Defining Abrnomality

• Mental Illness:
  - Society thinks there is an underlying biological factor (no biological test for this available)
                  +  highly unlikely that single biolog. Cause underlies it.
  - Mental health exp.: Mental disorder à collection of problems in thinking, emotion regulation and social behaviour

  Psychopathology: Study of people who suffer from physical, emotional, mental pain
   

• Cultural Norms:
  - Large role in defining abnormality (especially gender stereotypical expectiations)
                  1. influence symptom expression
                  2. Influence willingness to admit to behaviors and feelings
                  3. Influence acceptable treatment methods

Cultural Relativism:
No universal standards to label behaviour as abnormal. Abnormal can only be defined in societal context

• The 4 D´s
  - Definition of abnormal by:
                  1. Dysfunction: Person can´t have normal life
                  2. Distress: Distress themselves or people around them
                  3. Deviant: Behavior deviates from from social norm
                  4. Dangerous: Behavior is dangerous to ill person or others
  à maladaptive

Historical perspectives:

                1. Biological theories: Abnormality caused by physical breakdown
                2. Supernatural Theories: Abnormality = Divine intervention
                3. Psychological Theories: Result of traumas (stress)

• Ancient Theory:
  - Evil spirits, treated with exorcism

  Trephination: Sections of skull drilled or cut away, so that spirits can depart

- Balancing Yin and Yang: Insane people (mania) have too much positive power à food taken away, so that positive power decreases. “Vital Air” had to be at the right parts of the body.

- Egypt, Greece, Rome:
                Biological Theories: (wandering uterus = Egypt + Greek “hysteria = uterus”)
                Supernatural theories (minimal): Infliction from Gods (Greek public, Rome)
                à Mostly rejected from Greek physicians (Too much blood. Hiipocrates = first
                                attempt to find other explanations (social)

• Medieval views:
  - Mostly supernatural explanations: Witchcraft

  Psychic epidemics: Many people engage in abnormal behaviour (dance frenzy / Tarantism)

• Spread of Asylums:
  - 1200 start. Bad conditions. Warehousing
  - Treatment was physical (bleeding)

• Moral treatment:
  - 1800-1900

  Mental hygiene movement: People are separated from nature, too much stress cause of societal changes

  Moral Treatment:
  (Phillipe Pinel). Treat ill with respect and dignity.
  (Dorothea Dix): Spreads the moral treatment and builds many mental health hospitals.
  First popular, than unpopular because of exponential growth and declining results

Emergence of Modern Perspectives:

• Beginning of Biological Perspectives:
  1800-1900: Understanding of body increased à leads to biological explanations

  Parts missing because fucking word shut itself down (p14-16)

Modern Mental Health Care:

                1. 1950s: Drug treatment major breakthroughs:
                                                Phenotiazines: Drug vs hallucination and delusion.

• Deinstitutionalization:
  - 1960: Patients rights movement: ill should be reintegrated into society
  à Community mental health movement and care centers established by Kennedy 1963

  Halfway houses: Offer living in structured community

  Day Treatment centers: Offer day treatment.

  à Problem: Not enough resources to provide adequate care. Incarceration rate increases.

  - 4/5 of homeless have mental disorder
  - 2/3 of inmates could be diagonesed with mental disorder

Defining Abrnomality
 

• Mental Illness:
  - Society thinks there is an underlying biological factor (no biological test for this available)
                  +  highly unlikely that single biolog. Cause underlies it.
  - Mental health exp.: Mental disorder à collection of problems in thinking, emotion regulation and social behaviour

  Psychopathology: Study of people who suffer from physical, emotional, mental pain
   

• Cultural Norms:
  - Large role in defining abnormality (especially gender stereotypical expectiations)
                  1. influence symptom expression
                  2. Influence willingness to admit to behaviors and feelings
                  3. Influence acceptable treatment methods

Cultural Relativism:
No universal standards to label behaviour as abnormal. Abnormal can only be defined in societal context

• The 4 D´s
  - Definition of abnormal by:
                  1. Dysfunction: Person can´t have normal life
                  2. Distress: Distress themselves or people around them
                  3. Deviant: Behavior deviates from from social norm
                  4. Dangerous: Behavior is dangerous to ill person or others
  à maladaptive

Historical perspectives:

                1. Biological theories: Abnormality caused by physical breakdown
                2. Supernatural Theories: Abnormality = Divine intervention
                3. Psychological Theories: Result of traumas (stress)

• Ancient Theory:
  - Evil spirits, treated with exorcism

  Trephination: Sections of skull drilled or cut away, so that spirits can depart

- Balancing Yin and Yang: Insane people (mania) have too much positive power à food taken away, so that positive power decreases. “Vital Air” had to be at the right parts of the body.

