Cognitive Behaviour Therapy (CBT) Gerhard Ohrband - ULIM University, Moldova 3 rd lecture Classification of psychological disorders

Course Structure 1. Introduction: What is CBT? What are differences and similarities with other therapy schools? 2. Diagnostics in CBT 3. Classification of Psychological Disorders (ICD- 10, DSM-IV), Clinical Psychology (Etiology, prevalence, comorbidity and symptoms) 4. Etiological concepts in CBT: learning theories (classical and operant conditioning, vicarious learning, Mowrer’s Two-factor theory) 5. Systematic desensitization: in-vivo exposure and imaginatory 6. Aversion training: overt and covert

Course Structure 7. Response prevention: treating obsessive-compulsive disorder (OCD) 8. Social skills training: anger management, assertiveness training 9. Rational-emotive Therapy (RET) 10. Beck’s Cognitive Therapy for depression 11. Marital and Sex Therapy 12. Trauma Therapy: Expressive writing, work with affirmations, visualizations; working with victims of crimes, accidents and other difficult life-events 13. Relaxation techniques: yoga, meditation, Alexander technique, Feldenkrais 14. CBT at school: helping children with autism, hyperactivity, social phobia, social adjustment problems, learning difficulties and antisocial behaviour. 15. CBT in treating addiction and substance abuse

Content S-O-R-C-K model bio-psycho-social etiological model of psychological disorders classification of disorders (ICD-10 and DSM-IV mental disorders

S-O-R-C-K model SituationOrganismResponseContingencyConditioning

A bio-psycho-social model of psychological disorders Biological factors Psychological factors Social Factors Increased vulnerability Non-adaptive behaviour Chronic psychological disorder Stressful life-events reinforcement

Classification of disorders DSM-IV: Diagnostic and Statistical Manual (of Mental Disorders) IV by the American Psychiatric Association ICD-10: International Classification of Diseases 10 by the World Health Organization the two more alike than different (Andrews et. al., 1999)

DSM-IV Five axes: Axis I:Major clinical syndromes Axis II: Personality disorders Axis III: Physical disorders Axis IV: severity of experienced stress (usually within the last year) Axis V:overall level of psychological, social or occupational functioning, on a 100-point global assessment of functioning (GAF) scale, with 100 representing the absence or near absence of impaired functioning, 50 representing serious problems in functioning, and 10 representing impairment that may result in injury to the individual or others

DSM-IV Example: Axis I:Alcohol dependance Axis II:Antisocial personality disorder Axis III:Alcoholic cirrhosis of the liver Axis IV:Severe – divorce, loss of job Axis V:GAF evaluation = 30 (a very serious impairment of functioning

DSM-IV Axis I – Major clinical syndromes Disorders usually first appearing in infancy, childhood or adolescence Delirium, dementia, amnestic and other cognitive disorders Psychoactive substance abuse disorders Schizophrenia and other psychotic disorders Mood disorders Anxiety disorders Somatoform disorders Factitious disorders Dissociative disorders Sexual and sex identity disorders Eating disorders

DSM-IV Factitious disorders: fake mental disorders, such as Munchhausen syndrome, in which the individual is frequently hospitalised because of their claims of illness Dissociative disorders: loss of personal identity and changes in normal consciousness, including amnesia and multiple personality disorder, in which there exists two or more independently functioning personality systems

Anxiety, somatoform and dissociative mental disorders Anxiety disorders Generalised anxiety disorder (GAD) Panic disorder Phobic disorders Post-traumatic stress disorder (PTSD) Obsessive compulsive disorder Somatoform disorders Somatisation disorder Conversion disorder Dissociative disorders

Name and description of some common phobias NameObject or situation feared AcrophobiaHeights AgoraphobiaOpen spaces AilurophobiaCats AlgophobiaPain AstraphobiaStorms, thunder, lightning BelonophobiaNeedles ClaustrophobiaEnclosed spaces HaematophobiaBlood MonophobiaBeing alone MysophobiaContamination or germs NyctophobiaDarkness OchlophobiaCrowds PathophobiaDisease PyrophobiaFire SiderophobiaRailways SyphilophobiaSyphilis TaphophobiaBeing buried alive TriskaidekaphobiaThirteen ZoophobiaAnimals, or a specific animal

Social phobia American Psychiatric Association, 1994: ‘fear of one or more situations … in which the person is exposed to possible scrutiny by others and fears that he or she may do something or act in a way that will be humiliating or embarrassing.’ Most people with social phobia only mildly impaired Social phobics, like patient with GAD, seem to bias their attention towards threat-related stimuli

Personality disorders Abnormalities in behaviour that impair social or occupational functioning (DSM-IV) DSM-IV, Axis II personality disorders, 3 clusters: Cluster A (‘eccentric’): schizotypal and paranoid personality disorders Cluster B (‘dramatic’): narcissistic and antisocial personality disorders Cluster C (‘anxious’): avoidant and dependent personality disorders (Van Velzen and Emmelkamp, 1996)

… Psychoactive substance use disorders Schizophrenic disorders Mood disorders: mania and depression Season affective disorder (SAD) Sexual disfuctions Paraphilia

Discussion Points What are the advantages and disadvantages of classifying psychological disorders? Could you think of developing other systems for classification?

Literature Andrews, G., Slade, T., and Peters, L. (1999). Classification in psychiatry: ICD 10 versus DSM-IV. British Journal of Psychiatry, 174, 3-5. Langer, E.J. and Abelson, R.P. (1974). A patient by any other name … Clinician group difference in labeling bias. Journal of Consulting and Clinical Psychology, 42, 4-9. Wakefield, J.C. (2001). The myth of DSM’s invention of new categories of disorder: Hout’s diagnostic discontinuity thesis disconfirmed. Behaviour Research and Therapy, 39,

Journals American Journal of Psychiatry Annals of Psychiatry Archives of General Psychiatry Behaviour Research and Therapy British Journal of Clinical Psychology British Journal of Psychiatry Clinical Psychology and Psychotherapy Cognitive Neuropsychiatry Current Opinion in Psychiatry Journal of Abnormal Psychology Journal of Clinical Psychology Journal of Psychotherapy Practice and Research Psychotherapy

Internet resources documents/lit_cah.htm documents/lit_cah.htm A link to a collection of full-text articles on mental health t_Behaviour_Relationships/Clinical/ t_Behaviour_Relationships/Clinical/ A collection of links about mental health/clinical psychology A collection of links on mental health resources