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Introduction to Biological Psychology

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Introduction to Biological Psychology Powered By Docstoc
					Psychological Science, 3rd Edition
                      Michael Gazzaniga
                       Todd Heatherton
                          Diane Halpern
       Treating
Disorders of the
 Mind and Body
            15
      Questions to Consider:
How Are Mental Disorders Treated?

What Are the Most Effective Treatments?

Can Personality Disorders Be Treated?

How Should Childhood and Adolescent
 Disorders Be Treated?
How Are Mental Disorders
Treated?
   Psychotherapy Is Based on Psychological
    Principles
   Culture Can Affect the Therapeutic
    Process
   Medication Is Effective for Certain
    Disorders
   Alternative Biological Treatments Are
    Used in Extreme Cases
   Pseudotherapies Can Be Dangerous
Learning Objectives
Recognize different styles of
 psychotherapy.

Describe the uses, mechanisms, and
 side effects of common psychotropic
 medications.
Psychotherapy Is Based on
Psychological Principles
   With over 400 psychological therapies
    available, the precise techniques used by
    individual therapists may vary widely

   One factor known to affect the outcome of
    therapy is:
       The relationship between the therapist and the
        client
Psychotherapy Is Based on
Psychological Principles
   Psychodynamic therapy focuses on insight:

       Along with Josef Breuer, Sigmund Freud
        pioneered the method of psychoanalysis

       Treatment involved uncovering unconscious
        feelings and drives that, Freud believed, gave rise
        to maladaptive thoughts and behaviors

           Techniques included free association and dream
            analysis
Psychotherapy Is Based on
Psychological Principles
    The general goal of psychoanalysis is to increase
     clients’ awareness (insight) of these unconscious
     processes and how they affect daily functioning

    Over the past few decades, psychodynamic
     therapy has become controversial due to:

        Its expense, the length of time required for treatment,
         and the lack of evidence of effectiveness for most
         disorders
Psychotherapy Is Based on
Psychological Principles
   Humanistic therapies focus on the whole
    person:

       Emphasizes personal experience, belief systems
        and the phenomenology of individuals

       The goal of humanistic therapy is to treat the
        person as a whole
Psychotherapy Is Based on
Psychological Principles
    Key ingredients of client-centered therapy include:

        Creating a safe and comforting setting, empathy,
         reflective listening, and unconditional positive regard


    Many techniques advocated by Rogers are used
     currently to establish a good therapeutic
     relationship between practitioner and client
Psychotherapy Is Based on
Psychological Principles
   Cognitive-behavioral therapy targets thoughts
    and behaviors:

       Many of the most successful therapies involve
        trying to change people’s behavior and cognition
        directly

       Beck pioneered cognitive restructuring

       Ellis promoted rational-emotive therapy
Psychotherapy Is Based on
Psychological Principles
    Examples of these treatments include: behavior
     modification, modeling, social skills training,
     cognitive therapy and cognitive behavior therapy
     (CBT)

        Interpersonal therapy integrates insight therapy with
         cognitive therapy
        CBT is one of the most effective treatments available
         for anxiety and mood disorders
        Exposure is an effective treatment for phobias and
         relies on classical conditioning processes
Cognitive restructuring involves replacing maladaptive thought patterns with more realistic, positive
ones.
Psychotherapy Is Based on
Psychological Principles
   Group therapy builds social support:

       Group and family therapy have become more
        widespread

       Group therapy is less expensive than individual
        therapy

       Offers the opportunity for practice of social skills
        and peer learning
Psychotherapy Is Based on
Psychological Principles
   Family therapy focuses on the family context:

       Family therapy reflects an understanding of
        systems approaches—an individual is part of
        larger groups that can maintain or exacerbate
        behavior

           Negative expressed emotion within families, for
            example, has been linked to higher relapse rates
            among those diagnosed with schizophrenia
Psychotherapy Is Based on
Psychological Principles
   Confession is good for the spirit:

