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0:00
[light, lively music]
0:06
>> We're going to spend some time looking at depressive disorders, I don't think this is in your notes, so we're gonna cover that real quickly and then we'll go and cover
0:17
the topic of therapy today. Look at your notes and see if you have any questions, and then, there we go.
0:26
And so what I'll do is I'll cover some real quick class issues for the exam, as you know, which is on Wednesday, and then the final, I'll talk a little bit about it as we get started. So here's what I'll do,
0:49
let me begin by praying for us,
0:56
and then we'll start from there. Father, we just take a minute right now to ask You to be here with us. We know that in these busy times, especially just this last couple of weeks of school, that we have the ability of being sustained
1:16
by who You are, by Your care, Your patience, and forbearance with us, and also Your love for us, so we do that. And I just pray for the next couple of weeks, especially for many students who are dealing with the pressures and stresses of just a busy time, I pray for just protection and surrounding of them, and then for the way in which we know that You had protected all of us even during our travel, our vacations, and then the upcoming trips that we have, we just thank You for that.
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Thank You for being a God that cares deeply for us, that knows us intimately, and calls us Your children, so we just thank You, we invite You here today, in Jesus' name, Amen. >> Students: Amen. >> Well, as we go about looking at the last chapter
2:07
in this section, let me remind you, the exam on Wednesday covers the three chapters, I think the study guide has the chapter numbering wrong, but the content is correct.
2:23
The topics that we'll be covering on Wednesday on the exam will be personality disorders, which we've just finished, and therapy, which we will finish talking about today.
2:36
So that'll be on Wednesday, then the final is only over two chapters, health psychology and social psychology, and that final, if you wanna put it in your notes and make sure, is on Wednesday at 1 p.m. in this room,
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Wednesday at 1 p.m. in this room.
2:55
Does anybody have a schedule and know that they can confirm that's what you've seen in the schedule? >> Yes. >> I'm almost certain that's what I saw. Final, two chapters, social and health, so it's not a comprehensive final, and it is on Wednesday, and you do not need to show up
3:17
on Monday during finals week because I won't be lecturing, so Monday there's no class of finals week, and there is only class on Wednesday during the final, and if you're not taking it you don't even need to come.
3:35
Does that make sense?
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The exams, I'm gonna try and get them posted as soon as possible, you'll take them Wednesday, 'cause a lot of you will get, this week we're aiming to get everything that you've done put onto Blackboard so you will know whether or not you need to take the final or not based upon your results, so my goal is by Friday evening to get not only exam four, but everything else online, so you can just take a peek at it and know right away your point total. The latest will be of course Monday,
4:12
which is a week from today, that we'd like to get everything updated.
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Are there any questions about this or anything else related to class, and, yes? >> Student: Do you want us to submit our IQ-- >> Yeah, for those that are doing the IQ personality inventories, and you've read those articles and chapter, how many are there and are with me on that one? Right now the plan is to have you submit them online just like, you will go into Blackboard and do that, they're not due until Wednesday I believe, is that right? Maybe Thursday, I forget, but either way
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you'll do it right now, plan on just submitting it by Blackboard, you'll see a link that I'll put up that'll be open and then you just simply attach your paper that way.
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>> Student: Is it just the chapter six that we're doing? >> Yeah, there's an article, look on Blackboard what you need, and it's right there on there. Yeah, go 'head, question. >> Student: Say we somehow don't manage to get three experiments in, what is the goal for that? >> Yeah, three experiments, how many are still missing one experiment? Okay, how many are still missing two?
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Alright, here's what I'll need you to do, this week we will be putting on the last survey, which almost everybody will be able to participate in, the last surveys there have been just numbers that they only needed a certain amount, the one that we'll be putting on, you'll be able to complete it, and most of you will be able to get at least one experiment out of that. If you still need two there's one other possibility, and it's not for everyone, but what I have done is,
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what we will do is, we're trying to figure out a way, how many took the survey in which you got $5 that came that way?
6:04
How many didn't do that one? Most of you probably didn't see it, there were some who were selected to do that, we're looking to see if we could make that count as well, that might help some people, but I'll let you know that on Wednesday during the exam, I'll put a little note up about whether or not that's accepted. So on Wednesday, what'll happen, by this week you'll find that last link to a survey and then hopefully that'll take care of almost all of your survey experiment needs.
