Unit 8 Clinical Psychology Key Terms

learned helplessness

the hopelessness and passive resignation an animal or person acquires when unable to avoid repeated aversive events. Uncontrollable bad events → perceived lack of control → generalized helpless behavior. Self-defeating beliefs may arise from learned helplessness. Pessimistic, overgeneralized, self-blaming attributions may create a depressing sense of hopelessness

epigenetics

the study of environmental influences on gene expression that occur without a DNA change. Research on epigenetics (literally, "in addition to genetic") supports the vulnerability-stress model by showing how our DNA and our environment interact. In one environment, a gene will be expressed, but in another, it may lie dormant. For some, that will be the difference between developing a disorder or not developing it.

lithium

About 70% of people with bipolar disorder benefit from a long-term daily dose of lithium, which helps prevent or ease manic episodes and, to a lesser extent, lifts depression. Taking lithium also correlates with a lower risk of suicide among people with bipolar disorder—to about one-sixth the risk of those not taking lithium. Naturally occurring lithium in drinking water has also correlated with lower suicide rates across 18 Japanese cities and towns, and lower crime rates across 27 Texas counties.

biopsychosocial approach to mental illness

Biological, psychological, and social-cultural influences together weave the fabric of our behaviors, our thoughts, and our feelings. As individuals, we differ in the amount of stress we experience and in the ways we cope with stressors. Cultures also differ in their sources of stress and in their traditional ways of coping. What are the biopsychosocial factors that influence mental health? Biological: evolution, individual genes, brain structure and chemistry Psychological: stress, trauma, learned helplessness, mood-related perceptions and memories Sociocultural: roles, expectations, definitions of normality and disorder

psychologist training

Clinical psychologists- most are psychologists with a Ph.D (includes research training) or Psy.D (focuses on therapy) supplemented by a supervised internship and, often, post-doctoral training. About half work in agencies and institutions, half in private practice. Psychiatrists- psychiatrists are physicians who specialize in the treatment of psychological disorders. Not all psychiatrists have had extensive training in psychotherapy, but as M.D.s or D.O.s they can prescribe medications. Thus, they tend to see those with the most serious problems. Many have their own private practice. Clinical or psychiatric social workers- A two-year master of social work graduate program plus postgraduate supervision prepares some social workers to offer psychotherapy, mostly to people with everyday personal and family problems. About half have earned the National Association of Social Workers' designation of clinical social work. Counselors- Marriage and family counselors specialize in problems arisign from family relations. Clergy provide counseling to countless people. Abuse counselors work with substance abusers and with spouse and child abusers and their victims. Mental health and other counselors may be required to have a two-year master's degree.

vicious cycle of depression

Depression is both a cause and an effect of stressful experiences that disrupt our sense of who we are and why we are worthy human beings. 1.Stressful experiences interpreted through ... 2. a ruminating, pessimistic explanatory style create ... 3. a hopeless, depressed state that ... 4. hampers the way the person thinks and acts. This, in turn, fuels further stressful experiences such as rejection.

how do life experiences play a role in depression and bipolar disorder?

Diet, drugs, stress, and other environmental influences lay down epigenetic marks, molecular genetic tags that can turn certain genes on or off. Animal studies suggest that long-lasting epigenetic influences may play a role in depression. Prenatal experiences- drugs, toxins, nutrition stress, postnatal- neglect, abuse, variations in care, juvenile- social contact, environmental complexity, adult- cognitive challenges, exercise, nutrition- gene expression is affected by epigenetic molecules

disorganized speech

Disorganized speech is a positive symptom of schizophrenia. As with Maxine in the previous slide, jumbled ideas may make no sense even within sentences, forming what is known as word salad. For instance, one young man begged for "a little more allegro in the treatment," and suggested that "liberationary movement with a view to the widening of the horizon" will "ergo extort some wit in lectures."

mental illness early on

During the Middle Ages, mental illness was believed to have been induced by the Devil and required a harsh cure that would drive out the evil demon. People considered "mad" were sometimes caged or given "therapies" such as genital mutilation, beatings, removal of teeth or lengths of intestines, or transfusions of animal blood.

eye movement desensitization and reprocessing (EMDR)

EMDR (eye movement desensitization and reprocessing) is a therapy adored by thousands and dismissed by thousands more as a sham. During EMDR therapy, the client pulls back traumatic memories and simultaneously focus on external stimuli, such as the therapists waving finger, or an external focal point. Skeptics acknowledge that EMDR does work better than doing nothing. "Studies indicate that EMDR is just as effective with fixed eyes. If that conclusion is right, what's useful in the therapy (chiefly behavioral desensitization) is not new, and what's new is superfluous." ~Harvard Mental Health Letter, 2002. Skeptics suspect that what is therapeutic is not the eye movements, but the combination of exposure therapy—repeatedly calling up traumatic memories and reconsolidating them in a safe and reassuring context—and perhaps some placebo effect

psychotherapy benefits

Hope: any psychotherapy offers the expectation that, with commitment from the therapy seeker, things can and will get better. A new perspective: every therapy offers people a plausible explanation of their symptoms. An empathic, trusting, caring relationship: effective therapists are empathic. They seek to understand the client's experience. They communicate care and concern, and they earn trust through respectful listening, reassurance, and guidance.

humanistic therapy

Humanistic therapists aim to boost people's self-fulfillment by helping them grow in self-awareness and self-acceptance. The path to growth is taking immediate responsibility for one's feelings and actions, rather than uncovering hidden determinants. Promoting growth, not curing illness, is the therapy focus. Individuals in therapy are referred to as "clients" rather than "patients." Conscious thoughts are more important than the unconscious. The present and future are more important than the past. Therapy focuses on exploring feelings as they occur, rather than on achieving insights into the childhood origins of those feelings.

transcranial direct current stimulation (tDCS)

In contrast to ECT, which produces a brain seizure with about 800 milliamps of electricity, transcranial direct current stimulation (tDCS) administers a weak 1- to 2-milliamp current to the scalp. After reviewing recent studies, two European expert panels reported the "probable efficacy" of tDCS as a depression treatment. How does tDCS work?? The psychiatrist applies a weak current to the scalp.

mood-stabilizing drugs

Mood-stabilizing drugs help to control the manic, out-of-control feelings that often come with bipolar or other disorders. Depakote, an older mood stabilizer, was originally used to treat epilepsy. It was also found effective in controlling the manic episodes associated with bipolar disorder. Another, the simple salt lithium, effectively levels the emotional highs and lows of bipolar disorder.

diagnostic labels

Once labeling a person, we view that person differently. Labels can change reality by putting us on alert for evidence that confirms our view. In a classic study, teachers who were told certain students were "gifted" then acted in ways that elicited the behaviors they expected. Labels can be self-fulfilling. David Rosenhan and seven of his graduate students went to hospital admissions offices, complaining (falsely) of "hearing voices" saying empty, hollow, and thud. Apart from this complaint and giving false names and occupations, they answered questions truthfully. All eight healthy people were misdiagnosed with disorders. Until being released an average of 19 days later, those eight "patients" showed no other symptoms. Yet after analyzing their (quite normal) life histories, clinicians were able to "discover" the causes of their disorders, such as having mixed emotions about a parent. Even routine note-taking behavior was misinterpreted as a symptom. Getting a job or finding a place to rent can be a challenge for people recently released from a psychiatric hospital. Label someone as "mentally ill" and people may fear them as potentially violent. That reaction may fade as people better understand that many psychological disorders involve diseases of the brain, not failures of character. speaking out.

stimulus generalization

Remember from Module 26 that in classical conditioning, stimulus generalization is the tendency, once a response has been conditioned, for stimuli similar to the conditioned stimulus to elicit similar responses. In operant conditioning, stimulus generalization occurs when responses learned in one situation occur in other, similar situations. How does stimulus generalization explain anxiety, OCD and PTSD? Stimulus generalization occurs when a person experiences a fearful event and later develops a fear of similar events. If a child is bit by a dog, the fear associated with that bite may develop into a fear of all dogs.

physical exercise and diet reducing depression

Repetitive physical exercise, such as jogging, reduces depression in part because it increases serotonin, which affects mood and arousal. In one study, running for two hours increased brain activation in regions associated with euphoria. People who eat a heart-healthy "Mediterranean diet" (heavy on vegetables, fish, and olive oil) have a comparatively low risk of developing heart disease, stroke, late-life cognitive decline, and depression—all of which are associated with inflammation.

modeling

Researchers tested whether modeling of thinness impacted anorexia by giving some adolescent girls (but not others) a 15-month subscription to an American teen-fashion magazine. What were the results of the study? Compared with those who had not received the magazine, vulnerable girls—defined as those who were already dissatisfied, idealizing thinness, and lacking social support—exhibited increased body dissatisfaction and eating disorder tendencies.

