Crane 5.1 Abnormal psychology

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Crane 5.1 Abnormal psychology

• Concepts of Normality

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Defining Abnormality

• Abnormality
• The subjective experience of feeling not normal

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7 Criteria of Abnormal Behavior

• Rosenhan and Seligman (1984)
• Sufferingexperiencing distress or discomfort
• Maladaptivenessengage in difficult behaviors
• Irrationalityincomprehensible or unable to
  communicate
• Unpredictabilityact in ways that are unexpected
• Vividness and unconventionalityexperience
  different things
• Observer discomfortmakes others embarrassed
• Violation of moral or ideal standardshabitually
  break

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Mental Health Criteria

• Jahoda (1958) 6 Characteristics of Mental Health
• Efficient self-perception
• Realistic self-esteem and acceptance
• Voluntary control of behaviour
• True perception of the world
• Sustaining relationships and giving affection
• Self-direction and productivity
• Jahoda does not account for societal or cultural
  differences

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Classifying Abnormal Behaviour

• Use the 7 Criteria of Abnormal Behaviour
  (Rosenhan and Seligman, 1984) and the Mental
  Health Criteria (Jahoda, 1958) to classify each
• Transvestitism (p.530)
• Nail Biting
• Mathematics Anxiety (p.50)
• Talking to Oneself (p.285)
• Homosexuality
• Narcissistic Personality Disorder (p.661)
• Psychosis Risk Syndrome (worrying)
• Should these be listed in the Diagnostic and
  Statistical Manual of Mental Disorders (DSM IV)

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Is it abnormal? What to call it?

• Abnormal Behaviour
• Mental Illness (Psychopathology)
• Psychological illness that is based on the
  observed symptoms of a patient.
• Problems of the Brain OR Problems in Living?
• Psychological Disorder

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How do we diagnose Psychological Disorders?

• ABCS of Psychological Disorders
• Affective symptoms emotional elements (fear,
  sadness, anger)
• Behavioural symptoms observational behaviours
  (crying, physically withdrawn, pacing)
• Cognitive symptoms ways of thinking (pessimism,
  personalization, self-image)
• Somatic symptoms physical symptoms (facial
  twitching, stomach cramping, absence of
  menstruation)

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Diagnosing Mental Disorders

• Reading Disorder
• Separation Anxiety Disorder
• Caffeine-Induced Sleep Disorder
• Schizophrenia
• Agoraphobia
• Bipolar Disorder
• Hypochondrias
• Bulimia Nervosa
• Nightmare Disorder
• Antisocial Personality Disorder
• Hypersomnia Type

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Validity and Reliability of Diagnosis

• Reliable
• Should be possible for different clinicians to
  arrive at the same diagnosis for the same
  individual
• Valid
• Should be able to classify a real pattern of
  symptoms which can then lead to effective
  treatment
• Is the DSM-IV valid? (Ethnocentrism)
• Rosenhan (1973), READ p. 142
• http//www.youtube.com/watch?v8ZOcfllWBq8feature
  related

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Ethical Considerations in diagnosis

• Stigmatizedsocially exclude people
• Experience prejudice and discrimination
• Self-Fulfilling Prophecy
• Act as they think is expected of them

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Biases in diagnosis

• Racial and Ethnic
• Jenkins-Hall and Sacco (1991)
• Are African American women less socially
  competent?
• Confirmation Bias
• Rosenhan (1973)
• If I go in for evaluation, is it assumed that I
  have a problem?
• Powerlessness and Depersonalization
• Institutionalization
• Verbal and physical abuse

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Cultural Considerations

• Culture-Bound Syndromes
• Depression (absent in Asian societies)
• Reporting Bias
• Data based on hospital admissions
• Chinamental illness carries stigma
• Difference in Symptoms
• Affective (emotional symptoms)
• Somatic (physiological symptoms)
• Culture Blindness
• Whose cultural symptoms are the norm?

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General concerns about Culture and Validity

• Examine p. 199 (Jamison book)
• Read Supplemental book (p.157)

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Apply your knowledge

• Read the description of Anne on p. 147 and answer
  the following questions.

