CHAPTER 15 Chapter Summary

Do we diagnose and treat psychological disorders in the same way as we do physical illness?

Diagnosis of psychological disorders follows a medical model, similar to the diagnosis of physical illness. Psychological experiences (e.g., feelings of anxiety or depression) are seen as symptoms that arise from a psychological or biological cause. Therapists try to alter the brain and/or psychological functioning of the individual to treat that cause and to alleviate symptoms.

What are the advantages and disadvantages of focusing on the internal causes of psychological illness?

One advantage is that it has stopped people from treating mental illness as a moral failing, thereby promoting the ethical treatment of people suffering from mental illness. A second advantage is that the search for biological causes of mental illness led to research on therapeutic drugs. A disadvantage is that once individuals are labeled as mentally ill, they may be perceived as mentally incompetent. A second disadvantage is that the medical model’s process of diagnosis may lead professionals to search “inside the head” of the patient for causes that are “outside” in the environment.

What caution must we exercise when evaluating unusual behavior?

Sometimes unusual behavior reflects unusual life circumstances. Behavior that appears abnormal in one social or historical setting may seem completely normal in another.

What is the major tool mental health professionals use to diagnose and classify psychological problems?

Psychologists use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to classify disorders. The DSM specifies criteria that a person must exhibit in order to be classified as having a given disorder.

What are some criticisms of the diagnostic tool mental health professionals use to diagnose and classify psychological problems?

First, though the DSM’s categories are in part grounded in scientific research, they also rest on professional opinion, which can be unreliable. Second, the DSM classifies disorders according to symptoms, not causes. Finally, gender and other biases in the DSM may cause some mental illnesses to be overdiagnosed.

Why are there so many different types of therapy?

One reason is that there are a lot of different types of disorders and people who suffer from them. Another is that different clinicians embrace different therapy strategies.

What are some of the most prominent types of psychotherapy and what is it like to experience each of them?

Five types are particularly prominent: psychoanalysis, behavior therapy, cognitive therapy, humanistic therapy, and the family of group therapies. If you were to experience psychoanalysis, your therapist would use the free association method to reveal unconscious memories that are a source of distress. In this context, you may experience transference, whereby you unintentionally respond to the therapist as if he or she were a significant figure (e.g., a parent) from the past. This experience would enable you to analyze any emotions you may be re-experiencing.

A behavior therapist would alter your environment to teach you new ways of behaving, perhaps by providing reinforcers for desirable behaviors. In a token economy, for instance, you might be given tokens for desirable behaviors that you could later exchange for something valuable. If you had a fear you wanted to extinguish, you might experience exposure therapy, in which the therapist would reduce your fear by bringing you into direct contact with the feared object or situation, or systematic desensitization, in which this exposure would happen more gradually.

A cognitive therapist using Beck’s cognitive therapy would target your negative irrational cognitions that come to mind automatically, to increase your awareness of them, challenge them, and suggest positive thoughts to replace them. A humanistic therapist would help you achieve positive growth by building a good relationship with you. Three conditions necessary for this growth are genuineness, acceptance (via unconditional positive regard), and empathic understanding. In group therapy, your therapist would form and maintain the group, establish norms for behaviors within the group, and encourage you to focus on your thoughts and feelings in the “here and now” to help you gain insight into your interpersonal behavior.

Which psychological therapy is most popular?

Most therapists try to integrate the best methods of different approaches to fit the needs of each individual patient. Some therapists describe their work as eclectic therapy.

How did physicians figure out that psychological disorders could be treated with drugs?

The discovery was accidental. In the 1940s, a physician in France was searching for a drug that would help surgical patients during their postoperative recovery. The drug he tried calmed his postoperative patients. Psychiatrists used this drug to calm people suffering from mania, and the sufferers’ thinking became clearer.

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Antidepressants such as Prozac and Zoloft were not discovered accidentally, but were developed based on the theory that targeting serotonin, a neurotransmitter associated with mood, could alleviate depressive symptoms. As revealed in This Just In, antidepressants are not as effective as originally theorized.

How do drugs affect mental health?

Once drugs permeate the blood–brain barrier, they affect the functioning of brain cells and therefore affect thinking and emotion. A second way that drugs can affect mental health is through placebo effects, which occur because people believe that taking medication will cause them to improve; that expectation can cause actual improvement, a self-fulfilling prophecy.

What are some alternatives to drug therapies?

One is electroconvulsive therapy, in which a physician delivers electrical currents to the brain. Another is the lobotomy, now rare, in which a surgeon damages tissue in the brain’s frontal cortex.

What’s wrong with using case studies as evidence for a therapy’s effectiveness?

Case studies rely on the subjective observations of therapists, who may be biased in favor of their own therapy method. Case studies also lack a control group, so there is no way of knowing whether the client would have improved even without therapy. As you saw in Research Toolkit, the most carefully controlled method for empirically testing the efficacy of a therapy is the double-blind clinical outcome study.

What defines major depressive disorder and how prevalent is it?