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For some that still need one there's a way to get one, two, or three experiments done by simply looking in the syllabus page three, and there's a way of writing a very brief written report, you can write three, or two, or one of them to get credit for one, two, or three experiments. Look in the syllabus, it's a very brief written report, and that way if you're still missing an experiment you'll have an opportunity to write a quick summary of one instead of participating, and like I said,
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even if you need three you can write three little reports to get credit for three experiments, does that make sense? And that's been in the syllabus just in case some of the surveys you weren't able to get to or to do some of the experiments. If you have questions you can ask, yeah? >> Student: The IQ test, when you're writing that paper do you write about the actual testing? >> Yeah, you just give me a quick summary, for the IQ test you write a summary of the articles that you read,
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and it's about a page and a half, and you could briefly mention some of your experiences in there, of taking the IQ test, but that's just what it was like and your experience doing that. It's not really great, it just tells me that you've gone through it. Yeah? >> How long is the paper again? >> I don't remember, it's in the syllabus, I think it says under two pages. For the IQ thing? Yeah. For the written reports, they're about a page long if you look at that one. Alright, good, yeah one more.
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>> Student: So I looked on Blackboard and it said that the due date for the paper was Tuesday, December 1, so obviously-- >> We'll just make it December 1, which is Wednesday, is that right? Yeah sorry, just make it Wednesday.
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Okay.
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This is where I ended last time?
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Is that right? >> Yeah. >> Alright.
8:36
One of the things I'd like to make sure and have you think about as you look at your notes, are A, are there any questions on any of the disorders we covered? We covered anxiety disorders and all the specific kinds, what falls under anxiety disorders? Yeah, phobias, what else? Obsessive-Compulsive Disorder, what else falls underneath an anxiety disorder? >> Generalized. >> Generalized anxiety,
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the main ones we covered. We talked about schizophrenia and the different types, and the causes, and the prognosis, we looked at depression, things like what we call mood disorders. This was how we ended, by looking at some video clips, and in fact the last clip that we watched on Wednesday was about somebody who was suffering from major depression, who was able to undergo a fairly controversial type of treatment known as what? Electroconvulsive therapy, or ECT.
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And so we're gonna talk a little bit about the treatment using ECT for major depression, and some other treatments that are available for people that are suffering from some of these disorders. >> Student: Why is it so controversial? >> The controversy about ECT isn't necessarily because of its use today, the controversy is a little bit more historical in that in the past ECT was initially started, anybody familiar with the movie One Flew Over the Cuckoo's Nest?
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It's a fairly old movie with Jack Nicholson, it's an amazing movie, if you wanna see something eye-opening. The reason it's controversial is because of its history, it was started off by someone who originally believed that
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somebody with schizophrenia wouldn't have epilepsy, and that they didn't have seizures, and so they thought that these two things were incompatible with each other,
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and so someone got the idea that, well let's take schizophrenics then and give them seizures, so to speak, to see would that, electrically-induced seizures, would that stop their schizophrenia? And so they subjected many people that at the time were in hospitals, especially in severe cases, and that's what the movie depicted, was using convulsive therapy. Putting people underneath this very painful electrical stimulation which caused a seizure,
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and the movie is about what that was like, and then also the use of lobotomies, which was also at the time a treatment that was thought effective. Well, they were wrong, and that was the problem.
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Individuals with schizophrenia can have epilepsy, or can have seizures, but here's what happened, a lot of people that were misdiagnosed and that had depression, showing signs of psychosis,
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it actually began to help them. And so we'll talk a little bit about the controversy of it in that it appeared to in the past be used against patients, today it's a very effective treatment for severe depression, so it's not controversial in that regard of use today.
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I'll show you a little bit more about that, but here are the key variables just related to when we explain depression. Sometimes depression is explained by the various pressures that people feel. You don't have to put down the stuff on the right over here, the idea is that there's a variety of different things that affect people and affect their levels of depression, whether it's academic, financial, personal difficulties.
