Crane 5.1 Abnormal psychology. Concepts of Normality. Defining Abnormality. Abnormality: The subjective experience of feeling “not normal”. 7 Criteria of Abnormal Behavior. Rosenhan and Seligman (1984) Suffering—experiencing distress or discomfort
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Crane 5.1 Abnormal psychology Concepts of Normality
Defining Abnormality • Abnormality: • The subjective experience of feeling “not normal”
7 Criteria of Abnormal Behavior • Rosenhan and Seligman (1984) • Suffering—experiencing distress or discomfort • Maladaptiveness—engage in difficult behaviors • Irrationality—incomprehensible or unable to communicate • Unpredictability—act in ways that are unexpected • Vividness and unconventionality—experience different things • Observer discomfort—makes others embarrassed • Violation of moral or ideal standards—habitually break
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
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)
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
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emotional elements (fear, sadness, anger) • Behavioural symptoms: observational behaviours (crying, physically withdrawn, pacing) • Cognitive symptoms: ways of thinking (pessimism, personalization, self-image) • Somatic symptoms: physical symptoms (facial twitching, stomach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)
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
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?v=8ZOcfllWBq8&feature=related
Ethical Considerations in diagnosis • Stigmatized—socially exclude people • Experience prejudice and discrimination • Self-Fulfilling Prophecy • Act as they think is expected of them
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
Cultural Considerations • Culture-Bound Syndromes • Depression (absent in Asian societies) • Reporting Bias • Data based on hospital admissions • China—mental illness carries stigma • Difference in Symptoms • Affective (emotional symptoms) • Somatic (physiological symptoms) • Culture Blindness • Whose cultural symptoms are the norm?
General concerns about Culture and Validity • Examine p. 199 (Jamison book) • Read: Supplemental book (p.157)
Apply your knowledge • Read the description of Anne on p. 147 and answer the following questions.
Crane 5.2 Abnormal Psychology: Psychological Disorders • Making a diagnosis (Symptoms and Causes) • Symptomology—identification of symptoms • Examine symptoms of major depressive disorder, • Crane, 149 (Symptoms of Major Depressive Order) • Etiology—why people suffer from a disorder • Biological • Cognitive • Sociocultural Factors
Diagnosing depression in College Students • “Depression can strike early, undetected” • ABC News Article (Discussion) • http://abcnewsradioonline.com/health-news/depression-can-strike-early-undetected.html
Environmental Causes--Analysis • Seasonal Affective Disorder • “Have you cried today?” • August: • Men (4%) Women (7%) • December: • Men (8%) Women (21%)
“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
“Depression is nourished by a lifetime of ungrieved and unforgiven hurts.” Penelope Sweet
“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
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 pain;And an island never cries. Paul Simon (VIDEO BREAK!!!)
“Nobody tells me. Nobody keeps me informed. I make it 17 days come Friday since anybody spoke to me.” Eeyore
“After all, what are birthdays? Here today and gone tomorrow.” Eeyore
“Depression…is well adapted to make a creature guard itself against any great or sudden evil.” • Darwin (1887)
Crane 5.2 • Making a diagnosis (Examination of Data) • Prevalence Rate—total # of cases in a population • Lifetime Prevalence--% of the population that will experience the disorder at some time in their life • Onset Age—average age at which it is likely to appear
Crane 5.2 • Examine Depression (blue box) and Be a thinker, Crane, 149.
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)
Can Facebook make us depressed? • http://abcnews.go.com/GMA/video/facebook-blues-12796540
Quick Write • On your notes, write down as many symptoms of depression as you can think of
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
Center for Epidemiologic Studies Depression Scale (CES-D) • A Screening Test for Depression • http://counsellingresource.com/quizzes/cesd/index.html
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?
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???
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
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?
Integrative Analysis Chart • Using your Crane text (p.151-156), construct an integrative analysis chart on the causes/ factors of DEPRESSION
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).”
Etiology and Treatment • Must we know the causes prior to providing treatment? • Can we identify specific causes of disorders? • Examine your integrative analysis chart…
Treatment (Adv. vs. Disadv.) • Biological • Drug Therapy • Cognitive (Psychological) • Individual Therapies • Social • Group Therapy
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)
Biomedical—Evaluation • Effective in short term treatment (60-80%) • Kirsch and Sapirstein (1998/2008)) • (1998) Meta-analysis of 19 studies • (2008) review of 47 clinical trials
Biomedical—Evaluation • Effective in short term treatment (60-80%) • Kirsch and Sapirstein (1998/2008)) • (1998) Meta-analysis of 19 studies25% more effective than placebos, no more effective than tranquillizers • (2008) review of 47 clinical trials not more effective than placebos
Biomedical—Evaluation • 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 (_________ _______)
Biomedical—Evaluation • 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
Biomedical—Evaluation • 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???
Biomedical—Evaluation • 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?
Cognitive-Behavioural Therapy (CBT) • Distorted Cognitions cause depression • Cognitive psychologists (Aaron Beck, 1960’s) developed Cognitive ____________.
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