SSRIs

Several widely used antidepressant drugs are selective serotonin reuptake inhibitors—SSRIs. The most commonly prescribed drugs in this group, including Prozac, Zoloft and Paxil, work by prolonging the time serotonin molecules remain in the brain's synapses. How does neural transmission with serotonin typically work? The neural message is sent across the synaptic gap with the release of serotonin and received in the receptor sites on the post-synaptic neuron. After the message passed to the post-synaptic neuron, excess serotonin is reabsorbed by the sending neuron through a process called reuptake.

risks with schizophrenia

Some people diagnosed with schizophrenia have abnormally low brain activity in the frontal lobes, areas that are involved in reasoning, planning, and solving problems. Some scientists believe mishaps during prenatal development or delivery causes brain abnormalities in people with schizophrenia. Risk factors include low birth weight, maternal diabetes, older paternal age, and oxygen deprivation during delivery. Fetal-virus infections may increase the odds that a child will develop schizophrenia. However, many women get the flu during their second trimester of pregnancy, and only 2% of them bear children who develop schizophrenia. The 1-in-100 odds of any person's being diagnosed with schizophrenia become about 1 in 10 among those who have a sibling or parent with the disorder. The lifetime risk of developing schizophrenia varies with one's genetic relatedness to someone having this disorder. Across countries, barely more than 1 in 10 fraternal twins, but some 5 in 10 identical twins, share a schizophrenia diagnosis. About two-thirds of identical twins also share a placenta and the blood it supplies; the other third have separate placentas. If the co-twin of an identical twin with schizophrenia shared the placenta, the chances of developing the disorder are 6 in 10. If the identical twins had separate placentas, the co-twin's chances of developing schizophrenia drop to 1 in 10. Genes + viruses- Twins who share a placenta are more likely to share the same prenatal viruses. So, perhaps shared germs as well as shared genes produce identical twin similarities. Adoption studies help untangle genetic (nature) and environmental (nurture) influences. Children adopted by someone who develops schizophrenia do not "catch" the disorder. Rather, adopted children have an elevated risk if a biological parent is diagnosed with schizophrenia. Genes matter, but environment does as well. Schizophrenia is a group of disorders influenced by many genes, each with very small effects. And, as so often seen, nature and nurture interact. Most people with schizophrenia smoke. Smoking increases vulnerability to schizophrenia and contributes to people with schizophrenia having a 14.5-year shorter-than-average life expectancy. Recall that epigenetic factors influence whether genes will be expressed. Environmental factors such as viral infections, nutritional deprivation, and maternal stress can "turn on" the genes that put some at higher risk for schizophrenia. Heredity (nature) and life experiences (nurture) work together. Hoping to identify environmental triggers of schizophrenia, researchers have compared the experiences of high-risk children (for example, those with relatives with schizophrenia) and low-risk children. In one 2.5-year study that followed 163 teens and early-twenties adults who had two relatives with schizophrenia, the 20% of participants who developed schizophrenia showed social withdrawal or other abnormal behavior before the onset of the disorder. Researchers identified other possible early warning signs, including a mother whose schizophrenia was severe and long-lasting; birth complications; separation from parents; short attention span and poor muscle coordination; disruptive or withdrawn behavior; emotional unpredictability; poor peer relations and solo play; and childhood physical, sexual, or emotional abuse.

distorted perception

Women who view real and doctored images of unnaturally thin models and celebrities often feel ashamed, depressed, and dissatisfied with their own bodies—the very attitudes that predispose eating disorders

mania

a mood disorder marked by a hyperactive, wildly optimistic state

ADHD (attention-deficit hyperactivity disorder)

a psychological disorder marked by the appearance by age 7 of one or more of three key symptoms: extreme inattention/distractibility, hyperactivity, and impulsivity. The DSM has broadened the diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD). For those who experience these challenging symptoms, diagnosis and treatment can be a relief and bring improved functioning. However, critics suggest that the criteria are now too broad and may turn normal, childish rambunctiousness into a disorder. Twice as often in boys than girls. 11% 4-17 year olds. 2.5% adults

evidence-based practice

clinical decision making that integrates the best available research with clinical expertise and patient characteristics and preferences. Endorsed by the American Psychological Association and others, therapists using this approach integrate the best available research with clinical expertise and with patient preferences and characteristics. After rigorous evaluation, clinicians apply therapies suited to their own skills and their patients' unique situations.

rumination

compulsive fretting; overthinking our problems and their causes. Psychologist Susan Nolen-Hoeksema related women's higher risk of depression to what she described as their tendency to ruminate or overthink. Relentless, self-focused rumination can distract us, increase negative emotion, and disrupt daily activities. Social- when people scroll through social media feeds and see 'Maria having a blast with friends, Angelique enjoying a family vacation, and Tyra looking super in a swimsuit', the response may be "my life is terrible."

dissociative disorders

controversial, rare disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings. The result may be a fugue state (not knowing who you are, perhaps accompanied by travel or relocation to a new place), a sudden loss of memory or change in identity, often in response to an overwhelmingly stressful situation.

hallucination

false sensory experiences, or perceptions, such as seeing something in the absence of an external visual stimulus. People with schizophrenia sometimes have hallucinations—they see, feel, taste, or smell things that exist only in their minds. The auditory hallucinations tend to be voices, which sometimes make insulting remarks or give orders. For instance, the voices may tell the person that she is bad or that she must burn herself with a cigarette lighter.

posttraumatic growth

positive psychological changes as a result of struggling with extremely challenging circumstances and life crises

positive symptoms schizophrenia

positive symptoms- Those with positive symptoms may experience hallucinations, talk in disorganized and deluded ways, and exhibit inappropriate laughter, tears, or rage. In the case of schizophrenia, positive symptoms are inappropriate behaviors that are present

biomedical therapy

prescribed medications or procedures that act directly on the person's physiology. The psychiatrist or doctor may prescribe antidepressants for a person with severe depression or may suggest electroconvulsive shock therapy (ECT), or deep-brain stimulation.

behavior modification

reinforcing behaviors considered desirable, and failing to reinforce—or sometimes punishing—behaviors considered undesirable. Therapists practicing behavior modification use operant conditioning principles such as giving positive reinforcement to shape wanted behavior and using punishment to decrease unwanted behavior. In a step-by-step manner, they rewarded closer and closer approximations of the desired behavior. One study worked with 19 withdrawn, uncommunicative 3-year-olds with Autism Spectrum Disorder (ASD). For two years, 40 hours each week, the children's parents attempted to shape their behavior. They positively reinforced desired behaviors and ignored or punished aggressive and self-abusive behaviors. The combination worked wonders for some children. By first grade, 9 of the 19 were functioning successfully in school and exhibiting normal intelligence. In a group of 40 comparable children not undergoing this effortful treatment, only one showed similar improvement.

chronic schizophrenia

A form of schizophrenia in which symptoms usually appear by late adolescence or early adulthood. As people age, psychotic episodes last longer and recovery periods shorten. Social withdrawal, a negative symptom, is often found among those with chronic schizophrenia. Men, whose schizophrenia develops on average four years earlier than women's, more often exhibit negative symptoms and chronic schizophrenia.

acute schizophrenia

A form of schizophrenia that can begin at any age; frequently occurs in response to a traumatic event. When previously well-adjusted people develop schizophrenia rapidly following particular life stresses, this is called acute schizophrenia, and recovery is likely. People with acute schizophrenia more often have positive symptoms that respond to drug therapy.

choosing a therapist

A person seeking therapy may want to ask about the therapist's treatment approach. A person seeking therapy may want also want to ask about the therapist's values. It is also important to ask about the therapist's credentials and how much the therapist charges. In North America, Europe, and Australia, for example, most psychotherapists reflect their culture's individualism, which often gives priority to personal desires and identity. Clients with a collectivist perspective, as with many from Asian cultures, may assume people will be more mindful of social and family responsibilities, harmony, and group goals. These clients may have trouble relating to therapies that require them to think only of their own well-being. People living in "cultures of honor" prize being strong and tough. They may feel that seeking mental health care is an admission of weakness rather than an opportunity for growth. Some minority groups tend to be both reluctant to seek therapy and quick to leave it. Client-psychotherapist mismatches may also stem from religious values. Highly religious people may prefer and benefit from religiously similar therapists, and may have trouble forming an emotional bond with one who does not share their values.

agoraphobia

After several panic attacks, people may avoid situations where panic might strike. If their fear is intense enough, people may develop agoraphobia—fear or avoidance of public situations from which escape might be difficult. Given such fear, people may avoid being outside the home, in a crowd, or in an elevator.

three clusters of personality disorders

Anxiety- ...such as a fearful sensitivity to rejection that predisposes the withdrawn avoidant personality disorder. Eccentric or odd- ...such as the emotionless disengagement of schizotypal personality disorder. Dramatic or impulsive- ...such as the attention-getting borderline personality disorder, the self-focused narcissistic personality disorder, the callous, and often dangerous, antisocial personality disorder.

conditioning impacting mental health disorders

Anxious or traumatized people learn to associate their anxiety with certain cues. 58% of those with social anxiety disorder developed the disorder following a traumatic event. Anxiety or an anxiety-related disorder is more likely to develop when bad events happen unpredictably and uncontrollably.

how do the psychodynamic and learning perspectives view DID?

