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Running Head 1 Abnormal Psychology and Treatments Elisabeth Canady Rio Salado ABNORMAL PSYCHOLOGY AND TREATMENTS 2 Abstract For my Psychology assignment, we were asked to describe the major mental disorders, such as Major Depressive Disorder, Bipolar Disorder, Schizophrenia, Post Traumatic Stress Syndrome, and Generalized Anxiety Disorder. This paper will explain a little bit about each disorder, and then describe certain types of psychotherapy modalities. The certain kinds of psychotherapy approaches explained throughout this paper are the psychodynamic approach, humanistic therapy, cognitive therapy, behavior therapy, and the medicinal approach to the helping relationship. After explaining some of the major elements of these major mental disorders and psychotherapy approaches, I will show examples of how these approaches to therapy can be applied to Major Depressive Disorder, Schizophrenia, and Generalized Anxiety Disorder. ABNORMAL PSYCHOLOGY AND TREATMENTS 3 Abnormal Psychology and Treatments Major Depressive Disorder is also known as affective disorder or mood disorder. This particular disorder has also been called the common cold of mental illness, because large segments of the population experience it at sometime in their lives. People who suffer from major depressive disorder struggle with feelings of excessive sadness, show loss of interest in normal pleasurable activities, exaggerated feelings of guilt and worthlessness, and have thoughts of death or even suicide. People who suffer from depression also endure feelings of despair and hopelessness. Their thinking patterns most often feed into these dark moods. They often exaggerate minor setbacks or failures, and fail to acknowledge the positive. Physical changes also occur as well, such as diet and weight, diminished ability to concentrate, fatigue, chronic headaches, and unexplainable aches and pains. They experience significant unplanned weight loss or weight gain, due to a decrease or increase in appetite nearly every day. People with depression also encounter continuous bouts of insomnia or hypersonic every day; therefore, experience lack of energy and fatigue on a regular basis. Depression is a chronic illness. Research has shown that 88 percent of those who suffer from depression and receive therapy, improve within 6 months. Compare to men, women are twice as likely to experience depression, yet there are no gender differences in Bipolar Disorder. Major depressive disorder goes beyond being just an emotion. Depression is a serious illness, and can eventually lead to loss of life if not treated. Bipolar Disorder is considered a psychotic disorder, and is also known as Manic Depressive Psychosis. It is a condition in which depression alternates with mania. For most people, depression comes in cycles that may alternate with normal periods, but it may also alternate with mania. Mania is the exact opposite of depression. Symptoms of mania is hyperactivity, decreased sleep, talkative, excessive euphoria, inflated self esteem, and racing thoughts. People with Bipolar Disorder are easily distracted and their conversations will often switch from topic to topic without warrant. They often feel powerful and full of plans, although these plans are based on delusional ideas. They also find themselves getting into trouble, making risky and impulsive decisions, and go on extravagant spending sprees. The original dopamine hypothesis maintains that psychoses, both schizophrenia and bipolar, are the result of excessive dopamine activity in the mesolimbic dopamine system. Antipsychotic drugs work in treating this disorder because they block dopamine receptors in the mesolimbic dopamine system, therefore decreasing the excessive activity. Lithium works well in preventing both the mania and the depression. It is an effective treatment because it relieves mania and blocks the reoccurrence of depression. ABNORMAL PSYCHOLOGY AND TREATMENTS 4 Schizophrenia is also considered to be a psychotic disorder. Schizophrenia is derived from the Greek schizein, to split and phren, mind. This means the separation between thought and emotion. The symptoms of schizophrenia are classified into two types, positive and negative symptoms. Positive symptoms include hallucinations, delusions, or irrational beliefs that can be very complex and organized. They experience feelings of grandeur or paranoia; for example, The CIA is plotting against me, or God speaks to me all the time. Sometimes, they may even think that their thoughts and emotions are externally controlled by other people who are plotting against them. They have bizarre delusions of identity, and believe they are someone that they are not. People with schizophrenia often have false sensory experiences or hallucinations. Some people may even hear voices that reach a point where they will commit suicide just to escape these voices. They have impaired cognitive abilities and diminished thoughts. Disorganization in thinking and speech involves a loosening of association between thought and ideas. Thoughts often skip form one subject to another, and are completely unrelated. The speaker is unaware that the topics are unconnected, and express illogical jumble of words. This