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Basically these just simply increase a person's risk, the pressures of life, but another big category that has been examined now over probably the last 40, 50 years, and noticed, and that is where people live. We have more rates of depression in this country,
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up here you can see it's affected by the northern latitudes,
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then it would be in what's called the lower southern latitudes where the rates are significantly lower for depression. And so people started asking, is it possible that the lack of sunshine is causing higher amounts of depression because of people living up in the north versus a 1 to 2% rate, for example, of something called Seasonal Affective Disorder, or sometimes referred to as SAD. Seasonal Affective Disorder is a type of depression that strikes only during the winter season,
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or it seems to be associated with affecting people during the winter season, and quite possibly then, that's one of the variables, a lack of sunshine, and so they've been exploring that for a number of years now. Explaining depression, also you have to bring in the genetic link here, that you have a slightly increased risk
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if you're genetically predisposed to depression, and we see this in that there's higher rates for people with especially, of all the mood disorders, bipolar probably has the strongest genetic link of almost all the disorders. Bipolar Disorder has a strong genetic link,
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and in that case we know genetics plays a role as well.
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Ultimately then, the pressures of life, possibly where we might live, genetically being slightly predisposed to this one, especially the bipolar, of all the mood disorders, and then ways in which we think. Cognitive Learning Perspective talks a little bit about how our negative perceptions and our thoughts can influence rates of depression, and help explain some accounts of depression. So self-defeating beliefs might lead depressed people to evaluate their own behavior incorrectly,
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or their competency incorrectly, and so this type of perspective would say one way to explain depression is that people begin to think these thoughts in which they're not accurately identifying their competency level, or what they are like, and this is leading them to not only focus on their mistakes, but to ignore some of their successes. And you'll see this as one way that this kind of thinking
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might contribute to feelings of depression. Another one is focusing on mistakes, but also, especially in comparing them or comparing oneself to somebody else, so this compare themselves unfavorably with others, rejecting compliments from others, all of these lead into different ways in which a cognitive learning perspective is attempted to explain rates of depression. Okay, are there any questions on some of the key variables or some of the explanations?
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We're gonna wrap up the topic of depression, and then I wanna move into how do we go about helping people with some of these disorders that we've been identifying, and the psychological area of therapy has a long history
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of working in this area with individuals that are suffering from these disorders.
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>> Student: Exactly how genetic is bipolar, how genetic is depression and can is skip generations? >> Yeah, the question is the genetic link with mood disorders.
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As you saw before, there is definitely a genetic link,
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all mood disorders are not explained by genetics, there are other variables that come into play, but if you have both of your parents, for example, are bipolar, you have a much greater risk of suffering from Bipolar Disorder than the normal population, in fact, if you have an identical twin it's as high as 80% likelihood, which tells you there's a strong genetic link,
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but for mood disorders in general, they're not sure about the idea of skipping generations,
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it probably doesn't necessarily skip.
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This is a fairly complex area by the way, so we could find rates and see that you have an increased risk, but it doesn't necessarily mean that just because someone has bipolar in your family
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that you're going to get it, just the elevated risk is there and so we know there's a genetic link, but they're still trying to find out how big of a link and what are the other variables that contribute to it.
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Yeah, big area of study, and it has been for years now, trying to determine causes. >> Student: Is negative thinking a cause or an effect of-- >> Yeah, it's a good question, she says people who do these kinds of negative thinking, is it because this negative thinking leads to the depression, or does the depression cause negative thinking, and it's a question that is not easily answered, it's a combination, and it probably is one of these very difficult things,
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it's like dopamine and schizophrenia. If you find schizophrenics you tend to find increased amount of dopamine in their brains, does that mean that the dopamine, the elevated levels is causing schizophrenia or is it schizophrenia is causing
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elevated levels of dopamine, and it gets back to the idea of correlational studies that are just finding these things, hard to determine exactly what's happening. Okay, so when it comes to looking at then treatment,
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we have a variety of ways and things I wanna just talk about today related to therapy, so we're going to look through different attitudes toward therapy, what are the objectives of all the therapies that are out there, and we're gonna look specifically at the biomedical therapies, and briefly at the psychological therapies. I want you to look in the textbook at all of these, but let me just highlight what we're doing. You remember this individual, I forget his name now,
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maybe some of you remember it, I don't remember, he was dealing with schizophrenia. This is Jerry, how many remember Jerry twirling his hair like this, who was also paranoid schizophrenic, who showed symptoms that are all related to schizophrenia. Do you remember her, who was dealing with what type of disorder? >> Students: OCD. >> OCD, her obsessions were surrounding her children, especially her child, but also hand washing. If you remember for her, she would wash her hands
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in that 30-minute period, what was it? Like 20 times in that 30-minute period, the belief that she was getting germs,
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and then worried for her, you could see how it influenced and impacted her life. Then we have someone who is suffering from manic depression, and we saw Mary, which is where we ended class last week, in looking at Mary who showed strong depression and then was in this case helped by electroconvulsive therapy.
