Unit 13 Treatment of Abnormal Behavior Learning Targets
Unit 13 Treatment of Abnormal Behavior Learning Targets Module 73 The Biomedical Therapies and Preventing
Psychological Disorders 73-1 Examine how therapeutic lifestyle change could be considered an effective biomedical therapy, and explain how it works. 73-2 Describe the drug therapies, and discuss how double-blind studies help researchers evaluate a drugs effectiveness.
73-3 Discuss how brain stimulation and psychosurgery are used to treat specific disorders. 73-4 Describe the rationale for preventive mental health programs, and evaluate the importance of developing resilience. What is a lifestyle and how does it impact mental health? Our lifestylethe choices we make to exercise or to sit on
the couch playing video games, to eat whole, healthy foods or grab quick packaged and processed goodies, the relationships we choose to nurture, the activities we select for recreation, how we relax, and how religious or spiritually engaged we areaffects our mental health. (Schuch et al., 2016; Walsh, 2011) Thinking critically In what ways do you think your lifestyle is affecting your mental health? Are there any changes you can make to your lifestyle
that might improve your overall physical and mental health? Talk about it. How were humans designed? We were designed for physical activity and social engagement.
Our ancestors hunted, gathered and built in groups. How important is physical activity? Modern researchers have found that outdoor activity in a
natural environment reduces stress and promotes health. How important is aerobic activity? Physicians and psychologists agree. Regular aerobic activity, playing basketball, walking, running, swimming, shooting a soccer ball with friends, contributes to overall physical and mental well-being.
How important is socializing? Studies show friendships and group involvement help satisfy the need to belong. How important is sleep?
As discussed in Module 24, adequate sleep is essential to physical and mental health. Do lifestyle changes help relieve depression? An initial study showed that participants engaging in lifestyle change therapy experienced relief from depressive symptoms. What is psychopharmacology?
the study of the effects of drugs on mind and behavior Since the 1950s, discoveries in psychopharmacology have revolutionized the treatment of people with severe disorders, liberating hundreds of thousands from hospital confinement. Thanks to drug therapy and local community mental health programs, the resident population of U.S. state and county mental hospitals is now a small fraction of what it was in the mid-twentieth century. How was psychopharmacology initially
received? Almost any new treatment, including drug therapy, is greeted by an initial wave of enthusiasm as many people apparently improve. What are antipsychotic drugs? drugs used to treat schizophrenia and other forms of severe thought disorder First-generation antipsychotic drugs, such as
chlorpromazine (Thorazine), dampened responsiveness to irrelevant stimuli. They provided the most help to patients experiencing positive (actively inappropriate) symptoms of schizophrenia, such as auditory hallucinations and paranoia. (Lehman et al., 1998; Lenzenweger et al., 1989) What are some side effects of antipsychotic medication? Antipsychotics also have powerful side effects.
Some produce sluggishness, tremors, and twitches similar to those of Parkinsons disease (Kaplan & Saddock, 1989) Long-term use of antipsychotics can produce tardive dyskinesia, with involuntary movements of the facial muscles (such as grimacing), tongue, and limbs. What is the impact on dopamine from antipsychotic medications? The molecules of most conventional antipsychotic
drugs are similar enough to molecules of the neurotransmitter dopamine to occupy its receptor sites and block its activity. Antipsychotic drugs act as an antagonist for dopamine. This finding reinforces the idea that an overactive dopamine system contributes to schizophrenia. 1. What Would You Answer? Which neurotransmitter is affected by
antipsychotic medications? A. epinephrine B. dopamine C. norepinephrine D. acetylcholine E. serotonin What are antianxiety drugs? drugs used to control anxiety and agitation Like alcohol, antianxiety drugs, such as Xanax or Ativan, depress central nervous system activity.
