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Lecture+13(耶鲁大学-心理学导论讲稿) | 楼主 | 2017-08-23 02:58:38 共有3个回复 自我介绍 我要投稿
  1. 1Lecture+1(耶鲁大学-心理学导论讲稿)
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Lecture+1(耶鲁大学-心理学导论讲稿)2017-08-23 02:58:07 | #1楼回目录

1 Introduction to Psychology

Lecture 1 Yale University I'd like to welcome people to this course, Introduction to Psychology. My name is Dr. Paul Bloom. I'm professor of this course. And what this is going to be is a comprehensive introduction to the study of the human mind. So, we are going to cover a very, very wide range of topics including brains, children, language, sex, memory, madness, disgust, racism and love, and many others. We're going to talk about things like the proper explanation for differences between men and women; the question of whether animals can learn language; the puzzle of what grosses us out; the problem of why some of us eat too much and what we could do to stop; the question of why people go crazy in groups; research into whether you could your childhood memories; research into why some of us get depressed and others don't.

their way into the lectures, andThere's a textbook, Peter Gray's Psychology,, The Norton ReaderReader, and when Professor Marvin Chun There is a book review, a short book review, to be written towards near the end of the class. I'll give details about that later on in the semester. And there's also an experimental participation requirement, and next week I'll hand out a piece of paper describing the requirement. The point of the requirement is to give you

2 Introduction to Psychology

Lecture 1 Yale University all experience actually seeing what psychological research is about as well as to give us hundreds of subjects to do our experiments on.

The issue sometimes comes up as to how to do well in the course. Here's how to do well. Attend all the classes. Keep up with the readings. Ideally, keep up with the readings before you come to class. And one thing I would strongly suggest is to form some sort of study groups, either formally or informally. Have of the course.

I focus mostly on, which is trying to learn about how people develop and grow and learn; cognitive, which is the one term of the five that might be unfamiliar to some of you, but it refers to a sort of computational approach to studying the mind, often viewing the mind on analogy with a computer and looking at how people do things like understand language, recognize objects, play games, and so on. There is social, which is the study of how people act in groups, how people act with other people. And there is clinical, which is maybe the

3 Introduction to Psychology

Lecture 1 Yale University aspect of psychology that people think of immediately when they hear psychology, which is the study of mental health and mental illness. And we'll be covering all of those areas.

We'll also be covering a set of related areas. I am convinced that you cannot study the mind solely by looking at the discipline of psychology. The discipline of psychology spills over to issues of how the mind has evolved. Economics and game theory are now essential tools for understanding human thought and human many, many other domains. So, this course will be wide ranging in that sense.

more from pictures like that. And what a case like this, where is without The physical basis for everything that we normally hold dear, morality and mental life.

We'll talk a lot about children. This is actually son, Zachary, my younger son, that [laughter]. I study child development for a in several questions. So, one question is just the question speak and understand English. Everybody in this room has some of world works, how physical things behave. whether they're aggressive or shy; whether they're attracted to males, females, both or neither; whether they are good at music; whether they are politically liberal or conservative. Why are we different? What's the explanation for why we're different? And again, this could be translated in terms of a question of genes and environment. To what extent are things the result of the genes we possess? To what extent are our individual natures the result of how we were raised? And to what extent are they best explained in terms of

4 Introduction to Psychology

Lecture 1 Yale University an interaction? One common theory, for instance, is that we are shaped by our parents. This was best summarized most famously by the British poet Philip Larkin who wrote,

They meyou up, your mum and dad.

They may not mean to but they do.

They fill you with the faults they had

And add some extra just for you.

It's just a cute picture [laughter].

And one personal issue within any of us is what would we do in such situations?

Finally, throughout this course we will discumental illness. Now, towards the end of the claI want to devote a full week to discussing major disorders like depression and anxiety, because of their profound social importance. Such disorders are reasonably common in college students. Many people in this room are

5 Introduction to Psychology

Lecture 1 Yale University currently suffering from a mood disorder, an anxiety disorder or both, and I won't ask for a show of hands but I know a lot of people in this room are on some form of medication for this disorder. And we'll discuthe current research and why people get these disorders and what's the best way to make them better. But I also have a weaknefor the lecommon mental disorders that I think tell us something really interesting about mental life. So, when we talk about memory, for instance, we'll talk about disorders in we will discuan amazing case of Phineas Gage.

serious way.

discuthe debate over such not; whether they could be taken as a real that you're you are persuaded that you're dead. You're walking around. You know you're walking about these is--it's not--these are not just sort of big, screwy problems of messed up people. Rather, they're located--they're related at a pinpoint level to certain parts of your brain. And we're going to talk about the best modern theories as to why these syndromes occur.