Both the psychodynamic and learning perspectives have interpreted DID symptoms as ways of coping with anxiety. Some psychodynamic theorists see DID symptoms as defenses against the anxiety caused by the eruption of unacceptable impulses. In this view, a second personality enables the discharge of forbidden impulses. Learning theorists see dissociative disorders as behaviors reinforced by anxiety reduction.

brain structures in mental illness

Brain scans of people with OCD reveal elevated activity in the anterior cingulate cortex during behaviors such as compulsive hand washing, checking, ordering, or hoarding. The anterior cingulate cortex, a brain region that monitors our actions and checks for errors, seems especially likely to be hyperactive.

cognition and anxiety

Cognition, our thoughts, memories, interpretations, and expectations, influences our feelings of anxiety. Our past experiences shape our expectations and influence our interpretations and reactions. Whether we interpret the creaky sound simply as the wind or as a possible knife-wielding attacker determines whether we panic. What research has been conducted on cognition and anxiety? Susan Mineka experimented with six monkeys raised in the wild (all strongly fearful of snakes) and their lab-raised offspring (virtually none of which feared snakes). After repeatedly observing their parents or peers refusing to reach for food in the presence of a snake, the younger monkeys developed a similar strong fear of snakes. When the monkeys were retested three months later, their learned fear persisted.

disorders and violence

Do disorders increase the risk of violence? No. Most violent criminals are not mentally ill, and most mentally ill people are not violent. The few people with disorders who commit violent acts tend to be either those who experience threatening delusions and hallucinated voices that command them to act, who have suffered a financial crisis or lost relationship, or who abuse substances. AP® Exam Tip- Notice that the term insanity comes out of the legal system. Insanity in criminal law means that defendants cannot be held accountable for their actions at the time of the crime, typically due to mental disorder. It is not a psychological or medical diagnosis and does not appear in the DSM-5. Following the Newtown, CT., slaughter of 20 young children and 6 adults, people wondered: Could those at risk for violence be identified in advance by mental health workers and reported to police? Would laws that require such reporting discourage disturbed gun owners from seeking mental health treatment?

suicide risk factors

Each year over 800,000 despairing people worldwide will elect a permanent solution to what might have been a temporary problem. For those who have been anxious, the risk of suicide is tripled, and for those who have been depressed, the risk is quintupled. People seldom commit suicide while in the depths of depression, when energy and initiative are lacking. The risk increases when they begin to rebound and become capable of following through. Women are much more likely than men to attempt suicide. But men are two to four times more likely to actually end their lives. In late adulthood, suicide rates increase, with the highest rate among 45- to 64-year-olds and the second-highest among those 85 and older. Men exposed to a family suicide were 8 times more likely to commit suicide than were non-exposed men. Gay, transgender, and gender nonconforming youth facing an unsupportive environment, including family or peer rejection, are also at increased risk of attempting suicide. Following highly publicized suicides and TV programs featuring suicide, known suicides increase. Suicidal urges typically arise when people feel disconnected from others and a burden to them, or when they feel defeated and trapped by an inescapable situation. People—especially older adults— may choose death as an alternative to current or future suffering, a way to switch off unendurable pain and relieve a perceived burden on family members. How can we help someone considering suicide? 1) listen- empathize and offer friendship. 2) connect involve the school psychologist or counselor, refer the person to the Suicide Prevention Lifeline or Crisis Text Line. 3) protect- seek help from a trusted adult—a parent, a teacher, a school nurse or school counselor—or call 911

explanatory style

Explanatory style - who or what we blame for our failures - seems to be similar for those suffering from depression. Individuals diagnosed with depression often explain bad events in terms that are: stable ("It's going to last forever"), global ("It will affect everything I do"), and internal ("It's all my fault"). Depression-prone people respond to bad events in an especially self-focused, self-blaming way. When people diagnosed with depression describe themselves, their brains show extra activity in a region that processes self-relevant information. Individuals prone to depression have self-esteem that is more plastic—it climbs with praise and plummets with threats.

ADHD treatments

Extreme inattention, hyperactivity, and impulsivity can derail social, academic, and work achievements. The symptoms can be treated with stimulant medication, behavior therapy and aerobic exercise. The debate continues over whether normal high energy is too often diagnosed as a psychiatric disorder, and whether there is a cost to the long-term use of stimulant drugs in treating ADHD. Treatment- stimulant drugs (Ritalin and Adderall) calm hyperactivity, and increase ability to sit and focus. So do behavior therapy and aerobic exercise. Psychological therapies help with the distress of ADHD.

psychoanalysis

Freud believed the patient's free associations, resistances, dreams, and transferences—and the therapist's interpretations of them—released previously repressed feelings, allowing the patient to gain self-insight. He called this technique psychoanalysis. Freud believed that in therapy, people could achieve healthier, less anxious living by releasing the energy they had previously devoted to id-ego-superego conflicts discussed in Module 55. Freud assumed that we do not fully know ourselves. He believed that there are threatening things we repress—things we do not want to know, so we disavow or deny them.

biological factors for depression/bipolar

Genetic predispositions, neurochemical imbalances, and nutritional deficits. The risk of being diagnosed with major depressive disorder or bipolar disorder increases if your parent or sibling has the disorder. If one identical twin is diagnosed with major depressive disorder, the chances are about 1 in 2 that at some time the other twin will be, too. If one identical twin has bipolar disorder, the chances of a similar diagnosis for the co-twin are even higher—7 in 10—even for twins raised apart. What is the heritability of certain disorders? Using aggregated data from studies of identical and fraternal twins, researchers estimated the heritability of bipolar disorder, schizophrenia, anorexia nervosa, major depressive disorder, and generalized anxiety disorder. Heritability estimates (percent of variation due to genetic influence) for: bipolar disorder- 85%, schizophrenia- 81%, anorexia nervosa- 60%, major depressive disorder- 37%, and generalized anxiety disorder- 28%

free association

Imagine yourself as a patient using free association. You begin by relaxing, perhaps by lying on a couch. The psychoanalyst, who sits out of your line of vision, asks you to say aloud whatever comes to mind. At one moment, you're relating a childhood memory. At another, you're describing a dream or recent experience. Soon you notice how often you edit your thoughts as you speak. You pause for a second before uttering an embarrassing thought. You omit what seems trivial, irrelevant, or shameful. Sometimes your mind goes blank or you clutch up, unable to remember important details. You may joke or change the subject to something less threatening.

diagnosing disorders

In biology, classification creates order. To classify an animal as a "mammal" says a great deal—that it is warm-blooded, has hair or fur, and produces milk to nourish its young. In psychiatry and psychology, too, classification orders and describes symptoms. For instance, to classify a person's disorder as "schizophrenia" suggests that the person talks incoherently, has bizarre beliefs, shows either little emotion or inappropriate emotion, or is socially withdrawn. But diagnostic classification gives more than a thumbnail sketch of a person's disordered behavior, thoughts, or feelings. In psychiatry and psychology, classification also aims to predict a disorder's future course, suggest appropriate treatment, and prompt research into its causes. To study a disorder, we must first name and describe it.