- Egypt, Greece, Rome:
                Biological Theories: (wandering uterus = Egypt + Greek “hysteria = uterus”)
                Supernatural theories (minimal): Infliction from Gods (Greek public, Rome)
                à Mostly rejected from Greek physicians (Too much blood. Hiipocrates = first
                                attempt to find other explanations (social)

• Medieval views:
  - Mostly supernatural explanations: Witchcraft

  Psychic epidemics: Many people engage in abnormal behaviour (dance frenzy / Tarantism)

• Spread of Asylums:
  - 1200 start. Bad conditions. Warehousing
  - Treatment was physical (bleeding)

• Moral treatment:
  - 1800-1900

  Mental hygiene movement: People are separated from nature, too much stress cause of societal changes

  Moral Treatment:
  (Phillipe Pinel). Treat ill with respect and dignity.
  (Dorothea Dix): Spreads the moral treatment and builds many mental health hospitals.
  First popular, than unpopular because of exponential growth and declining results

Emergence of Modern Perspectives:

• Beginning of Biological Perspectives:
  1800-1900: Understanding of body increased à leads to biological explanations

  Part missing, Word shut itself down. (2 pages)

Modern Mental Health Care:

                1. 1950s: Drug treatment major breakthroughs:
                                                Phenotiazines: Drug vs hallucination and delusion.

• Deinstitutionalization:
  - 1960: Patients rights movement: ill should be reintegrated into society
  à Community mental health movement and care centers established by Kennedy 1963

  Halfway houses: Offer living in structured community

  Day Treatment centers: Offer day treatment.

  à Problem: Not enough resources to provide adequate care. Incarceration rate increases.

  - 4/5 of homeless have mental disorder
  - 2/3 of inmates could be diagonesed with mental disorder

• Managed Care
  - Collection of methods to coordinate care. AOK and insurances.
  - Beneficail for people with long-term serious mental health issues.
  - Problematic, because the net can have holes, so patients drop out or are unmonitored.

Professions within Abnormal Psychology:
- Psychiatrists
-Clinical Psychologists
- General Counselors
- Clinical Social workers
- Psychiatric nurses
 

• Managed Care
  - Collection of methods to coordinate care. AOK and insurances.
  - Beneficail for people with long-term serious mental health issues.
  - Problematic, because the net can have holes, so patients drop out or are unmonitored.

Professions within Abnormal Psychology:
- Psychiatrists
-Clinical Psychologists
- General Counselors
- Clinical Social workers
- Psychiatric nurses

Introduction

 

- Hayes: ACT, Acceptance and commitment therapy

Theory: Set of propositions that guide the posation of questions and interpretations of a phenomenon

Therapy: Treatment, usually based on a theory

- Nature Nurture debate about the reasons of psychopathological problem.

Biopsychosocial approach: Different causes of psychological problems à Risk factors

Transdiagnostic risk factors: Increase risk for multiple different types of psychological problems.

Diathesis-stress model: Combination of “predisposing” cause and “precipitating” cause, that lead to a disorder.

- Each approach lead to different treatments, now mostly biological and psychotherapy are used combined.

Biological Approaches
 

• Brain Dysfunctiions

• Biochemical Imbalances:

  Neurotransmitter: Substance that acts as messenger between to neurons
                  - Related to many psychopathological symptoms
                 
                  Reuptake: Reabsorbation of neurotransmitter into the presynaptic neuron

                  Degradation: Break down of neurontransmitter through enzymes

  - Psychological problems can also be the number of receptors
  - Changes in functioning can be caused by psychological experiences
  - 100 Different neurotransmitters

  1. Serotonin:
  - Important for emotional wellbeing and impulses

  2. Dopamine:
  - Important for Reward and Reinforcement processes (affected by many drugs like alcohol)
  - Functioning of muscle systems à plays role in Parkinson´s disease

  3. Norepinephrine (Noradrenaline)
  - Mood regulation (not enough à depressed)
  - Action is prolongued by cocaine and amphetamine