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In this case, psychotherapy is an attempt
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to help individuals that are suffering from these disorders, and it's defined as this emotionally-charged
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confiding interaction between a trained professional,
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or a trained therapist, and then someone who suffers from psychological difficulties.
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In this case this leads to a whole host
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of types of therapies that are out there, because this is just the broadest definition possible of what we call psychotherapy, it's an emotionally-charged, confiding interaction between a trained therapist and someone with psychological difficulties, you find lots of room and lots of different approaches to helping treat people. In this case all of these individuals have received treatment.
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Now the treatment varies depending upon who they talk with, but this is really, if you want the broadest sense
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of what goes on in a therapy-type session.
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This idea of a confiding interaction is what's very important, and that is,
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there's the idea that you can talk with somebody who's around who's also trained with somebody who suffers, and there's a variety of different perspectives that have occurred, including our own views and our own attitudes toward therapy. So some general attitudes out there that exist can vary,
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even within different cultures professional or trained therapists are sometimes thought of as people who can help, and sometimes treated with maybe less likelihood of believing that they can help.
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Of those that are suffering the most, those that are mentally ill, at least the most recent numbers are showing a good 50% of people will even deny that they're ill. So people that are sad, depressed, even those that are dealing with anxiety, schizophrenia, 50% of those that seem to be suffering deny the fact, why would they deny that they are ill? What is it about humans, what is about people that are suffering from, let's say one of these disorders,
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why would they not want to admit that they're sick? Is there something wrong with it? Is there something that leads individuals, well, this is probably why there are still available options
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that have to be used, and some things, like involuntary hospitalizations, can occur.
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Just to give you some raw numbers that are out there,
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involuntary hospitalizations, they occur on a daily basis right here in Los Angeles County, and it is something in the California Welfare and Institutions Code that allow for this, it's called a 5150, it's a police term for if they go on a call
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and they suspect that somebody is dealing with mental illness they can invoke section 5150, in fact if you ever hear a police officer when they are talking with you use that number they don't believe that you are mentally all there, and a 5150 simply allows them to get the authorization to hold a person for up to 72 hours, and you can petition the courts for as long as 14 days to hold somebody. Anybody know of a recent person that you heard this was occurring, involuntary hospitalization?
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>> Britney Spears. >> Yeah, Britney Spears was one where she was, they were called out, they were concerned about her behavior and her actions, about her safety, the safety of those around her, and the LAPD by the way, on average, gets about 100 calls a day that are related to individuals
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that they suspect are mentally ill, of which a quarter of them, 20 to 25, lead to involuntary hospitalization. Britney Spears, somebody mentioned, is a perfect example,
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somebody called, they went out, and the police decided that for her own interests, and for the interests of her children and the family that she was not dealing with everything as she should be, and they put her in involuntary hospitalization. I think she was only there probably for 72 hours, but at least you can still do that. By the way, while a lot of these institutions are designed to help, you actually find, for example one guy did a study, he found out that,
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they sent individuals to a state hospital to find out could they themselves get themselves committed, and one of the most effective ways of a person walking off the street and getting help was simply admitting that they were hearing voices. If they said that they were hearing voices they would almost always be admitted for 72 hours, which is very interesting because what was occurring is in some cultures that notion, that idea, is indicative of somebody who's probably dealing with
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maybe a psychotic break, or a potential psychotic break, and so those kinds of things would get a person
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under 72 hours of evaluation. And so when police officers go out and deal with this, this is a very important thing that they can use to help individuals. Now, after 72 hours if the person convinces them that they are not a danger to themselves or a danger to others, they can be released and let back out, and that is just part of what we use to help. Now, this just goes back to show that a lot of people, ultimately, that are dealing with mental illness never get any of the help that they need,
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and so you can see here, of all the schizophrenics, less than half ever receive treatment, and that's a pretty big number if you think about it, that those that are suffering from this less than half are getting the treatment that they need. Mood disorders, maybe a third of the individuals are getting treatment.