6 Introduction to Psychology

Lecture 1 Yale University Now, the reason to be interested in them, again, is not because they're frequent. They aren't. And it's not because of some sort of gruesome, morbid curiosity. Rather, by looking at extreme cases, they can help us best understand normal life. Often by looking at extremes it throws into sharp contrast things we naturally take for granted. The issue of psychopathy, of people who, either due to brain damage or because they are born that way, have no moral understanding, can help us cope with questions of free will and responsibility; of the relationship or difference between mental illneand evil. Multiple personality cases force us to lists many more.

to include four guest lecturers. The first one is Dr. Marvin the Introduction to neuroscience, especially the cognitive neuroscience of is the world's see you next week.

Lecture18(耶鲁大学-心理学导论讲稿)2017-08-23 02:55:42 | #2楼回目录

I am extremely pleased to introduce the fourth and final guest lecture of the semester. Professor Susan Nolen-Hoeksema. Susan is a professor in the Department of Psychology and the Director of Graduate Studies. She is well known for her work in clinical psychology and especially her research in depression, the nature and causes of people with depression, with special focus on sex differences in depression. She basically does everything someone can do. She is a noted scientist, winning many awards and publishing massive amounts of work in scientific journals. She is an award-winning teacher and has authored what, in my mind, is the very best textbook in her area. And she's a noted popular writer who has written popular and accessible books bringing the message and ideas and theories of clinical psychology to the broader let's please welcome Dr. Susan Nolen-Hoeksema. [applause]

Professor Susan Nolen-Hoeksema:what is now called bipolar disorder, what you may know more as manic-depression, as sort of meets the or not. Unfortunately, these judgment calls, because they are so subjective, can be highlight a few of them.

The first is social norms. Whether you get labeled as having a mental disorder or a problem depends very heavily on what your social or cultural norms are. So, a woman wearing a veil in a Muslim community or culture would be seen as typical, even prescribed, behavior. Whereas a woman wearing a veil in a non-Muslim culture, especially until fairly recently, was often looked upon as very atypical or abnormal behavior.

The second kind of thing that gets--that influences whether something is called normal or abnormal is certain characteristics of the target person. In particular, I've highlighted here, gender. Whether you're a man or you're a woman really influences how unusual a certain behavior is. So, crying is a good example. A man crying in our culture is seen as fairly unusual, whereas a woman crying is seen as much leunusual. On the other hand, a woman beating up someone is taken as quite unusual behavior where it's leunusual for a man. So, we have gender stereotypes, gender roles for what is acceptable behavior, and our judgments as to whether something is normal or abnormal get influenced by those gender roles.

getting hurt or killed. Whereas, if you're in a quiet little farm in Central being they may cause other people distress.

who are depressed often become completely non-functional. They get they can't go to work; they can't interact with their friends; they And then finally, "deviance," the behaviors or feelings are highly unusual. This is probably the most controversial of the three because it weighs, it is so heavily influenced by the social norms. What's deviant in one culture is not deviant in another culture. But if a set of behaviors is completely unacceptable to a culture, highly unusual, they're more likely to end up getting labeled as abnormal.

Okay. So, how do we pull this all together? Well, these days the manual for making diagnoses in clinical psychology and psychiatry in the United States is called the Diagnostic and Statistical Manual or the DSM, and it's in its fourth revision. It's been around since the, I believe the '50s, and the early editions in the

'50s and '60s were highly subjective and based on Freudian theory. But since 1980 there's been real effort to make the criteria much more objective, to make the set of behaviors or observations that are required to diagnose someone be things that are observable, that you can see in other people that they can report on reliably, and that one clinician and another clinician will agree upon. So, the DSM gives lists of symptoms with the required symptoms for a diagnosis, the number of symptoms that have to be present, and the notions of deviation, dysfunction and distreare built into these criteria. And I'm going to give you a couple of examples of these criteria when we talk about the specific types of mood disorder.

and understanding psychopathology, but I also just want to impart some information mood depression in their lives. So, these are extremely common kinds of problems people onset times for these disorders as well.

then bipolar disorders where the person cycles between mania. And here are the DSM criteria for major depression, one of the most depression. And as I said, the DSMDSM for major depression is to sleep at all. You're just up for the rest of the night. But other people want to sleep all day long, and in the clip I'm going to show you in just a minute the woman talks about sleeping twenty, twenty-two hours a day, getting up, eating a little bit, and then going back to bed because she was exhausted still.