       Irrespective of type of therapy, evidence suggests
        that simply talking about (or writing about) one’s
        problems can have a positive effect
Culture Can Affect the
Therapeutic Process
   Culture impacts the way mental disorders are
    expressed, which people are likely to recover,
    and people’s willingness to seek help

   Stigmas exacerbate the problem because
    people will often suffer in silence, failing to
    get the psychotherapy that can help them

       Stigma varies from culture to culture
Culture Can Affect the
Therapeutic Process
   Culture also plays a critical role in:

       Determining the availability, use, and
        effectiveness of different types of psychotherapy


   Psychotherapy and definitions of mental
    health are based on the dominant cultural
    paradigm
Medication Is Effective for
Certain Disorders
   Drugs that affect mental processes are called
    psychotropic medications

   The success of medication in the treatment of
    mental disorders is largely responsible for the
    era of deinstitutionalization

       Scores of patients were discharged from mental
        hospitals and treated with drugs as outpatients
Medication Is Effective for
Certain Disorders
   Most psychotropic medications fall into three
    categories:

       Anti-anxiety drugs

       Antidepressants

       Antipsychotics
Medication Is Effective for
Certain Disorders
   Anti-anxiety drugs
       Reduce anxiety and promote relaxation, but they
        also induce drowsiness and are highly addictive
           They should be used sparingly


   Antidepressants:

       There are several classes including MAO
        inhibitors, tricyclic antidepressants, and the SSRIs
SSRIs, such as Prozac, work by blocking reuptake into the presynaptic neuron, thereby allowing
serotonin to remain in the synapse, where its effects on postsynaptic receptors are prolonged.
Medication Is Effective for
Certain Disorders
   Antipsychotics (neuroleptics)
       Block the effects of dopamine
       Antipsychotics are not always effective
       They have significant side effects that can be
        irreversible
           Tardive dyskinesia
       These drugs are not useful for treating the
        negative symptoms of schizophrenia
           Such as apathy and social withdrawal
Alternative Biological Treatments
Are Used in Extreme Cases
   Alternative biological methods often are used
    as last resorts because they are more likely
    to have serious side effects than will either
    psychotherapy or medication
Alternative Biological Treatments
Are Used in Extreme Cases
   Lobotomies:
       One of the earliest formal procedures used on
        patients with severe mental illness was
        psychosurgery
           Areas of the frontal cortex were selectively damaged


       These prefrontal lobotomies were used to treat
        severe mental disorders, including:
           Schizophrenia, major depression, and anxiety
            disorders
Alternative Biological Treatments
Are Used in Extreme Cases
    Patients who received lobotomies were often
     listless and had flat affect

    The procedure often impaired many important
     mental functions, such as abstract thought,
     planning, motivation, and social interaction

    With the development of effective
     pharmacological treatments in the 1950s, the use
     of lobotomy was discontinued
Alternative Biological Treatments
Are Used in Extreme Cases
   Electroconvulsive therapy (ECT):
       Common in the 1950s and 1960s to treat mental
        disorders including schizophrenia and depression

       ECT now generally occurs under anesthesia with
        powerful muscle relaxants

       ECT is particularly effective for some cases of
        severe depression, although there are some risks
        to its use
Alternative Biological Treatments
Are Used in Extreme Cases
   Transcranial magnetic stimulation and deep
    brain stimulation are newer techniques that
    may be promising

       Especially in relation to depression and OCD
In TMS, current flows through a wire coil placed over the scalp area to be stimulated.
Pseudotherapies Can Be
Dangerous
   Some treatments widely believed to be
    effective are actually counterproductive:

       Including encouraging people to describe their
        experiences following major trauma
       Scaring adolescents into going straight
       Having police officers run drug education
        programs (DARE)
       Using hypnosis to recover painful memories
Pseudotherapies Can Be
Dangerous
   It is important to recognize the difference
    between evidence-based psychotherapies
    and ―alternative‖ or ―fringe‖ pseudotherapies