  4. GABA (gamma-aminobutyric acid)
  - Inhibits action of other neurotransmitters
  - Tranquilizing effect
  - Important for anxiety symptoms

  Endocrine System: System of glands that produce hormones

  sdfGH                Hormone: Message carrier through the body, affects mood, energylevel, stressreaction
                 
                  Pituitary gland (mastergland): Produces largest number of hormones. Lies below
                  Hypothalamus. Controls secretion of other glands.
                  - Interacts with Hypthalamus: Eg. Stressreaction: Hypothalamus releases CRF corticotr
                     pinrealease, which activates the release of the adrenocorticotropic hormone (ACTH)
                     à major stress hormone. This is released to the other glands which release further hor-
                      mones.
                  - Malfunction of the HPA Axis (hypothalamic-pituitary-adrenal axis) can lead to OCD,
                    Anxiety, Mood or suicide.

• Genetic Abnormalities
  - Genetic Factors influence the environment we chose
  - The environment is a catalyst to the activation of genes.

  Epigenetics: Study of heritable changes in expression of genes that do not affect the gene sequence

  - Eg: Licking rat-mothers vs non licking – changes resilience toward stress, even if genes are not
           Primarily activated at birth.

  - S/S, S/L, L/L alleles: Declining risk factors to development of a disorder due to maltreatment in childhood

Therapyforms – Biological Approaches

• Drug Therapies:

  Antipsychotic drugs: Reduce symptoms of psychosis
  - Phenothiazines
  - typical and atypical (many side effects vs little)

  Antidepressant drugs: Reduce symptoms of depression
  - SSRI: Selective serotonin reuptake inhibitors
  - SNRI: Selective serotonin-norepinephrine reuptake inhibitors
  - tricyclic antidepressants: (old drugs)

  Lithium + Anticonvulsants: Metal present in sea and tissue of living things
  - Treatment for bipolar disorders (good for mood regulation)

  Antianxiety drugs:
  - Barbiturates (1900)
  - Benzodiazepines (also sleep pills)

• Electroconvulsive Therapy and Brain stimulation
  - Reduce symptoms of depression and auditory hallucinations
  - Brain stimulation can cause long-term changes in neurotransmitter function

  ECT: Induced brain seizure by electrical currents

  rTMS:  Repetitive transcranial magnetic stimulation: Repeated high intensity magnetic
  impulses on certain brain areas

  Deep brain stimulation + Vagus nerve stimulation: Surgical implantation of electrodes

• Psychosurgery:
  - Trephination (Chapter 1)
  - Antonio de Egas Moniz

  Prefrontal lobotomy: Cutting away, or disconnecting parts of the prefrontal cortex from the rest of the brain
  à Many devastating sideffect

Psychological Approaches

• Behavioral approaches: Focus on the influence of reinforcement and punishment on behaviour.
  - Classical conditioning: USàUR, NS + US à CR
  - Operant conditioning: Shaping of behaviour by reward and punishment (Thorndike)
                  - Continous reinforcement: ratio
                  - Partial reinforcement: variable
                  - Extinction: Elimination of learned behaviour
                  - 2 Factor model: combination of classical + operant conditioning is responisible for fears

  - Social learning theory: People learn behaviour by watching others

                  Modeling: Learning by imitation from authority figure or similar person
                  Observational learning: Learning by seeing the reinforcement or punishment of other´s
                  behaviors

  - Behavioral therapies: Focus on identification of reinforcers for maladaptive behaviors
   à Behavioral assessment

  Systematic desensitization therapy: Gradual method to extinguish anxiety response by learning relaxation techniques first and then gradually approach the fearful stimuli.
  - often combined with modelling
  - in vivo exposure most effective

  - Behavioral theories are high scientific standard and proven to be very effective

• Cognitive Approaches
  - Good for: Mood, anxiety, sexual, substance disorders
  cognitions: Thoughts and beliefs that shape behaviour and emotions are responsible for problems
  - People ask themselves “why” something happened.
    à causal attribution

  Global assumptions: People have beliefs about themselves, the world, relationships

  - Cognitive therapy: Helps client to identify and challenge their belief-systems and helps to develop better coping strategies. Mostly short-term 12-20 weeks. 3 main goals:

                  1. Identification beliefs
                  2. Encourage challenge beliefs
                  3. Encourage to face fears

  - Often combined with behavioural therapy CBT – cognitive-behavioral therapy.
  à assignemnts, real life testing ect.