Some antianxiety drugs have been successfully used in combination with psychological therapy to enhance exposure therapys extinction of learned fears and to help relieve the symptoms of posttraumatic stress disorder and obsessive-compulsive disorder. (Davis, 2005; Kushner et al., 2007) What are anti depressant drugs? drugs used to treat depression, anxiety disorders, obsessive-compulsive disorder, and posttraumatic stress disorder
Many antidepressants work by increasing the availability of neurotransmitters, such as norepinephrine or serotonin, which elevate arousal and mood and are scarce when a person experiences feelings of depression or anxiety. What are SSRIs and what is their function? Several widely used antidepressant drugs are selective serotonin reuptake inhibitorsSSRIs.
The most commonly prescribed drugs in this group, including Prozac, Zoloft and Paxil, work by prolonging the time serotonin molecules remain in the brains synapses. Remind yourself. Using your AP Psychology vocabulary, talk through the steps in neural transmission with the person next to you.
How does neural transmission with serotonin typically work? The neural message is sent across the synaptic gap with the release of serotonin and received in the receptor sites on the post-synaptic neuron. After the message passed to the post-synaptic neuron, excess serotonin is reabsorbed by the sending neuron through a process called reuptake. How does Prozac
work? Prozac, an SSRI, partially blocks normal reuptake of the neurotransmitter serotonin; excess serotonin in synapse enhances its moodlifting effect. What do double-blind trials regarding the
placebo effect? In double-blind clinical trials, placebos produced improvement comparable to about 75 percent of the active drugs effect. For those with severe depression, the placebo effect is less and the added drug benefit somewhat greater. (Fournier et al., 2010; Kirsch et al., 2008; Olfson & Marcus, 2009) So, if one suffers from mild depression, might an alternative therapy work as well as medication?
Considering the placebo effect, what is the recommendation for use of antidepressants? Irving Kirsch, of the Program in Placebo Studies at Harvard University recommends limited antidepressant use. Since antidepressants often have unwanted side effects, and aerobic exercise and cognitive behavioral therapy are also effective antidotes to mild or moderate depressions, if antidepressants are to be used at all, they should be a last resort. (Kirsch, 2016)
What are mood-stabilizing drugs? Mood-stabilizing drugs help to control the manic, out-of-control feelings that often come with bipolar or other disorders. Depakote, an older mood stabilizer, was originally used to treat epilepsy. It was also found effective in controlling the manic episodes associated with bipolar disorder. Another, the simple salt lithium, effectively levels the emotional highs and lows of bipolar disorder.
What does research show about the benefits of lithium? About 70% of people with bipolar disorder benefit from a longterm daily dose of lithium, which helps prevent or ease manic episodes and, to a lesser extent, lifts depression. (Solomon et al., 1995) Taking lithium also correlates with a lower risk of suicide among people with bipolar disorderto about one-sixth the risk of those not taking lithium. (Oquendo et al., 2011) Naturally occurring lithium in drinking water has also correlated with lower suicide rates across 18 Japanese cities and towns,
and lower crime rates across 27 Texas counties. (Ohgami et al., 2009; Schrauzer & Shrestha, 1990, 2010; Terao et al., 2010) What is electroconvulsive shock therapy (ECT)? a biomedical therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized patient In ECT, the patient receives a general anesthetic and a muscle relaxant (to prevent bodily convulsions). A psychiatrist then delivers a brief pulse of electrical
current, sometimes only to the brains right side, which triggers a 30- to 60-second seizure. Within 30 minutes, the patient awakens and remembers nothing of the treatment or of the preceding hours. How effective is ECT? A Journal of the American Medical Association editorial
concluded that the results of ECT in treating severe depression are among the most positive treatment effects in all of medicine (Glass, 2001) What is transcranial direct current stimulation (tDCS)?