is known as word salad. People who suffer from schizophrenia loose touch with reality. They misunderstand events going on around them, and often make inappropriate emotional responses to those events. These behaviors can range from child like play, to unpredictable and violent agitation. Negative symptoms include affective flattening or a catatonic stupor. This is when the persons face is immobile, unresponsive, and shows diminished range of emotional expressiveness. They show signs of improvised speech, their replies are often brief and uncommunicative, and they seem to reflect diminished thinking. People with Schizophrenia also show symptoms of avolition; the inability to initiate or engage in goal directed activities. The person sits for long periods of time and shows no interested in participating in work or social activities. Symptoms may appear months before hallucinations or delusion do. They may even continue even when the more dramatic (positive) symptoms are in remission. People with schizophrenia may start to loose motivation to take care of themselves, such as not taking baths or poor eating habits. They might also start to loose the initiative to interact with others, stop working, and become isolated or withdrawn. They might even get to the point where they are emotionally flat showing no emotion. Even though these signs may appear early, the first full blown psychotic episodes usually occur in late adolescence, or early in adulthood. This is caused because during adolescence, the brain goes through a lot of changes and development. The brain undergoes the natural pruning away of synapses. The schizophrenic brain will aggressively prune away at too many synapses. ABNORMAL PSYCHOLOGY AND TREATMENTS 5There are other contributing factors to schizophrenia such as genetic predisposition, structural brain abnormalities, and prenatal problems or complications at birth. A child who has one parent with schizophrenia has a 12 percent chance of having it as well. This number more than doubles when there is two parents with schizophrenia. The dopamine hypothesis main theory is that schizophrenia is the result of excess dopamine in the brain. There are also signs that neurotransmitter abnormalities such as serotonin and glutamate are also involved in schizophrenia. Damage to the fetal brain due to the mother being malnourished, having the flu virus within the first four months of pregnancy, or complications during birth such as lack of oxygen also may be contributing factors to schizophrenia. Post Traumatic Stress Disorder is an anxiety disorder in which a person who has experienced a traumatic life event has symptoms such as psychic numbing, reliving trauma, and increased physiological arousal. Other symptoms may include insomnia, agitation, jumpiness, and impaired concentration. These symptoms will usually persist a month or longer after the traumatic experience. People with PTSD usually relive the trauma on a reoccurring basis. The have visions replaying inside there head of the event, have feelings of fear and panic, and they can see, hear, and almost feel everything that took place during this event. The Hippocampus in the brain is involved in autobiographical memory, and people with PTSD have shown that their hippocampus is more likely to be smaller than average. This may figure in the difficulty of some trauma survivors to react to their memories as event from their past, which is why they keep reliving them in the present. They may also have a sense of detachment from others, and have loss of interest in activities. 60 percent of Americans have experienced a traumatic event, but only 8 percent of the men, and 20 percent of the women actually develop PTSD. Genetic predisposition causes some people to experience PTSD, and makes them more prone to this disorder. Prior history of psychological problems and experiences, or other traumatic experiences, and if they had a poor emotional adjustment to them, can also play a role in whether a person will go on to experience PTSD. Some peoples general way of thinking can also play a factor because they are more likely to produce anxiety or self defeating thoughts. People who suffer from PTSD lack the social psychological and neurological resources to deal with their experiences. Many cases of PTSD seem to be a result of impaired cognitive and neurological function that existed before the trauma ever took place, and was just triggered by the traumatic event. Obsessive Compulsive Disorder is known as an anxiety disorder. A person who suffers from Obsessive Compulsive Disorder, feels like