The third criterion is psychomotor retardation or agitation. The retardation is much more common, and what this means is that sort of everything about the person's movement is slowed down. They'll walk more slowly. Their reaction times will be slowed down. And because they're so much more slow moving, depressed people are often more prone to accidents. They just can't react as quickly as they need to when they're

driving or when they're crossing the road and a car is coming at them suddenly. So, they get into more accidents. And their speech may be slowed down. They may talk very, very slowly and it's as though it just takes a tremendous amount of energy to get even a common sentence out. A much more, much smaller number of people get agitated instead of slow down. They may be hyper and just feel like they can't sit still and such, but the agitation is much more rare than the retardation. People feel really tired, fatigued and like they have absolutely no energy. They can't get up and can't get moving. As I said, they may want to just sleep all of the time.

themes. They may believe that they are Satan and that they have to So, you have to have at least symptoms plus sadneor anhedonia, and these months. So, people for a very long period of time, but the minimum criterion in the DSMOkay. There are couple of things she talks about that I just want to comment on. One is this differentiation between everyday sad mood and the kind of depressions we all experience and the kind of debilitating, overwhelming depression that she experiences. And it is true that there is this continuum from getting bummed out because you didn't do well on a test or because you broke up with a boyfriend or girlfriend or something like this and being completely not functional, vegetative, the way that this woman becomes whenever she gets depressed. And it would be nice if we were really sure where the cutoff was between those normal everyday depressions and what's really a disorder. But the reality is we don't really have real clear demarcation lines. There are a lot of people who have more moderate forms of depression than Tara

here talks about but who still would qualify for a diagnosis and are still suffering and impaired by their symptoms. So, I don't want you to get the sense that if you don't have the kind of horrible version on the extreme end of the continuum of depression that Tara has, then there's nothing wrong with you, because that's not the case. People who are really slowed, whom their functioning is interfered with--they're just really unhappy with life--have problems that can be helped and do need attention. And it is the case that much more moderate forms of depression can morph into more serious forms if they're left untreated. So, there is this continuum.

trying to keep up with their schoolwork or their employment. But they're and not where they have to get help.

disorder involves symptoms or periods of periods of the opposite of They're highly distractible. And then there is this increase in this--what the DSM calls this "goal-directed activity." Out of their grandiosity will come these grand schemes for--often for making a lot of money and they'll pursue these with great vigor no matter how totally irrational they are. So, it's not at all uncommon for them to cash out all the family bank accounts, to sell the house, to sell the car, to sell the kids so that they can finance this great scheme for making a zillion dollars on the Internet tomorrow. Right? Okay. And they'll pursue this with tremendous vigor.

They'll also get involved in all kinds of, what thediscreetly calls "pleasurable but dangerous activities." There's a lot of sexual promiscuity, a lot of drug abuse, a lot of, as I said, getting--going and gambling, believing that you're on a hot streak, there's nothing can stop you. You know, you're just so brilliant and you've got this scheme, you've got the plan. You're going to make it. Okay? So, the individual has three of more of these kinds of symptoms plus this elevated, expansive and often quite irritable mood. It's not just that they're happy, you know, and sort of upbeat. It's just that they're just impatient and irritable and trigger-fire. And sometimes they can become violent because they're just--they're so incredibly agitated and irritable.

whenever you--we do it. [video clip plays]

that middle ground.

and things that they see and hear that aren't really there tend to be very Now, there are people who have--who cycle between fairly low levels of mania and fairly low levels of depression, back and forth. And there's been some argument that people who are kind of chronically, mildly manic--especially if they're really smart or they have a special talent 鈥 can make it work for them. And there is a wonderful book by Kay Jamison, who is a professor at Johns Hopkins where she chronicles--She does sort of historical biographies on a number of well-known authors and poets and musicians, Robert Schumann and a number of politicians, Winston Churchill and such, arguing that they actually had mild forms of bipolar disorder and that they were able to sort of channel the manic episodes through extraordinary talent or intelligence in ways that made it work for them. There are also a number of arguments that very,

very successful CEOs sometimes are people who are chronically slightly manic. They can go on a couple of hours a night of sleep; they're obviously really quite grandiose and self-confident, and that they can maintain this kind of moderate level of mania, keep it under control and channel it in ways that work for them. So, if you're interested in that book, send me an email and I'm happy to send you the citation for it. But for the most part, mania can get people into tremendous trouble. They can, as I said, get involved in sexual promiscuity that puts them at risk for sexually transmitted diseases. They can get involved in drug activity. They can get themselves arrested. They can certainly send themselves and their family into a debilitating depression.