       The latter can prevent people from getting
        effective treatment and may even be dangerous
What Are the Most Effective
Treatments?
   Treatments That Focus on Behavior and on
    Cognition Are Superior for Anxiety Disorders
   Many Effective Treatments Are Available for
    Depression
   Lithium Is Most Effective for Bipolar Disorder
   Pharmacological Treatments Are Superior for
    Schizophrenia
   There Are Important Considerations in Selecting
    a Psychotherapist
   Critical Thinking Skill: Avoiding the Sunk Costs
    Fallacy
Learning Objectives

Identify the therapies most
  effective for treating specific
  disorders.
What Are the Most Effective
Treatments?
   According to Barlow, three features
    characterize psychological treatments:

       They vary according to the client and disorder
       The techniques used in these treatments have
        been developed in the laboratory by psychological
        scientists
       No overall grand theory guides treatment
           Treatment is based on evidence of its effectiveness
Behavioral and Cognitive Treatments
Are Superior for Anxiety Disorders

   Cognitive-behavioral therapy (CBT) works
    best to treat most adult anxiety disorders

   Anxiety-reducing drugs are also beneficial in
    some cases

       Although there are risks of side effects and, after
        drug treatment is terminated, the risk of relapse
Behavioral and Cognitive Treatments
Are Superior for Anxiety Disorders

   Specific phobias:

       Systematic desensitization is most effective

       Brain imaging data indicate that successful
        treatment with CBT alters the way the brain
        processes the fear stimulus
Behavioral and Cognitive Treatments
Are Superior for Anxiety Disorders

    Findings suggest that psychotherapy effectively
     ―rewires‖ the brain

    Both Prozac and CBT are effective in treating
     social phobia

        However, those taking Prozac report more physical
         complaints, such as a lack of sexual interest
Behavioral and Cognitive Treatments
Are Superior for Anxiety Disorders

   Panic attacks:
       Imipramine prevents panic attacks
           But does not reduce the anticipatory anxiety that
            occurs when people fear they might have an attack


       CBT
           Helps break the learned association between the
            physical symptoms and the feeling of impending doom
           Cognitive restructuring addresses ways of reacting to
            the symptoms of a panic attack
Behavioral and Cognitive Treatments
Are Superior for Anxiety Disorders

    In the short term:

        CBT alone and imipramine alone were effective for
         treating panic disorder, and they did not differ in
         results


    However, six months after treatment had ended:

        Those who received psychotherapy were less likely to
         relapse than those who had taken medication
Behavioral and on Cognitive Treatments
Are Superior for Anxiety Disorders

   OCD:
       SSRIs and CBT are effective treatments

       Researchers imaged the brains of patients with
        OCD who were being treated either with Prozac
        or with CBT
           Patients in both treatment groups showed the same
            changes in neural activity
           CBT may be a more effective way of treating OCD
            than medication, especially over the long term
Treatments for OCD can include the drug clomipramine, exposure, and ritual prevention, with varying
rates of success.
Behavioral and Cognitive Treatments
Are Superior for Anxiety Disorders

    Deep brain stimulation may be an effective
     treatment for those with OCD who have not found
     relief from CBT or medications

        DBS leads to a clinically significant reduction of
         symptoms and increased daily functioning in about
         two-thirds of those receiving treatment
Many Effective Treatments Are
Available for Depression
   Pharmacological treatment:

       Early antidepressant medication – MAO inhibitors
        and tricyclics:
           Fairly effective in reducing depression but had serious
            side effects


       Prozac, an SSRI, was developed in the 1980s
        and lacks the serious side effects of earlier
        antidepressant drugs
Many Effective Treatments Are
Available for Depression
    Approximately 60 to 70 percent of patients who
     take antidepressants experience relief from their
     symptoms

    Some evidence suggests that tricyclics might be
     beneficial for the most serious forms of
     depression
        But SSRIs are generally considered first-line
         medications because they have the fewest serious
         side effects
Many Effective Treatments Are
Available for Depression
   Cognitive-behavioral treatment of depression:

       Just as effective as biological therapies in treating
        depression
       The goal of CBT is to help the client think more
        adaptively
       Although CBT can be effective on its own,
        combining it with antidepressant medication is
        significantly more effective than either one of
        these approaches alone
Many Effective Treatments Are
Available for Depression
    As with other mental disorders, treatment of
     depression with psychotherapy leads to changes
     in brain activation similar to those observed for
     drug treatments

        In slightly different areas of the brain
Many Effective Treatments Are
Available for Depression
   Alternative treatments:
       Phototherapy is the treatment of choice for those
        experiencing SAD
       Regular aerobic exercise can reduce depression
        and prevent recurrence
Incidence of SAD varies by latitude.
Many Effective Treatments Are
Available for Depression
    Electroconvulsive therapy has been effective for
     some people with major depression

        Although ECT frequently results in an amelioration of
         depressed mood, the mechanism by which this occurs
         is unknown

        ECT does have some serious limitations, including a
         high relapse rate (often necessitating repeated
         treatments), and memory impairments
Many Effective Treatments Are
Available for Depression
    Transcranial magnetic stimulation can reduce
     depressive symptoms

        A series of studies has demonstrated that TMS over
         the left frontal regions results in a significant reduction
         in depression

        In October 2008, TMS was approved by the U.S. Food
         and Drug Administration for the treatment of major
         depression in patients who are not helped by
         traditional therapies
Many Effective Treatments Are
Available for Depression
   Deep brain stimulation:

       As with OCD, recent case studies indicate that
        DBS might be valuable for treating severe
        depression when all other treatments have failed
Many Effective Treatments Are
Available for Depression
   Gender issues in treating depression:
       Female-specific stressors:
           The way work and family interact to place additional
            burdens on women
           The biological realities of reproduction and of
            menopause
       Men are reluctant to admit to depression and
        even more reluctant to seek appropriate therapy
           Efforts are being made to help men stop masking their
            depression with alcohol, isolation, and irritability
Lithium Is Most Effective for
Bipolar Disorder
   Only about 20% of patients maintained on
    lithium will experience relapses
   Lithium seems to modulate neurotransmitter
    levels
       Balancing excitatory and inhibitory activities
   Although lithium is effective in stabilizing
    mood, it has unpleasant side effects including
    thirst, hand tremors, excessive urination, and
    memory problems
Lithium Is Most Effective for
Bipolar Disorder
   Because lithium works better on mania than
    on depression, patients often are treated with
    both lithium and an antidepressant
       SSRIs are preferable to other antidepressants
        because they are less likely to trigger episodes of
        mania


   CBT can help increase compliance with
    medication regimens
Pharmacological Treatments
Are Superior for Schizophrenia
   Pharmacological treatments:

       Early antipsychotic drugs such as haloperidol and
        chlorpromazine allowed those suffering from
        psychotic disorders to be released from hospitals

           These drugs, however, created major side effects and
            only addressed the positive symptoms of the patients
Pharmacological Treatments
Are Superior for Schizophrenia
    Clozapine is different from previous antipsychotic
     medications in a number of ways:

        Acts not only on dopamine receptors but also on those
         for serotonin, norepinephrine, acetylcholine, and
         histamine
        Beneficial in treating the negative as well as the
         positive symptoms of schizophrenia
        No signs of Parkinson’s symptoms or of tardive
         dyskinesia appeared in any of the patients taking the
         drug
Pharmacological Treatments
Are Superior for Schizophrenia
    Clozapine’s side effects are serious:

        Seizures, heart arrhythmias, substantial weight gain, a
         fatal reduction in white blood cells


    More recently, second-generation antipsychotics
     have been introduced that do not reduce white
     blood cell counts
Pharmacological Treatments
Are Superior for Schizophrenia
   Psychosocial treatments:

       Medication does not substantially affect patients’
        social functioning

       Social skills training is an effective way to address
        some deficits in schizophrenics

       Initial studies using CBT indicate that it is more
        effective than other psychological treatments in
        reducing symptoms
Pharmacological Treatments
Are Superior for Schizophrenia
   Prognosis in schizophrenia:

