Historical Approaches to Abnormal Behavior, Part III January 29, 2014 PSYC 2340: Abnormal Psychology Brett Deacon, Ph.D. Announcement. Sona systems mass testing has begun. From Last Class. Understanding drug action (disease- vs. drug-centered models)
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Historical Approaches toAbnormal Behavior, Part IIIJanuary 29, 2014PSYC 2340: Abnormal PsychologyBrett Deacon, Ph.D.
Announcement • Sona systems mass testing has begun
From Last Class • Understanding drug action (disease- vs. drug-centered models) • Disconnect between biomedical model’s assumptions and research evidence • Chemical imbalance theory
Patient Advocacy Groups “Scientific research has firmly established that major depression is a biological, medical illness.” “A large body of scientific evidence suggests that OCD results from a chemical imbalance in the brain.”
Health Websites • WebMD: “Depression is a disease…When you have depression, chemicals in your brain called neurotransmitters are out of balance.” • Mayo Clinic: “If you have depression, you may have a serotonin imbalance.”
Biomedical Model: Limitations • “Chemical imbalance is sort of last-century thinking. It’s much more complicated than that. It's really an outmoded way of thinking.” – Joseph Coyle, editor of Archives of General Psychiatry • “In truth, the ‘chemical imbalance’ notion was always a kind of urban legend – never a theory seriously propounded by well-informed psychiatrists…In the past 30 years I don’t believe I have ever heard a knowledgeable, well-trained psychiatrist make such a preposterous claim, except perhaps to mock it.” – Ronald Pies, editor of Psychiatric Times
Chemical Imbalance Theory • I informed you that evidence does not support the claim that mental disorders are caused by a chemical imbalance in the brain • There is no test for measuring neurotransmitter levels in the brain of a living person • We have no basis for distinguishing a chemical “balance” from a chemical “imbalance” • Despite its incredible popularity, the chemical imbalance theory has never been substantiated • So, what is the basis of its popularity? http://www.madinamerica.com/2013/09/united-states-biomedical-model-five-anecdotes/
Chemical Imbalance Theory: Sources of its Popularity • Reasoning backward from drug effects • What are the drug effects? • Drug marketing • Drug adherence • Reducing uncertainty about the cause of depression • Stigma reduction • A few of my experiences are summarized here: http://www.madinamerica.com/2013/09/united-states-biomedical-model-five-anecdotes/
A Critical Thinking Exercise • Serotonin helps regulate… • Mood, anger, aggression, sexual desire function, appetite, metabolism, sleep, memory and learning, body temperature, and social behavior • What would a bona fide imbalance of serotonin look like?
What a Real Chemical Imbalance Looks Like • Parkinson’s Disease, a brain disease believed to be caused by a dopamine imbalance • Symptoms include: tremors, rigidity, slowness or absence of movement, failure of postural reflexes, gait and posture disturbances, speech problems, drooling, difficulty swallowing, fatigue, lack of facial expressiveness, impaired fine and gross motor ability and coordination, depressed mood, executive dysfunction, memory problems, sleep disturbances, urinary incontinence, diminished sex drive and function, weight loss
A Note on Causal Explanations • Mental disorders often develop through an extremely complex interaction between biological, psychological, and environmental contributions • This is why we take an integrative approach • We should be skeptical of simple, one-sided explanations of psychopathology from any tradition • An entertaining example from the biological tradition: http://www.youtube.com/watch?v=-M-vnmejwXo
Insanity – Not a Mental Disorder • A legal term, not a psychological term • American Law Institute Standard Criteria: • Persons has a mental illness • Can’t distinguish right from wrong • Cannot control behavior • Diminished capacity (absence of criminal intent)
The Psychological Tradition • Psychoanalysis • Humanism • Behaviorism, cognitive-behavioral models
The Psychoanalytic Tradition • Freudian theory • The unconscious is our primary source of motivation • We are driven to remain unaware of these motives • They are available to us only in disguised form • Defense mechanisms • Psychosexual stages of development
The Psychoanalytic Tradition • Psychoanalysis • Unearth the hidden intrapsychic conflicts • Techniques • Free association and dream analysis
The Psychoanalytic Tradition • Lasting contributions to how therapists, and the public, think about the treatment of mental disorders • Therapy is long-term in nature • Therapy is an exercise in self-exploration • Symptoms are symbolic of deeper conflicts • Must identify the “root cause” of problem to overcome it • Insight about cause of the problem makes the problem go away • Therapist is distant and mostly inactive, client determines content of the session • Therapist is an expert in the art of interpretation, not in scientifically-based understanding of the mind
The Psychoanalytic Tradition • Little evidence that psychoanalysis is effective in the treatment of mental disorders • Dominated psychology and psychiatry for more than half a century and contributed virtually nothing to science • There is a reason you won’t hear much about Freud and psychoanalysis again in this (science) course
The Psychoanalytic Tradition • Source of persistent beliefs about psychotherapy that can interfere with current attempts to disseminate effective mental health treatments • Psychotherapy should explore the past to gain insight into causes of current problems vs. psychotherapy should be focused on solving current problems • Therapist is inactive and lets client determine course of therapy vs. therapist actively uses methods of assisting client to solve problems with scientifically demonstrated effectiveness • Is there a place for psychoanalysis?