disorder in many ways from depression alone.

this is the case are very interesting.

networks a of other historical cultural changes. The other sort of side of the 鈥 depression is There are also gender differences in depression. These are data from a compilation of hundreds of studies of children and adolescents, looking at not full-blown depression but levels of depression on self-report questionnaires. Probably most of you have filled out these questionnaires, like the Beck Depression Inventory that ask you how you've been feeling in the last month. And there's a kiddy version of this, and these are data from that, from several thousand children. And as you can see here, prior to the age of about thirteen, boys and girls have relatively similar levels of depression. But beginning around the pubertal years, girls' rates of depression go up quite dramatically and boys' rates stay the same or go down. And by the

time they're eighteen or twenty you get almost a two-to-one ratio of depressed girls to depressed boys. And then this is true for the rest of the adult age span.

There are lots of hypotheses about this, why it's true. There are biological hypotheses that have to do with hormones. There are sociological hypotheses that have to do with the kinds of stress, and particularly abuse, in girls' lives relative to boys'. We don't know exactly why. It's probably a lot of these things coming together that make this huge two-to-one ratio true.

So, let's talk a little bit about the major theories and treatments for the mood disorders. are disorder. There is very strong evidence in bipolar disorder, and there are a of you 鈥difference there is very strong evidence that there's a to the transmission of the genetic component to them than others. And particular, folks who have what's called "early onset between serotonin and depression, but there are two other monoamines, and that have also been linked to both of the mood disorders, both bipolar in order to function normally. But now the theories on what the role of neurotransmitters is have a lot more to do with the receptors for these neurotransmitters and their functioning. And the notion is that the receptors for neurotransmitters like serotonin don't function efficiently. So, even if there's enough of the chemicals in the synapses in the brain, the neurons can't make use of them because the receptors aren't functioning appropriately. And so what the drugs that help relieve depression do is to improve the functioning of these neurotransmitters.

There's a very interesting line of work that's going on right now looking at the intersection of genetic predisposition neurotransmitter functioning and stress. And we have one of the world's experts on this kind of work now here at Yale, Julia Kim-Cohen, who just joined us in the last year. But there are several recent studies. There's another person in psychiatry, Joan Kaufman, who's done some of this work. But there are several recent studies that find that certain variations or polymorphisms on the serotonin transporter gene predict who will become depressed in the face of stress.

So, a classic study was done by Avshalom Caspi and colleagues, and they found that people who have one or with stress, they were more likely to develop depression. But it's important to So other forms of major trauma. And basically the story is, it the of a genetic for all genetic predispositions or all forms of depression, but finding has actually been the disorder.

regulating emotion.

with amygdala responses to emotional information. This is true in both anterior cingulate may be involved in the person's difficulty in responding appropriately in choosing good coping behaviors and changing their behaviors whenever their behaviors aren't working well.

So, from the biological theories come a number of different drugs to treat the mood disorders. Two of the older classes are called the monoamine oxidase inhibitors and the tricyclic antidepressants. The tricyclics are still used these days to some extent. They're relatively effective. About 60% of people respond well to the tricyclics, but they have a lot of side effects, and they can be fatal in overdose. And so there was a--has been always a search for other alternatives to them. The drugs that have really taken over the

market are the selective serotonin re-uptake inhibitors or SSRIs. This is Paxil, Prozac and the like. They were introduced in 1987--Prozac was--in the U.S. market and truly took over the market in the treatment of depression and anxiety and a number of other disorders. Now, they're not that much more effective than the sort of old style antidepressants, but they have fewer side effects and they tend to be easier for people to tolerate.

