Neuroscience for Psychologists and Other Mental Health
Professionals Promoting Well Being and Treating Mental
Illness - 1st Edition
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Jill Littrell, PhD, LCSW, is an associate professor at Georgia State University,
where she teaches psychopathology, drug and alcohol addictions, and research
methods to social work students. After 8 years as a social worker, she obtained a
doctorate in clinical psychology from Arizona State University. Following a U.S.
Department of Veterans Affairs internship in alcohol and drug abuse, she worked
as a psychologist in the Alcohol and Drug Dependency Department at Cigna.
During her time at Cigna, she completed a two-volume work on alcoholism.
This endeavor further acquainted her with the neuroscience literature and the
proliferating research on how stress influences the immune system and mood.
Having been intrigued by the connections between mind and body, she pursued
a master's degree in biology (molecular genetics and biochemistry) while on
faculty at Georgia State. Much of her class work and laboratory experience was
focused on immunology and neuroscience. She continues to work in the immu-
nology lab of Dr. Yuan Liu. In recent years, she has published various papers on
the links among behavior, disease, and immune system function, as well as on
the efficacy of antidepressants.
Neuroscience for Psychologists
and Other Mental Health
Professionals
Promoting Well-Being and Treating
Mental Illness
Jill Littrell, PhD, LCSW
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Library of Congress Cataloging-in-Publication Data
Littrell, Jill, author.
Neuroscience for psychologists and other mental health professionals : promoting well-
being and treating mental illness / Jill Littrell.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-8261-2278-0 — ISBN 978-0-8261-2279-7 (e-book)
I. Title.
[DNLM: 1. Mental Disorders—physiopathology. 2. Mental Disorders—therapy. 3. Brain—
physiopathology. 4. Brain Chemistry—immunology. 5. Mental Disorders—etiology.
6. Psychophysiology. WM 140]
RC454.4
616.89—dc23 2015000573
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This work is dedicated to my husband, Gus Levine,
who makes everything I do better.
Contents
Prefaceâ•…â•…xv
Share Neuroscience for Psychologists and Other Mental Health Professionals:
Promoting Well-Being and Treating Mental Illness
1. Ways of Thinking About Behavioral Syndromesâ•…â•… 1
The Current Paradigm and How We Got Thereâ•…â•… 1
History of the Diagnostic and Statistical Manuals of the
â•… American Psychiatric Associationâ•…â•… 2
Major Depression and Anxiety Used to Be Neurosisâ•…â•… 6
The DSM-IV Continues the Tradition of Medicalizing
More of Usâ•…â•… 6
Controversy Over the DSM-5â•…â•… 7
The Limitations of Current Diagnostic Categoriesâ•…â•… 9
Abandonment of the DSM-5â•…â•… 11
Extensive Nature of the Mind–Body Connectionâ•…â•… 11
Are Diagnoses Needed?â•…â•… 13
What Should Be the Criteria for Disorder?â•…â•… 17
Has Labeling Ordinary Behavior as Mental Illness
Resulted in Better Outcomes?â•…â•… 17
The Approach in This Bookâ•…â•… 18
2. Physiologyâ•…â•… 25
Section€1: Genes and Epigenetics╅╅ 26
The Two-Step Process of Making a Proteinâ•…â•… 26
How the Cell Decides Whether to Make a Proteinâ•…â•… 28
Epigeneticsâ•…â•… 29
Telomeresâ•…â•… 31
Section€2: Neurons and Neurotransmitters╅╅ 32
The Life Cycle of a Neurotransmitterâ•…â•… 34
vii
viiiâ•… contents
How Are the Functions of Neurotransmitters
Investigated?â•…â•… 34
Specific Neurotransmittersâ•…â•… 35
Section€3: The Immune System╅╅ 48
Two Major Divisions: Innate and Adaptive Immunityâ•…â•… 49