double blind trials/placebo effect

In double-blind clinical trials, placebos produced improvement comparable to about 75 percent of the active drug's effect. For those with severe depression, the placebo effect is less and the added drug benefit somewhat greater. So, if one suffers from mild depression, might an alternative therapy work as well as medication? Considering the placebo effect, what is the recommendation for use of antidepressants? Irving Kirsch, of the Program in Placebo Studies at Harvard University recommends limited antidepressant use. Since antidepressants often have unwanted side effects, and aerobic exercise and cognitive behavioral therapy are also effective antidotes to mild or moderate depressions, if antidepressants are to be used at all, they should be a last resort.

brain structures depression and bipolar

In people with bipolar disorder, studies discovered a decrease in myelinated axons and enlarged fluid-filled ventricles. Depression can cause the brain's reward centers to become less active. During positive emotions, the left frontal lobe and an adjacent reward center become more active. How is the brain changing during a manic episode? These top-facing PET scans show that brain energy consumption rises and falls with the patient's emotional switches. Red areas are where the brain rapidly consumes glucose. Manic state- lots of red and yellow. How do neurotransmitter systems influence depressive disorders and bipolar disorder? Norepinephrine, which increases arousal and boosts mood, is scarce during depression and overabundant during mania. Serotonin is scarce or inactive during depression. One study showed that depression is related to the combination of two factors—significant life stress plus a variation of a serotonin-controlling gene.

transference

In psychoanalysis, the patient's transfer to the analyst of emotions linked with other relationships (such as love or hatred for a parent). Over many sessions, your relationship patterns surface in your interaction with your therapist. You may find yourself experiencing strong positive or negative feelings for your analyst. The analyst may suggest you are transferring feelings, such as dependency or mingled love and anger, that you experienced in earlier relationships with family members or other important people.

trephining

In the Stone Age, drilling skull holes like these may have been an attempt to release evil spirits and cure those with mental disorders.

aaron beck

In the late 1960s, a woman left a party early. Things had not gone well. She felt disconnected from the other party-goers and assumed no one cared for her. A few days later, she visited cognitive therapist Aaron Beck who challenged her thinking. After she then listed a dozen people who did care for her, Beck realized that challenging people's automatic negative thoughts could be therapeutic. Beck's cognitive therapy assumes that changing people's thinking can change their functioning.

how prevalent is depression?

In the past year, have you at some time "felt so depressed that it was difficult to function"? If so, you were not alone. In one national survey, 31 percent of American college students answered Yes. In a survey of American high school students, 29 percent "felt so sad or hopeless almost every day for 2 or more weeks in a row that they stopped doing some usual activities."

self-help groups

More than 100 million Americans have belonged to small religious, interest, or support groups that meet regularly—with 9 in 10 reporting that group members "support each other emotionally." In an individualist age, with more and more people living alone or feeling isolated, the popularity of support groups—for the addicted, the bereaved, the divorced, or simply those seeking fellowship and growth—may reflect a longing for community and connectedness.

light exposure therapy

National Institute of Mental Health researchers in the early 1980s had an idea: give people a timed daily dose of intense light. Sure enough, people reported they felt better. One study exposed some people with a seasonal pattern in their depression symptoms to 90 minutes of bright light and others to a sham placebo treatment—a hissing "negative ion generator" that was just producing white noise. After four weeks, 61% of those exposed to morning light had greatly improved, as had 50% of those exposed to evening light and 32% of those exposed to the placebo. (Eastman et al., 1998) So, the verdict is... Studies have shown that 30 minutes of morning exposure to 10,000-lux white fluorescent light produces relief for most depressed people.

selective attention schizophrenia

One cause of disorganized thinking may be a breakdown in selective attention. Recall from Module 16 that we normally we have a remarkable capacity to give our undivided attention to one set of sensory stimuli while filtering out others. People with schizophrenia are easily distracted by tiny unrelated stimuli, such as the grooves on a brick or tones in a voice. Maxine, a young woman with schizophrenia, believed she was Mary Poppins. Communicating with Maxine was difficult because her thoughts spilled out in no logical order. Her biographer, Susan Sheehan observed her saying aloud to no one in particular, "This morning, when I was at Hillside [Hospital], I was making a movie. I was surrounded by movie stars. . . . Is this room painted blue to get me upset? My grandmother died four weeks after my eighteenth birthday."

risk factors for mental illness

One example of a risk factor for a psychological disorder—poverty—crosses ethnic and gender lines. The incidence of serious psychological disorders is 2.5 times higher among those below the poverty line. Risk factors include- academic failure, birth complications, caring for those who are chronically ill or who have a neurocognitive disorder, child abuse and neglect, chronic insomnia, chronic pain, family disorganization and conflict, low birth weight, low socioeconomic status, medical illness, neurochemical imbalance, parental mental illness, parental substance abuse, personal loss and bereavement, poor work skills and habits, reading disabilities, sensory disabilities, social incompetence, stressful life events, substance abuse, trauma experiences

genes and mental illness

One research team identified 17 gene variations associated with typical anxiety disorder symptoms. Other teams have found genes associated specifically with OCD. If one identical twin has an anxiety disorder, the other is also at risk. Even when raised separately, identical twins may develop similar phobias. Some genes influence disorders by regulating brain levels of neurotransmitters. These include serotonin, which influences sleep, mood, and attending to threats. Genes also regulate the levels of glutamate, which heightens activity in the brain's alarm centers. Our experiences change our brain, paving new pathways. Traumatic fear-learning experiences can leave tracks in the brain, creating fear circuits within the amygdala. These fear pathways create easy inroads for more fear experiences.

deep brain stimulation (DBS)

Patients whose depression has resisted both drugs and ECT have benefited from an experimental treatment pinpointing a neural hub that bridges the thinking frontal lobes to the limbic system. Since 2003, researcher Helen Mayberg and her colleagues have used DBS to treat some 200 depressed patients via implanted electrodes in the subcallosal cingulate, a brain area that functions as the neural "sadness center." By comparing the brains of patients with and without depression, researcher Helen Mayberg identified a brain area (highlighted in red) that appears active in people who are depressed or sad, and whose activity may be calmed by deep-brain stimulation. How does DBS work? Psychiatrist stimulates electrodes implanted in "sadness centers" to calm those areas.

catastrophizing

Perhaps you can identify with the anxious students who, before a test, make matters worse with self-defeating thoughts: "This test's probably going to be impossible. Everyone seems so relaxed and confident. I wish I were better prepared. I'm so nervous I'll forget everything." Psychologists call this sort of relentless, overgeneralized, self-blaming behavior catastrophizing.

persistent depressive disorder

Persistent depressive disorder (also called dysthymia) is similar to major depressive disorder, but with milder depressive symptoms that last a much longer period of time. How is persistent depressive disorder diagnosed? Adults diagnosed with persistent depressive disorder (also called dysthymia) have experienced a mildly depressed mood more often than not for two years or more. They also display at least two of the following symptoms: difficulty with decision making and concentration, feeling hopeless, poor self-esteem, reduced energy levels, problems regulating sleep, problems regulating appetite

psychosurgery today

Precise, microscale psychosurgery is sometimes used in extreme cases such as uncontrollable seizures. Surgeons can deactivate the specific nerve clusters that cause or transmit the convulsions. MRI-guided precision surgery is also occasionally done to cut the circuits involved in severe obsessive-compulsive disorder. Because these procedures are irreversible, neurosurgeons perform them only as a last resort.

prozac

Prozac, an SSRI, partially blocks normal reuptake of the neurotransmitter serotonin; excess serotonin in synapse enhances its mood-lifting effect.

reinforcement with mental illnesses

Recall from Module 27, in operant conditioning, reinforcement is any event that strengthens the behavior it follows. Reinforcement helps maintain learned fears and anxieties. Anything that enables us to avoid or escape a feared situation can reinforce maladaptive behaviors. Fearing a panic attack, we may decide not to leave the house. Reinforced by feeling calmer, we are likely to repeat that behavior in the future. If washing our hands relieves our feelings of anxiety, we may wash our hands again when those feelings return.

dopamine and schizophrenia

Researchers studying the brains of schizophrenia patients after death found an excess number of dopamine receptors, including a six-fold excess for the dopamine receptor D4. What else is known about dopamine and its relationship to schizophrenia? A hyper-responsive dopamine system may intensify brain signals in schizophrenia, creating positive symptoms such as hallucinations and paranoia. Drugs that block dopamine receptors (antagonists) often lessen these symptoms. Drugs that increase dopamine levels (agonists), such as amphetamines and cocaine, sometimes intensify them.