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By the way, when they do seek help, while the majority tend to get untreated, they do seek help from a variety of sources, whether it's professionally trained psychologists or psychiatrists, medical doctors, clergy and pastors, and oftentimes support groups, these are the locations where they oftentimes try and get help. So who seeks therapy, and I'll just put up a list of different types of therapy and different specialists,
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so some specialize, for example, in working only with children, maybe they would see a large number of kids who would suffer from Attention Deficit or Hyperactivity Disorder, some developmental disabilities, even autism now, so you can have a therapist who specializes in a certain age, or even in a certain illness, and they only deal with, let's say depression, but the majority of therapists would see anybody in all of these categories from children, to teenagers,
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college students, all the way up through individual therapy, grief therapy, whatever it may be.
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Alright, what I wanna do is, let's see if I can get a video clip to show in just a minute of a typical therapy session, so you can look at the other screens and I'll see if I can get the middle one to play.
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>> Video Narrator: This is David's second meeting with Dr. Jim Manager a Reach Out-- >> Okay let's see.
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Okay, one more time.
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>> Video Narrator: This is David's second meeting with Dr. Jim Manager, a Reach Out volunteer psychiatrist who tries to treat schizophrenia with a combination of supported talking therapy and medications. [video drowned out by background noise] >> Okay, we'll wait and see if I can get that in a minute. Ultimately, there are different views
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and a different relationship when we start talking about
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the history between how do Christians view professional therapy, and are there different approaches that they take,
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we can outline here some of the different ways in which there's more positive and more negative views, and I'll just put some up here. There are, probably has been historically a change over the last number of years
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that have contributed to a more positive view, and anybody come from a church background in which psychological therapies is suspect or there wouldn't be, anybody have a church background or a history like that where there's really not
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a positive view towards professional psychological therapy?
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Very different today, by the way, than 20 years ago, 20 years ago you would find much more of those on the negative side,
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that there was some suspect between the disciplines, that is, a Christian approach to how we deal with problems and the belief that psychology was encroaching upon, or was even almost anti-Christian. And so it's been a very marked change over the last 20 years, most of the churches now out there have psychologists that they use that when somebody comes and deals with a struggle or an issue that's beyond their abilities, they almost have a great referral list,
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and that's been a big change over the last 15 to 20 years, and so you don't find as many on the negative side as in the past. Are there any questions that you have about this though, or questions about this area and how we used to view therapy?
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Because there's probably again some remnants of this, Biola, by the way, used to get picketed. 20 years ago when I was here there was a guy who used to come around and say that Biola and individuals here were not in the will of God because they had a Department of Psychology, and that they should avoid coming to school here simply because it was one in which we were using something called non-Biblical therapy, you're not using the Bible and then therefore it's not appropriate,
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and that's been around for a little while now.
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Okay, let's see, I think I got this to play, maybe.
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>> Man In Video: So there still might be qualifying paranoia, or my carefulness. Anyway, and anything that's been saved prior to this, on this day, we'll just use [mumbling] today. Tuesday, October 24 was safe, [faint speaking] to my knowledge the camera was not running, therefore I have not consented to this taping. >> You guys remember David? >> Yeah. [David speaking faintly]
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>> Jim: So it's been a couple of weeks since we met, can you bring me up to date on how you've been since then?
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>> David: My weekends have been fine, my week nights have been hellish. >> Jim: And the weekends you have a place to stay, and during the week you don't, right? >> That's correct, and I, every week I--
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>> Okay, it's not gonna come on, but the idea of any type of session that an individual is in was illustrated in this little clip where the goal was to try and get somebody, whether they were on the streets, somebody that was dealing with any of the disorders, to be able to begin to function more optimally. That's the goal, get them to function,
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enhance some of their personal growth and development, and then be able to get them to a point where there's at least satisfaction with their life and their life circumstances, that's the objective of most therapies.
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Increase their satisfaction with their lot in life, their personal circumstances, help them to develop and to grow, personal enhancement, and then that they're functioning, who they are and what they are like is optimized. Now, the textbook gives a great definition in general
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of what the goal of most, or objectives of therapy would be, and this goal would be to offer hope for the demoralized,
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giving people a new perspective,
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in an empathic, trusting, and caring relationship.
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So for a lot of therapists who ultimately decide to go into this field, what they're struck with is people who are oftentimes demoralized,
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struggling and not functioning well, realizing that they don't like what's happening to them, they don't understand it, and it's hard, it hurts, and they are motivated to try and help to bring hope, to give them ways of coping, ways of dealing with things, new insights into their beings and to their thoughts, and then they do it in a way that provides a trusting, caring relationship. And success, it can be found in many cases,
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where a person is able to come out of, oftentimes, sessions in which they're learning new ways of living, new strategies for coping, and new insights, and so this is really the objective of the therapies.
