Treatment of Disorders

History of Treatment

Ethical Issues in Treatment• Deinstitutionalization occurred during

the mental health movement of the 1960sDon’t exclude mentally ill from society, but

help them function within societyShorten in-patient treatment (only keep in

hospital if necessary) More out-patient care

• APA guidelines

Who Provides Treatment?• Psychiatrists – Medical doctors, MD• Psychologists – PhD, PsyD, some MA• Clinical Social Workers, MA• Marriage/Family Therapists, MA• Licensed Professional

Counselors, MA• Psychiatric Nurses, RN• Substance Abuse Counselors,

CADC• Pastoral Counselors

• Psychotherapy – trained therapist uses psychological techniques to help someone to overcome problems or difficulties

• Biomedical therapy – prescribed medication that acts on nervous system

• Eclectic approach – use a blend of therapies and approaches

Psychoanalysis• Free association– Say whatever comes to mind,

no censoring of thoughts – Overcome resistance

(blocking of anxiety-laden material)

• Transference– Patient transfers unconscious

feelings towards someone else onto the therapist

– i.e. patient w/Electra complex has attraction to Freud (transfers attraction to father onto therapist)

Type of Therapy Cause/Problem Aim of TreatmentPsychodynamic Unconscious forces &

childhood experiencesReduce anxiety through self-insight; analysis & interpretation

Client-centered (Humanistic)

Barriers to self-understanding & self-acceptance

Personal growth through self-insight

Behavior Maladaptive behaviors (learned or observed)

Extinguish maladaptive behaviors

Cognitive Negative, self-defeating thoughts

Healthier thinking, positive self-talk

Group (Family) Stressful relationships Relationship healing, better communication

Biomedical Chemical imbalances or nervous system dysfunction

Prescribed medications of medical surgery

Psychodynamic• Childhood experiences• Enhance self-insight • Interpersonal therapy – brief

(12-16 session) treatment, effective for depression

Psychoanalysis v. Humanistic

• Humanistic therapies differ from psychoanalysts in focusing on…1) Present & future (not past)2) Conscious rather than

unconscious3) Immediate responsibility 4) Promoting growth instead of

curing illness

Client-Centered Therapy (Carl Rogers) • Nondirective Active listening– Clarification or “reflect” what has been

said back to patient• Genuineness, acceptance, empathy• Unconditional positive regard no

judgment

Behavior Therapies – Classical Conditioning

• Counterconditioning– Pair feared stimulus w/good

outcome• Exposure therapy – expose patient to feared

stimulus– Learn relaxation techniques– Systematic desensitization

hierarchy • Aversive conditioning– Pair the undesirable

behavior with bad outcome

Behavior Therapy Systematic Desensitization

Behavior Therapy Aversion

therapy for alcoholics

Behavior Therapies – OperantBehavior Modification – use reinforcement to increase desired behaviors

Token Economy – provide “tokens” each time desired behavior is performed that can be redeemed later for a bigger reward

Cognitive Therapies• Cause = irrational thinking patterns• Aim = correct habitual thinking errors• Aaron Beck’s Cognitive(-Behavioral) Therapy

Cognitive Triad1) Negative feelings about self

“I am a failure”2) Negative feelings about world

“The world is unfair”3) Negative feelings about future

“The future is hopeless, itwill never get better”

Beck’s Cognitive Therapy for Depression• Over-generalization drawing general conclusions

from a single (usually negative) event. E.g. thinking that failing to be promoted at work means a promotion will never come.

• Minimalization and Maximization Getting things out of perspective: e.g. either grossly underestimating own performance or overestimating the importance of a negative event.

• Dichotomous thinking Thinking that everything is either very good or very bad so that there are no gray areas. In reality, of course, life is one big gray area.

Cognitive-Behavioral Therapies

Albert Ellis’s Rational Emotive Behavior Therapy (REBT)The A-B-C modelA= Adversity (anticipating event)B = Belief about “A”C = Consequences (behavioral, emotional)

Stress Inoculation Training• SIT is a form of cognitive

restructuring as it is a method of changing an individual’s thinking patterns about themselves and their lives. The aim is to change their emotional responses and their behavior ideally before the individual becomes very anxious or depressed as a result of stress.

Nontraditional Psychotherapies• Eye movement desensitization and

reprocessing (EMDR)• Often used for PTSD• Uses patients’ rhythmic eye movements• Therapist moves finger from left to right while

patient recalls disturbing event or issue

Evaluating Psychotherapies

To whom do people turn for help for psychological difficulties?

Is Psychotherapy Effective?• Overestimation– Clients enter in crisis (temporary)–Want to believe it was worth the effort– Placebo effect (expect to get better)– Regression toward the mean (the usual

state is better than rock bottom, which is where most patients start)

Is Psychotherapy Effective?• Those not treated often improve, but those

undergoing therapy are more likely to improve

• No one therapy is best in all cases• Evidence-based practice – clinical decision

making that integrates best available research w/clinical expertise and patient characteristics

Three Benefits of Psychotherapies

1) Offer expectation that things can and will get better

2) Offers plausible explanation for symptoms and alternative way of thinking

3) Effective therapists are empathetic and seek to understand builds trust

Evaluating Psychotherapies

Poor outcome Good outcome

Averageuntreated

person

Averagepsychotherapy

client

Number ofpersons

80% of untreated people have pooreroutcomes than average treated person

Biomedical Therapies• Psychopharmacology – study of

drugs and their effects on mind and behavior

Antipsychotic Drugs• Treats schizophrenia• Decrease receptiveness to

irrelevant stimuli• Block dopamine • Thorazine, Haldol, neuroleptics• Atypical antipsychotics

(Clozapine)• Tardive dyskinesia – involuntary

movements of face, tongue, limbs

Antianxiety Drugs• Depress CNS activity (tranquilizers –

benzodiazepines)• Boost GABA• Xanax, Ativan, D-cycloserine• Can lead to psychological and physiological

dependence• Treats anxiety disorders

(PTSD, OCD)

Antidepressant Drugs• Increase serotonin & norepinephrine• Selective Serotonin Reuptake Inhibitors (SSRIs)

– Prozac, Zoloft, Paxil– Block reabsorption of

serotonin from synapse• Treat depression, some

anxiety disorders (OCD)• Tricyclics are more

effective (serotonin & norepinephrine)

Lithium• Mood stabilizer• Treats bipolar disorder• Lowers risk of suicide

Brain Stimulation Techniques• Electroconvulsive Therapy (ECT)– Side effects (memory loss)

• Repetitive transcranial magnetic stimulation (rTMS)– Less side effects

Psychosurgery• Removes or destroys brain tissue to

change behavior• Lobotomy • ONLY USED IN

EXTREME CASES