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Crane 5.2 Abnormal Psychology Psychological
Disorders

• Making a diagnosis (Symptoms and Causes)
• Symptomologyidentification of symptoms
• Examine symptoms of major depressive disorder,
• Crane, 149 (Symptoms of Major Depressive Order)
• Etiologywhy people suffer from a disorder
• Biological
• Cognitive
• Sociocultural Factors

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Diagnosing depression in College Students

• Depression can strike early, undetected
• ABC News Article (Discussion)
• http//abcnewsradioonline.com/health-news/depressi
  on-can-strike-early-undetected.html

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Environmental Causes--Analysis

• Seasonal Affective Disorder
• Have you cried today?
• August
• Men (4) Women (7)
• December
• Men (8) Women (21)

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• This is my depressed stance. When you're
  depressed, it makes a lot of difference how you
  stand. The worst thing you can do is straighten
  up and hold your head high because then you'll
  start to feel better. If you're going to get any
  joy out of being depressed, you've got to stand
  like this.
• Charlie Brown

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• Depression is nourished by a lifetime of
  ungrieved and unforgiven hurts.
• Penelope Sweet

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• Depression is not sobbing and crying and giving
  vent, it is plain and simple reduction of
  feeling...People who keep stiff upper lips find
  that it's damn hard to smile.
• Judith Guest

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• Hiding in my room, safe within my womb,I touch
  no one and no one touches me.I am a rock,I am
  an island.And a rock feels no painAnd an
  island never cries.
• Paul Simon (VIDEO BREAK!!!)

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• Nobody tells me. Nobody keeps me informed. I
  make it 17 days come Friday since anybody spoke
  to me.
• Eeyore

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• After all, what are birthdays? Here today and
  gone tomorrow.
• Eeyore

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• Depressionis well adapted to make a creature
  guard itself against any great or sudden evil.
• Darwin (1887)

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Crane 5.2

• Making a diagnosis (Examination of Data)
• Prevalence Ratetotal of cases in a population
• Lifetime Prevalence-- of the population that
  will experience the disorder at some time in
  their life
• Onset Ageaverage age at which it is likely to
  appear

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Crane 5.2

• Examine Depression (blue box) and Be a thinker,
  Crane, 149.

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Analyze paper 2

• Discuss Cultural and Ethical considerations in
  Diagnosis
• Culture Bound Syndromes (depression in Asia)
• Culture Blindness in Diagnosis (normative white)
• Social Class
• Stressful Life-Experiences (coping resources)
• Biological Differences (fluctuations in hormones)
• Gender and the Environment (power relationships)

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Can Facebook make us depressed?

• http//abcnews.go.com/GMA/video/facebook-blues-127
  96540

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Quick Write

• On your notes, write down as many symptoms of
  depression as you can think of

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Major Depressive Disorder--Symptoms

• Two weeks of either a depressed mood or a loss of
  interest and pleasure
• Additional Requirements (must have 4 additional)
• Insomnia
• Appetite Disturbances
• Loss of Energy
• Feelings of Worthlessness
• Thoughts of suicide
• Difficulty concentrating

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Center for Epidemiologic Studies Depression Scale
(CES-D)

• A Screening Test for Depression
• http//counsellingresource.com/quizzes/cesd/index.
  html

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Prevalence and Recurrence

• Prevalence Rate
• Affects 15 of people
• ¼ of all psychiatric admissions in the UK (1980)
• 2-3 times more common in women than men
• More frequent among low socio-economic groups
• More frequent among young adults
• Recurrent 80 subsequent episode (3-4 months/ 4
  times)
• Making diagnosis Is the person really suffering
  from depression?

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Prevalence and Recurrence

• 1 reason people seek mental health services
• Leading cause of disability worldwide
• Can depression be a form of psychic hibernation?
• Slows us down
• Defuses aggression
• Restrains risk taking
• Redirect energy to positive experiences
• Darwin anyone???

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Is it depression or dysthymic disorder?

• The difference between a blue mood after bad
  news and a mood disorder is like the difference
  between gasping for breath after a hard run and
  being chronically short of breath
• Myers

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Etiology of Major Depressive Disorder (Causes)

• Is depression a response to a single event?
• Or, to long-term consequences (continual stress
  and disappointment)
• Does stress always lead to depression?

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Integrative Analysis Chart

• Using your Crane text (p.151-156), construct an
  integrative analysis chart on the causes/ factors
  of DEPRESSION

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Research in Psychology

• Read/ Discuss
• Crane p.153
• Crane p.156
• HW Crane p.155
• Discuss the interaction of biological,
  cognitive, and sociocultural factors in abnormal
  behavior (depression).

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Etiology and Treatment

• Must we know the causes prior to providing
  treatment?
• Can we identify specific causes of disorders?
• Examine your integrative analysis chart

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Treatment (Adv. vs. Disadv.)

