety and worry about a number of events for at least 6 months Person finds it hard to control worry Three of six symptoms:

o o o o o o OCD

Restlessness Difficulty concentrating Muscle Tension Sleep Disturbance (hard to fall or stay asleep) Easily fatigued Irritability

Obsessions: recurrent thoughts/images that are difficult to control o Examples: contamination, symmetry, safety, harming another Compulsions: repetitive behaviors/mental acts that are performed to control the obsessions o Examples: washing, counting, checking, ordering, praying, repeating words silently Thought-action fusion Other Anxiety Disorders Specific Phobias o Fear of a specific object or situation o Rarely seek treatment b/c doesnt interfere with functioning much--- they simply avoid what they fear PTSD o Develops in response to experiencing traumatic event o One or more of these: re-experience the event, avoid trauma reminders, emotional numbing, increased arousal Cognitive-Behavioral Therapy for Anxiety Disorders CBT for Anxiety Disorders CBT for anxiety disorders is focused on: o Changing behavior (typically through exposure to feared objects, places, sensations) o Modifying maladaptive thinking patterns (that maintain or exacerbate anxiety) Collaboration between patient and therapist Out-of-session homework practice Cognitive Techniques Focused on identifying, challenging, and developing more rational thinking pattern Danger and vulnerability are key themes Three primary targets are: o More accurate estimations of probabilities How likely is the feared event to occur? o More objective understanding of how bad or dangerous the feared situation would actually be o More accurate appraisals of ability to cope Panic Disorder Muscular relaxation Abdominal breathing retraining (to reduce hyperventilation symptoms) Interoceptive exposure to feared sensations In vivo exposure to avoided situations Modifying thoughts about how dangerous panic symptoms actually are GAD Muscular relaxation

Imaginal exposure to feared outcomes that are worried about Scheduling discrete periods to worry Modifying thoughts about ones control over worry topics, ability to cope, and likelihood of feared outcomes OCD Prolonged, in-session exposure to obsessions Prevention of compulsions Collaboration of spouse/friend to monitor at-home practice o Cognitive techniques used less frequently PTSD Prolonged exposure to thoughts/memories related to the traumatic event (often retelling the story or writing about it) Modifying thoughts about the meaning of the trauma, negative self-assumptions, ability to cope Stress management/coping skills Phobias Prolonged, in-session in vivo exposure to feared objects/situations o Until fear significantly declines o Repeated over several sessions Group therapy with social phobia o Sometimes social skills training ******Get Notes for Tuesday, Nove. 13 or 14 Medication Treatments Antidepressant medications o Tricyclics(imipramine, amitriptyline) o SSRIs (Prozac, Zoloft, Lexapro, Celexa, paxil) o Atypical antidepressants: SNRIs (Effexor, Cymbalta, Pristiq) Slightly fewer side effects than SSRIs Wellbutrin (NE and dopamine agonist Rarely causes sexual problems or weight gain Schizophrenia o Schizophrenia is a psychotic disorder o Psychotic disorders typically include: Delusions or hallucinations(respond best to meds) Loss of touch with reality Disorganized speech and behavior Inappropriate emotions o Misconceptions about violence, multiple personalities o Basics Lifetime prevalence: .5%-1% Typical onset: mid to late 20s Later onsets have better outcomes Risk increases 10-fold if you have a first-degree relative with schizophrenia Course: Chronic May be stable over time or worsen Complete remission is very rare o Symptoms TWO or more of the following:

Delusions( strongly held false beliefs) Hallucinatins (false sensory experiences) Disorganized speech Disorganized or catatonic behavior (inappropriate affect, anger, problems with ADLs Negative symptoms (absence of normal behaviors eg, social withdrawal, limited speech, flat affect) Social/Work dysfunction Duration of at least 6 months Positive vs. negative symptoms o Positive symptoms: presence of unusual behaviors Delusions and hallucinations Respond best to medication o Negative symptoms: absence of normal behaviors Flat affect Alogia (poverty of speechbrief and slow responses) Avolition( inability to engage I goal-directed activities) Anhedonialoss of interest or pleasure Social withdrawal Delusions o Persecutory (most common) Person believes he is being spied on, followed, or tormented o Control Thoughts are being controlled, inserted, or removed by outside force (like aliens) o Grandeur Belief you are unsusually important o Reference Interpreting random messages as if they were meant for you specifically Hallucinations o Typically auditory (but may be other types) Experienced as voices that are distinct from the persons own thoughts Most commonly are threatening or pejorative Does not include auditory hallucinations that occur prior to falling asleep or upon awakening, or those that are a part of certain religious cultures Subtypes of Schizophrenia o Paranoid Prominent delusions/hallucinations Relatively intact cognitive functioning and affect Best prognosis o Disorganized Disorganized speech, behavior, and flat/inappropriate affect Unusually self-absorbed (may look in mirror lots) o Catatonic Psychomotor disturbance (immobility, odd postures, Resistance to being moved) o Undifferentiated Treatment o Psychotherapy can help manage stress for the patient and families o But antipsychotic medications are best Traditional antipsychotics (Haldol, Thorazine) Reduce dopamine activity Produce motor side effects (tardive dyskinesia)

Newer atypical antipsychotics (clozapine, Risperdal, zyprexa) Better than the older ones at treating negative symptoms Do not produce tardive dyskinesia

