Psychological Science, 3rd Edition Michael Gazzaniga Todd Heatherton Diane Halpern

1. Psychological Science, 3rd EditionMichael Gazzaniga Todd Heatherton Diane Halpern

2. Treating Disorders of the Mind and Body 15

3. Questions to Consider: How Are Mental Disorders Treated? What Are the Most Effective Treatments? Can Personality Disorders Be Treated? How Should Childhood and Adolescent Disorders Be Treated?

4. How Are Mental Disorders Treated? • Psychotherapy Is Based on Psychological Principles • Culture Can Affect the Therapeutic Process • Medication Is Effective for Certain Disorders • Alternative Biological Treatments Are Used in Extreme Cases • Pseudotherapies Can Be Dangerous

5. Learning Objectives Recognize different styles of psychotherapy. Describe the uses, mechanisms, and side effects of common psychotropic medications.

6. Psychotherapy Is Based on Psychological Principles • With over 400 psychological therapies available, the precise techniques used by individual therapists may vary widely • One factor known to affect the outcome of therapy is: • The relationship between the therapist and the client

7. Psychotherapy Is Based on Psychological Principles • Psychodynamic therapy focuses on insight: • Along with Josef Breuer, Sigmund Freud pioneered the method of psychoanalysis • Treatment involved uncovering unconscious feelings and drives that, Freud believed, gave rise to maladaptive thoughts and behaviors • Techniques included free association and dream analysis

8. Psychotherapy Is Based on Psychological Principles • The general goal of psychoanalysis is to increase clients’ awareness (insight) of these unconscious processes and how they affect daily functioning • Over the past few decades, psychodynamic therapy has become controversial due to: • Its expense, the length of time required for treatment, and the lack of evidence of effectiveness for most disorders

9. Psychotherapy Is Based on Psychological Principles • Humanistic therapies focus on the whole person: • Emphasizes personal experience, belief systems and the phenomenology of individuals • The goal of humanistic therapy is to treat the person as a whole

10. Psychotherapy Is Based on Psychological Principles • Key ingredients of client-centered therapy include: • Creating a safe and comforting setting, empathy, reflective listening, and unconditional positive regard • Many techniques advocated by Rogers are used currently to establish a good therapeutic relationship between practitioner and client

11. Psychotherapy Is Based on Psychological Principles • Cognitive-behavioral therapy targets thoughts and behaviors: • Many of the most successful therapies involve trying to change people’s behavior and cognition directly • Beck pioneered cognitive restructuring • Ellis promoted rational-emotive therapy

12. Psychotherapy Is Based on Psychological Principles • Examples of these treatments include: behavior modification, modeling, social skills training, cognitive therapy and cognitive behavior therapy (CBT) • Interpersonal therapy integrates insight therapy with cognitive therapy • CBT is one of the most effective treatments available for anxiety and mood disorders • Exposure is an effective treatment for phobias and relies on classical conditioning processes

13. Cognitive restructuring involves replacing maladaptive thought patterns with more realistic,positive ones.

14. Psychotherapy Is Based on Psychological Principles • Group therapy builds social support: • Group and family therapy have become more widespread • Group therapy is less expensive than individual therapy • Offers the opportunity for practice of social skills and peer learning

15. Psychotherapy Is Based on Psychological Principles • Family therapy focuses on the family context: • Family therapy reflects an understanding of systems approaches—an individual is part of larger groups that can maintain or exacerbate behavior • Negative expressed emotion within families, for example, has been linked to higher relapse rates among those diagnosed with schizophrenia

16. Psychotherapy Is Based on Psychological Principles • Confession is good for the spirit: • Irrespective of type of therapy, evidence suggests that simply talking about (or writing about) one’s problems can have a positive effect

17. Culture Can Affect the Therapeutic Process • Culture impacts the way mental disorders are expressed, which people are likely to recover, and people’s willingness to seek help • Stigmas exacerbate the problem because people will often suffer in silence, failing to get the psychotherapy that can help them • Stigma varies from culture to culture

18. Culture Can Affect the Therapeutic Process • Culture also plays a critical role in: • Determining the availability, use, and effectiveness of different types of psychotherapy • Psychotherapy and definitions of mental health are based on the dominant cultural paradigm

19. Medication Is Effective for Certain Disorders • Drugs that affect mental processes are called psychotropic medications • The success of medication in the treatment of mental disorders is largely responsible for the era of deinstitutionalization • Scores of patients were discharged from mental hospitals and treated with drugs as outpatients

20. Medication Is Effective for Certain Disorders • Most psychotropic medications fall into three categories: • Anti-anxiety drugs • Antidepressants • Antipsychotics

21. Medication Is Effective for Certain Disorders • Anti-anxiety drugs • Reduce anxiety and promote relaxation, but they also induce drowsiness and are highly addictive • They should be used sparingly • Antidepressants: • There are several classes including MAO inhibitors, tricyclic antidepressants, and the SSRIs

22. SSRIs, such as Prozac, work by blocking reuptake into the presynaptic neuron, thereby allowing serotonin to remain in the synapse, where its effects on postsynaptic receptors are prolonged.