• Biological
• Drug Therapy
• Cognitive (Psychological)
• Individual Therapies
• Social
• Group Therapy

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Biomedical

• Drugs are used due to a chemical imbalance
• Antidepressants
• Elevate the mood of people suffering from
  depression
• Serve to increase or decrease levels of
  neurotransmitters
• Selective serotonin re-uptake inhibitors (SSRIs)
• Prozac (fluoxetine)

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BiomedicalEvaluation

• Effective in short term treatment (60-80)
• Kirsch and Sapirstein (1998/2008))
• (1998) Meta-analysis of 19 studies?
• (2008) review of 47 clinical trials?

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BiomedicalEvaluation

• Effective in short term treatment (60-80)
• Kirsch and Sapirstein (1998/2008))
• (1998) Meta-analysis of 19 studies?25 more
  effective than placebos, no more effective than
  tranquillizers
• (2008) review of 47 clinical trials? not more
  effective than placebos

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BiomedicalEvaluation

• Blumenthal et al. (1999)
• __________ was as effective as SSRIs
• Leuchter and Witte (2002)
• Drug treatment was as effective as ____________!
• Changes to same area of brain (_________ _______)

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BiomedicalEvaluation

• Blumenthal et al. (1999)
• EXERCISE was as effective as SSRIs
• Leuchter and Witte (2002)
• Drug treatment was as effective as PLACEBOS!
• Changes to same area of brain (PREFRONTAL CORTEX)
• Drug? lessoned activity in prefrontal cortex
• Placebo? increased activity in prefrontal cortex

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BiomedicalEvaluation

• Elkin et al. (1989) 28 clinicians/ 280 patients
• G 1 Antidepressant drug (imipramine)
• G 2 Interpersonal therapy (IPT)
• G 3 Cognitive- Behavioral therapy (CBT)
• G C Placebo pill w/ weekly therapy sessions
• All patients were assessed at the
• Start
• 16 weeks
• 18 months
• What did they find???

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BiomedicalEvaluation

• Elkin et al. (1989) 28 clinicians/ 280 patients
• G 1 Antidepressant drug (imipramine) 50
• G 2 Interpersonal therapy (IPT) 50
• G 3 Cognitive- Behavioral therapy (CBT) 50
• G C Placebo pill w/ weekly therapy sessions 29
• Is it acceptable to give a patient a placebo pill
  instead of real antidepressants?

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Cognitive-Behavioural Therapy (CBT)

• Distorted Cognitions cause depression?
• Cognitive psychologists (Aaron Beck, 1960s)
  developed Cognitive ____________.

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Cognitive-Behavioural Therapy (CBT)

• Beck Cognitive Restructuring
• Idea!!! Negative self-schemas bias a persons
  thinking
• 1. Identify negative, self critical thoughts
• 2. Note the connection between negative thought
  and depression
• 3. Examine each negative thought and decide
  whether it can be supported
• 4. Replace distorted negative thoughts with
  realistic interpretations of each situation

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Cognitive-Behavioural Therapy (CBT)

• 1. Aim Identify and Correct faulty cognitions
  and unhealthy behaviors (Cognitive Restructuring)
• Examine 6 patterns of faulty thinking on Crane
  175.
• With a partner, come up with 3 examples for each
  of the 6 patterns of faulty thinking

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Cognitive-Bahavioural Therapy (CBT)

• 2. Aim Encourage people to increase gradually
  any activities that could be rewarding
• Teasdale (1997)
• Teach the client meta-awareness, the ability to
  think about their own thoughts

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CBTEvaluation

• Riggs et al. (2007) studied effectiveness of CBT
  in combination with either a placebo or an SSRI
• 126 adolescents suffering from depression and
  substance abuse
• Found
• 67 Placebo and CBT
• 76 SSRI and CBT
• Were judged as Very much improved

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CBTEvaluation

• Criticized for focusing on symptoms rather than
  causes

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Group TreatmentEvaluation

• Couples Therapy (marital problems)
• Toseland and Siporin (1986) meta-analysis (74)
• 75 Group treatment was as effective as
  individual treatment in
• 25 Group treatment was more effective
• Is group therapy more cost effective?

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Group TreatmentEvaluation

• McDermut et al. (2001) meta-analysis (48 studies)
• 43 studies showed reduction in depressive
  symptoms following group psychotherapy
• 9 showed no difference between group and
  individual
• 8 showed CBT to be more effective than group

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Group TreatmentEvaluation

• Factors to consider
• Group Cohesion all people must belong to the
  group
• Exclusion any characteristics that should be
  excluded?
• Substance abusers, married men, certain health
  conditions
• Relationship with Therapist therapist is not
  one of us

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Etiology and Treatment

• Multifaceted Approach to Treatment
• Biopsychosocial (bio-psycho-social) perspective