they are in a constant state of danger; therefore, they try repeatedly to reduce the resulting anxiety. People with OCD experience obsessions such as unwanted, repetitive, persistent thoughts; accompanied by compulsive, repetitive ritualized behaviors. These people feel that these rituals need to be followed through with in order to avoid disastrous conditions. These obsessions and compulsions become a disorder only when they become uncontrollable, and start to interfere with the persons life. ABNORMAL PSYCHOLOGY AND TREATMENTS 6Obsessive thoughts can consume a person with freighting thoughts; for example, thoughts of hurting a child or injuring another person, or becoming contaminated by something as harmless as a hand shake. Compulsions are repetitive rituals such as hand washing, counting, touching, and checking. People who suffer with Obsession Compulsive Disorder find these rituals to be meaningless, but they are tormented by the feeling of anxiety until they give into these illogical rituals. Research has shown that people who are diagnosed with OCD, have a depleted supply of serotonin in their prefrontal cortex in the brain. This would mean that the person would have the inability to let go of certain thoughts. There is also signs that show that several parts of the brain are hyperactive. There is a certain area within the frontal lobes that sends messages of danger to other areas involved in controlling the movement of the limbs, and preparing the body to feel fear in response to external threats. In people who are not diagnosed with OCD, normally when the threat of danger has past, the brains alarm signals turn off. People with OCD, have false alarms that keep clanging, and the emotional networks keeps sending out faulty fears. Generalized Anxiety Disorder is an anxiety disorder characterized by chronic anxiety. They endure intrusive, unwanted worrying and tensions, even when there is little or nothing to provoke it. The main characteristics of GAD is continuous, uncontrollable anxieties, worries, and feeling of dread, that is not brought on by physical causes such as disease, drugs, or caffeine. People with generalized anxiety disorder can't seem to let go of their concerns. Their worries are accompanied by physical symptoms such as restlessness, headaches, muscle tension, muscle aches, difficulty swallowing, shortness of breath, trembling, irritability, sweaty palms, racing heart, hot and cold flashes, and difficulty concentrating. These symptoms can be sporadic, or whenever the person is in a challenging or uncontrolled situation. Chronically anxious people may have a history of being unable to control or predict their environment. Activity in the locus coeruleus is associated with mood and believed to be associated with fear, panic, and anger. PET images show that the locus coeruleus, and other places in the brain, where is send its axons, becomes highly active when people are having panic attacks. Benzodiazepines increase inhibitory effects of GABA and help to relieve the anxiety. GABA stabilizes the brain by preventing an overexcited mode. A calming effect is derived from the GABA, and helps induce relaxation or sleep. ABNORMAL PSYCHOLOGY AND TREATMENTS 7I am now going to discuss some of the psychotherapy approaches used in the helping relationship. The Psychodynamic approach explores the unconscious dynamics of personality. The goal is to make the client conscious of unconscious material and to reconstruct the clients personality in order to attain a healthy balance. The therapist investigates into the deep, unconscious process believed to be the source of the clients problems. Based on object relation theory, emphasis is put on the unconscious influence of peoples earliest mental representations of their parents, and how these affect the reactions to separation and losses throughout life. Concentration is put on past and unconscious anxieties. There are four major phases of psychodynamic therapy. The first phase is the opening phase. The second phase is the development of transference. The third phase of psychodynamic therapy is working through the transference, and the last one is resolution of transference. Transference is a major process in psychodynamic therapy, in which the client relives emotions and attitudes, positive or negative, originally present in the parent child relationship, and directs them toward the therapist. Through analysis of transference, psychodynamic therapists believe that the client will be able to see their emotional conflict in action; therefore, will be able to work through them. The Humanistic approach focuses on clients freewill to change rather than past conflicts. The belief here is that human beings are always in the process of becoming. The assumption with this approach is that people are responsible for, and are capable of making their own decisions with in the framework of environmental factors. The Humanistic approach also follows the assumption that human nature is good, and that people developed problems or problematic behavior when they are corrupted by self imposed limits. Humanistic therapist want to see how the client views the world and how they see themselves subjectively. The therapist will usually focus on the here and now, and not concentrate on the clients past. The therapist will also help the client develop the will and courage to change and achieve their goals. The client will thoroughly explore and understand their feelings, thoughts, and actions. Whatever the clients specific complaint is, the goal is to build their self esteem and self acceptance, and help them find a more productive way of seeing their problems. People are capable of learning new behaviors and eliminating (or lessening) existing behaviors. They strive for reinforcements that are meaningful, and want to feel good about themselves. People are also controlled to a certain extent by their environment. They are able to