More recently, there are selective serotonin/norepinephrine re-uptake inhibitors. These drugs, by the way, what these drugs supposedly do is to prevent the re-uptake of serotonin or serotonin and norepinephrine one that works.

manic episodes but it doesn't really relieve the depression.

as well. The cognitive behavioral Beck's Negative Cognitive Theory of calls this the "negative cognitive negative cognitive triad is fed by specific cognitive stable. They see bad things as lasting forever and that are global. They see bad events as many areas of their life, which, again, feeds their depression and their general assumption that life is terrible. And evidence that these--for these cognitive theories, that these negative cognitive styles predict depression--one of the best studies predicting this was a study that was jointly done at Temple University and the University of Wisconsin where they identified first year college students with a negative cognitive or attributional style. But these were people who had never experienced an episode of depression yet. They then tracked them for the next two years, and the bars here--the red bars are the percent of those with a negative cognitive style who developed an episode of major depression in that two and a half years versus the percent of those without a negative cognitive style. And as you can

see, there's quite a substantial difference between the two. So prospectively, these characteristics seem to predict your risk for depression.

In turn, there is a cognitive behavioral therapy that's based on Beck's theory. And the major steps in this involve identifying the themes in a person's negative thoughts and triggers for them and in helping the person challenge those thoughts by asking them what the evidence is for their interpretations, whether there are other ways of looking at the situation, how they could cope with the situation if a bad thing really did happen. So, the therapist helps the client recognize negative beliefs or assumptions and then challenges the truth value of these, and then change aspects of the environment that are related to be extremely effective and as effective in some ways as the drug treatments.

alone, of those people who got cognitive behavioral therapy, only about 35% interestingly, the daughter of Aaron Beck and his heir in terms of the practice and development of cognitive behavioral therapy. And she's demonstrating CBT. This is actually a role play, but it's a pretty realistic role play, of how she goes after and helps to challenge a gentleman's negative cognitions about himself. This is a guy in the role who's recently lost his job and is really depressed over his job loss. [video clip playing]

Okay. I'm going to stop there because we're running out of time. But I just want to comment on a couple of things that she's doing. So, you see that she's having him generate his own challenges to his negative

thoughts and write them down. And the whole--one of the major premises in CBT is it's not just what goes on in the therapy session that is effective. In fact, that's a minor part of it, but what the person practices in the time between therapy sessions. And so, what she's doing is helping him come up with a series of phrases he can say to himself when he feels discouraged and plunging down. She's also helping him do what's called "anticipatory coping," anticipating those situations that are going to trigger negative feelings and negative thoughts and coming up with ways of combating them in the moment that he can enact at the time. Cognitive behavioral therapy is very structured, it's very focused and it's designed to be relatively clients understand their negative self-views and how they're rooted past past. CBT is very focused on the present and dealing with the current and combating that and developing coping styles for that.

over again.

much.

Lecture+18(耶鲁大学-心理学导论讲稿)2017-08-23 02:56:48 | #3楼回目录

1 Introduction to Psychology

Lecture 18 Yale University

I am extremely pleased to introduce the fourth and final guest lecture of the semester. Professor Susan Nolen-Hoeksema. Susan is a professor in the Department of Psychology and the Director of Graduate Studies. She is well known for her work in clinical psychology and especially her research in depression, the nature and causes of people with depression, with special focus on sex differences in depression. She basically does everything someone can do. She is a noted scientist, winning many awards and publishing massive amounts of work in scientific journals. She is an award-winning teacher and has authored what, in my mind, is the very best textbook in her area. And she's a noted popular writer who has written popular and accessible books bringing the message and ideas and theories of clinical psychology broader let's please welcome Dr. Susan Nolen-Hoeksema. [applause]

Professor Susan Nolen-Hoeksema:what is now called bipolar disorder, what you may know more as sort of meets the or not. Unfortunately, these judgment calls, because they are so subjective, can be influenced by a lot of factors. And we won't have a chance to go into these too much today, but just to highlight a few of them.

The first is social norms. Whether you get labeled as having a mental disorder or a problem depends very heavily on what your social or cultural norms are. So, a woman wearing a veil in a Muslim community or culture

2 Introduction to Psychology

Lecture 18 Yale University

would be seen as typical, even prescribed, behavior. Whereas a woman wearing a veil in a non-Muslim culture, especially until fairly recently, was often looked upon as very atypical or abnormal behavior.