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For me, I remember just simply working with schizophrenics, or at least the majority were schizophrenics, and in this particular hospital that I was doing an internship in,
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it almost felt like it was impossible to help. There were so many ways in which you would begin to see how strongly people's lives were impacted by this disorder, and yet you knew that if some of them would just maintain some of the treatment, and even some of the new drug treatments that were out, that they would get better, and a lot of them wouldn't wanna take pills, or they wouldn't wanna participate in the therapy. We'd have to watch them take their medications
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because some would take it and pretend that they took it,
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they would believe that they weren't sick, and we always knew that there were ways in which treatment helped, but you can't force somebody, you couldn't force them to do this. By the way, as far as improvement, we do find that there is an increase in what we call improvement at the moderate to excellent level, for those that do get into therapy. So there's evidence that it is effective, the problem has been making sure people participate and are able to do some of the treatments
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that are out there.
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As far as specific kinds of therapy, one of the big new ones out there is biomedical therapies, I've already showed you electroconvulsive therapy which is one of the biomedical therapies that we'll talk about, but this one has taken off as far as numbers. How many have heard of Prozac before? Why have you heard of Prozac? It's because it's advertised everywhere,
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Prozac is now one of these multibillion-dollar drugs,
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and as an industry this is a huge, huge industry. We call it psychopharmo co-therapy, or drug therapy, which has its basis of course in treating some of the major disorders that we've been talking about by using things like drugs, huge. Today if I sent every one of you away to a doctor's office this afternoon, and you had a doctor's appointment with your primary care physician, a good percentage of you could walk away with drugs tonight simply by going in and expressing
39:22
that you are not feeling well, you're sad, if you expressed any form of depression and if they identified that you are being honest about it, but you just talked about your sadness, you talked about the anxiety you were experiencing, by far the largest percentage of you would come away with a new prescription today. It is a huge industry out there with different treatment levels, and different approaches, but primarily they involve the use of categories of drugs
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that I'll give you in a just a second. Do you have a question, go 'head. >> Student: Yeah, why are people so resilient to not take their [faint speaking], why is it human nature for people not to want counseling? >> I don't know why people, how many of you all, he asked why is it likely that some either deny their illness or they wanna go get help, was that the question?
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There are still times in which, how many of you all have ever felt like you've been sick, or ill, and you didn't want to go into a doctor to waste the time, to just go in, and it's like I'll just get better, or maybe I'm not that sick. I think a lot of people feel that way, and then sometimes it's just, if I don't go in maybe I'll just get better, there could be a lot of different motivations, yeah. There are different times I know where, like I told you, I got hit, remember, with a golf ball
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and I did not wanna go in until I finally had to, I told you about that, I think I did.
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It was also one in which you just start to deny, or maybe you just feel like, no, it's not that bad, or if I admit it it won't turn out well, whatever it is, there's a lot of different motivations. >> Student: [faintly speaking] it's prideful, 'cause we don't like to be vulnerable. >> Yeah, there's another part about vulnerability, that she mentioned, I think is true. The way we get treated by other people if we admit this, and there's a little bit of pride that can be involved.
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>> Student: If you took Prozac if you weren't actually depressed would it help? >> Yeah, Prozac, by the way, Prozac is one of those types of drugs, it falls into this antidepressant category,
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Zoloft, Paxil, lots of these drugs.
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Well actually with Prozac it can be used even beyond an antidepressant, Prozac is used even with some forms of antianxiety and other things, so it probably wouldn't hurt, it would depend upon, if you were just completely normal my guess is you would just experience some of the side effects of it, which wouldn't be all that fun, but it probably wouldn't have a huge affect on you, but in their tests they're safe enough at certain dosages to give to people even who might've been misdiagnosed,
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but my guess is you wouldn't feel all that different,
42:17
but it depends I guess on how much you took. All of these you've seen advertised simply because this is a huge industry.