direct their lives more than they think. Client centered therapy is a humanistic approach. This is a self theory and it is based on a belief that people act in accordance with their self concept, and their self concept is heavily influenced by their experiences with others. The therapists ability to be empathetic, understanding, and accept what the client says is important. Therefore the client will eventually internalize the therapists support and become more self accepting. The client is taught that they are capable of assuming responsibility for themselves, and making choices that can lead to independent self actualization. This type of therapy isnt concerned with causes or changing behavior. It focuses on the persons current experiences, feelings, and interactions. ABNORMAL PSYCHOLOGY AND TREATMENTS 8Existential therapy is another humanistic approach. The goal of this approach is to help the client find meaning of existence. The therapist helps the patient cope with the unavoidable realities of life such as death, or to courageously face the notorious questions of existence such as freedom, alienation of oneself, and meaningless. This approach encourages the client to explore the meaning of life, and Existential therapists believe that people have the power and free will to choose ones own destiny, and their lives are not necessarily determined by our pasts. Cognitive therapy emphasizes on rationality, thinking processes, meaning, and understanding. This approach helps the client identify road blocks in thoughts, associate feelings with behaviors, and find alternatives responses to negative thoughts and tasks. The basis of this therapy is that one needs to retrain their thinking in order to correct problematic behavior or negative emotions. Therapists help client emphasize on the positive rather than the negative. Rational Emotive Behavior therapy is a cognitive approach that challenges the clients unhealthy thoughts. Developed by Albert Ellis, he believed that people must take full responsibility fro themselves and for their own fate. Clients are taught to understand themselves, to understand others, to react differently, and to change their basic life philosophy by correcting faulty thinking. Therapists encourage the client to turn negative thoughts and emotions, into rational and productive responses. The Behavioral application of techniques derived from principles of classical and operant conditioning, thus helping people changed self defeating or problematic behaviors. Psychologists who practice behavioral therapy get directly to the problem, and do not focus on the past or unconscious anxieties. The philosophy of behavioral approach came about from the need to predict and measure outcomes of helping; based on specific, observable, objective, and measurable variables. All behavior is learned, and in turn, can be unlearned. Difficulties occur when learned, maladaptive behavior results in anxiety; the anxiety is learned as a possibility of the learned maladaptive behavior. This assumes that people have no internal control over their behavior, no self determinism; all behavior is determined by environmental variables. Behavior and cognitive therapy go hand in hand, and the assumption of both is that by changing peoples thinking, one can change their belief system, which in turn changes their behavior and emotions. Exposure therapy is a behavioral approach for treating fears and panic. If a person has a phobia or fear, they tend to avoid confronting it or thinking about it. Exposure treatments help alleviate this. The therapist either gradually or directly helps the client confront these fears until the feeling of panic or anxiety declines. System desensitization is a step by step behavior therapy that desensitizes a client to a feared object or experience. It is based on the classical conditioning procedure of counterconditioning. At each step, the client
must be confident and relaxed before graduating on to the next step. This will gradually start to move forward until the clients fearful responses are extinguished. Before people are able to change their behavior, they have to identify the reinforcers that are supporting their unwanted habits. Behavior self monitoring is a method of keeping careful data on the frequency and consequences of the behavior to be changed. Once the unwanted behavior is identified, along with the reinforcers that have been maintaining it, a treatment program can be put into affect. Skills training is used in behavior therapy to help a client learn skills that they may lack, as well as new constructive behaviors to replace self defeating ones. A therapist would also change a clients reinforcers that were maintaining a problematic behavior, and replace them with more positive reinforcers. ABNORMAL PSYCHOLOGY AND TREATMENTS 9The medicinal approach to treating mental and emotional disorders is the most commonly used biological treatment. Antipsychotic drugs are also known as neuroleptics, meaning clasping of the neuron. It refers to the capacity of these drugs to cause rigidity in limbs and difficulty in movement. This family of drugs is named after its side effect because at one time, it was believed that both effects were related. People believed that these drugs would