1. Chapter 15: Treatment of Psychological Disorders 1

2. 2 Types of Treatment Psychotherapy –Insight therapies “talk therapy” (Family/Martial) –Behavior therapies Changing overt behavior –Biomedical therapies (Drugs) Biological functioning interventions

3. Chapter 15: Treatment of Psychological Disorders 3 Who Seeks Treatment? 15% of U.S. population in a given year Most common presenting problems –Anxiety and Depression Women more than men Medical insurance Education level

4. Chapter 15: Treatment of Psychological Disorders 4 Figure 15.2 Therapy utilization rates

5. Chapter 15: Treatment of Psychological Disorders 5 Figure 15.3 Psychological disorders and professional treatment

6. Chapter 15: Treatment of Psychological Disorders 6 Who Provides Treatment? Psychologists. Must earn Doctorate Degree –Clinical psychologists. “ Full fledged disorders”, psychological testing, psychotherapy, & research –Counseling psychologists. “ Treat everyday problems”, psychological testing, psychotherapy, & research Psychiatrists. Diagnosis & treatment of disorders including severe (schizo/mood). M.D. degree & Drug Treatment Other Mental Health Professionals –Clinical social workers. Masters, integrate patients back into society. –Psychiatric nurses. B.A. or Masters, impatient treatment –Counselors. Masters, work in schools, colleges, family planning, rehab & drug counseling

7. Chapter 15: Treatment of Psychological Disorders 7 Insight Therapies: Psychoanalysis Insight. Verbal interactions intended to enhance self knowledge and promote healthy changes in personality & behavior. Sigmund Freud and followers –Goal: discover unresolved unconscious conflicts, by probing to find issues using these techniques Free association. Uncensored spontaneous thoughts Dream analysis. Symbolic meaning of dreams Interpretation. Explain the inner significance –Resistance and transference

8. Chapter 15: Treatment of Psychological Disorders 8 Figure 15.4 Freud’s view of the roots of disorders

9. Chapter 15: Treatment of Psychological Disorders 9 Insight Therapies: Client- Centered Therapy Carl Rogers (Humanistic) –Goal: restructure self-concept to better correspond to reality (the problem is incongruence) –Therapeutic Climate (reduce defenses) Genuineness. Therapist must be honest Unconditional positive regard. Complete acceptance Empathy. Therapist must understand Therapeutic Process. Must work together and use clarification

10. Chapter 15: Treatment of Psychological Disorders 10 Figure 15.5 Rogers’s view of the roots of disorders

11. Insight Therapies: Cognitive Therapy Aaron Beck & Albert Ellis. Focused on recognizing & changing negative thoughts or maladaptive beliefs. –Goals & Techniques. Help clients see how unrealistic their thought are. Kinship with Behavioral Therapy. HW was common, to engage in responses outside of the office. Chapter 15: Treatment of Psychological Disorders 11

12. Chapter 15: Treatment of Psychological Disorders 12 Figure 15.10 Beck’s view of the roots of disorders

13. Insight Therapy: Group Therapy Group Therapy. Simultaneous treatment of 4 to 15 people, 8 is ideal. –Participants Role. Function as therapist for each other, describe problems, share experiences & discuss strategies. Provide acceptance & emotional support. They work hard to display healthy changes to win the groups approval –Therapist Role. Selecting participants, setting the goals for the group, initiating & maintaining therapeutic process, protecting clients from harm. –Advantages. Save time & money, patients realize their misery is not alone, & they work on social skills. Chapter 15: Treatment of Psychological Disorders 13

14. Evaluating Insight Therapies Hans Eysenck found 2/3 of people recovered from neurotic disorders without being treated which is the same rate of recovery with treatment. –Spontaneous Remission. Recovery without treatment –Critics of Eysenck. He compared groups that were not matched in severity. Insight Therapy treat pathological symptoms as signs of an underlying problem, Behavior Therapist think the symptoms are the problem. Chapter 15: Treatment of Psychological Disorders 14

15. Chapter 15: Treatment of Psychological Disorders 15 Behavior Therapies B.F. Skinner and colleagues –Goal: unlearning maladaptive behavior and learning adaptive ones –Systematic Desensitization – Joseph Wolpe Used to reduce phobias through counter conditioning. To relax instead of anxiety. Classical conditioning Anxiety hierarchy. Least to Most Fear and client must work through it while remaining relaxed.

