Personality

1. Personality Stability vs. Situation?

2. Personality • Traits vs. States vs. Types • 18,000 personality terms to 32 traits to- • Big five: • Extraversion (outgoing, sociable, positive) • Neuroticism (prone to negative emotions) • Conscientiousness (organized, efficient, disciplined) • Openness to experience (non-conventional, curious) • Agreeableness (trusting & easygoing with others) 40 to 60% heritable

3. Situationism • Low correlations across situations • Strong vs. weak situations • But-brain differences and heritability • Introverts more sensitive to external stimuli • More reactive central nervous system • Low pain tolerance • Underactive Nor-epi system • Sensation seeking extraverts

4. Heritability: Big five correlations • Identical twins vs. fraternal twins : Identical Fraternal • Reared together- .51 .23 • Reared apart- .50 .21

5. Personality Theories • Psychoanalytic • Childhood experience, ucs influence, dynamics, conflict, defenses, development and identification • Humanistic • Focus on self & self-actualization, existential approach, flow & happiness • Social-Cognitive Theory • Beliefs, thoughts & personal constructs, often acquired from social interactions& imitation shape behavior • Behavioral Theory • Learning history, self-perception theory, self-control

6. Disorders Who Gets What?

7. Defining Abnormality • Medical approach • Statistical approach • Functional approach These reflect two basic views of disorders --brain based --behavior/experience/situation based The “two worlds” of psychiatry

8. DSM-IV • Axis 1: Syndromes (Scz, Depress, etc.) • Axis 2: Retardation & Personality Disorders • Axis 3: General Medical Condition • Axis 4: Social/Environmental Problems • Axis 5: Global Assessment & Coping • Older classification (primarily of Axis 1 & 2) dichotomized: Neuroses & Psychoses • Mood (Dep. Bipolar) vs. Thought (Scz) Disrdr • Now replaced by highly elaborated DSM-V

9. Three Broad Types/Dimensions • Personality (Psychopathy…..) • Mood (Depression, Bipolar) • Thought (Scz. Delusions, Hallucinations)

10. SCZ Manifestations/Symptoms Positive symptoms: -- Hallucinations • delusions • Disorganized or strange behavior & speech • Negative symptoms: • Flat affect & other behavior • Catatonia • Withdrawel from others

11. Prevalence of Neurotic Disorders by Age Hollingshead & Redlech New Haven Study, 1958

12. Prevalence of Neurosis by Age & Social Class

15. Prevalence of Psychosis by Age & Gender

16. Treatment Duration & Social Class

17. Psychosis: Age and Social Class

18. Heritability of Psychosis: Schizophrenia

19. Scz incidence & poverty/residential area

20. Some Interim Conclusions • Psychoses (focus on SCZ) is a disorder of heredity and/or prenatal environment • But it’s also a disorder of poverty (and that may be bidirectional)! • Another view of prevalence and recent dramatic changes in prevalence

21. Deinstitutionalization

22. Prevalence • Schizophrenia: approx. 1% • Bipolar Disorder: approx. 1% • Depression: approx. M 13% F 21%

23. Basic Models of Disorder Stress: Functional Disorder -Cognitive & Social Origins Illness: Medical/Biological • Brain-based (synaptic & neural network/connectivity) Mixed Model: VulnerabilityStress Szasz: Radical Anti-medical Approach

24. Treatment

25. Overview • Brief History • Psychological Treatments • Biomedical Treatments • Client-Therapist Relationship • Is Treatment Effective?

26. History • Earliest history • Mental illness believed to be caused by evil spirits. Hippocrates began to dismantle this. • Treatments were harsh, ineffective • Drill holes in skulls to create exits for spirits • Make the body horribly uncomfortable for the spirits • Purge demons through inducing vomiting

27. History • Middle Ages • Mental illness viewed more like a disease • Mental institutions were created • Purpose: confine madmen • Included other social “undesirables” • Inhumane treatment (shackles and chains)

28. Beginning of Reform • Early to Mid 1800s • Philippe Pinel put in charge of Paris’ hospital system • Removed shackles and chains • Patients allowed to exercise, venture outside

30. Beginning of Reform • Dorthea Dix • Fought for humane treatment of patients in U.S. • 19th century • Freud’s “talking cure” (Charcot)

31. Psychological TreatmentOverview • Treatment involves addressing three major components of the illness: • Biological • Psychological • Social • Something to keep in mind: • These three major components are not necessarily black-and-white/separable

32. Who provides treatment? • Clinical psychologists • Psychologists • Neurologists • Psychiatric Nurses • Marriage and Family Counselors • Social workers • School counselors • Clergy

33. Who seeks treatment? • People with mental illness, hoping to relieve pain and dysfunction • People looking for assistance in recovering from grief, anxiety, confusion, relationship issues and other life challenges… • Women • European Americans • Financially well off • People with Health Insurance (which increasingly controls things)!