The second kind of thing that gets--that influences whether something is called normal or abnormal is certain characteristics of the target person. In particular, I've highlighted here, gender. Whether you're a man or you're a woman really influences how unusual a certain behavior is. So, crying is a good example. A man crying in our culture is seen as fairly unusual, whereas a woman crying is seen as much leunusual. On whether something is normal or abnormal get influenced by those gender roles.

getting hurt or killed. Whereas, if you're in a quiet little farm in being extremely they may cause other people distress.

a good example. People who are depressed often become completely non-functional. They can't and go to class; they can't go to work; they can't interact with their friends; they withdraw and become totally isolated socially. So, they might lose their job; they might flunk out of school. And this complete decline in functioning is one of the major reasons that we consider depression one of the most debilitating disorders.

And then finally, "deviance," the behaviors or feelings are highly unusual. This is probably the most controversial of the three because it weighs, it is so heavily influenced by the social norms. What's deviant

3 Introduction to Psychology

Lecture 18 Yale University

in one culture is not deviant in another culture. But if a set of behaviors is completely unacceptable to a culture, highly unusual, they're more likely to end up getting labeled as abnormal.

Okay. So, how do we pull this all together? Well, these days the manual for making diagnoses in clinical psychology and psychiatry in the United States is called the Diagnostic and Statistical Manual or the DSM, and it's in its fourth revision. It's been around since the, I believe the '50s, and the early editions in the '50s and '60s were highly subjective and based on Freudian theory. But since 1980 there's been real effort reliably, and that one clinician and another clinician will agree upon. So, the with the required symptoms for a diagnosis, the number of symptoms that to the notions of deviation, dysfunction and distreare built into these criteria. a and understanding psychopathology, but I also just want to because mood depression in their lives. So, these are extremely that people experience, onset times for these disorders as well.

then bipolar disorders where depression and mania. And here are the DSM criteria for major one severe forms of depression. And as I said, the DSMDSM for major depression is lose your interest in eating and lose a lot of weight, or some people go on eating binges. I had a very good friend who was depressed for about a year, and she gained fifty pounds because she would just eat. She would binge eat, especially at night.

There are sleep disturbances--insomnia, which is having trouble sleeping, or hypersomnia, which is sleeping all the time. There's a particular form of insomnia that's especially likely in depression where you can go to

4 Introduction to Psychology

Lecture 18 Yale University

sleep at night, but then you wake up at about three or four in the morning every night and you can't go back to sleep at all. You're just up for the rest of the night. But other people want to sleep all day long, and in the clip I'm going to show you in just a minute the woman talks about sleeping twenty, twenty-two hours a day, getting up, eating a little bit, and then going back to bed because she was exhausted still.

The third criterion is psychomotor retardation or agitation. The retardation is much more common, and what this means is that sort of everything about the person's movement is slowed down. They'll walk more takes a tremendous amount of energy to get even a common sentence out. A sleep all of the time.

themes. They may believe that they are Satan to commit suicide because they're So, you have have at least one--four of those symptoms plus sadneor anhedonia, and these symptoms--it can't just be a bad day that you're having. These symptoms have to be present persistently for at least two weeks to get the diagnosis. Now, truth be told, most episodes of major depression actually last a lot longer than two weeks. In fact, the average length of an episode, if it's not treated, is at least six months. So, people stay this miserable for a very long period of time, but the minimum criterion in the DSM is at least two weeks.

5 Introduction to Psychology

Lecture 18 Yale University

So, what I want to do is to just show you a short clip of a woman who has had a lot of episodes of depression. Fortunately, at the moment she's not in an episode. But she can speak very articulately about what it's like to be in the midst of an episode and some of the significant symptoms that she had. [video clip plays]

Okay. There are couple of things she talks about that I just want to comment on. One is this differentiation between everyday sad mood and the kind of depressions we all experience and the kind of debilitating, overwhelming depression that she experiences. And it is true that there is this continuum from getting something like this and being completely not functional, vegetative, the way that this there is this continuum.

trying to keep up with their But they're miserable and they're not disorder periods of depression but then also distinct periods of the opposite of or got an "A," but rather, it's this unusually positive, expansive mood for at least one week persistently. And then the person has to have three or more of the following symptoms.

First, inflated self-esteem or grandiosity. The individual may feel as though they are the smartest, the most creative, insightful, powerful person on earth, and they are perfectly happy to tell you this. So, there is no problem with self-esteem, thank you very much. "If you can't keep up with me it's your fault." There's

6 Introduction to Psychology

Lecture 18 Yale University

a decreased need for sleep; they may only sleep a couple of hours a night and get up raring to go. They tend to be more talkative than usual, and there's a really pressure to their talk. They'll talk really pressured, and they'll talk really, really fast. And one of the reasons they're talking really, really fast is they have this flight of ideas. The thoughts are just racing through their mind, and they can't talk fast enough to get them out. And if you can't follow them, that--well, that's because you're not smart enough to follow them. But they've just got too many good ideas and they've got to get them out.

