I. Affective disordersa. Depressionb. Bipolar disorderI. Early psychiatric treatmentsa. ECTb. Lobotomyc. rTMSd. ABAII. PhobiasIII. TherapyEarly Psychiatric Treatment: Lobotomy (1935): cut fibers in white matter connecting thalamus and limbic system with frontal lobes.Rationale: these brain systems underlie emotional and reasoning. Some early research with non-human primates and suggested that this might work to reduce ‘irrational emotionality’.Did it work?  poor tests used to assess improvement. Poor research methods (no R-DB-PC CTs)In 1952, procedure abandoned. Regarded as not generally effective, some severe side effectsModern version: cingulectomy/tracheotomy. Applied when psychotherapy and drug treatments don’t workECT (Electroconvulsive Therapy): for severe depression when drug or behavioral treatments are not effective. Has also been used to treat mania and schizophrenia.rTMS procedure: magnetic pulses stimulate the left prefrontal cortex (linked to depression). Invented as a tool to investigate mental processes. Seemed to elevate the subject’s moodApplied behavior analysis (ABA): Modifcation of unlearned and learned behaviors by applying principles of conditioning and reinforcement. Conditioning-based therapies attempt to weaken learned associations, or extinguish existing habitual responses (unlike drug therapies). Emphasis is on modifying disturbed, distressing, maladaptive behavior rather than on “underlying causes”.Extinction procedures, counter-conditioning, positive reinforcement and shaping of desired behaviors, punishment procedures to suppress unwanted behaviors, combine conditioning theory and cognitive theoryNathan Azrin: believes in 1-day toilet training. Use modeling and observational learning and some informed common sense.Generalized Anxiety Disorder : “…worry more or less continuously … muscle tension, irritability, difficulty sleeping … attuned to threatening stimuli [hypervigilance] … to a far greater extent and with much less provocation.” Older terminology: neurotic.Relationship with depression: co-morbid in 60% of GAD cases.Theories of causations of phobias, or exaggerated, irrational fears of specific objects and situations1) Classical psychodynamic: phobic object as a symbol related to early experience, unresolved unconscious conflict.2) Conditioning: phobia as result of traumatic avoidance/escape conditioning. Vicarious (observational) learning may be sufficient.3) Biological: "preparedness" for fear learning of specific things & situations.4) Brain: Heritable individual differences in limbic and autonomic nervous systems.Treating phobias: exposure, extinction, counter-conditioningABA: Treating OCD/Tourette’s Syndrome With Habit-Reversal Therapy: Train patients to replace the tic with a competing response. Try to disrupt the automatic chain of events underlying the expression of a tic. This is effective.Childhood autism:• A heritable neuro-developmental disability.• Failure to develop basic social interaction, awareness of others, communication.• Self-involved; strange ritualistic behaviors.• Mental retardation in many cases.• No know psychogenic causes.Ivor Lovaas' treatment program at UCLA: Use operant conditioning techniques to shape normal social behavior. Food as primary reinforcer. Attention, affection, praise as secondary reinforcers.Cognitive-behavioral therapy for depression:Behavioral: depression as a reaction to punishment and non-reinforcement. Anger, frustration turned inwards. Can be positively reinforced (attention). Can lead to further negative experience and lack of reinforcement (social withdrawal and lack of social reinforcers).Cognitive: "Attributional style" as a factor in the initiation and maintenance of depression: the tendency to attribute aversive experience to "global and stable" factors ('I'm just no good') rather than to transitory or external factors (“I’m having a bad hair day").Goal of therapy: Change attributional style (habits of thought); bring “automatic” maladaptive cognitions and behaviors to the patient’s attention.Does psychotherapy work:There are behaviorally-based therapies that are highly effective in treating certain classes of disorders (anxiety, OCD).The direct effects of these kinds of therapy can be seen directly in altered brain function following therapy (fMRI studies).: diminished limbic system activity following extinction training; reduction of frontal lobe over-activity in OCD cases.But for some kinds of problems (relationships, interpersonal therapy, self-image), the type of therapy and the credentials (education, experience) of the therapist may not make much difference.Therapist effectsPatients: ‘neurotic depression’, anxiety reactions.Randomly assigned to “professionally trained and credentialed psychologists”; or to “university professors who had no background in psychology.”Result: all patients show improvement, and equally for the two kinds of therapists“Common Factors” explanation: all therapies include support (acceptance, empathy, encouragement, guidance) and hope (person’s motivation and expectation of/confidence in the possibility of change and improvement)Patients are usually self-selected- not usually a random sample, they go and seek therapy themselvesRegression effect: you can’t get any worse, so you get better, even if the therapy is bogusMilieu therapy: “A form of psychotherapy conducted in a facility that can function as a therapeutic community and provide a stable environment, in which personal growth and behavior change may be promoted through interaction of individuals within the total therapeutic environment.”Emile Coue: original nice guy, chit-chat therapist. Early 1900’sPSYC 100 1st Edition Lecture 22 Outline of Last Lecture I. Affective disordersa. Depressionb. Bipolar disorderOutline of Current Lecture I. Early psychiatric treatmentsa. ECTb. Lobotomyc. rTMSd. ABAII. PhobiasIII. TherapyCurrent Lecture Early Psychiatric Treatment: Lobotomy (1935): cut fibers in white matter connecting thalamus and limbic system with frontal lobes. - Rationale: these brain systems underlie emotional and reasoning. Some early research with non-human primates and suggested that this might work to reduce ‘irrational emotionality’.- Did it work?  poor tests used to assess improvement. Poor research methods (no R-DB-PC CTs) - In 1952, procedure abandoned. Regarded as not generally effective, some