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Abnormal Psychology




Treatment of Abnormal Behavior

  1. Drug therapy (psychopharmacology)

    1. Anxiolytics: used primarily to reduce anxiety (e.g., benzodiazepines like Valium, Xanax, Ativan, Klonopin). Not useful for all anxiety disorders (e.g., panic disorder). Used along with SSRIs for OCD.

    2. Antidepressants: medications to relieve symptoms of depressive disorders

      1. Tricylics (TCAs such as Elavil, Tofranil, Pamelor, Anafranil): reduce the reuptake of norepinephrine and serotonin

      2. Selective serotonin reuptake inhibitors (SSRIs such as Prozac, Paxil, Zoloft, Luvox):reduce reabsorption of serotonin that has been released into the synapse. Can cause agitation.

      3. Monoamine oxidase inhibitors (MAOIs such as Nardil, Parnate): prevents the breakdown of neurotransmitters like serotonin and dopamine by inhibiting the enzyme MAO. Bad side effects if taken with cheese, red wine, and other foods.

    3. Mood stabilizers: (e.g., Lithium, Tegretol, Depekene [valproic acid]) for bipolar disorders

    4. Antipsychotic agents (neuroleptics such as Thorazine, Haldol, Stelazine): used to quiet positive symptoms of schizophrenia. Also used to treat acute mania. Prolonged use can cause tardive dyskinesia (involuntary, often tic-like, movements of limbs and face, smacking of lips, tongue protrusion) in about 20% of cases. So-called atypical antipsychotics include Risperadal, Zyprexa, and Clozaril. About 75% of patients relapse within a year if medication is discontinued.

  2. Electroconvulsive therapy (ECT): effective for serious depression in many cases that have been refractory to medication. Brain seizure is induced via electrical current to patient’s brain. Usually requires 6–12 treatments. Some studies report that 60% improve, but there is a high relapse rate.

  3. Light therapy: Exposure to bright light can reduce depressive symptoms in some cases of SAD.


Psychological Treatments

Individual Psychotherapy
  1. Behavior therapy

    1. Application of learning principles from classical and operant conditioning

    2. Main approaches:

      1. Systematic desensitization: helping the client practice relaxation while confronting stimuli based on a progressive hierarchy of anxiety/fear, from low to high

      2. In vivo exposure or flooding: presentation of the feared stimulus

      3. Aversion therapy: pairs the undesirable behavior with punishment

      4. Token economy: shapes behavior via positive reinforcement

  2. Cognitive-behavioral therapy (CBT)

    1. Modification of cognitions that are linked to maladaptive behavior

    2. Main approaches:

      1. Rational-emotive therapy (RET) (Ellis): focuses on altering irrational beliefs (e.g., one must be perfect or loved by everyone)

      2. Cognitive therapy (Beck): identifies the client’s automatic beliefs and negative assumptions; encourages client to be objective in gathering information relevant to their maladaptive views so that disconfirmation is possible

  3. Psychodynamic/interpersonal therapies

    1. Aim is to promote positive personality change via insight and the healing properties of a good relationship with the therapist.

    2. Main approaches:

      1. Psychoanalysis and psychoanalytic therapy: interpretations of the patient’s transference (emotional reliving of past, core conflicts and relationships, via the therapist) and resistance (reluctance to become aware of warded-off mental contents and to institute changes based on insights). Therapeutic alliance between client and therapist is very important.

      2. Supportive therapy: does not explore the transference or analyze the client’s defenses; instead, offers calm support, guidance, and a focus on current problems

  4. Existential-Humanistic therapy: aim is to promote client’s personal growth, self acceptance, and search for meaning

    1. Person-centered therapies: Developed by Carl Rogers, this approach aims to create conditions that enable the client to resume thwarted efforts at self-actualization. The conditions include unconditional positive regard by the therapist, conveyed by empathic reflection of what the client is saying and feeling.

    2. Gestalt therapy: Developed mainly by Fritz Perls, this approach focuses on gaining conscious access to blocked emotions and bodily sensations; uses the empty chair technique, in which the client addresses someone with whom he or she has a conflicted relationship.

    3. Existential therapy: focuses on issues of alienation, personal responsibility, meaning of life, authenticity, mortality

  5. Eclectic/integrative therapies: various attempts to borrow techniques from several of the major approaches to best meet the therapeutic needs of a given client

  6. Brief psychotherapies: a variety of time-limited approaches that try to condense the work of therapy into a much shorter period of time

  7. Crisis intervention: deals with immediate problem (e.g., telephone hotline for rape victims, suicidal individuals, runaways)

Group Psychotherapies
  1. Family therapy: treats the family as the unit, based on the idea that the identified client often expresses the fact that there are significant psychological problems in the patterns of family interaction

    1. Structural family therapy (Minuchin): assumes that changes in the patterns of interactions (e.g., rigidity, overprotectiveness, enmeshment, faulty communication) will facilitate less pathological functioning for each family member

  2. Couples therapy: variety of approaches, but common goals are improving communication, identifying unproductive power struggles and incompatibilities, increasing each partner’s awareness of and respect for the other partner’s issues and vulnerabilities. Homework assignments, contracts, and videotaped playback of the session are some of the techniques used.

Milieu Therapy and Other Community Interventions

Focus is on the social context of psychopathology

  1. Creation of therapeutic communities for schizophrenic patients; residential psychiatric hospitals for those with severe emotional or substance abuse problems; halfway houses; day treatment centers

  2. Primary and secondary prevention programs: aim at prevention or early detection of potential mental illness

    1. Primary prevention: programmatic efforts in the general population to forestall behaviors that have a high psychiatric risk (e.g., educational programs to prevent teenage pregnancy)

    2. Secondary prevention: identification of high-risk populations followed by interventions (e.g., having college students serve as buddies or mentors to children at risk, such as those from abusive family environments)


Research in Psychotherapy

  1. Most studies that combine data from individual research projects (meta-analyses) find that therapy works but that no one approach is consistently superior.

  2. Efficacy vs. effectiveness: key unresolved issue in psychotherapy research

    1. Efficacy studies show that certain treatments can provide a benefit. Studies used include the following:

      1. Randomized clinical trials (RCTs)

      2. Patients who do not have comorbid conditions

      3. Patients treated for a specified time period

      4. Patients randomly assigned to different treatments conducted according to a manual to which the therapists adhere

    2. Effectiveness refers to whether results from the efficacy studies can be generalized to the real world of clinical practice.


Psychopathology and Society

  1. Legal issues

    1. Competence to stand trial: Can the person participate in his own defense?

    2. Insanity defense: Was the person so mentally incapacitated at the time he/she committed the crime that he/she is not responsible for the act?

  2. Mental hospital commitment

    1. Involuntary commitment: criteria for being placed in a mental hospital include:

      1. Imminent danger to self or to others

      2. Diagnosable mental disorder

      3. Profound disability

        • Approximately 25% of inpatients are hospitalized involuntarily.

    2. Short-term commitments do not require a court order, but longer ones do. Patients have a right to be treated as well as a right to refuse treatment.

  3. Clinicians

    1. Clinicians are required to protect patient confidentiality except:

      1. When involuntary commitment is necessary

      2. To take steps to protect a client and others from physical harm

      3. To report suspected cases of child abuse or elder abuse