Chapter 15 Treatment of Psychological Disorders

Table of Contents Types of Treatment Psychotherapy –Insight therapies “talk therapy” –Behavior therapies Changing overt behavior –Biomedical therapies Biological functioning interventions

Table of Contents 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

Table of Contents Fig Therapy utilization rates. Olfson and Pincus (1996) gathered data on the use of nonhospital outpatient mental health services in the United States in relation to various demographic variables. As you can see, people are more likely to enter therapy if they have medical insurance than if they do not. With regard to marital status, utilization rates are particularly high among those who are divorced or separated. The use of therapy is greater among those who have more education and, in terms of age, utilization peaks in the 35–49 age bracket. Finally, females are more like to pursue therapy than males.

Table of Contents Fig Psychological disorders and professional treatment. Not everyone who has a psychological disorder receives professional treatment and not everyone who seeks treatment has a clear disorder. This graph, from the Surgeon General’s report on mental health, shows that 15% of the U. S. adult population receives mental health treatment each year. Almost half of these people (7%) did not receive a psychiatric diagnosis, although some of them probably have milder disorders that are not assessed in epidemiological research. This graph also shows that over two-thirds of the people who do have disorders do not receive professional treatment. (Adapted from Mental Health: A Report of the Surgeon General, U.S. Department of Health and Human Services, 1999)

Table of Contents Who Provides Treatment? Clinical psychologists Counseling psychologists Psychiatrists Clinical social workers Psychiatric nurses Counselors

Table of Contents Fig Who people see for therapy. Based on a national survey by Olfson and Pincus (1994), this pie chart shows how therapy visits were distributed among psychologists, psychiatrists, other mental health professionals (social workers, counselors, and such) and general medical professionals (typically physicians specializing in family practice and internal medicine). As you can see, psychologists and psychiatrists account for about 62% of outpatient treatment.

Table of Contents Insight Therapies: Psychoanalysis Sigmund Freud and followers –Goal: discover unresolved unconscious conflicts Free association Dream analysis Interpretation –Resistance and transference

Table of Contents Fig Freud’s view of the roots of disorders. According to Freud, unconscious conflicts between the id, ego, and superego sometimes lead to anxiety. This discomfort may lead to pathological reliance on defensive behavior.

Table of Contents Insight Therapies: Client Centered Therapy Carl Rogers –Goal: restructure self-concept to better correspond to reality –Therapeutic Climate Genuineness Unconditional positive regard Empathy

Table of Contents Fig Rogers’s view of the roots of disorders. Rogers’s theory posits that anxiety and self-defeating behavior are rooted in an incongruent self- concept that makes one prone to recurrent anxiety, which triggers defensive behavior, which fuels more incongruence.

Table of Contents Insight Therapies: Cognitive Therapy Aaron Beck –Cognitive therapy Albert Ellis –Rational-emotive therapy Goal: to change the way clients think –Detect and recognize negative thoughts –Reality testing –Kinship with behavior therapy

Table of Contents Fig Beck’s view of the roots of disorders. Beck’s theory initially focused on the causes of depression, although it was gradually broadened to explain other disorders. According to Beck, depression is caused by the types of negative thinking shown here.

Table of Contents Behavior Therapies B.F. Skinner and colleagues –Goal: unlearning maladaptive behavior and learning adaptive ones –Systematic Desensitization – Joseph Wolpe Classical conditioning Anxiety hierarchy –Aversion therapy Alcoholism, sexual deviance, smoking, etc. –Social skills training Modeling Behavioral rehearsal –Biofeedback

Table of Contents Fig The logic underlying systematic desensitization. Behaviorists argue that many phobic responses are acquired through classical conditioning, as in the example diagrammed here. Systematic desensitization targets the conditioned associations between phobic stimuli and fear responses.

Table of Contents Fig Aversion therapy. Aversion therapy uses classical conditioning to create an aversion to a stimulus that has elicited problematic behavior. For example, in the treatment of drinking problems, alcohol may be paired with a nausea-inducing drug to create an aversion to drinking.

Table of Contents Biomedical Therapies Psychopharmacotherapy –Antianxiety - Valium, Xanax, Buspar –Antipsychotic - Thorazine, Mellaril, Haldol Tardive dyskinesia Clozapine –Antidepressant: Tricyclics – Elavil, Tofranil Mao inhibitors (MAOIs) - Nardil Selective serotonin reuptake inhibitors (SSRIs) – Prozac, Paxil, Zoloft –Mood stabilizers Lithium Valproic acid Electroconvulsive therapy (ECT)

Table of Contents Fig Antidepressant drugs’ mechanisms of action. The three types of antidepressant drugs all increase activity at serotonin synapses, which is probably the principal basis for their therapeutic effects. However, they increase serotonin activity in different ways, with different spillover effects (Marangell et al. 1999). Tricyclics and MAO inhibitors have effects at a much greater variety of synapses, which presumably explains why they have more side effects. The more recently developed SSRIs are much more specific in targeting serotonin synapses.

Table of Contents Current Trends and Issues in Treatment Managed care Empirically validated treatments Blending Approaches to treatment Multicultural sensitivity Deinstitutionalization –Revolving door problem –Homelessness

Table of Contents Fig Declining inpatient population at state and county mental hospitals. The inpatient population in public mental hospitals has declined dramatically since the late 1950s, as a result of deinstitutionalization and the development of effective antipsychotic medication. (Data from the National Institute of Mental Health)

Table of Contents Fig Percentage of psychiatric inpatient admissions that are readmissions. The extent of the revolving door problem is apparent from these figures on the percentage of inpatient admissions that are readmissions at various types of facilities. (Data from the National Institute of Mental Health)