• Psychodynamic approach
  - Behaviors are influenced by the subconscious
  - Freud 1890
                  - ID: Libido and aggressive drive. Pleasure pain principle (subconscious-preconscious)
                  - EGO: Gratification of ID´s wishes in a socially acceptable way (conscious)
                  - Superego: Storehouse of rules -> moral standards

                  - Psychosexual stages: Stages that individuals have to pass or master in order to develop
                    a healthy personality

                  1. Oral stage: 0-18m: Stimulation of mouth area (mistrust, fear of abandonement)
                  2. Anal stage: 18-3y: Pleasure with toilet activities (stubborn, controlling)
                  3. Phallic stage: 3-6: Pleasure in genitals.
                                  Oedipus complex: Envy on father àResolution leads to strong superego
                                  Electra complex: Lack of penis is problem. Envy mother.
                                  à Resolution of both lead to normal gender roles
                  4. Latency stage: Development of skills and interests in society
                  5. 12+ years: Sexual focus emerges again

  Psychoanalysis: Theory of personality and psychopathology + Method of investigating mind and form a treatment à Relief of repressed experiences
                 
                  catharsis: Release of emotions connected to painful past memories

Defense mechanisms: Operations to repress, disguise or transform unconscious wishes

-Psychodynamic theories:
                ego psychology: Ability to direct healthy defense mechanisms
                object relations: Drive theory + early relationship theory à How they influence self concepts
                                                or other pictures about relationships
                self psychology+
                relational psychology: Emphasize unconscious dimensions of relationships

- Carl Jung: Spiritual and Religious drives are important as well.
                Collective unconscious: Wisdom is transferred over the generations

- Psychodynamic therapies:
                - Limitations: Not scientific, expensive, lack of structure, no immediate help
                - longterm
                - focused on current experience ≠ psychoanalysis therapy

Focus on uncovering unconscious processes. Goal is to recognize maladaptive coping strategies and                unconscious conflicts.

                Free association: Client talks freely and resistance  are clues for the therapist.
                                                   Transference:  Projecting unto the therapist. Also clue.

                Interpersonal therapy IPT: Shift focus from unconscious to pattern of relationships
                - Therpaist gives active advice and structures the therapy more.

• Humanistic Approach:
  - Carl Rogers 1960
  - Humans have inner capacity for goodness and purpose
  - not scientific
  - Good vs Depression, alcoholism, anxiety, schizophrenia, personality disorder (moderate problems)
  self- acutalization: Fulfillment of life purpose
  à is obstructed by social pressures

  - Humanistic Therapy:
                  - Goal is to discover life goals

                  Client centered therapy CCT: Help clients discover their prupose by supporting them through
                                  reflection: empathic approach in trying to understand what the client experienced and                                    communicates

• Family Systems Approach:
  - Familiy is the focus of investigation (difficult)
  - Psychopathology of an individual is an indicator of a disfunctional family system
                  -Enmeshed family: Individuals very dependent on each other
                  -Disengaged: Members pay no attention to each other
                  -Pathological triangular: Parents avoid conflicts and pull children into them

  Behavioral family systems therapy BFST:  Focus on communication and problem solving withing the family
  - Makes use of behavioural methods
  - Therapist is active

• Third Wave Approach
  - Focus on poor regulation of emotion = transdiagnostic risk
  - Combination of behavioural, cognitive, meditation

  Dialectical behaviour therapy DBT: Focus on constant tension that arises from images or emotions that are not well handled à Learn to manage emotions and impulses

  Acceptance and commitment therapy, ACT: Thinks that experiental avoidance of ones life is the cause of psychopathology.

• New Technologies
  - Problem: Too little mental health experts
  - App and Internet useful to deliver tipps

• Sociocultural Approach
  - Very vague, unscientific

   1. Socioeconomic disadvantages
   2. Disintegration of societies (war)
   3. Social norms that stigmatize groups
   4. Implicit or explicit societal rules for what behaviour is abnormal

  - Cross-cultural issues in Treatment
                  1. Problems because cultures differ (indivudalist-collectivist, Gender). Focus on individual
                  2. Therapy values emotion expression and free speech
                  3. Clients are expected to take initiative
                  4. Socioeconomic status between client and therapist may cause tension.
                  à Solution: Cultural sensitivity of therapist

• Culturally specific therapies:
  - Shamanic, religious, spiritual practises, rituals
  - Herbs