1. Treatment Modalities for Psychological Disorders

2. “Brutal” to “Gentle” Transition Dorothea Dix and Philippe Pinel (mid 1800s) – Advocates of mental hospitals to provide more human treatment Mid 1950s: exodus from mental hospitals: – Introduction of therapeutic drugs – Community-based treatment programs

3. Two Main Treatment Modalities Psychotherapy Biomedical therapy Combination of the two 50% of psychotherapists say they use an “ecclectic approach,” using a blend of therapies

4. 4 Main Psychological Therapies 1. Psychoanalysis Sigmund Freud 2. Humanistic Carl Rogers 3. Behavioral Pavlov/Skinner 4. Cognitive Aaron Beck

5. 1. Psychoanalysis Psychological problems = Repressed impulses and conflicts from childhood Aim: work through ‘buried’ feelings and take responsibility for their own growth Release energy ‘wasted’ on id-ego-superego conflicts

6. 1. Psychoanalysis How does it work? Free association But watch out for “resistance”… blocks in the flow of free association Therapist would interpret the ‘meaning’ of your resistance Interpretation of latent content in dreams

7. 1. Psychoanalysis One result of therapy: Transference Occasionally followed by “Countertransference” This is why the APA has a “Code of Ethics”!

8. 1. Psychoanalysis Be ready to open you wallet! Traditional psychoanalysis is 3-4 visits/week for several years Conservatively speaking, at $125/hour, this is $68,250 for 3 years Maybe just take a few nice vacations!

9. 1. Psychoanalysis Modern “alternative” is: – Psychodynamic Therapy Goal is to understand current symptoms in terms of childhood and important relationships Face-to-face; generally once a week for several months

10. 2. Humanistic Therapy Carl Rogers (1902-1987) “Client-centered therapy” (Not “patient”) – Aim is to grow in self-awareness and acceptance Focus is on: – Dealing with present & future – Conscious thoughts rather than unconscious – Taking responsibility for one’s feelings & actions

11. 2. Humanistic Therapy Therapists strive to exhibit : – Genuineness – Acceptance – Empathy Which leads to “unconditional positive regard” Mechanism: “Active Listening”

12. 3. Behavior Therapies You don’t need “self-awareness” to heal from psychological problems! A. Classical Conditioning Techniques B. Operant Conditioning Techniques

13. 3A. Classical Conditioning “Counter-conditioning”: Pair the trigger stimulus with a new response (relaxation) Idea: can’t be both fearful AND relaxed Two techniques: – Exposure therapy – Aversive conditioning

14. 3A. Classical Conditioning Exposure Therapy/Response Prevention (ERP)

15. 3A. Classical Conditioning Aversive Conditioning: Substitute an aversive response for a positive response to a harmful stimulus Also, Faradic aversion conditioning!

16. 3B. Operant Conditioning Behavior Modification Use positive reinforcers to shape behavior

17. 3B. Operant Conditioning Token Economies

18. 3B. Operant Conditioning Concerns with Behavior Modification How ‘durable’ are the effects? It is OK for one human to control another’s behavior?

19. 4. Cognitive Therapy Works with the assumption that our thoughts color our feelings Aaron Beck: Expose irrational thinking, and then persuade the person to remove the dark glasses through which they view life

20. 4. Cognitive Therapy

21. Therapies to Avoid! Energy therapy – manipulating invisible energy fields Recovered-memory therapy Rebirthing therapy Facilitated communication Crisis debriefing

22. Biomedical Therapies: Drugs Antipsychotic Drugs Antianxiety Drugs Antidepressant Drugs Mood-Stabilizing Drugs

23. Biomedical Therapies: Adjuncts or Alternatives to Drugs Electroconvulsive Therapy Magnetic Stimulation Deep-Brain Stimulation

24. Biomedical Therapies: Drugs Antipsychotic Drugs Most common drugs help alleviate “positive” symptoms of schizophrenia Ex. Chlorpromazine (Thorazine) Work by blocking activity of dopamine Major side-effects: tardive dyskinesia, obesity, diabetes

25. Biomedical Therapies: Drugs “Atypical” Antipsychotic Drugs Help alleviate ‘negative’ symptoms of schizophrenia Ex. clozapine (Clozaril)

26. Biomedical Therapies: Drugs Anti-anxiety Drugs Examples: Xanax, Atavan, Valium ALL depress the central nervous system Anti-anxiety drugs plus ________ make a lethal combination? – ALCOHOL!

27. Biomedical Therapies: Drugs Anti-anxiety Drugs Criticisms: – 1. do not treat underlying problem, just symptoms – 2. Psychological dependence: “popping a Xanax” – 3. Physiological dependence: cessation of drug can lead to great anxiety and insomnia – New standard drug treatment for anxiety….

28. Biomedical Therapies: Drugs Antidepressant Drugs Also successfully treat anxiety disorders in addition to depression Selective-serotonin-reuptake inhibitors (SSRIs) – Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine)

29. Biomedical Therapies: Drugs

30. Biomedical Therapies: Brain Stimulation Electroconvulsive Therapy 1938: 100 volts administered to wide- awake patient Today: general anesthesia, muscle relaxant, 30 second electrical stimulation Refractory Depression: 80% of patients improve with ECT, but 4 in 10 relapse within 6 months

31. Biomedical Therapies: Brain Stimulation Electroconvulsive Therapy

32. Biomedical Therapies: Brain Stimulation Alternative Neurostimulation 1. Magnetic Stimulation: repetitive transcranial megnetic stimulation (rTMS)

33. Biomedical Therapies: Brain Stimulation Alternative Neurostimulation 2. Deep-Brain Stimulation

34. Biomedical Therapies: Psychosurgery Frontal Lobotomy 1930s, Portuguese physician, Dr. Moniz In the U.S. during 1950s: 35,000 lobotomies performed J.F. Kennedy’s sister, Rosemary, received a lobotomy – No longer performed – Nobel Peace Prize awarded to Moniz

35. Therapeutic Life-Style Change Aerobic exercise: 30 min. 3x a week Adequate sleep: 7-8 hours per night Light exposure Social connection Anti-rumination Nutritional supplements: omega-3 fatty acids