23. Medication Is Effective for Certain Disorders • Antipsychotics (neuroleptics) • Block the effects of dopamine • Antipsychotics are not always effective • They have significant side effects that can be irreversible • Tardive dyskinesia • These drugs are not useful for treating the negative symptoms of schizophrenia • Such as apathy and social withdrawal

24. Alternative Biological Treatments Are Used in Extreme Cases • Alternative biological methods often are used as last resorts because they are more likely to have serious side effects than will either psychotherapy or medication

25. Alternative Biological Treatments Are Used in Extreme Cases • Lobotomies: • One of the earliest formal procedures used on patients with severe mental illness was psychosurgery • Areas of the frontal cortex were selectively damaged • These prefrontal lobotomies were used to treat severe mental disorders, including: • Schizophrenia, major depression, and anxiety disorders

26. Alternative Biological Treatments Are Used in Extreme Cases • Patients who received lobotomies were often listless and had flat affect • The procedure often impaired many important mental functions, such as abstract thought, planning, motivation, and social interaction • With the development of effective pharmacological treatments in the 1950s, the use of lobotomy was discontinued

27. Alternative Biological Treatments Are Used in Extreme Cases • Electroconvulsive therapy (ECT): • Common in the 1950s and 1960s to treat mental disorders including schizophrenia and depression • ECT now generally occurs under anesthesia with powerful muscle relaxants • ECT is particularly effective for some cases of severe depression, although there are some risks to its use

28. Alternative Biological Treatments Are Used in Extreme Cases • Transcranial magnetic stimulation and deep brain stimulation are newer techniques that may be promising • Especially in relation to depression and OCD

29. In TMS, current flows through awire coil placed over the scalp area to bestimulated.

30. Pseudotherapies Can Be Dangerous • Some treatments widely believed to be effective are actually counterproductive: • Including encouraging people to describe their experiences following major trauma • Scaring adolescents into going straight • Having police officers run drug education programs (DARE) • Using hypnosis to recover painful memories

31. Pseudotherapies Can Be Dangerous • It is important to recognize the difference between evidence-based psychotherapies and “alternative” or “fringe” pseudotherapies • The latter can prevent people from getting effective treatment and may even be dangerous

32. What Are the Most Effective Treatments? • Treatments That Focus on Behavior and on Cognition Are Superior for Anxiety Disorders • Many Effective Treatments Are Available for Depression • Lithium Is Most Effective for Bipolar Disorder • Pharmacological Treatments Are Superior for Schizophrenia • There Are Important Considerations in Selecting a Psychotherapist • Critical Thinking Skill: Avoiding the Sunk Costs Fallacy

33. Learning Objectives Identify the therapies most effective for treating specific disorders.

34. What Are the Most Effective Treatments? • According to Barlow, three features characterize psychological treatments: • They vary according to the client and disorder • The techniques used in these treatments have been developed in the laboratory by psychological scientists • No overall grand theory guides treatment • Treatment is based on evidence of its effectiveness

35. Behavioral and Cognitive Treatments Are Superior for Anxiety Disorders • Cognitive-behavioral therapy (CBT) works best to treat most adult anxiety disorders • Anxiety-reducing drugs are also beneficial in some cases • Although there are risks of side effects and, after drug treatment is terminated, the risk of relapse

36. Behavioral and Cognitive Treatments Are Superior for Anxiety Disorders • Specific phobias: • Systematic desensitization is most effective • Brain imaging data indicate that successful treatment with CBT alters the way the brain processes the fear stimulus

37. Behavioral and Cognitive Treatments Are Superior for Anxiety Disorders • Findings suggest that psychotherapy effectively “rewires” the brain • Both Prozac and CBT are effective in treating social phobia • However, those taking Prozac report more physical complaints, such as a lack of sexual interest

38. Behavioral and Cognitive Treatments Are Superior for Anxiety Disorders • Panic attacks: • Imipramine prevents panic attacks • But does not reduce the anticipatory anxiety that occurs when people fear they might have an attack • CBT • Helps break the learned association between the physical symptoms and the feeling of impending doom • Cognitive restructuring addresses ways of reacting to the symptoms of a panic attack

41. Behavioral and Cognitive Treatments Are Superior for Anxiety Disorders • In the short term: • CBT alone and imipramine alone were effective for treating panic disorder, and they did not differ in results • However, six months after treatment had ended: • Those who received psychotherapy were less likely to relapse than those who had taken medication

42. Behavioral and on Cognitive Treatments Are Superior for Anxiety Disorders • OCD: • SSRIs and CBT are effective treatments • Researchers imaged the brains of patients with OCD who were being treated either with Prozac or with CBT • Patients in both treatment groups showed the same changes in neural activity • CBT may be a more effective way of treating OCD than medication, especially over the long term

43. Treatments for OCD can include thedrug clomipramine, exposure, and ritual prevention, with varying rates of success.

44. Behavioral and Cognitive Treatments Are Superior for Anxiety Disorders • Deep brain stimulation may be an effective treatment for those with OCD who have not found relief from CBT or medications • DBS leads to a clinically significant reduction of symptoms and increased daily functioning in about two-thirds of those receiving treatment

45. Many Effective Treatments Are Available for Depression • Pharmacological treatment: • Early antidepressant medication – MAO inhibitors and tricyclics: • Fairly effective in reducing depression but had serious side effects • Prozac, an SSRI, was developed in the 1980s and lacks the serious side effects of earlier antidepressant drugs

46. Many Effective Treatments Are Available for Depression • Approximately 60 to 70 percent of patients who take antidepressants experience relief from their symptoms • Some evidence suggests that tricyclics might be beneficial for the most serious forms of depression • But SSRIs are generally considered first-line medications because they have the fewest serious side effects

47. Many Effective Treatments Are Available for Depression • Cognitive-behavioral treatment of depression: • Just as effective as biological therapies in treating depression • The goal of CBT is to help the client think more adaptively • Although CBT can be effective on its own, combining it with antidepressant medication is significantly more effective than either one of these approaches alone

48. Many Effective Treatments Are Available for Depression • As with other mental disorders, treatment of depression with psychotherapy leads to changes in brain activation similar to those observed for drug treatments • In slightly different areas of the brain

50. Many Effective Treatments Are Available for Depression • Alternative treatments: • Phototherapy is the treatment of choice for those experiencing SAD • Regular aerobic exercise can reduce depression and prevent recurrence