not relieve psychosis unless they were causing neuroleptics effects as well. Many psychoses are thought to be caused by an excess of the neurotransmitter dopamine. Many antipsychotic drugs are designed to block or reduce the sensitivity of brain receptors that respond to dopamine. Some antipsychotic medications also increase levels of serotonin (a neurotransmitter that prevents dopamine activity. ) These drugs can lessen schizophrenic episodes, and reduce agitation, delusions, and hallucinations; but, they offer little relief of negative symptoms such as jumbled thoughts, difficulty concentrating, apathy, emotional flatness, or the inability to interact with others. The most pronounced, unwanted side effects on antipsychotic medicines is the alterations in movement, such as muscle rigidity, hand tremors, and other involuntary muscle movements. After taking these medications for a period of time, patients are likely to develop a neurological disorder called tardive dyskinesia. This is characterized by involuntarily repetitive movements of the face, such as lip smacking and twitching. Unfortunately in some people, these symptoms are permanent and do not go away after the drug is stopped. Some of the newer atypical drugs also have other risks such as weight gain that can lead to diabetes, which can cause medical complications and even lead to death. Many patients fail to follow through with taking this type of medication because of the unpleasant and sometimes dangerous side effects. Antidepressant drugs are often used in treating depression, anxiety, phobia, and obsession compulsive disorders. They need to be taken continuously for 2 to 3 weeks before there is a noticeable difference. MAOIs (monoamine oxidase inhibitors) elevate the levels of norephinephrine and serotonin in the brain by blocking or inhibiting monoamine oxidase, the enzyme that deactivates these neurotransmitters. TCAs (Tricyclic) antidepressants are named after their structure, which contains three rings of atom. These antidepressant boost norephinephrine and serotonin levels by preventing the reuptake of these substances. SSRIs (Selective serotonin reuptake inhibitors) are second generation antidepressants such as Prozac and Zoloft. These types of antidepressants have the same principle as TCAs. They block the ability of presynaptic cells to reabsorb and recycle serotonin. Some of the unpleasant physical reactions to antidepressant may be dry mouth, headaches, constipation, nausea, weight gain, restlessness, and decreased sex drive. ABNORMAL PSYCHOLOGY AND TREATMENTS 10Tranquilizers are used to reduce panic disorders. Benzodiazepines such as Valium and Xanax, increase the activity of the neurotransmitter gamma aminobutyric acid. Even though they are prescribed to help with mild anxiety, they are often over prescribed by general physicians for patients who complain of more serious mood disorders. A significant amount of people over use these types of medications and develop problems with withdrawal and tolerance. Tranquilizers are a short term relief from panic and anxiety, and are not considered to be a long term treatment. The element of lithium is used to treat and prevent bipolar disorder. It is usually sold as the salt lithium carbonate. It produces its effects by moderating levels of norephinephrine, or protecting brain cells from being over stimulated by glutamate. Lithium must be given in precise, accurate doses, and blood levels need to be carefully monitored. Too little will not help, yet too much can be deadly. Anticonvulsant drugs are now more widely used to treat bipolar disorder than lithium. Drugs such as Tegretal, Depakote, and Lamictal are some if these newer drugs. There are several different ways to go about treating Major Depressive Disorder. My first choice would to use the combination of psychodynamic, cognitive, and medicinal route. There are some elements of the behavior and humanistic approach that would also be beneficial to treating this disorder. First I would start with finding the best antidepressant medication for the client. In the mean time I would try to get some insight on the patients emotional state, and what kind of things were going on in their life that might be contributing to some of the depression. I would also evaluate if there were any reasons to hospitalize the client for any suicidal symptoms. Through psychodynamic therapy, I could investigate the patients unconscious and hopefully explore more into what may be the source of the clients problems. Through the process of transference, my patient would see their emotional conflicts in action, and we would be able to work through them together. This would help explore any problems with relationships and experiences, and find better ways to cope and solve these problems. I would also try to apply the cognitive and behavior approaches. This would identify negative beliefs and behaviors and replace them with healthy, positive ones. I would base this on the idea that the patients own thoughts (not other people or situations ) would determine how they may feel or behave. If these unwanted situations do not change, I would help the client find other ways to change the way they think and behave in a more positive and productive way. The next approach