diagnosis of DID

Skeptics also find it suspicious that the disorder has such a short and localized history. Between 1930 and 1960, the number of North American DID diagnoses averaged 2 per decade. By the 1980s, when the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) contained the first formal code for this disorder, the number had exploded to more than 20,000. Researchers cite findings of distinct body and brain states associated with differing personalities. Abnormal brain anatomy and activity can also accompany DID. Brain scans show shrinkage in areas that aid memory and detection of threat. Heightened activity appears in brain areas associated with the control and inhibition of traumatic memories.

nonsuicidal self-injury

Some people may engage in nonsuicidal self-injury (NSSI). Such behavior, though painful, is not fatal. Those who engage in NSSI may cut or burn their skin, hit themselves, insert objects under their nails or skin, or self-administer tattoos. Does NSSI lead to suicide? Usually not. Who is most at risk for nonsuicidal self-injury? Self-injury rates peak higher for females than for males. What does research show about people who engage in NSSI? People who engage in NSSI tend to experience bullying, harassment, and other life stress. They are generally less able to tolerate and regulate emotional distress. They are often extremely self-critical and struggle to communicate, solve problems, and perform academically.

diagnostic and statistical manual of mental disorders (DSM5), fifth edition

The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is a widely used system for classifying psychological disorders. Mental health professionals use the detailed diagnostic criteria in the DSM-5 to guide diagnosis and treatment. 5th edition- the conditions formerly called "autism" and "Asperger's syndrome" were combined under the label autism spectrum disorder. "Mental retardation" became intellectual disability. New disorders, such as hoarding disorder and binge-eating disorder, were added. Critics have long faulted the DSM for casting too wide a net and bringing "almost any kind of behavior within the compass of psychiatry." Some psychologists believe the DSM-5's even wider net will extend the pathologizing of everyday life. Another concern critics of the DSM-5 raise is the over-labeling of what might be common everyday feelings and practical responses to traumatic events. For example, The DSM also now classifies severe grief following the death of a loved one as a possible depressive disorder. Critics suggest that such grief could instead simply be considered a "normal" reaction to tragic life events. For those who experience these challenging symptoms, diagnosis and treatment can be a relief and bring improved functioning. In psychiatry and psychology, classification also aims to predict a disorder's future course, suggest appropriate treatment, and prompt research into its causes. To study a disorder, we must first name and describe it.

when a person should seek therapy

The American Psychological Association offers these common trouble signals. Feelings of hopelessness, deep and lasting depression, self-destructive behavior, such as substance abuse, disruptive fears, sudden mood shifts, thoughts of suicide, compulsive rituals, such as hand washing, hearing voices or seeing things that other's don't experience.

disorders around the world

The U.S. National Institute of Mental Health has estimated that just under 1 in 5 adult Americans currently have a "mental, behavioral, or emotional disorder (excluding developmental and substance use disorders)" or have had one within the past year. What disorders are most prevalent in America? Depressive disorder or bipolar disorder- 9.3%, phobia of a specific object or situation- 8.7%, social anxiety disorder- 6.8%, ADHD- 4.1%, PTSD- 3.5%, generalized anxiety disorder- 3.1%, schizophrenia- 1.1%, OCD- 1% How prevalent are disorders across the globe? A World Health Organization study—based on 90-minute interviews with thousands of people who were representative of their country's population—estimated the number of prior-year mental disorders in 28 countries. US has most, then Ukraine, Colombia, New Zealand, and France.

biology and natural selection driving fears

The biological perspective helps us understand why most people have more fear of heights than does Alex Honnold, shown at right in 2017 becoming the first person to free solo climb (no safety ropes) Yosemite National Park's El Capitan granite wall. We seem biologically prepared to fear threats faced by our ancestors. Our phobias focus on specific fears such as spiders, snakes, and other animals; enclosed spaces and heights; storms and darkness. Those fearless about these occasional threats were less likely to survive and leave descendants. Even in Britain, with only one poisonous snake species, people often fear snakes.

vulnerability-stress model (diathesis stress)

The biopsychosocial approach gave rise to the stress vulnerability model (also called the diathesis-stress model). This model suggests that genetic predispositions combine with environmental stressors to increase or decrease the likelihood of developing a psychological disorder.

emotions and schizophrenia

The expressed emotions of schizophrenia are often utterly inappropriate, split off from reality. Maxine laughed after recalling her grandmother's death. On other occasions, she cried when others laughed, or became angry for no apparent reason. How are emotions diminished in schizophrenia? Some people diagnosed with schizophrenia lapse into an emotionless flat affect state of no apparent feeling. Most people with schizophrenia have an impaired theory of mind—they have difficulty perceiving facial expressions and reading others' states of mind. Unable to understand others' mental states, those with schizophrenia struggle to feel sympathy and compassion. Those with schizophrenia may experience catatonia, characterized by motor behaviors ranging from a physical stupor —remaining motionless for hours—to senseless, compulsive actions, such as continually rocking or rubbing an arm, to severe and dangerous agitation.

antisocial personality disorder genetic variability

The genetic vulnerability of people with antisocial and unemotional tendencies appears as low arousal in response to threats. Awaiting aversive events, such as electric shocks or loud noises, they show little autonomic nervous system arousal. Other studies have found that preschool boys who later became aggressive or antisocial adolescents tended to be impulsive, uninhibited, unconcerned with social rewards, and low in anxiety. Researchers have found reduced activation in a murderer's frontal lobes. This brain area (shown at right) helps brake impulsive, aggressive behavior.

evidence-based clinical decision making

The ideal clinical decision making can be visualized as a three-legged stool, upheld by research evidence, clinical expertise, and knowledge of the patient.

dopamine and antipsychotics

The molecules of most conventional antipsychotic drugs are similar enough to molecules of the neurotransmitter dopamine to occupy its receptor sites and block its activity. Antipsychotic drugs act as an antagonist for dopamine. This finding reinforces the idea that an overactive dopamine system contributes to schizophrenia.

therapy and disorders

The more specific the problem, the greater the hope that psychotherapy might solve it. Those who experience phobias or panic or who are unassertive, can hope for improvement. Those with less-focused problems, such as depression and anxiety, usually benefit in the short term but often relapse later. Which therapies seem most effective with which disorders? Cognitive and cognitive-behavioral therapies—anxiety, posttraumatic stress disorder, insomnia, and depression. Behavioral conditioning therapies— specific behavior problems, such as bed-wetting, phobias, compulsions, marital problems, and sexual dysfunctions. Psychodynamic therapy—depression and anxiety. Nondirective (client-centered) counseling— mild to moderate depression

behavior therapy

The psychodynamic and humanistic therapies, the insight therapies, expect people's problems to diminish as they gain insight into their unresolved and unconscious tensions and as people get in touch with their feelings. Rather than delving deeply below the surface looking for inner causes, behavior therapists assume that problem behaviors are the problems. If maladaptive symptoms are learned behaviors, why not apply learning principles to replace them with new, constructive behaviors? As Pavlov and others showed, we learn various behaviors and emotions through classical conditioning. If we're attacked by a dog, we may thereafter have a conditioned involuntary fear response when other dogs approach. (Our fear generalizes, and all dogs become conditioned stimuli.) So, if phobias, anxiety and perhaps depression can be learned.... can they be unlearned?

social-cognitive perspective

The social-cognitive perspective explores how people's assumptions and expectations influence what they perceive. Many depressed people view life through the dark glasses of low self-esteem. Their intensely negative assumptions about themselves, their situation, and their future lead them to magnify bad experiences and minimize good ones. Expecting the worst, depressed people's self-defeating beliefs and their negative explanatory style feed their depression. Overthinking, or rumination, may also impact depression.

protective factors for mental illness

There are many factors that can help shield people against mental illness. Protective factors include- aerobic exercise, community offering empowerment, opportunity, and security, economic independence, effective parenting, feelings of mastery and control, feelings of security, high self-esteem, literacy, positive attachment and early bonding, positive parent-child relationships, problem-solving skills, resilient coping with stress and adversity, social and work skills, social support from friends and family

bipolar implications

Though bipolar disorder is much less common than major depressive disorder, it is more dysfunctional, claiming twice as many lost workdays early. Bipolar disorder is a potent predictor of suicide. Americans are twice as likely as people of other countries to have ever had a diagnosis of bipolar disorder.

important components to a lifestyle

We were designed for physical activity and social engagement. Our ancestors hunted, gathered and built in groups. Modern researchers have found that outdoor activity in a natural environment reduces stress and promotes health. Physicians and psychologists agree. Regular aerobic activity, playing basketball, walking, running, swimming, shooting a soccer ball with friends, contributes to overall physical and mental well-being. Aerobic exercise, 30 minutes a day, at least three times weekly (increases fitness and vitality, stimulates endorphins). Regular exercise rivals the healing power of antidepressant drugs. Studies show friendships and group involvement help satisfy the need to belong. Social connection, with less alone time and at least two meaningful social engagements weekly helps satisfy the human need to belong. As discussed in Module 24, adequate sleep is essential to physical and mental health. Adequate sleep, with a goal of 7 to 8 hours per night (increases energy and alertness, boosts immunity), a complete night's sleep improves mood and energy. An initial study showed that participants engaging in lifestyle change therapy experienced relief from depressive symptoms. 77% of those who completed the program experienced relief from depressive symptoms.