42:27
As you know, only psychiatrists and medical doctors can prescribe these medications, psychologists cannot,
42:34
and there are ways in which some, at least one state is attempting to change that, but the vast majority of psychologists must refer out to either a primary care or a psychiatrist in order to get a prescription for, let's say one of these types of categories. Alright, questions on drugs? Lithium, by the way, for bipolar, lithium does this, if your disorder is bipolar, and we talked about these cycles of up to mania, down to depression, lithium pretty much just calms the highs
43:08
and brings up the lows. And lithium is a fairly, not that uncommon of a substance
43:18
that's out there, but it's very effective for sufferers of Bipolar Disorder. Yeah. >> Student: Is there a difference between each of the drugs, like just in one of the categories,
43:34
or why they have more than one? >> Yeah, and by the way, there are so many different kinds listed up here that, I didn't put 'em all down, these were just ones I thought maybe people would've heard about. They do, they target different parts, let's say, of even brain chemistry, and so for some people Prozac may be all you need if you're depressed, but it may not help you as well, and so doctors usually start with those that they think are, they've had experience with that are most effective,
44:02
but let's say for example, Paxil or Zoloft might be more effective and might help somebody else because they work in a slightly different way. Most of these antidepressants are what we call SSRIs, I don't know if you remember we were talking about neurotransmitters where the selective serotonin reuptake, the vacuum cleaner, most of these block the vacuum cleaner so that the reuptake mechanism of serotonin, so it continues to process and to go through the system, and most of these are that way
44:33
but they work in different parts, or different ways, or different effectiveness. And for some people, it's like taking the difference between taking Tylenol for some, and not to minimize these, versus taking let's say ibuprofen, sometimes it just works differently for people. Alright, questions so far? Big area, the expenditure in millions is now in the billion range, this is even old, but spending that goes on and the cost of these drugs is huge, and that's been, by the way, the main criticism,
45:08
is that we are too easy to prescribe medication for these major disorders, that's the biggest criticism that we have, a very quick trigger, and people can go in, like I mentioned, you can go in and walk away with a prescription, is not a good sign for a lot of people. They worry about the fact that we're overmedicating our country, and that people are walking away with prescriptions that they're not being treated psychologically, or they're not being engaged to get to the root of the issue,
45:45
that we're putting band-aids on this. So that's been the major criticism of the biomedical therapies, especially the drug treatments, is that they're being overused. In many cases, by the way, it could be very helpful, I'll talk a little bit about that, I wanted to just mention before we leave, the electroconvulsive therapy, the use has gone up, here are the numbers. It was higher back here in the 70's, but we didn't keep as many records on these, certainly over time the numbers went down
46:19
and then they've exploded, now there's probably hundreds of thousands of people who are getting electroconvulsive treatments today for major depression when antidepressants don't work. It's a very effective treatment in major depression, and you can see here the number of patients per year is now over 100,000 receiving ECT.
46:46
By the way here is, just their depression ratings for before ETC and after are fairly significant.
46:56
You saw Mary, the big difference between Mary was that she was now down in this range, how many remember seeing Mary after treatment, what she looked like, how positive she was, and it was like she almost smiled and laughed at herself, and it was clear that there was something that happened. And let me just say this,
47:16
the answer to why somebody that's depressed, when you put them into a convulsion like that, a seizure, it does something to the brain and no one yet knows what it does. That is, Mary, you saw clearly this major depressive,
47:36
these characteristics and symptoms that she was showing, went and received this treatment, and it's still unclear what happened in her brain. No one knows why being in a seizure, why did that cause her to no longer feel depressed? And no one knows why, there's no good, yet, answer
47:59
that satisfies everybody, that oh, that's what a seizure does, but you can see the difference in her behavior.
48:06
And there are some theories out there about what it's doing chemically to the brain, but this is still a mystery, yeah. >> Student: There's a musical about someone who gets ECT but she experiences amnesia and she forgets everything. Does that happen? >> Yeah, one of the side effects, and in fact it's one that most people are well aware of, is the idea of amnesia. Instead of amnesia it's just simply a lack of memory of right before and right after treatment,
48:36
and many individuals like Mary have been asked would you do this again when you're depressed, would you want to get this treatment? And she says even though I forget things, even though I don't remember this period of maybe couple of days, I still want that to happen when I'm depressed, please do that. But yeah, one of the side effects is memory loss,
48:56
so it's not uncommon, it's not that great, but there is a period of time. Yeah, there's jokes about this all of the time, people that are, they talk about ways in which this helps them, but they realize that they need to make this decision when they're doing well, because when they're depressed they don't even wanna go through this, but they will talk about how shock has brought, this kinda shock treatment, it's like getting fried they call it, or they're going to see The Colonel
49:31
some will say, it's like a KFC person to go get fried and they're about to go get help. [student faintly speaking] Wait, one more time? >> Student: Do you have to keep [speaking faintly]? >> Yeah, unfortunately Mary will not necessary stay this way,
49:51
she will probably need to do this perhaps a couple of times
49:57
in the matter of that year, just to get the effective treatment. So it's not just a one-time, for some it is, it could be effective, but for some you have to do this a couple of times, but it seems as if it still helps each time, but it's not just a one-time thing, is that what your question? Yeah, it has to be repeated. Yeah, go 'head. >> Student: Can you build up a tolerance? >> Yeah, it's a good question about tolerance, that will it eventually stop working,
50:23
and I don't know the answer to that, I don't think they do, I think they space them out enough that it does take them out of major depression, but I don't know if the effectiveness wanes over time, I haven't heard that it does.
