Treatment of Disorders

History of Treatment

Ethical Issues in Treatment Deinstitutionalization occurred during the mental health movement of the 1960s  Don’t exclude mentally ill from society, but help them function within society  Shorten 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 Aim of treatment is to make client aware of their unconscious & resolve unconscious childhood conflicts

Psychoanalysis Free association – Say whatever comes to mind, no censoring of thoughts – Overcome resistance (blocking of anxiety-laden material) Transference – Patient transfers unconscious hostilities or attraction to therapist

Type of TherapyCause/ProblemAim of Treatment PsychodynamicUnconscious forces & childhood experiences Reduce anxiety through self- insight; analysis & interpretation Client-centered (Humanistic) Barriers to self- understanding & self- acceptance Personal growth through self-insight BehaviorMaladaptive behaviors (learned or observed) Extinguish maladaptive behaviors CognitiveNegative, self-defeating thoughts Healthier thinking, positive self-talk Group (Family)Stressful relationshipsRelationship healing, better communication BiomedicalChemical imbalances or nervous system dysfunction Prescribed medications of medical surgery

Psychodynamic Causes: childhood experiences and unconscious forces Does not emphasize sexual development Aim = enhance insight by exploring feelings & thoughts Psychodynamic therapist interprets and analyzes the patient Interpersonal therapy – brief (12-16 session) treatment, effective for depression

Client-Centered Therapy (Carl Rogers) Causes = barriers to self-understanding, lack of self-acceptance Focuses on patient’s conscious self- perceptions without judgment – Genuineness, acceptance, empathy Nondirective therapy  Active listening – Echo, clarify, and reflect what patient has said Unconditional positive regard  total acceptance of client

Psychoanalysis v. Humanistic Humanistic therapies differ from psychoanalysts in focusing on… 1) Present & future (not past) 2) Conscious rather than unconscious 3) Immediate responsibility 4) Promoting growth instead of curing illness

Behavior Therapies – Classical Conditioning Disorders caused by learning or observing maladaptive behaviors/responses Aim of treatment is to replace maladaptive behaviors/responses with desirable ones

Behavior Therapies – Classical Conditioning Counterconditioning – Pair feared stimulus w/good stimulus Exposure therapy – Learn relaxation techniques – Systematic desensitization = hierarchy of feared stimulus Aversive conditioning – Pair the undesirable behavior with bad response

Behavior Therapy  Systematic Desensitization

Behavior Therapy  Aversion therapy for alcoholics

Behavior Therapies – Operant Behavior Modification – reinforcement & punishment Token Economy

Cognitive Therapies Cause = irrational thinking patterns or incorrect perceptions of the world Aim = correct habitual thinking errors Aaron Beck’s Cognitive(-Behavioral) Therapy  Cognitive Triad 1) 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, it will 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. depression.php

Cognitive-Behavioral Therapies Albert Ellis’s Rational Emotive Behavior Therapy (REBT) - It is not the events but our beliefs about the events that cause harm The A-B-C model A= Adversity (anticipating event) B = Belief about “A” C = Consequences (behavioral, emotional)

Group & Family Therapies

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 – Regression toward the mean (the usual state is better than rock bottom)

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 Average untreated person Average psychotherapy client Number of persons 80% of untreated people have poorer outcomes than average treated person

Biomedical Therapies Psychopharmacology = study of drug effects on mind and behavior

Antipsychotic Drugs Work by decreasing receptiveness to irrelevant stimuli, block dopamine Treats schizoprhenia, sometimes bipolar Thorazine, Haldol, neuroleptics Atypical antipsychotics (Clozapine) Tardive dyskinesia – involuntary movements of face, tongue, limbs

Antianxiety Drugs Work by depressing CNS activity (tranquilizers – benzodiazepines), boost GABA Boost GABA Xanax, Ativan, D-cycloserine Can lead to psychological and physiological dependence Treats anxiety disorders (PTSD, OCD)

Antidepressant Drugs Work by increasing serotonin &/or 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 used to treat bipolar disorder Lowers risk of suicide

Brain Stimulation Techniques Electroconvulsive Therapy (ECT) – Severely depressed patients – Electric current sent through brain to produce seizure Repetitive transcranial magnetic stimulation (rTMS) – Patient is awake – Painless magnetic field through skull to brain – Less side effects

Psychosurgery Removes or destroys brain tissue to change behavior Lobotomy ONLY USED IN EXTREME CASES