       One long-term study followed participants for an
        average of 32 years:
           Between half and two-thirds were recovered or had
            considerable improvement in functioning on follow-up


       The prognosis for schizophrenic patients depends
        on factors including age of onset, gender, and
        culture
There Are Important Considerations
in Selecting a Psychotherapist

   The major types of specialized mental health
    practitioners include the following:

       Clinical psychologists
       Psychiatrists
       Counseling psychologists
       Psychiatric social workers
       Psychiatric nurses
       Paraprofessionals
There Are Important Considerations
in Selecting a Psychotherapist

   The right therapist must have the appropriate
    training and experience for the specific
    mental disorder, and the person seeking help
    must believe the therapist is trustworthy and
    caring
Critical Thinking Skill
   Avoiding the sunk cost fallacy

       People often stick with something because they
        have already invested so much in it, even if it’s
        not working
       The investment is gone, you cannot get it back
       Instead, you should focus on deciding what is the
        best option for the future
Can Personality Disorders Be
Treated?

   Dialectical Behavior Therapy Is Most
    Successful for Borderline Personality
    Disorder

   Antisocial Personality Disorder Is Difficult to
    Treat
Learning Objectives

Explain why personality
 disorders are difficult to treat.
Dialectical Behavior Therapy and
Borderline Personality Disorder
   The most successful treatment approach to
    date for borderline personality disorder was
    developed by Marsha Linehan in the 1980s

   Dialectical behavior therapy (DBT) combines
    elements of the behavioral, cognitive, and
    psychodynamic approaches
Dialectical Behavior Therapy and
Borderline Personality Disorder
   Therapy proceeds in three stages:
       In the first stage, the therapist targets the patient’s
        most extreme and dysfunctional behaviors
           Replacing these behaviors with more appropriate ones
       In the second stage, the therapist helps the
        patient explore past traumatic experiences that
        may be at the root of emotional problems
       In the third stage, the therapist helps the patient
        develop self-respect and independent problem-
        solving skills
Dialectical Behavior Therapy and
Borderline Personality Disorder
   Those undergoing DBT are more likely to
    remain in treatment and less likely to be
    suicidal than are patients in other types of
    therapy

   SSRIs are often prescribed along with DBT to
    treat feelings of depression
Antisocial Personality
Disorder Is Difficult to Treat
   Therapeutic approaches for antisocial
    personality disorder

       Stimulants prescribed to normalize arousal levels

           Evidence indicates that these drugs are beneficial in
            the short term but not the long term
Antisocial Personality
Disorder Is Difficult to Treat
    Anti-anxiety drugs may lower hostility levels
     somewhat, and lithium has shown promise in
     treating the aggressive, impulsive behavior of
     violent criminals who are psychopathic

        Overall, however, psychotropic medications have not
         been effective in treating this disorder
Antisocial Personality
Disorder Is Difficult to Treat
    Behavioral approaches

        Seems to work best when the therapist controls
         reinforcement, the client cannot leave treatment, and
         the client is part of a group


    Cognitive approaches have also been tried for
     antisocial personality disorder with some
     promising results
Antisocial Personality
Disorder Is Difficult to Treat
   The prognosis for antisocial personality
    disorder:
       The prognosis that patients will change their
        behaviors as a result of therapy is poor
       Fortunately for society, antisocial individuals
        without psychopathy typically improve after age
        40
           But many continue to commit crimes and exhibit the
            callousness and manipulativeness characteristic of
            this disorder
For this longitudinal study, the percentage of participants in prison during each five-year period is shown.
How Should Childhood and
Adolescent Disorders Be Treated?
   The Use of Medication to Treat Adolescent
    Depression Is Controversial
   Children with ADHD Can Benefit from
    Various Approaches
   Critical Thinking Skill: Evaluating
    Alternatives in Decision Making
   Autistic Children Benefit from a Structured
    Treatment Approach
Learning Objectives
Explain key arguments in the debate
 about prescribing medication to
 children with depression and ADHD.