The Glial Cellsâ•…â•… 51
Section€4: Circuits╅╅ 52
Appetitive Signalingâ•…â•… 52
Creating Learned Helplessnessâ•…â•… 54
Regulation of Impulses, Motor Activity,
and Emotionsâ•…â•… 58
Putting It All Together: BAS and BISâ•…â•… 62
Section€5: Emotions╅╅ 64
Emotions in Generalâ•…â•… 64
Autonomic Nervous Systemâ•…â•… 66
Hormonal Activityâ•…â•… 70
Specific Emotionsâ•…â•… 74
Section€6: The Human Brain Is Social╅╅ 77
Exercises to Rehearse the Vocabulary Used
â•… in Subsequent Chaptersâ•…â•… 93
3. Psychopharmacologyâ•…â•… 97
Pharmacokinetics and Pharmacodynamicsâ•…â•… 98
Ways to Ingest Drugsâ•…â•… 98
Ways in Which Drugs Are Eliminated
From the Bodyâ•…â•… 99
Drug Dependenceâ•…â•… 101
General Conceptsâ•…â•… 102
Major Classes of Psychotropic Drugsâ•…â•… 102
Stimulantsâ•…â•… 103
Antipsychoticsâ•…â•… 103
Antidepressantsâ•…â•… 105
Sedative-Hypnotic Agentsâ•…â•… 106
Mood Stabilizersâ•…â•… 107
Major Classes of Drugs of Abuseâ•…â•… 107
Marijuanaâ•…â•… 108
Opioidsâ•…â•… 108
contentsâ•… ix
Nicotineâ•…â•… 110
Alcoholâ•…â•… 111
Marketing of Drugs in the United Statesâ•…â•… 115
Concerns About Threats to Healthâ•…â•… 117
Concerns Over Costâ•…â•… 119
Where Does the Pharmaceutical Industry Spend
Its Money?â•…â•… 121
Mechanisms for Controlling Medical Practiceâ•…â•… 122
Psychiatric Medicationsâ•…â•… 125
The Role of Behavioral Health Clinicians
â•… With Regard to Pharmaceuticalsâ•…â•… 127
Obligations in Assuming Responsibilities
for Monitoring Side Effectsâ•…â•… 128
Clinicians Functioning Independentlyâ•…â•… 129
Informed-Consent Duties of Clinicians
in Clear Mental Health Professional Rolesâ•…â•… 130
What Can Nonmedical Clinicians Say About
Medications?â•…â•… 131
Websites for Information Regarding Drugsâ•…â•… 132
4. Depressionâ•…â•… 143
The Syndrome of Depressive Behaviorsâ•…â•… 143
Prevalence Over Time and Culturesâ•…â•… 143
Findings in Those With Major Depressionâ•…â•… 144
Brain Imaging and EEG Findingsâ•…â•… 144
Hormonal Findingsâ•…â•… 146
Thinking Stylesâ•…â•… 146
Emotional Control or Regulationâ•…â•… 147
Brain-Derived Neurotrophic Factorâ•…â•… 148
Theoriesâ•…â•… 148
Learned Helplessnessâ•…â•… 148
Inflammationâ•…â•… 149
Heritabilityâ•…â•… 153
Drug Treatmentâ•…â•… 154
Efficacyâ•…â•… 154
Withdrawalâ•…â•… 156
Side Effectsâ•…â•… 158
xâ•… contents
Pregnancyâ•…â•… 159
Changing Recommendationsâ•…â•… 160
Ketamineâ•…â•… 160
Novel Drugsâ•…â•… 160
Electrical Stimulation Treatmentâ•…â•… 161
Transcranial Magnetic Stimulationâ•…â•… 161
Deep Brain Stimulationâ•…â•… 162
Activities to Increase Regulatory Capacityâ•…â•… 162
Cognitive Behavioral Therapyâ•…â•… 163
Ways to Target Inflammationâ•…â•… 164
Increasing HRV (Vagal Tone)â•…â•… 164
Direct Anti-Inflammatoriesâ•…â•… 164
Dietâ•…â•… 165
Obtaining Adequate Sleepâ•…â•… 169
Exerciseâ•…â•… 169
Meditationâ•…â•… 170
Social Engagementâ•…â•… 171
Summaryâ•…â•… 171
Useful Websites and Information on Foodâ•…â•… 171
5. Anxietyâ•…â•… 195
The Physiology of Anxietyâ•…â•… 195
Basic Physiology of Fearâ•…â•… 195
Differentiating Anxiety From Fearâ•…â•… 197
Fear Memoriesâ•…â•… 198
How Does Extinction Happen?â•…â•… 199
Possibility of Reconsolidationâ•…â•… 199
Teaching Active Copingâ•…â•… 201
Types of Anxiety Disordersâ•…â•… 202
Generalized Anxiety Disorderâ•…â•… 202
Obsessive-Compulsive Disorderâ•…â•… 205
Posttraumatic Stress Disorderâ•…â•… 208
Treatmentsâ•…â•… 212
Talk Therapiesâ•…â•… 212
Medications for Anxietyâ•…â•… 213
Other Nondrug Treatmentsâ•…â•… 214
contentsâ•… xi
Ways in Which to Talk About and Deal
With Past Traumatic Eventsâ•…â•… 215
Making Decisions About How to Proceedâ•…â•… 220
6. Psychotic Disordersâ•…â•… 231
Physiology of Psychosisâ•…â•… 231