The Humanistic Tradition • Major theme • People are basically good • We strive toward self-actualization • Treatment • Therapist conveys empathy, genuineness, and unconditional positive regard • Minimal therapist interpretation, advice, or direction
The Humanistic Tradition • The reason you won’t hear much about the humanistic tradition again in this (science) course: • Minimal evidence from well-conducted scientific studies that humanistic therapies work • This is partially a product of how we study psychotherapy • Clinical trials of specific treatments for specific problems
Studying Psychotherapy • Gold standard: randomized, controlled clinical trial • Design: Clients randomly assigned to a treatment group or control group • Clients: individuals with a specific DSM-defined mental disorder • Therapy: provided in accordance with a standardized treatment manual • Therapists: trained to competence in the therapy • Outcomes: reduced symptoms of the disorder
Studying Psychotherapy: An Example DeRubeis et al (2005)
Studying Psychotherapy • Assumptions of the randomized, controlled clinical trial approach to studying psychotherapy • Client problems are best described in terms of DSM-defined mental disorders • Reducing symptoms of DSM-defined disorders should be the goal of psychotherapy • The delivery of psychotherapy can be standardized across clients • We can scientifically measure the process and outcome of psychotherapy
Psychotherapy Research is Controversial • Can we study psychotherapy? • Can the relevant variables be measured scientifically? • Is it possible to faithfully recreate the process of psychotherapy in a research context? • Is psychotherapy an art or a science (or both)?
Psychotherapy Research is Controversial • Is it important to study psychotherapy? • Is the relationship between the therapist and the client all that is needed for success? • Are the benefits of psychotherapy entirely attributable to factors that all therapies have in common?
Psychotherapy Research is Controversial • Is psychotherapy research relevant to clinicians in the real world? • Objections to clinical trials: • Clients with simple problems, use of tightly standardized treatment manuals by expert therapists, focus on symptom reduction • “My client is a unique individual, so research findings don’t apply.”
Assumptions of a Scientific Approach to Abnormal Psychology • We can study psychotherapy. • It is important to study psychotherapy. • Psychotherapy research is relevant to clinicians in the real world.
Findings From the Scientific Approach to Abnormal Psychology • Psychotherapy research has revealed that: • Some psychological treatments are harmful. • Some psychological treatments are no better than no treatment at all. • Some psychological treatments are more effective than others for certain mental disorders.
The Humanistic Tradition • Humanistic approach rejects: • Focus on DSM disorders as target problems (i.e., “medical model”) • Use of standardized treatment manuals • Use of randomized, controlled clinical trial approach to study psychotherapy • Notion that psychotherapy involves “application of specific procedures to alleviate specific disorders”
The Humanistic Tradition The humanistic philosophy of psychotherapy: “Training becomes less of a matter of acquisition of technological skills to be applied consistently and with mastery, and more a matter of the development of: perceptual and interpersonal sensitivity; self-awareness; higher order mental capacities such as the ability to take multiple perspectives on issues and problems and the ability to engage in more complex thinking about values; the skill of relating general research findings and scholarly discourse to specific persons in naturally occurring contexts; and other non-formalizable complex skills for facilitating human growth and liberating client creativity. This emphasis on the therapist's development of his or her own mental and relational capacities follows from the humanistic position that therapists must be able to entertain and really appreciate multiple perspectives on reality, and that it is clients who are ultimately the experts on their own lives, their own life circumstances, and the contextualized complexities interwoven around their problems. Therapists must be able to believe that it is only clients who can ultimately know what are the appropriate ways for them to approach and resolve their problems, within the contexts of their life structures, life histories, and the constraints of society. This means that the therapist's sensitive and flexible ability to dialogue with clients becomes the ultimate therapeutic modality.” http://www.academyprojects.org/alternatives.htm
The Humanistic Tradition • What therapy is, and is not, within the humanistic tradition • Carol Rogers and client-centered therapy • http://www.youtube.com/watch?v=m30jsZx_Ngs&feature=related • Critical analysis?