ADHD support and criticism

What are the arguments regarding the diagnosing of ADHD? Energetic child + boring school = ADHD overdiagnosis. Children are not meant to sit inside for hours in chairs. The youngest children in a class tend to be more fidgety and more often diagnosed. Older students may seek out stimulant ADHD prescription drugs-"good-grade pills." What are the long-term effects of drug treatment? Why the increased diagnoses worldwide? What do the supporters of ADHD diagnoses note? More diagnoses reflect increased awareness. ADHD is a real neurobiological disorder whose existence should no longer be debated." ADHD is associated with abnormal brain structure, abnormal brain activity patterns, and future risky or antisocial behavior.

electroconvulsive therapy (ECT)

a biomedical therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized patient. In ECT, the patient receives a general anesthetic and a muscle relaxant (to prevent bodily convulsions). A psychiatrist then delivers a brief pulse of electrical current, sometimes only to the brain's right side, which triggers a 30- to 60-second seizure. Within 30 minutes, the patient awakens and remembers nothing of the treatment or of the preceding hours. How effective is ECT? A Journal of the American Medical Association editorial concluded that "the results of ECT in treating severe depression are among the most positive treatment effects in all of medicine"

theraputic alliance

a bond of trust and mutual understanding between a therapist and client, who work together constructively to overcome the client's problem

unconditional positive regard

a caring, accepting, nonjudgmental attitude, which Carl Rogers believed would help clients develop self-awareness and self-acceptance Given a nonjudgmental, grace-filled environment that provides unconditional positive regard, people may accept even their worst traits and feel valued and whole.

rational-emotive behavior therapy (REBT)

a confrontational cognitive therapy, developed by Albert Ellis, that vigorously challenges people's illogical, self-defeating attitudes and assumptions. According to Albert Ellis, the creator of rational-emotive behavior therapy (REBT), many problems arise from irrational thinking.

schizophrenia

a disorder characterized by delusions, hallucinations, disorganized speech, and/or diminished, inappropriate emotional expression. During their most severe periods, people with schizophrenia live in a private inner world, preoccupied with the strange ideas and images that haunt them. The word itself means "split" (schizo) "mind" (phrenia). It refers not to a multiple personality split but rather to the mind's split from reality. This year, 1 in 100 people will join an estimated 21 million others worldwide who have schizophrenia. This disorder knows no national boundaries, and it typically strikes as young people are maturing into adulthood. Men tend to be struck earlier, more severely, and more often.

posttraumatic stress disorder (PTSD)

a disorder characterized by haunting memories, nightmares, hypervigilance, social withdrawal, jumpy anxiety, numbness of feeling, and/or insomnia that lingers for four weeks or more after a traumatic experience. Typical symptoms include recurring haunting memories and nightmares, laser-focused attention to possible threats, social withdrawal, jumpy anxiety, and trouble sleeping. Many military war veterans participate in an intensive recovery program using deep breathing, massage, and group and individual discussion techniques to treat their PTSD. Why do some develop PTSD after a traumatic event? About half of us will experience at least one traumatic event in our lifetime, yet 5 to 10% of people develop PTSD after a traumatic event and others don't. One factor that might explain why some develop PTSD and others do not might be the amount of trauma-related emotional distress. The higher the distress, such as the level of physical torture suffered by prisoners of war, the greater the risk for posttraumatic symptoms. Some people may have a more sensitive emotion-processing limbic system that floods their bodies with stress hormones, which explains why PTSD may coexist with another disorder. Twins, compared with non-twin siblings, more commonly share PTSD cognitive risk factors. And the odds of experiencing PTSD after a traumatic event are about two times higher for women than for men.

obsessive-compulsive disorder (OCD)

a disorder characterized by unwanted repetitive thoughts (obsessions), actions (compulsions), or both. Obsessive thoughts are unwanted and so repetitive it may seem they will never go away. Compulsive behaviors are often responses to those thoughts. Rituals and fussy behaviors cross the fine line between normality and disorder when they persistently interfere with everyday living and cause distress. Obsessions (repetitive thoughts) and percentage reporting symptom- concern with dirt, germs, or toxins (40%), something terrible happening (fire, death, illness- 24%), symmetry order or exactness (17%). Compulsions (repetitive behaviors) and percentage reporting symptom- excessive hand washing, bathing, toothbrushing, and grooming (85%), repeating rituals (in/out of a door, up/down from a chair)- 51%, checking doors, locks, appliances, car brakes, homework (46%) What is the difference between a normal behavior and one suggesting OCD? Normal- Checking that you locked the door is normal. Washing your hands thoroughly is normal.Organizing your markers and pens in rainbow order is normal. Sign of disorder- Checking 10 times that you locked the door is not. Washing your hands so often that your skin becomes raw is not. Not being able to use a pen unless it is in rainbow order is not.

bipolar disorder

a disorder in which a person alternates between the hopelessness and lethargy of depression and the overexcited state of mania (formerly called manic-depressive disorder.) When a depressive episode ends, a euphoric, overly talkative, wildly energetic, and extremely optimistic state called mania follows. But before long, the mood either returns to normal or plunges again into depression. What does research show about the manic phase of bipolar disorder? During the manic phase, people with bipolar disorder typically have little need for sleep. They show fewer sexual inhibitions. Their positive emotions persist abnormally. Their speech is loud, flighty, and hard to interrupt. They find advice irritating. They need protection from their own poor judgment, which may lead to reckless spending or unsafe sex. Thinking fast feels good, but it also increases risk taking. In milder forms, mania's energy and flood of ideas can fuel creativity. Clusters of genes associated with high creativity increase the likelihood of having bipolar disorder, and risk factors for developing bipolar disorder predict greater creativity.

conversion disorder

a disorder in which a person experiences a very specific physical symptom that is not compatible with recognized medical or neurological conditions (Also called functional neurological symptom disorder.) A patient with a conversion disorder might, for example, lose sensation in a way that makes no neurological sense. Other conversion disorder symptoms might be unexplained paralysis, blindness, or an inability to swallow.

illness anxiety disorder

a disorder in which a person interprets normal physical sensations as symptoms of a disease (Formerly called hypochondriasis.) In this relatively common disorder, people interpret normal sensations (a stomach cramp today, a headache tomorrow) as symptoms of a dreaded disease. Sympathy or temporary relief from everyday demands may reinforce such complaints.

delusion

a false belief, often of persecution or grandeur, that may accompany psychotic disorders. People with schizophrenia also have disorganized, fragmented thinking, often distorted by false beliefs called delusions. If they have paranoid tendencies, they may believe they are being threatened or pursued.

binge-eating disorder

a feeding and eating disorder characterized by significant binge-eating episodes, followed by distress, disgust, or guilt, but without the compensatory behavior (purging, fasting or excessive exercise) that marks bulimia nervosa. A U.S. National Institute of Mental Health-funded study reported that, at some point during their lifetime, 0.6% of Americans met the criteria for anorexia, 1% for bulimia, and 2.8% for binge-eating disorder.

anorexia nervosa

a feeding and eating disorder in which a person (usually an adolescent female) maintains a starvation diet despite being significantly underweight; sometimes accompanied by excessive exercise. Anorexia nervosa typically begins as a weight-loss diet. People with anorexia drop significantly below normal weight, yet they feel fat, fear being fat, diet obsessively, and sometimes exercise excessively. About half of those with anorexia display a binge-purge-depression cycle.