34. Psychological Treatments • Focused on changing the way the patient thinks and behaves • Involves discussion, instruction, training, relationship analysis • Over 500 different forms of such treatment • Psychodynamic • Humanistic • Behavioral • Cognitive

35. Psychodynamic Approaches • Illness result of unconscious conflicts developed early in childhood • Defense mechanisms shield from the inner conflict • This can lead to symptoms of mental illness • Treatment: Uncovering unconscious desires and conflicts, and resolving them • Integrate thoughts and memories coherently

36. Psychodynamic Approaches • “Working through” the conflict • Transference • Used as a therapeutic tool • In order to be effective, therapist must remain neutral

37. Humanistic Approaches • Based off of Freud’s “talking cure” • However, less focused on basic drives • Instead, focus on creating meaning • Clients need to take responsibility for their lives and actions, and live in the “here and now”

38. Humanistic Approaches • Client-Centered Therapy (Carl Rogers) • Focuses on achieving self-acceptance • Does not pass judgment, or provide instruction • Aim is to create an environment in which the client feels understood and valued -Requires & elicits a capable client

39. Humanistic Approach • Creating the therapeutic environment • Genuineness- sharing authentic reactions • Unconditional positive regard • Non-judgmental, accepting • Empathic Understanding- putting oneself in the patients’ shoes

40. Behavioral Approaches • Reaction to Freud’s psychoanalysis • Viewed Freud’s approach as too unscientific • Treatment directed at reducing or eliminating problematic behaviors (because behavior is all there is!) • Institutional control mechanism (humane?) • Approach involves replacing old habits with more effective or adaptive behaviors • Classical conditioning, operant conditioning, modeling

41. Behavioral ApproachesClassical Conditioning Techniques • Treatment of Phobias • Extinguish the association between the neutral stimulus and the fearful stimulus • Exposure Therapy • Train clients in deep muscle relaxation, pair relaxation with the fearful stimulus • Create a hierarchy of progressively more frightening stimuli • Systematic desensitization: gradual exposure to the real phobic stimulus

42. Systematic Desensitization

43. Behavioral ApproachesOperant Conditioning Techniques • Token economies • Earn tokens for positive behaviors, which can be exchanged for prizes • Shaping • Contingency Management • Strict consequences for certain behaviors • Successful for shaping communicative behavior in children with autism (Lovaas) • Modeling Techniques • Therapist perceived as role model

44. Cognitive-Behavioral Approaches • Rational Emotive Behavioral Therapy (Albert Ellis) • People typically think that an event causes them to behave a certain way • But…beliefs matter • Focused therapy on changing beliefs • Teacher-like

45. Cognitive Therapy • Aaron Beck • Focused on changing dysfunctional thought • Cognitive Restructuring • Challenge a person’s unhealthy beliefs or interpretations • Used persuasion and confrontation • Brief, problem-focused • Initially treated depression

46. Cognitive-Behavioral Therapy Followers of Ellis and Beck blended the two therapies to form CBT Focus on addressing problems the patient wishes to solve Intimate relationship between behavior and thought! Often clients are assigned homework Practice new ways skills or thought techniques

47. Eclecticism Modern therapy tends to blend aspects from many of these perspectives Makes sense, since there are often many causes of mental illness

48. Client-Therapist Relationship • Therapeutic Alliance • Support • Trust • Hope • Understanding

49. Group Therapies • Often groups are chosen because they share similar problems (e.g., Alcoholics Anonymous) • Focus on the shared problems, less on the individuals’ emotions • Advantages • Social support • Share advice, information • Observe other peoples’ successes • Realize that not alone, others share similar problems

50. Couple and Family Therapy • Views the family or relationship as a complex system • One person’s negative behavior or cognitions may reflect a larger issue for the entire family or relationship • Can be extended to • treating children who have little control (work with family to change situation/mileau)