50:39
By the way, the use of drug therapies are most effective when combined with psychological therapies. This is really the goal of what we call
50:53
psychopharmacological therapy, or again, the combination of psychological and talking therapies with drug treatment, with drug therapies. By far the most effective treatment is when they're combined.
51:11
When you combine drug therapies with psychological talking therapies, you almost always have greater rates of remission, and will have greater benefit to people who are struggling than if they only took drugs or if they only had the psychological therapies, so in a combined way these work best. Now, the psychological therapies have a variety of different ways you can do this. If any of you all have an interest in going into this field, the needs have not changed in the 20-some odd years
51:44
I've been in this field, in fact it feels like there's more people struggling with things even now more so than ever, but you can do lots of different things if you decide to go into this field professionally. After your college degree you can go into counseling psychology, you can go into clinical psychology, or psychiatry, but all of these would allow you the opportunity to work in this field, slightly different ways and different clients, but these are some different pathways.
52:13
Just so you know, most people who go into using what we call psychotherapy are what we call eclectic, they follow a variety of different types of theories. And so some that you might find out there might use a particular type of therapy, let's say it's a cognitive behavioral approach, or psychoanalysis, maybe a psychodynamic approach, but the vast majority of therapists use different techniques or different sources or different methods from these very different theoretical schools,
52:59
and we call that eclectic. So most psychotherapists are not just coming out of one type of method, or one type of theoretical school, they use a variety of different sources in their approach, because sometimes if you deal with somebody with a phobic disorder it's going to be very different, and you have to use different methods
53:25
and different practices than if somebody was dealing with depression or OCD. So in this regard you can see here eclectic would be the vast majority, others like client-centered, or cognitive, or psychodynamic. And of course there are different alternatives, counseling, even Biblical counseling and support groups, would all be different ways that people could also get help besides going, let's say, into psychotherapy route. Okay questions?
53:59
Go 'head. >> Student: Can I ask a question about how specific drugs work?
54:05
>> All of the drugs have,
54:09
the drugs that we are talking about, depending upon which kind, they use, they approach and affect different, serotonin for example, the mood disorders would primarily be serotonin, a lot of the schizophrenic or antipsychotics would affect most of your dopamine neurotransmitters,
54:29
and then antianxiety would be a combination of things, probably things like if you remember our inhibitories, like inhibitors like GABA, that would be an example.
54:42
Yeah? >> Student: Are there types of therapy that you disagree with? >> There are different kinds of therapies that are out there that you would find more controversy over, usually if they're used in the right way with the right person, or let's say the right treatment, then it's not a problem, but there are some times in which if somebody constantly uses the same approach for anybody that comes in, then it may not be as effective, and so disagreement would be that some would criticize
55:14
somebody from using a single method, or a single approach, from a single theoretical school, to deal with all kinds of different areas, and that's when people would say I'm not sure that's the best approach. But that's about as far as a lotta people would go with this. Okay, guess what? We're gonna end early.
55:36
Here's the thing, all I want you to do is look at your major approaches; psychoanalysis, person-centered, behavioral, and cognitive, and we're gonna end early today, so what you'll have to do is make sure that you read the section on, of course all three chapters. Let me just tell you this, read all of the textbook, it's very important, personality, the disorders, and therapy, read it, know all about it, use the study guide to help you follow along,
56:11
and use my notes to also show what's important on this test. It'll be the same as the other ones, 50 questions, multiple choice and true/false. Alright? Alright, we'll see you Wednesday.
56:27
>> Announcer: Biola University offers a variety of Biblically-centered degree programs, ranging from business, to ministry, to the arts and sciences. Visit biola.edu to find out how Biola could make a difference in your life. [light, joyful music]
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