bulimia nervosa

a feeding and eating disorder in which a person's binge eating (usually of high-calorie foods) is followed by inappropriate weight-loss promoting behavior, such as vomiting, laxative use, fasting, or excessive exercise. Bulimia nervosa, unlike anorexia nervosa, is marked by weight fluctuations within or above normal ranges, making the condition easier to hide. Bulimia may also be triggered by a weight-loss diet, broken by gorging on forbidden foods.

client-centered therapy

a humanistic therapy, developed by Carl Rogers, in which the therapist uses techniques such as active listening within an accepting, genuine, empathic environment to facilitate clients' growth (Also called person-centered therapy). In this nondirective therapy, the client leads the discussion. The therapist listens, without judging or interpreting, and refrains from directing the client toward certain insights. Believing that most people possess the resources for growth, Carl Rogers encouraged therapists to foster that growth by exhibiting acceptance, genuineness, and empathy. When therapists enable their clients to feel unconditionally accepted, drop their facades and genuinely express their true feelings, and empathically sense and reflect their clients' feelings, the clients may deepen their self-understanding and self-acceptance.

antisocial personality disorder

a personality disorder in which a person (usually a man) exhibits a lack of conscience for wrongdoing, even toward friends and family members; may be aggressive and ruthless or a clever con artist. People with antisocial personality disorder can display symptoms by age 8. Their lack of conscience becomes plain before age 15, as they begin to lie, steal, fight, or display unrestrained sexual behavior. People with antisocial personality disorder (sometimes called sociopaths or psychopaths) may show lower emotional intelligence—the ability to understand, manage, and perceive emotions.

cognitive-behavioral therapy (CBT)

a popular integrative therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior). Cognitive-behavioral therapy (CBT) takes a combined approach to depression and other disorders. This widely practiced integrative therapy aims to alter not only the way people think but also the way they act.

meta-analysis

a procedure for statistically combining the results of many different research studies. Simply said, meta-analyses give us the bottom-line result of lots of studies. Rather than conducting one study, researchers look through the results of dozens, even hundreds of similar studies and summarize the data using statistics to paint a larger picture.

psychosis

a psychological disorder in which a person loses contact with reality, experiencing irrational ideas and distorted perceptions

somatic symptom disorder

a psychological disorder in which the symptoms take a somatic (bodily) form without apparent physical cause (Formerly called somatoform disorder). One person may have a variety of complaints—vomiting, dizziness, blurred vision, difficulty in swallowing. Another may experience severe and prolonged pain.

lobotomy

a psychosurgical procedure once used to calm uncontrollably emotional or violent patients. In the 1930s, Portuguese physician Egas Moniz developed what would become the best-known psychosurgical operation: the lobotomy. Moniz found that cutting the nerves connecting the frontal lobes with the emotion-controlling centers of the inner brain calmed uncontrollably emotional and violent patients. Failed lobotomy- This 1940 photo shows Rosemary Kennedy (center) at age 22 with brother (and future U.S. president) John and sister Jean. A year later her father, on medical advice, approved a lobotomy that was promised to control her reportedly violent mood swings. The procedure left her confined to a hospital with an infantile mentality until her death in 2005 at age 86.

what is Dissociative Identity Disorder (DID)?

a rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities (Formerly called multiple personality disorder.) The disease is characterized by two or more distinct identities—each with its own voice and mannerisms— seem to control a person's behavior at different times. Thus, the person may be prim and proper one moment, loud and flirtatious the next. Typically, the original personality denies any awareness of the other(s). Psychologist Nicholas Spanos asked college students to pretend they were accused murderers being examined by a psychiatrist. Under hypnosis, most spontaneously expressed a second personality. Perhaps dissociative identities are simply a more extreme version of the varied "selves" we normally present—as when we display a goofy, loud self while hanging out with friends, and a subdued, respectful self around grandparents.

major depressive disorder

a state of hopelessness and lethargy lasting several weeks or months. How is major depressive disorder diagnosed? at least five signs of depression (including either depressed mood or loss of interest or pleasure) last two or more weeks. The DSM-5 classifies major depressive disorder as the presence of at least five of the following symptoms over a two-week period of time (minimally including depressed mood or reduced interest): depressed mood most of the time, dramatically reduced interest or enjoyment in most activities most of the time, significant challenges regulating appetite and weight, significant challenges regulating sleep, physical agitation or lethargy, feeling listless or with much less energy, feeling worthless, or feeling unwarranted guilt, problems in thinking, concentrating, or making decisions, thinking repetitively of death and suicide.

psychological disorder

a syndrome marked by a clinically significant disturbance in an individual's cognition, emotion regulation, or behavior. Significantly disturbed thoughts, emotions, or behaviors are dysfunctional or maladaptive—they interfere with normal day-to-day life. For instance, believing your home must be thoroughly cleaned every weekend is not a disorder. But if cleaning rituals interfere with work and leisure, they may be signs of a disorder.

aversive conditioning

a type of counterconditioning that associates an unpleasant state (such as nausea) with an unwanted behavior (such as drinking alcohol). Aversive conditioning procedure is simple: It associates the unwanted behavior with unpleasant feelings. For example, to treat nail biting, the therapist may suggest painting the fingernails with a nasty-tasting nail polish. After repeatedly drinking alcohol mixed with a drug that produces severe nausea, some people with a history of alcohol use disorder develop at least a temporary conditioned aversion to alcohol.

systematic desensitization

a type of exposure therapy that associates a pleasant relaxed state with gradually increasing anxiety- triggering stimuli. Behavior therapists utilizing the tool of systematic desensitization might have an anxious patient develop an anxiety hierarchy of stimuli that are causing fear and help the patient to work through each step on the hierarchy, getting closer and closer to the fear-producing stimulus. At each level of the hierarchy relaxation methods are practiced until the client is calm at that level of exposure. For instance, a person with a phobia of flying may first learn to relax when looking at airline sale ads in the paper, then learn to relax when driving by an airport. The therapist may then have the patient visit a museum of aircraft and work on relaxation techniques. As each new level or step of fear is mastered with relaxation, the patient soon attempts to sit on a plane or fly on a plane.

generalized anxiety disorder

an anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal. Out-of-control, agitated feelings suggest generalized anxiety disorder, which is marked by excessive and uncontrollable worry that persists for six months or more. People with this condition (2/3 are women) worry continually, and they are often jittery, agitated, and sleep-deprived. The person usually cannot identify, and therefore relieve or avoid, the tension's cause. To use Sigmund Freud's term, the anxiety is free-floating (not linked to a specific stressor or threat). Generalized anxiety disorder is often accompanied by depressed mood, but even without depression it tends to be disabling. Moreover, it may lead to physical problems, such as high blood pressure, sleep disturbances and other issues.

phobia

an anxiety disorder marked by a persistent, irrational fear and avoidance of a specific object, activity, or situation. Specific phobias may focus on animals, insects, heights, blood, or close spaces- heights, animals, enclosed spaces, blood, water, storms, flying, being alone.

panic disorder

an anxiety disorder marked by unpredictable, minutes-long episodes of intense dread - panic attacks- in which a person may experience terror and accompanying chest pain, choking, or other frightening sensations; often followed by worry over a possible next attack. For the 3% of people with panic disorder, panic attacks are recurrent. These anxiety tornados strike suddenly, wreak havoc, and disappear, but are not forgotten. Golfer Charlie Beljan experienced what he later learned were panic attacks during an important tournament. His thumping heartbeat and shortness of breath led him to think he was having a heart attack. Overcoming panic- Hospital tests revealed that Beljan's symptoms were not related to a physical illness. He recovered, went on to win $846,000, and has become an inspiration to others.

virtual reality exposure therapy

an anxiety treatment that progressively exposes people to simulations of their greatest fears, such as airplane flying, spiders, or public speaking

eclectic approach

an approach to psychotherapy that uses techniques from various forms of therapy. Some therapists combine techniques. Indeed, many psychotherapists describe their approach as eclectic, using a blend of therapies. For instance, a therapist may use dream interpretation or free association during sessions (psychoanalytic), but also help you to change your flawed or faulty thinking patterns (cognitive).

token economy

an operant conditioning procedure in which people earn a token (a chip, stamp or other non-monetary item) for exhibiting a desired behavior and can later exchange tokens for privileges or treats. For instance, when people display a desired behavior, such as getting out of bed, washing, dressing, eating, talking coherently, cleaning up their rooms, or playing cooperatively, they receive a token or plastic coin. Later, they can exchange a number of these tokens for rewards, such as candy, TV time, day trips, or better living quarters.