Understand that sometimes behavioral
 treatments are best for biological
 disorders such as autism.
The Use of Medication to Treat
Adolescent Depression Is Controversial

   Fewer than 30 percent of children who have
    mental health problems receive any type of
    treatment

   Twice as many of those taking SSRIs
    reported having suicidal thoughts (4 percent)
    as those taking a placebo (2 percent)
       None of the children or adolescents committed
        suicide
The Use of Medication to Treat
Adolescent Depression Is Controversial

   The FDA voted in 2004 to require
    manufacturers to add to their product labels a
    warning that antidepressants increase the
    risk of suicidal thinking and behavior in
    depressed children and adolescents
The Use of Medication to Treat
Adolescent Depression Is Controversial

   The Treatment of Adolescents with
    Depression Study provides clear evidence
    that the SSRI Prozac is effective in treating
    adolescent depression

       Although the combined group had the best
        outcomes (86% improvement), improvement with
        CBT alone (81%) was similar to that with Prozac
        alone (81%)
The Use of Medication to Treat
Adolescent Depression Is Controversial

    All treatment groups experienced a reduction in
     thoughts of suicide compared with the baseline

    Participants in the Prozac group were twice as
     likely to have serious suicidal thoughts or
     intentions compared with those undergoing other
     treatments
        Although prescribing drugs without CBT might be cost
         effective, it may not be in the best interests of
         depressed children
Children with ADHD Can Benefit
from Various Approaches
   Pharmacological treatment of ADHD
       The most common treatment is a central-nervous-
        system stimulant, Ritalin

           Children on Ritalin experience an increase in positive
            behaviors and a decrease in negative behaviors

           Side effects include sleep problems, reduced appetite,
            body twitches, and temporary growth suppression
Children with ADHD Can Benefit
from Various Approaches
    Evidence indicates that although stimulants are
     beneficial in the short term, their benefits may not
     be maintained over the long term

    In addition, there is a very real risk of abuse

        Numerous cases of children and adolescents buying
         and selling these stimulants
Children with ADHD Can Benefit
from Various Approaches
   Behavioral treatment of ADHD:

       Aims to reinforce positive behaviors and ignore or
        punish problem behaviors

       Medication plus behavioral therapy is more
        effective than either approach alone.
           Medications may be important in the short term;
            psychological treatments may produce superior
            outcomes that last
Critical Thinking Skill
   Evaluating alternatives in decision making:

       The first step to good decision making is to frame
        the question that needs deciding
       Then evaluate each alternative along many
        dimensions
       Putting the process on paper allows you to
        consider multiple alternatives without being limited
        by working memory
Autistic Children Benefit from a
Structured Treatment Approach
   Behavioral treatment for autism:

       Applied behavioral analysis (ABA)

           Developed by Ivar Lovaas and his colleagues
           One of the best-known and perhaps most effective
            treatments for autistic children
           Based on principles of operant conditioning
           This very intensive approach requires a minimum of
            40 hours of treatment per week
Autistic Children Benefit from a
Structured Treatment Approach
    Although the ABA program has been
     demonstrated to be effective, it has some
     drawbacks:

        Time commitment
        Financial and emotional drains on the family
        Other children may feel neglected or jealous because
         of the amount of time and energy expended on the
         disabled child
Autistic Children Benefit from a
Structured Treatment Approach
   Biological treatment for autism:

       SSRIs have been tried as a treatment for autism
        because:

           SSRIs such as Prozac reduce compulsions in patients
            diagnosed with obsessive-compulsive disorder
           Autism involves compulsive and repetitive behavior
           Some evidence indicates abnormal serotonin
            metabolism in autistic children
Autistic Children Benefit from a
Structured Treatment Approach
    Indeed, in some autistic children Prozac reduces
     repetitive motor behavior and self-injury and
     improves social interactions

    More recent research has focused on oxytocin
Autistic Children Benefit from a
Structured Treatment Approach
   Prognosis for children with autism:

       Long-term prognosis is poor

           Studies indicate that nearly three-quarters of adults
            with autism had severe social difficulties and were
            unable to live and work independently
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