They're highly distractible. And then there is this increase in this--what the DSMthey'll pursue this with tremendous vigor.

They'll also get involved in all kinds of, what the DSM discreetly but dangerous gambling, believing that you're on a hot streak, there's You know, you're just so irritable and trigger-fire. And sometimes they because they're just--they're so incredibly agitated and irritable.

whenever you--we do it. [video clip plays]

So, I want to show you another clip--it's a little bit longer--of a man who has bipolar disorder. He is not currently in an episode of either depression or mania, but again, he can talk about some of the things he got himself into and how it manifested in his behavior. [video clip plays] Hypomania is a more mild version of mania, but it's the same symptoms. [video clip resumes]

7 Introduction to Psychology

Lecture 18 Yale University

Okay. Just a couple of things that Bernie talks about that I want to comment on. One is that just as in depression, mania has--runs along a continuum. So, it can be relatively mild all the way to extremely severe and even psychotic. So, when a person with mania loses touch with reality, instead of having beliefs that they are Satan or they've done some horrible thing, they'll believe that they are some supernatural being. They may believe that they are the Messiah or that they are Albert Einstein, you know, come back to life, or that they have supernatural powers or something of this sort, so that their false beliefs, their delusions and their hallucinations, the things that they see and hear that aren't really there tend to be very see it still gets him into trouble.

Now, there are people who have--who cycle between fairly low levels of low of manic--especially if they're really smart or they have a special talent 鈥does sort of historical biographies on a number of well-known musicians, Robert hours a night of sleep; they're obviously really and that they can activity. They can get arrested. certainly send themselves and their family into people between the ages of fifteen and fifty-five, and these are the percentages of people in this study. And there were several thousand people in the study. These are not people who have sought treatment for depression but just a random community sample. And this is the percentage who've had an episode of major depression in the past month. And as you can see, the fifteen to twenty-four age range has the highest rates, and then they go down somewhat, although the thirty-five to forty-four is fairly high as well with age. You might be surprised to learn that the rates of major depression in the elderly are actually quite low by

8 Introduction to Psychology

Lecture 18 Yale University

most national statistics. And that's true up to about age eighty or eighty-five. And the arguments for why this is the case are very interesting.

There are some people who argue that as you get older you get wiser, and so that's why we see lower rates of depression in older age. There are other people who argue that current generation--younger generations now; your generation and the one above you--are more prone to depression and will be for the rest of your life compared to your grandparents, because of historical changes in the kinds of social support and family networks available and a number of other historical cultural changes. The other sort of of the argument is that because depression is known to impact negatively your physical health 鈥questionnaires. Probably most of you have filled out these like the Beck Depression Inventoryin girls' lives relative to boys'. We don't why. It's probably a lot of these things coming So, let's talk a bit major theories and treatments for the mood disorders. There are is evidence in bipolar disorder, and there are a number of ways--Have you 鈥over a 60% chance of having the disorder yourself. In contrast, if it's your--if you're just a fraternal twin of a person with bipolar disorder, you only have about a 12% chance of having the disorder. So, that massive difference there is very strong evidence that there's a genetic component to the transmission of the disorder. Similarly, the more distant you get in terms of your biological relation to a person with bipolar disorder, the lower your rate or your risk of the disorder is. So, the second degree relatives of a person with bipolar disorder only have about 2% chance of getting the disorder. And that's barely above what's in

9 Introduction to Psychology

Lecture 18 Yale University

the general population, which is about a 1% chance of getting the disorder. So, it's very clear that bipolar disorder has a genetic component to it.

With depression alone, major depression, there are probably versions of the disorder that have a stronger genetic component to them than others. And in particular, folks who have what's called "early onset depression," where their first episodes come on in childhood or very early adolescence, seem to have a form of depression that has a stronger genetic component to it. Whereas, people who have depression that is linked strongly to genetic factors.

you've heard about the link between serotonin and depression, but there norepinephrine and dopamine, that have also been linked to both of the both bipolar functioning appropriately. And so what the drugs depression do is to improve the functioning of these neurotransmitters.