counterconditioning

behavior therapy procedures that use classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors; include exposure therapies and aversive conditioning. Pairing the fear-provoking stimulus with new, positive responses, can change the behavior.

exposure therapies

behavioral techniques, such as systematic desensitization and virtual reality exposure therapy, that treat anxieties by exposing people (in imaginary or actual situations) to the things they fear and avoid. These therapies, in a variety of ways, try to change people's reactions by repeatedly exposing them to stimuli that trigger unwanted reactions. With repeated exposure to what they normally avoid or escape, people adapt.

antianxiety drugs

drugs used to control anxiety and agitation. Like alcohol, antianxiety drugs, such as Xanax or Ativan, depress central nervous system activity. Some antianxiety drugs have been successfully used in combination with psychological therapy to enhance exposure therapy's extinction of learned fears and to help relieve the symptoms of posttraumatic stress disorder and obsessive-compulsive disorder.

antidepressant drugs

drugs used to treat depression, anxiety disorders, obsessive-compulsive disorder, and posttraumatic stress disorder. Many antidepressants work by increasing the availability of neurotransmitters, such as norepinephrine or serotonin, which elevate arousal and mood and are scarce when a person experiences feelings of depression or anxiety.

antipsychotic drugs

drugs used to treat schizophrenia and other forms of severe thought disorder. First-generation antipsychotic drugs, such as chlorpromazine (Thorazine), dampened responsiveness to irrelevant stimuli. They provided the most help to patients experiencing positive (actively inappropriate) symptoms of schizophrenia, such as auditory hallucinations and paranoia. Antipsychotics also have powerful side effects. Some produce sluggishness, tremors, and twitches similar to those of Parkinson's disease Long-term use of antipsychotics can produce tardive dyskinesia, with involuntary movements of the facial muscles (such as grimacing), tongue, and limbs.

active listening

empathic listening in which the listener echoes, restates, and clarifies. To Rogers, "hearing" was active listening. The client-centered therapist echoes, restates, and seeks clarification of what the person expresses (verbally or nonverbally) and acknowledges those expressed feelings. Active listening is now an accepted part of counseling practices in many schools, colleges, and clinics. How can we listen more actively? 1- Paraphrase- Check your understanding by summarizing the person's words out loud, in your own words. 2- Invite clarification- "What might be an example of that?" may encourage the person to say more. 3- Reflect feelings- "It sounds frustrating" might mirror what you're sensing from the person's body language and intensity.

OCD-related disorders

hoarding disorder (cluttering one's space with acquired possessions one can't let go), body dysmorphic disorder (preoccupation with perceived body defects), trichotillomania (hair-pulling), excoriation disorder (excessive skin-picking)

interpretation

in psychoanalysis, the analyst's noting supposed dream meanings, resistances, and other significant behaviors and events in order to promote insight. If offered at the right moment, the therapist's interpretation—of, say, your not wanting to talk about your mother or call, text, or message her—may illuminate the underlying wishes, feelings, and conflicts you are avoiding.

resistance

in psychoanalysis, the blocking from consciousness of anxiety-laden material. To the analyst, the mental blocks and editing that occur during free association indicate resistance. They hint that anxiety lurks and you are defending against sensitive material. The analyst will note your resistance and then provide insight into its meaning.

personality disorders

inflexible and enduring behavior patterns that impair social functioning. The inflexible and enduring behavior patterns of personality disorders interfere with social functioning. The ten disorders in DSM-5 tend to form three clusters characterized by anxiety, eccentric behavior or dramatic and impulsive behavior.

social anxiety disorder

intense fear and avoidance of social situations (formerly called social phobia). People with social anxiety disorder become extremely anxious in social settings where others might judge them, such as parties, class presentations, or even eating in public. To stave off anxious thoughts and feelings (including physical symptoms such as sweating and trembling), they may avoid going out at all.

negative symptoms schizophrenia

negative symptoms- Those with negative symptoms may exhibit an absence of emotion in their voices, expressionless faces, or unmoving—mute and rigid—bodies. Negative symptoms are appropriate behaviors that are not present.

anxiety disorders

psychological disorders characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety. Four anxiety disorders will be covered in this Module: Social anxiety disorder, generalized anxiety disorder, panic disorder, phobia and agoraphobia

mood disorders

psychological disorders characterized by emotional extremes

psychosurgery

surgery that removes or destroys brain tissue in an effort to change behavior Because its effects are irreversible, psychosurgery—surgery that removes or destroys brain tissue—is the most drastic and least-used biomedical intervention for changing behavior.

repetitive transcranial magnetic stimulation (rTMS)

the application of repeated pulses of magnetic energy to the brain; used to stimulate or suppress brain activity Repetitive transcranial magnetic stimulation (rTMS)—is performed on wide-awake patients over several weeks. Repeated pulses surging through a magnetic coil held close to the skull can stimulate or suppress activity in areas of the cortex. The rTMS procedure produces no memory loss or other serious side effects, aside from possible headaches. The psychiatrist sends a painless magnetic field through the skull to the surface of the cortex to alter brain activity.

lifestyle

the choices we make to exercise or to sit on the couch playing games, to eat whole, healthy foods or grab quick packaged and processed goodies, the relationships we choose to nurture, the activities we select for recreation, how we relax, and how religious or spiritually engaged we are— affects our mental health.

medical model

the concept that diseases, in this case psychological disorders, have physical causes that can be diagnosed, treated, and, in most cases, cured, often through treatment in a hospital. By the 1800s, researchers discovered that syphilis infects the brain and distorts the mind. Researchers began to look for physical causes of other mental disorders and for treatments that would cure them. Hospitals replaced asylums, and the medical model of mental disorders was born.

resilience

the personal strength that helps most people cope with stress and recover from adversity and even trauma. Faced with unforeseen trauma, most adults exhibit resilience. More than 9 in 10 New Yorkers, although stunned and grief-stricken by 9/11, did not have a dysfunctional stress reaction. Especially resilient were those who enjoyed supportive close relationships and who had not recently experienced other stressful events.

psychopharmacology

the study of the effects of drugs on mind and behavior. Since the 1950s, discoveries in psychopharmacology have revolutionized the treatment of people with severe disorders, liberating hundreds of thousands from hospital confinement. Thanks to drug therapy and local community mental health programs, the resident population of U.S. state and county mental hospitals is now a small fraction of what it was in the mid-twentieth century. Almost any new treatment, including drug therapy, is greeted by an initial wave of enthusiasm as many people apparently improve.

insight theories

therapies that aim to improve psychological functioning by increasing a person's awareness of underlying motives and defenses. Because they share the goal of helping patients gain insight into their problems, the psychodynamic and humanistic therapies are often referred to as insight therapies. But humanistic therapies differ from psychodynamic therapies in many ways.

group therapy

therapy conducted with groups rather than individuals, providing benefits from group interaction. Benefits: helps more people and costs less per person than individual therapy, learning that others have similar problems, getting feedback on new ways of behaving

psychodynamic therapy

therapy deriving from the psychoanalytic tradition; views individuals as responding to unconscious forces and childhood experiences, and seeks to enhance self-insight. Although influenced by Freud's ideas, psychodynamic therapists don't talk much about id-ego-superego conflicts. Instead they try to help people understand their current symptoms by focusing on important relationships, including childhood experiences and the therapist-client relationship. Client-therapist meetings take place once or twice a week (rather than several times weekly) and often for only a few weeks or months. Rather than lying on a couch, out of the therapist's line of vision, clients meet with their therapist face-to-face and gain perspective by exploring defended-against thoughts and feelings.

cognitive therapy

therapy that teaches people new, more adaptive ways of thinking; based on the assumption that thoughts intervene between events and our emotional reactions. The cognitive therapies assume that our thinking colors our feelings. Between an event and our response lies the mind. Self-blaming and overgeneralized explanations of bad events feed depression. Anxiety arises from an "attention bias to threat." The person's emotional reactions are produced not directly by the event but by the person's thoughts in response to the event.

family therapy

therapy that treats people in the context of their family system and views an individual's unwanted behaviors as influenced by, or directed at, other family members. Benefits- help family members identify their roles within the family's social system, improve communication, discover new ways of preventing or resolving conflicts

psychotherapy

treatment involving psychological techniques; consists of interactions between a trained therapist and someone seeking to overcome psychological difficulties or achieve personal growth. The therapist may explore a client's early relationships, encourage the client to adopt new ways of thinking, or coach the client in replacing old behaviors with new ones.