In contrast to ECT, which produces a brain seizure with about 800 milliamps of electricity, transcranial direct current stimulation (tDCS) administers a weak 1- to 2-milliamp current to the scalp. After reviewing recent studies, two European expert panels reported the probable efficacy of tDCS as a depression treatment. (Brunoni et al., 2016; Lefaucheur et al., 2017) How does tDCS
work?? The psychiatrist applies a weak current to the scalp. What is repetitive transcranial magnetic stimulation (rTMS)? the application of repeated pulses of magnetic energy to the brain; used to stimulate or suppress brain activity
Repetitive transcranial magnetic stimulation (rTMS) is performed on wide-awake patients over several weeks. Repeated pulses surging through a magnetic coil held close to the skull can stimulate or suppress activity in areas of the cortex. The rTMS procedure produces no memory loss or other serious side effects, aside from possible headaches. How does rTMS work? The psychiatrist sends a
painless magnetic field through the skull to the surface of the cortex to alter brain activity. What is deep-brain stimulation (DBS)? Patients whose depression has resisted both drugs and ECT have benefited from an experimental treatment pinpointing a neural hub that bridges the thinking frontal lobes to the limbic system.
(Becker et al., 2016; Brunoni et al., 2017; Ryder & Holtzheimer, 2016) Since 2003, researcher Helen Mayberg and her colleagues have used DBS to treat some 200 depressed patients via implanted electrodes in the subcallosal cingulate, a brain area that functions as the neural sadness center. (Lozano & Mayberg, 2015) Is there a depression switch? By comparing the brains of patients with and without
depression, researcher Helen Mayberg identified a brain area (highlighted in red) that appears active in people who are depressed or sad, and whose activity may be calmed by deep-brain stimulation. How does DBS work? Psychiatrist stimulates electrodes
implanted in sadness centers to calm those areas. What is psychosurgery? surgery that removes or destroys brain tissue in an effort to change behavior Because its effects are irreversible, psychosurgery surgery that removes or destroys brain tissueis the most
drastic and least-used biomedical intervention for changing behavior. 2. What Would You Answer? Juliettes depression is not responding to the normal biomedical treatments. Her therapist has suggested that she try several sessions of _____ to energize her left frontal lobe and reduce her symptoms. A. psychosurgery
B. rTMS C. ECT D. CBT E. REBT What is a lobotomy? a psychosurgical procedure once used to calm uncontrollably emotional or violent patients In the 1930s, Portuguese physician Egas Moniz developed what would become the best-known psychosurgical operation: the lobotomy.
Moniz found that cutting the nerves connecting the frontal lobes with the emotion-controlling centers of the inner brain calmed uncontrollably emotional and violent patients. Failed lobotomy. This 1940 photo shows Rosemary Kennedy (center) at age 22 with brother (and future U.S. president) John and sister Jean. A year later her father, on medical
advice, approved a lobotomy that was promised to control her reportedly violent mood swings. The procedure left her confined to a hospital with an infantile mentality until her death in 2005 at age 86. Is psychosurgery still used today? Precise, microscale psychosurgery is sometimes used in extreme cases such as uncontrollable seizures. Surgeons can deactivate the specific nerve
clusters that cause or transmit the convulsions. MRI-guided precision surgery is also occasionally done to cut the circuits involved in severe obsessivecompulsive disorder. (Carey, 2009, 2011; Sachdev & Sachdev, 1997) Because these procedures are irreversible, neurosurgeons perform them only as a last resort. Comparing biomedical therapies What is the traditional thinking regarding disorders?
Psychotherapies and biomedical therapies tend to locate the cause of psychological disorders within the person. We infer that people who act cruelly must be cruel and that people who act crazy must be sick. We attach labels to such people, thereby distinguishing them from normal folks. It follows, then, that we try to treat abnormal people by giving them insight into their problems, by changing their thinking, by helping them gain control with drugs.
But is that the only viewpoint? We could interpret many psychological disorders as understandable responses to a disturbing and stressful society. According to this view, it is not just the person who needs treatment, but also the persons social context. Better to prevent a problem by reforming an unhealthy situation and by developing peoples coping competencies than to wait for and treat problems.