There's a very interesting line of now looking at the intersection of genetic with to develop depression. But it's important to sort of dissect this. So of becoming depressed at some time in your life. And this has been replicated with other samples, with other forms of major trauma. And basically the story is, it takes the intersection of a genetic predisposition and major streto create full-blown depression in some people. Now, that may not be true for all genetic predispositions or all forms of depression, but this serotonin finding has actually been replicated now in at least four different studies. So, it seems to be a pretty reliable effect. So again, genes

10 Introduction to Psychology

Lecture 18 Yale University

do not determine the disorder, but the intersection of genes and streseems to be a major risk factor for the disorder.

There are a number of brain areas that seem to be involved in the mood disorders where there is just dysregulation or dysfunction. The prefrontal cortex, as you probably have studied, is an area of the brain that's very involved in higher order complex thinking and problem solving and in goal-directed behavior. In people with depression, there's lowered activity in the prefrontal cortex, suggesting that--which may play a regulating emotion.

with mood disorders show overactive amygdala responses to emotional both dysregulation of the anterior cingulate may be involved in difficulty in responding appropriately to stress, in choosing good coping behaviors behaviors whenever their behaviors aren't working well.

a--has been always a search them. The drugs that have really taken over the Lithium is the drug of choice for the treatment of bipolar disorder. It seems to stabilize the mood swings by stabilizing the number of different neurotransmitter systems. But the lithium is problematic because there are tremendous side effects. It's also dangerous for women to take while they're pregnant in terms of fetal development. So, it's a very tough drug to stay on. There are lots of gastrointestinal side effects

11 Introduction to Psychology

Lecture 18 Yale University

and such, and people are often on lithium and the antidepressants because lithium often only affects the manic episodes but it doesn't really relieve the depression.

And then finally anti-psychotic medications, that is those help people who've lost touch with reality, are sometimes used to treat the mood disorders whenever the person has lost touch with reality.

I'm going to go through and talk about some of the psychosocial treatments because I want to get to them as well. The cognitive behavioral therapies are based on Aaron Beck's Negative of calls this the "negative cognitive triad." And this negative cognitive triad is by themselves--that are stable. They see bad and that are global. They see bad events as affecting many areas of their life, their depression and their general done at Temple University and where they identified first year college the truth these, and then change aspects of the environment that are related to depressive symptoms. So, they challenge your rational thinking, but they also recognize that there are really bad things that sometimes are going on the life of a person who is depressed, and they help them engage in more active problem solving to change those environments. They also teach the person ways to manage their mood so that they don't tumble down into depression. And these cognitive behavioral therapies have been shown to be extremely effective and as effective in some ways as the drug treatments.

12 Introduction to Psychology

Lecture 18 Yale University

So, this is a recent study in which they had 240 patients with major depressive disorder. They gave them four months of acute treatment with either cognitive behavioral therapy or Paxil, which is an SSRI. And in eight weeks here--they also had a placebo control group where they just got a pill, but it was a sugar pill. At eight weeks, the Paxil group, which is in red, and the CBT group, which is in yellow, were relatively even, although the Paxil group had a little bit of an edge over the CBT group. But by sixteen weeks the Paxil and CBT group were absolutely even in terms of the percent of people who were no longer depressed. So, both of them resulted in about 60% of people not being depressed.

alone, about 50% relapsed. But of those therapy, only about 35% rate of relapse in depression quite dramatically.

interestingly, the daughter of in terms of the practice and development of clip playing]

things that she's that she's having him generate his own challenges to his negative Cognitive behavioral therapy is very structured, it's very focused and it's designed to be relatively short-term. The one other major kind of psychotherapy for depression is interpersonal therapy. It's based on the theory that negative views of the self and expectations about the self and relationships are based on upbringings that really fostered these kinds of negative self-views. And so, what you need to do is to help clients understand their negative self-views and how they're rooted in their past relationships.

13 Introduction to Psychology

Lecture 18 Yale University

Interpersonal therapy is lestructured than cognitive behavioral therapy, and it's more focused on the past. CBT is very focused on the present and dealing with the current situation that you're facing and combating that and developing coping styles for that.

There are a few studies comparing interpersonal therapy with CBT, but much leresearch has been done on IPT than CBT. But it is a positive alternative for some people, particularly those who find that their depression is very tied-up in recurrent themes in their relationships that seem to happen over and over and over again.

much.

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