Treatment of Psychological Disorders

1. Treatment of Psychological Disorders Chapter 13

2. Types of Mental Health Therapy • Psychotherapy – trained therapist uses psychological techniques to assist someone seeking to overcome difficulties or achieve personal growth • Often used for learning-related disorders (like phobias) • Biomedical therapy – prescribed medication or medical procedure that acts directly on a patient’s nervous system • Used for biologically influenced disorders (like schizophrenia) • Eclectic approach – uses techniques from various forms of therapy

3. Psychotherapies • Psychoanalysis – not used very often • Goals – bring repressed feelings into conscious awareness • Methods: • Free association – saying whatever comes to your mind which indicates resistance – blocking from consciousness of anxiety-laden material • Interpretation – analyst notes supposed dream meanings, resistances and other significant behaviors and events in order to promote insight • Use of dream analysis • Transference – patient's transfer to the analyst of emotions linked with other relationships • Involves several years of several sessions a week with therapist traditionally out of view of the patient

4. Psychotherapies -cont- • Psychodynamic therapists – views individuals as responding to unconscious forces and childhood experiences and seeks to enhance self-insight • Therapists talks to clients face to face and weekly for a few months • Interpersonal psychotherapy– variation to psychodynamic therapy • Goal: help people gain insight into the roots of their difficulties and works for symptom relief rather than overall personality change

5. Psychotherapies -cont- • Humanistic Therapies • Differences with psychoanalysis • Focus on present and future more than past • Focus on conscious rather than unconscious feelings • Take immediate responsibility for one’s feelings and actions rather than uncovering hidden determinants • Promote growth instead of cure illness • Use of client-centered therapy – therapists uses active listening within a genuine, accepting, empathic environment to facilitate clients’ growth • Uses active listening – echoing, restating and seeking clarification of what the person expresses and acknowledging expressed feelings • Developed by Carl Rogers

6. Psychotherapies -cont- • Humanistic therapies -cont- • Use of unconditional positive regard – caring, accepting, nonjudgmental attitude to help clients develop self-awareness and self-acceptance • Tips for active listening: • Paraphrase • Invite clarification • Reflect feelings

7. Psychotherapies -cont- • Behavior therapies – applies learning principles to the elimination of unwanted behaviors • Counterconditioning – uses classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors • Exposure therapy – expose people to what they normally avoid • Systematic desensitization – associates a pleasant relaxed state with gradually increasing anxiety-triggering stimuli • Virtual reality exposure therapy – progressively exposes people to simulations of their greatest fears • Aversive conditioning – associates an unpleasant state with an unwanted behavior

8. Psychotherapies -cont- • Behavior therapies -cont- • Operant conditioning • Behavior modification – reinforcing desired behaviors and withholding reinforcement or enacting punishment for undesired behaviors • Token economy – people earn a token for displaying an appropriate behavior which can later be exchanged for privileges or treats • Criticisms: • Are the conditioned behaviors durable? • Is it ethical for one human to control another’s behavior?

9. Psychotherapies -cont- • Cognitive therapies – teaches people new, more adaptive ways of thinking and acting based on the assumption that thoughts intervene between events and our emotional reactions • Beck’s therapy for depression – uses gentle questioning to reveal irrational thinking in clients and persuades people to change the lens through which they see life • Cognitive-behavioral therapy – aims to change self-defeating thinking and change behavior

10. Psychotherapies -cont- • Group and family therapies • Family therapy – treats the family as a system and views an individual’s unwanted behaviors as influenced by or directed at other family members

11. Psychotherapies -cont- • Evaluating Psychotherapies • Effectiveness • Approximately 90% of clients report feeling better – but keep in mind that clients • Enter therapy in crisis • May need to believe therapy was worth the effort • Generally speak kindly of their therapists • Meta-analysis – a procedure for statistically combining the results of many different research studies • Has shown that the average therapy clients ends up better off than 80% of untreated individuals on waiting lists • Therapy is most effective when the problem is clear-cut • APA encourages evidence-based practices – clinical decision-making that integrates the best available research with clinical expertise and patient characteristics and preferences

12. Treatment vs. No Treatment

13. Psychotherapies -cont- • Commonalities Among Psychotherapies • Offer hope for demoralized people • Offer people a plausible explanation for their symptoms and an alternative way of looking at themselves or responding to the world • Provide an empathic, caring and trusting relationship

14. Biomedical Therapies • Biomedical therapy – physically changing the brain’s functioning by altering its chemistry with drugs or affecting its circuitry with electroconvulsive shock, magnetic impulses or psychosurgery • In most cases can only be offered by psychiatrists • Drug Therapies • Antipsychotic drugs – used to treat schizophrenia and other forms of severe thought disorder • Long-term use can promote tardive dyskinesia – involuntary movement of the facial muscles, tongue and limbs

15. Biomedical Therapies -cont- • Drug Therapies -cont- • Antianxiety drugs – used to control anxiety and agitation • Depress central nervous system activity • Can result in psychosocial dependence or withdrawal • Antidepressants - used to treat depression • Increase norepinephrine or serotonin • Research shows that placebos account for about 75% of the effectiveness of antidepressants • Mood-stabilizing drugs

16. Biomedical Therapies -cont- • Brain Stimulation • Electroconvulsive therapy (ECT) – biomedical therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized patient • 80%+ of people show marked improvement after 3 sessions a week for 2-4 weeks • Can result in some memory loss • Repetitive transcranial magnetic stimulation (rTMS) – application of repeated pulses of magnetic energy to the brain to stimulate or suppress brain activity • Only stimulates the brain’s surface and results in no memory loss

17. Biomedical Therapies -cont- • Psychosurgery – surgery that removes or destroys brain tissue in an effort to change behavior • Least used • Lobotomy – rarely used psychosurgical procedure that cut the nerves connecting the frontal lobes to the emotion-controlling centers of the inner brain • Often caused lethargy and reduced creativity • Therapeutic Life-Style Change • Exercise • Sleep • Light exposure • Social connection • Anti-rumination – identifying and redirecting negative thoughts • Nutritional supplements

18. Therapists and Their Training