Final only covers what we have been over since Exam 3. Does not cover material from Exams 1 and 2. Social Psychology: Influencing Other People and How they Influence Us Social Perception and Cognition o Stereotypes and Prejudice Stereotype: Belief about a particular group of people Prejudice: Negative attitude toward a group of people Often results in discrimination (unfair treatment) o No one admits their prejudices anymore! But almost all of us have them! We dont ask people directly about prejudice We study them in sneaky ways o Implicit Association Test Reaction time test Measures reactions to combinations of categories Faster reaction times to pairings that conform to our prejudices, even subconsciously! Even when we deny being prejudiced Findings Whites respond faster to White/pleasant and black/unpleasant than vice versa African Americans do not show these same prejudices Women prefer women over men; men prefer both equally Whats the Point?!?! That kind, well-meaning people have prejudices Even if we arent aware of them o https://implicit.harvard.edu/implicit/demo/ o Overcoming Prejudice Cooperation instead of competition Requires in-depth, repeated contact with the group you are prejudiced against As roommates Members of the same sports team Working toward a common goal (Robbers Cave study) Attributions Internal: characteristics, personality, likes External: environment, situation We make internal attributions when a persons behavior surprises us o But were often WRONG Behavior determined by culture, context Fundamental Attribution error Remember this? Tendency to underestimate external causes of another persons behavior o We make internal attributions o Particularly true of Americans Actor-Observer Effect We make internal attributions for the behavior of others (actor) and external attributions for our own behavior (observer) Why do we do this?

o Interpersonal Influence Social Facilitation Social Facilitation: o Mere presence of others can increase our performance (eg, if in a group, if being watched) On difficult tasks our performance suffers Social comparison We evaluate our beliefs and behaviors by comparing them to others o If unsure of how to act, we act like others do Mass Hysteria and Urban Legends o False stories that people believe b/c they are repeated so many times and play on our negative emotions Pool urine detectors, HIV needles at movie theatres, Pop rocks, and soda Giving in to others: Conformity Conformity: changing your beliefs or behavior in order to follow group norms o Aschs study We are most likely to conform when: o All other group members are unanimous o There are several people in the group We are less likely to conform when someone else in the group doesnt Compliance: changing your behavior b/c someone asks you to Could you please stand up? Obedience: changing your behavior b/c someone told you to I was just following orders Nuremberg trials, Abu Ghraib Milgrams shock study 65% of people will shock someone to a lethal level when told to do so by an authority figure Most likely to obey when an authority figure is present, when the authority figure is very close by, and when we feel less responsibility Its all about the situation!

Because we dont know the situations of others See only the behavior, not the cause Because it is self-serving

Giving in to Others: Obedience Obedience: changing your behavior b/c someone told you to I was just following orders o Nuremberg trials, Abu Ghraib o Milgrams shock study 65% of people will shock someone to a lethal level when told to do so by an authority figure most likely to obey when an authority figure is present, when the authority figure is very close by, and when we feel less responsibility its all about the situation Diffusion of Responsibility we are less likely to help someone when other people are around (bystander nonintervention) o Because we feel less responsibility o Murder of Kitty Genovese in 1964, accidents even seminary students will pass up a person in distress if they are on their way to give a lecture on the Good Samaritan o We are most likely to help when we are alone

o Its all about the situation were in Deindividuation We will engage in uncharacteristic behaviors when we are stripped of our usual identities (assigned new role) o Zimbardo prison experiment o Students assigned roles of prisoner or guard o Study cut short b/c guards became abusive Influence The Psychology of Persuasion Dr. Robert Cialdini What Factors Affect How People are Influenced by Others? #1 Reciprocity: we try to repay others when they have provided something for us can be used to bring about unequal exchanges Examples: o Door in the face o Professor who mailed out Christmas cards to strangers o Harry Krishnas who give you free books or flowers o Car salesman who lower the price and then are ore likely to sell you the car

#2 Commitment and Consistency: We feel pressure o behave in a way consistent with a previous choice or behavior (commitment) Examples: o Foot in the door o Bait and switch: Parents promise to buy their children popular Christmas toys and do so even after prices are hiked up o Calling people and asking them to vote increase turnout #3 Social Proof/Social Validation: we determine what is correct behavior by finding out what others are doing Examples: o Canned laughter on TV shows o an insurance company tells you lots of people have switched their car insurance o Followers of cults #4 Linking: we are more likely to comply with a request from someone we like o we are also more likely to buy a product if it is associated with something or someone we like Examples: o Tupperware parties hosted by friends o Sports cars are paired with beautiful women in bikinis o Political candidate like to have celebrities endorse them #5 Authority: we are more likely to comply with a request from someone in a position of authority o even the appearance of authority works (titles, clothes, etc) Examples: o Celebrities promoting products o Teachers telling you to do things you normally wouldnt o Holocaust o People honk more at an economy car than a luxury car #6 Scarcity: opportunities are more valuable to us when they are less available o we often respond more to threats of loss than gain Examples: o Mammogram screening pamphlets are used most of if potential loss, rather than gain, is emphasized o Last chance, Limited time only, Nothing else like it o Telemarketing scams offering a one time chance to buy o we seek out information that has been banned