that may be beneficial to the patient would be the humanistic approach. I think that this would focus the patient on the here and now, and help give them the courage to fix these problems, and encourage them to achieve future goals. In turn, this would build the patients self esteem, and find a more productive way to view the possible problems that may be contributing to their depression. When treating a patient for schizophrenia, I would first try to fix the chemical imbalances that were most likely contributing to the disorder, by starting them on a antipsychotic. Like mentioned above, these drugs can lessen schizophrenic episodes, and reduce agitation, delusions, and hallucinations. This would be a good start, but they offer little relief of negative symptoms such as jumbled thoughts, difficulty concentrating, apathy, emotional flatness, or the inability to interact with others. My next approach to treatment would to apply behavior and cognitive therapy. This would hopefully help with treating the negative symptoms. This would help the patient to understand their thoughts and process them in a more productive, and realistic way. This would also work with the behavior reactions to their negative symptoms, and how to cope with them. I would approach some of the patients thought processes through rational emotive behavior therapy, in hopes that they could express themselves more freely, and in a more appropriate way. I would use behavior approaches to help strengthen the patients interpersonal skills and control social stressors; therefore, helping the client to deal and interact with others. I would use the humanistic approach to encourage my patient to subjectively see themselves, and how they perceive the world around them. I would help the client realize that they do have more control than they think, and the patient can work through this. I would encourage the client to continue therapy, and help me help them through this disorder. Another approach to treating a patient with schizophrenia would be the psychodynamic approach. I would explore the symptoms and possible sources of the patients disorder. Maybe try to see if there was only underlining sources for their voices; an unconscious reason for some of these symptoms, and the messages that they are trying to convey (if any). ABNORMAL PSYCHOLOGY AND TREATMENTS 11The next disorder I am going to apply the designated therapy modalities to is Generalized Anxiety Disorder. Like the first two disorders, I would start the patient on medicinal therapy. I would start them on an antidepressant in an attempt to try to correct the activity of brain chemicals (neurotransmitters) thought to be playing a role in their anxiety. This would be my long term goal for treating the patients anxiety, and this would take some time before the patient would notice any difference. I would also prescribe something such as Xanax (tranquilizer) for the patient to have for a relief medication. This would be just incase the patient has an full blown panic attack, and it the short term goal for the medicinal approach. Since anxiety takes many forms, I believe that all the psychotherapy modalities listed would be beneficial to the patient. Psychodynamic
therapy would aim for both the patient and I to work out any underlying life stresses and concerns of the patients, and make the appropriate behavior changes. Cognitive therapy focuses on teaching the patient specific skills to identify negative thoughts and behaviors and replaces them with positive ones. Even if an undesirable situation doesn't change, the patient can reduce stress and gain more control over their life by changing the way they respond to stressing situations. This would also give the patient the skills to develop a more rational way of thinking, therefore reducing any thoughts that can lead to anxiety. I would also rehearse different behaviors that can reduce or eliminate any anxiety, in the event the patient goes into a situation or has experiences thoughts that may seem overwhelming. I would also help the patient monitor their anxiety, including what triggers it, and what the specific things they tend to worry about. Humanistic therapy would give the patient more strength when it came to their anxiety. The patient would be able to see that they have more control over their pattern of thinking and behavior than they believe. They do not have to let anxiety take control of their emotional well being. ABNORMAL PSYCHOLOGY AND TREATMENTS 12 ReferencesWikipedia (2011). Rational emotive behavior therapy. Retrieved from http //en. wikipedia. org/wiki/Rational_emotive_behavior_therapyNACBT Online Headquarters (2011) Cognitive Behavioral Therapy. Retrieved from http //www. nacbt. org/whatiscbt. htmBarbara Okun, Ricki Kantrowitz (2008) Effective Helping Interviewing and Counseling Techniques, Stage 2 Applying Strategies. (pp 217 250) Wade Carole, Travis Carol (2008) Psychology, Psychological Disorders. (pp 597 637)Wade Carole, Travis Carol (2008) Psychology, Approaches To Treatment and Therapy. (pp 639 672)Wade Carole, Travis Carol (2008) Psychology, Approaches To Treatment and Therapy. (pp 639 672)William A McKim (2007) Drugs and Behavior An Introduction to Behavior Pharmacology, Antipsychotic Drugs. (pp 283 295)