A person is diagnosed with major depressive disorder only if a majority of the following symptoms last two weeks or longer: consistent depressed mood; loss of interest in most daily activities; change in body weight; change in sleep patterns; fatigue; feelings of worthlessness, hopelessness, or helplessness; difficulty concentrating; and thoughts of suicide. A survey of U.S. adults indicated that 6.7% of the population suffered from major depressive disorder at some point during the previous year. The lifetime prevalence of the disorder is about 15%, although the prevalence varies with different groups in American society. As you learned in Cultural Opportunities, prevalence rates differ across cultures. In Hunan, China, major depression is rarely diagnosed, largely because the Hunanese seldom talk about their emotional lives.

What therapies effectively treat major depressive disorder?

One approach is that of behavioral therapists, who emphasize that the environment affects people’s psychological life. A second approach is cognitive therapy, where the therapist challenges negative beliefs in an effort to replace the depressive thoughts with more positive ones. A third approach is interpersonal therapy, in which therapists try to alleviate depression by identifying interpersonal problems that contribute to the client’s current depression, and to reduce the client’s social isolation by expanding his or her network of relationships. A fourth strategy is drug therapy.

What defines bipolar disorder and how prevalent is it?

To be diagnosed with bipolar disorder, an individual must display depression for at least two weeks and mania for at least four days in a row. Manic symptoms include abnormally high energy, racing thoughts, extreme talkativeness, high levels of self-esteem, and involvement in fun activities that are costly or risky. About 1% of adults suffer from bipolar disorder.

What therapies effectively treat bipolar disorder?

Bipolar disorder is treated with mood stabilizers including lithium, anticonvulsants, and antipsychotics.

What defines generalized anxiety disorder and how prevalent is it?

To be diagnosed with generalized anxiety disorder, an individual must worry about two or more aspects of life on the majority of days, and symptoms must persist for at least three months. Generalized anxiety disorder affects nearly 7 million adults in the United States and is about twice as common among women as men.

What therapies effectively treat generalized anxiety disorder?

Generalized anxiety disorder is treated with anti-anxiety drugs, typically benzodiazepines, in conjunction with cognitive therapy and behavior therapy.

What defines panic disorder and how prevalent is it?

The key defining feature of panic disorder is panic attacks: episodes of extreme fear, including high levels of physical arousal, that occur suddenly and without apparent cause. During panic attacks, sufferers feel as if they are losing control of their body, having a heart attack, dying, or going insane. To be diagnosed with the disorder, the person must worry about the attack and its consequences for at least one month and the panic attacks must not be side effects of a medication or other drug. Panic disorder affects about 6 million Americans and is twice as common among women as men.

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What therapies effectively treat panic disorder?

Panic disorder is treated with psychoanalytic therapy, cognitive-behavioral therapy, exposure therapy, and drug therapies.

What defines social anxiety disorder and how prevalent is it?

Social anxiety disorder is marked by a persistent fear of social situations and the expectation that the individual will experience humiliation and embarrassment in them. Symptoms must last at least six months and sufferers must recognize that the anxiety is excessive. Surveys indicate that 12.1% of U.S. citizens experience social anxiety disorder at some point in their adult lives. Some have suggested the disorder is overdiagnosed.

What therapies effectively treat social anxiety disorder?

Social anxiety disorder is treated with anti-anxiety drugs in conjunction with cognitive and behavioral therapies. People with social anxiety disorder also benefit from group therapy, which has the unique advantage of building social skills.

What defines phobias and how prevalent are they?

Phobias are strong, persistent fears caused by situations that pose little or no actual threat; specific phobias are fears directed toward particular objects or situations. Nearly 8 to 9% of American adults experience some form of specific phobia.

What therapies effectively treat phobias?

A form of exposure therapy called mastery therapy is often effective. In it, therapists accompany clients to situations that they fear and perform activities with them, gradually reducing the amount of help they give, so clients can master their own fears. This approach is commonly combined with cognitive strategies designed to boost clients’ confidence in their ability to overcome their fears.

What defines obsessive-compulsive disorder and how prevalent is it?

To be diagnosed with obsessive-compulsive disorder, the individual must have recurring thoughts about potential harm that they try to suppress and must engage in repetitive behaviors in response to those thoughts. These obsessive thoughts and compulsive behaviors must take up more than an hour a day of the person’s time and interfere with his or her social or professional life.

What therapies effectively treat obsessive-compulsive disorder?

Exposure and response prevention therapy has been effective. In it, therapists expose clients to the stimuli that trigger their obsessions and prevent them from engaging in their compulsions. This is anxiety provoking at first, but after repeated exposure, clients notice that no harm has befallen them and their anxiety dissipates. Cognitive therapies and drug therapies have also been effective.

What defines posttraumatic stress disorder and how prevalent is it?

Posttraumatic stress disorder (PTSD) develops when people encounter extremely high levels of stress, such as during military combat experience. Individuals with PTSD experience flashbacks that can trigger intense anxiety that interferes with everyday life. Other symptoms are emotional, including anxiety when exposed to stimuli that trigger memories of the trauma, persistent negative emotions, and high levels of arousal. Its prevalence among adults in the United States is 3.5%.

What therapies effectively treat posttraumatic stress disorder?

Cognitive-behavioral therapy has been effective in helping clients learn to cope with their traumatic memories. Therapists have also used virtual reality technologies to present lifelike images of trauma to clients. The clients are then able to develop skills for coping with their emotions in a nonthreatening environment.