16. Chapter 15: Treatment of Psychological Disorders 16 Figure 15.7 The logic underlying systematic desensitization

17. Chapter 15: Treatment of Psychological Disorders 17 Behavior Therapies B.F. Skinner and colleagues –Aversion therapy (last resort therapy) Aversive stimulus is paired a stimulus that elicits an undesirable response Alcoholism, sexual deviance, smoking, etc. –Social skills training. To improve interpersonal skills Modeling Behavioral rehearsal Shaping

18. Chapter 15: Treatment of Psychological Disorders 18 Evaluating Behavioral Therapies Not effective globally Only effective for Phobias, OCD, Sexual Dysfunctions, Schizophrenia, Drug Problems & Eating Disorders

19. Chapter 15: Treatment of Psychological Disorders 19 Biomedical Therapies: Treatment with Drugs Psychopharmacotherapy (Drug Therapy) 1.Antianxiety Drugs- Relieves tension, apprehension & nervousness. Valium, Xanax, Benzodizepine(tranquilizer) -Side Effects: Drowsiness, depression, nauseam confusion, drug dependence, overdose, withdrawal symptoms. 2. Antipsychotic Drugs- Treat Schizophrenia/mood disorders it gradually reduces psychotic symptoms including hyperactivity, mental confusion, hallucinations & delusions, decrease dopamine. Schizophrenia patients are placed on it indefinitely. Thorazine, Mellaril, Haldol - Side Effects include: Drowsiness, constipation, cotton mouth, tremors < Tardive dyskinesia. 20-30% of long term use. Ticks <Clozapine. Atypical drug when patients do not respond

20. Chapter 15: Treatment of Psychological Disorders 20 Biomedical Therapies 3. Antidepressant Drugs- Elevate mood, helps 2/3 of people Tricyclics – Elavil, Tofranil Mao inhibitors (MAOIs) - Nardil Selective serotonin reuptake inhibitors (SSRIs) – Prozac, Paxil, Zoloft –Side Effects include: Suicide, Homicide, weight gain, sleep problems & sexual dysfunctions 4. Mood stabilizers Lithium. Used to control mood swings (bipolar) it prevents future episodes Valproic acid. Treats bipolar with less adverse effects –Side Effects include: Toxic blood, kidney & thyroid gland complication

21. Chapter 15: Treatment of Psychological Disorders 21 Figure 15.12 Antidepressant drugs’ mechanisms of action

22. Electroconvulsive therapy (ECT) Came from the idea that epilepsy & schizophrenia could not coexist. So it was used to cure schizophrenia by inducing seizures with electric shock. Electric Shock produced cortical seizures accompanied by convulsions. Shock the right hemisphere for 1 second & triggers seizures for 30 seconds, patients are given light anesthesia 1 or 2 hours following treatment. Patients were confused, disorientated & nausea. Memory loss are common short term effects. Only 8% of psychiatrist administer ECT (100,000 people yearly) Effectiveness: Over 50% relapse within 6 to 12 months Chapter 15: Treatment of Psychological Disorders 22

23. Chapter 15: Treatment of Psychological Disorders 23 Current Trends and Issues in Treatment Managed care. –Fee for Service System. Medicaid/Medicare, Prepaid plan with co-pay (HMO). Empirically validated treatments. Solid research based attesting to their effectiveness. Blending Approaches to treatment. Blending 2 or more perspectives. Multicultural sensitivity. Cultural, language, access & institutionalization barriers

24. Chapter 15: Treatment of Psychological Disorders 24 Figure 15.15 Declining inpatient population at state and county mental hospitals

25. Institutional Treatment in Transition Mental Hospital. A mental institution providing inpatient care for psychological disorders. Disenchantment with Mental Hospitals. Underfunded, overcrowded & understaffed. Untrained & overworked contribute to developing more disorders. Deinstitutionalization. Transferring the treatment from inpatient to outpatient. –Revolving door problem –Homelessness 1/3 of homeless people suffer from a mental disorder, 1/3 suffer from alcohol or drug abuse. Chapter 15: Treatment of Psychological Disorders 25

26. Chapter 15: Treatment of Psychological Disorders 26 Figure 15.16 Percentage of psychiatric inpatient admissions that are re-admissions