What is resilience? the personal strength that helps most people cope with stress and recover from adversity and even trauma Faced with unforeseen trauma, most adults exhibit resilience. More than 9 in 10 New Yorkers, although stunned and grief-stricken by 9/11, did not have a dysfunctional stress reaction. Especially resilient were those who enjoyed supportive close relationships and who had not recently
experienced other stressful events. (Bonanno et al., 2007) What is posttraumatic growth? positive psychological changes as a result of struggling with extremely challenging circumstances and life crises Struggling with challenging crises can even lead to posttraumatic growth. For instance, many cancer survivors have reported a greater appreciation for life, more meaningful
relationships, increased personal strength, changed priorities, and a richer spiritual life. (Tedeschi & Calhoun, 2004) Make a difference Can you think of a specific way that improving the environment in your own community might prevent some psychological disorders among its residents? Talk with your class. Brainstorm ideas. Start a
campaign! Learning Target 73-1 Review Examine how therapeutic lifestyle change could be considered an effective biomedical therapy, and explain how it works. Therapeutic lifestyle change is considered a biomedical therapy because it influences the way the brain responds. Mind and body are a unit; affect one and you will affect the other.
Our exercise, nutrition, relationships, recreation, relaxation, and religious or spiritual engagement affect our mental health. Learning Target 73-1 Review cont. Examine how therapeutic lifestyle change works.
People who undergo a program of: aerobic exercise, adequate sleep, light exposure, social engagement, rumination reduction, and better nutrition have gained relief from depressive
symptoms. Learning Target 73-2 Review Describe the drug therapies. Psychopharmacology, the study of drug effects on mind and behavior, has helped make drug therapy the most widely used biomedical therapy. Antipsychotic drugs, used in treating schizophrenia, block dopamine activity. Side effects may include tardive dyskinesia (with involuntary movements of facial muscles, tongue,
and limbs) or increased risk of obesity and diabetes. Learning Target 73-2 Review part II Describe the drug therapies, and discuss how double-blind studies help researchers evaluate a drugs effectiveness. Antianxiety drugs, which depress central nervous system activity, are used to treat anxiety disorders, obsessive compulsive disorder, and posttraumatic stress disorder. These drugs can be physically and
psychologically addictive. Lithium and Depakote are mood stabilizers prescribed for those with bipolar disorder. Studies may use a double-blind procedure to avoid the placebo effect and researchers bias. Learning Target 73-2 Review part III Describe the drug therapies. Antidepressant drugs, which increase the availability of serotonin and norepinephrine, are used for depression, often with modest
effectiveness beyond that of placebo drugs. The antidepressants known as selective serotonin reuptake inhibitors (SSRIs) are now used to treat other disorders including strokes, anxiety disorders, obsessive-compulsive disorder, and posttraumatic stress disorder. Learning Target 73-3 Review Discuss how brain stimulation and psychosurgery are used to treat specific disorders.
Electroconvulsive therapy (ECT), in which a brief electric current is sent through the brain of an anesthetized patient, is an effective treatment for people with severe depression who have not responded to other therapy. Transcranial direct current stimulation (tDCS) administers a far weaker current to the scalp. Learning Target 73-3 Review part II Discuss how brain stimulation and psychosurgery are used to
treat specific disorders. Newer alternative treatments for depression include repetitive transcranial magnetic stimulation (rTMS) and, in preliminary clinical experiments, deep-brain stimulation that calms an overactive brain region linked with negative emotions. Learning Target 73-3 Review part III Discuss how brain stimulation and psychosurgery are used to treat specific disorders.
Psychosurgery removes or destroys brain tissue in hopes of modifying behavior. Radical psychosurgical procedures such as the lobotomy were once popular, but neurosurgeons now rarely perform brain surgery to change behavior or moods. Brain surgery is a last-resort treatment because its effects are irreversible. Learning Target 73-4 Review Describe the rationale for preventive
mental health programs, and evaluate the importance of developing resilience. Preventive mental health programs are based on the idea that many psychological disorders could be prevented by changing oppressive, esteemdestroying environments into more benevolent, nurturing environments that foster growth, selfconfidence, and resilience. Building resilience might prevent some disorders or even enable posttraumatic growth.
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