Chapter 18

Treatment

The Effect of Drug Treatment on Hospitalization for Mental Illness

• The introduction of chlorpromazine in the 1950s led to deinstitutionalization.

• Psychoactive drugs became an important component of modern health care.

Who Does Psychotherapy?

• Psychologists and psychiatrists tend to see more patients with Axis I disorders.

• Counselors and social workers tend to see more people with "adjustment of living" problems.

Freudian Psychoanalytic Processes

• Free Association - the patient describes whatever comes to mind, including thoughts, images, and dreams

• Resistance - behaviors a patient engages in to delay the therapeutic process

• Transference - a patient redirects to the therapist emotions experienced with significant others in childhood

Systematic Desensitization

• Confront a patient with a series of realistic models of a phobic stimulus

• Allowing the fear to extinguish at each stage slowly reduces the patient's fear

Aversion Therapy

• The taste of alcohol can be made aversive through classical conditioning

Biofeedback Therapy

• Biofeedback provides clients with information about the status of normally unconscious physiological systems

• Types of biofeedback - electromyograms and thermal feedback

• Treatment of choice for stress-related disorders, including migraine and tension headaches, low back pain, and hypertension

Albert Ellis's Rational-Emotive Therapy

Irrational thoughts and beliefs

emotional responses

Aaron Beck's Cognitive Therapy

• Negative Cognitive Triad of Depression

depressed person’s perception

personally inadequate

without hope

social and occupational

failures

Carl Rogers's Person-Centered Therapy

• The main source of a client's anxiety is the discrepancy between the self-concept and the opinion of others.

• Clients explore this issue through nondirective therapy.

self-concept anxiety perceptions of others

Goals of Humanistic Therapy

• Increased awareness

• Increased self-acceptance

• Increased interpersonal comfort

• Increased cognitive flexibility

• Increased self-reliance

• Increased overall functioning

Gestalt Therapy

• Restoration of holistic functioning of the self• Keep the patient in the "here and now”• Client is always "on the hot seat”

Cognitive-Behavioral Treatmentof Eating Disorders

• Stage 1 (eight weeks)– Patient attends twice-weekly educational session on long-term

health hazards of the disorder and goals for treatment

– Patient fulfills behavioral measures• Eats 3 to 4 meals plus 1 or 2 snacks daily

• Keeps a food journal

• Participates in weigh-ins

• Stage 2 (eight weeks)– Therapist subjects the client's thoughts and beliefs about body size

and the control of eating to rational scrutiny

– The client's rigidly prescribed eating patterns are relaxed

• Stage 3– Patient develops insight and increased confidence in her ability to

maintain healthy eating habits on her own

Exposure and Response Prevention in the Treatment of Eating Disorders

Stimulus Response Negative Reinforcer

Binge eating Vomiting relieves anxiety associated

with binge eating

• ERP

• Client is exposed to foods normally associated with vomiting, but is prevented from vomiting.

• Because the vomiting is not reinforced, this procedure eventally causes the response to extinguish.

• The bingeing behavior also decreases in frequency.

Cognitive-Behavioral Treatment of Panic Disorders

• Panic Control Treatment (PCT) consists of:

• Cognitive restructuring

• Exposure to the breathing cues associated with panic attacks

• Retraining of breathing

Group Therapy

• Sensitivity training sessions

• Group systematic desensitization training

• Alcoholics Anonymous

• Self-help Support Groups

Evaluating Insight Therapies

• A cost-benefit analysis of the therapeutic gains over the course of insight therapy shows that most gains are made in the early sessions.

Medical Treatmentsof the 20th Century

• Psychosurgery

• Electroconvulsive shock therapy

• Drug treatment

The Effects of Electroconvulsive Therapy to treat Severe Depression

The Use of Psychoactive Drugs,Prehistory to the Present