Fast-Spiking, GABA-Producing Interneuronsâ•…â•… 232
Problems With the NMDA Receptorâ•…â•… 234
Inflammatory Factors and Free Radicalsâ•…â•… 235
Limitations in Current Diagnostic Practicesâ•…â•… 237
Current Treatmentsâ•…â•… 238
Side Effects With Current Treatmentsâ•…â•… 239
Questions Raised by Long-Term Follow-Up Studiesâ•…â•… 240
Better Targets for Treatmentâ•…â•… 242
Dilemma for Society and Cliniciansâ•…â•… 248
7. Bipolar Disordersâ•…â•… 263
History of the Conceptâ•…â•… 263
Why Was Bipolar II Added?â•…â•… 265
Bipolar Iâ•…â•… 267
Does Depression Always Occur in Those With Mania?â•…â•… 269
Bipolar IIâ•…â•… 270
Nonclinical College Student Samples of Bipolar IIâ•…â•… 270
Summaryâ•…â•… 272
Treatmentâ•…â•… 273
Must Pharmacological Treatment Be Initiated
to Prevent Kindling?â•…â•… 273
The Pharmacological Treatments: Lithium, Anticonvulsants,
and Atypical Antipsychoticsâ•…â•… 275
Efficacy of Pharmacological Treatmentâ•…â•… 276
Current Outcomes for Those With Bipolar IIâ•…â•… 278
Alternative to Drugsâ•…â•… 278
Regular Routinesâ•…â•… 278
Omega-3sâ•…â•… 279
N-Acetylcysteineâ•…â•… 280
Where Have We Been and Where Are We Going?â•…â•… 280
xiiâ•… contents
8. Addictionsâ•…â•… 291
Neuroscience of Addictionâ•…â•… 292
The Process of Becoming Addicted: Drug Sensitizationâ•…â•… 292
It Is Not About Pleasureâ•…â•… 293
The Brain Is Being Changedâ•…â•… 294
When Are Addicts More Vulnerable to Relapse?â•…â•… 296
Understanding Addictionâ•…â•… 296
Do Addicts Use Because They Are in Pain?â•…â•… 298
Substance Abusers Are a Heterogeneous Populationâ•…â•… 300
Genetic Predispositionâ•…â•… 302
How to Approach Clientsâ•…â•… 302
Is Breaking Down Denial Relevant?â•…â•… 302
New Approaches: Transtheoretical Models of Change and
Motivational Interviewingâ•…â•… 305
What Level of Drug Consumption Should Be Changed?â•…â•… 306
The Wisdom of Initial Sobrietyâ•…â•… 308
Initial Engagementâ•…â•… 309
Assessing Detox Requirementsâ•…â•… 311
Assessing Level of Careâ•…â•… 311
Goals of Treatmentâ•…â•… 312
Relapse Preventionâ•…â•… 312
Developing Self-Regulationâ•…â•… 314
Dealing With Abstinence Violation Syndromeâ•…â•… 316
Pharmaceutical Treatmentsâ•…â•… 316
Efficacy of Treatmentâ•…â•… 317
Reflections on U.S. Drug Policyâ•…â•… 318
9. Childrenâ•…â•… 331
Rise in Medicating Childrenâ•…â•… 331
Pediatric Bipolar Disorderâ•…â•… 332
The Push to Medicateâ•…â•… 334
Side Effects of the Drugsâ•…â•… 335
The Status of the Diagnosisâ•…â•… 336
Major Depressionâ•…â•… 336
Efficacy of Antidepressantsâ•…â•… 336
Attention Deficit Hyperactivity Disorderâ•…â•… 339
Genetics and Neurobiologyâ•…â•… 340
contentsâ•… xiii
Stimulant Treatment Efficacyâ•…â•… 341
Alternativesâ•…â•… 344
Foster Careâ•…â•… 346
Posttraumatic Stress Disorderâ•…â•… 348
General Alternatives for Childrenâ•…â•… 349
10. New Opportunities and How to Proceedâ•…â•… 363
Mental Illness in the United States Is an Epidemicâ•…â•… 364
Case Against Diagnoses That Create Harmâ•…â•… 366
Lessons From the Resilience Literatureâ•…â•… 368
The Goal of Flourishingâ•…â•… 369
What to Do to Increase Positive Moodâ•…â•… 371
Primacy of Social Supportâ•…â•… 372
Humorâ•…â•… 374
Musicâ•…â•… 375
Making Blessings Salientâ•…â•… 376
Meditation and Yogaâ•…â•… 377
Envisioning Positive Future Selvesâ•…â•… 378
Being Able to Forgiveâ•…â•… 378
Increasing the Probability of Taking Actionâ•…â•… 379
Integrating Behavioral Health Into Primary Careâ•…â•… 380
Screeningâ•…â•… 382
Larger Social Changeâ•…â•… 384
Appendix: Screening Instrumentsâ•…â•… 393
Alcohol Use Disorders Identification Testâ•…â•… 393
CAGE Questionnaireâ•…â•… 395
The Satisfaction With Life Scaleâ•…â•… 396
The Center for Epidemiologic Studies Depression Scaleâ•…â•… 396
Indexâ•…â•… 399
