Chapter 16 Treatment of Psychological Disorders

Table of Contents Types of Treatment Analyze This and Analyze That - misconceptions Types of therapies –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 –Treatment seeking for various disorders – Figure 15.1 Mood disorders Utilization rates – Figure 15.2 Women more than men Medical insurance Education level Psychological Disorders and professional treatment – Figure 15.3

Table of Contents Figure 15-1 – Treatment seeking for various disorders

Table of Contents Figure 15-2 – Therapy utilization rates – Olfson et al. (2002)

Table of Contents XX 15.3

Table of Contents Who Provides Treatment? Slide 8 Clinical psychologists Counseling psychologists Psychiatrists Clinical social workers Psychiatric nurses Counselors On-line treatment?

Table of Contents XXXXX Slide 8

Table of Contents Insight Therapies: Psychoanalysis Sigmund Freud and followers –Goal: discover unresolved unconscious conflicts - Figure 15.4 Free association Dream analysis Interpretation –Resistance and transference Psychodynamic Therapies Figure 15.4 Freud’s view of the roots of disorders

Table of Contents Insight Therapies: Client Centered Therapy Carl Rogers –Cause: Figure 15.5 –Goal: restructure self-concept to better correspond to reality –Therapeutic Climate Genuineness Unconditional positive regard Empathy

Table of Contents Therapies Inspired by Positive Psychology Martin Seligman Uses theory and research to better understand the positive, adaptive, creative, and fulfilling aspects of human existence –well-being therapy –positive psychotherapy can be an effective treatment for depression – F 15.6

Table of Contents Figure 15.6 Positive psychotherapy for depression

Table of Contents Other issues Groups therapy –Group size –Advantages – social dimension of change Effectiveness of Insight therapies – Figure 15.7 –Spontaneous remission Talk therapies or other approaches? –Common factors contribute to progress in those treated

Table of Contents Figure 15.7 – Recovery as a function of number of therapy sessions

Table of Contents Behavior Therapies B.F. Skinner and colleagues –Goal: unlearning maladaptive behavior and learning adaptive ones –Systematic Desensitization – Joseph Wolpe Classical conditioning – Figure 15.8 Anxiety/Fear hierarchy – Figure 15.9 –Aversion therapy – Figure Alcoholism, sexual deviance, smoking, etc. –Social skills training Modeling Behavioral rehearsal –Biofeedback

Table of Contents XXX 15.8

Table of Contents XXX 15.10

Table of Contents Cognitive-Behavioral Therapy Aaron Beck –Cognitive therapy –Depression and negative thinking – Figure Albert Ellis –Rational-emotive therapy Goal: to change the way clients think –Detect and recognize negative thoughts –Reality testing Effectiveness of Behavior Therapies –Efficacy of behavioral interventions for a variety of disorders

Table of Contents XXX 15.11

Table of Contents Biomedical Therapies Psychopharmacotherapy –Antianxiety - Valium, Xanax, Buspar –Antipsychotic - Thorazine, Mellaril, Haldol Tardive dyskinesia Atypical antipsychotic – reduce motor effects and other neurotransmitters Time course – Figure –Antidepressant: - Actions - Figure Tricyclics – Elavil, Tofranil Mao inhibitors (MAOIs) - Nardil Selective serotonin reuptake inhibitors (SSRIs) – Prozac, Paxil, Zoloft – side effects – Table 15.1 Risk of suicide – Figure –Mood stabilizers Lithium, Valproic acid Electroconvulsive therapy (ECT) – pages Transcranial Magnetic Stimulation Deep brain stimulation – Figure 15.15

Table of Contents Figure Antidepressant drugs’ mechanisms of action

Table of Contents Figure Deep brain stimulation

Table of Contents Current Trends and Issues in Treatment Managed care Empirically validated treatments Blending Approaches to treatment – Figure –Conjunctive therapy – Figure Multicultural sensitivity Deinstitutionalization –Dorthea Dix - Figure –Changes in population – Figure Factors – treatments, legal, service delivery model –Revolving door problem – Slide 26 –Homelessness –Increase use of criminal justice system

Table of Contents Figure The leading approaches to therapy among psychologists

Table of Contents Figure – Relapse rates in Reynolds et al. (1999) study

Table of Contents XX 15.19

Table of Contents Slide 26 – Percentage of psychiatric inpatient admissions that are readmissions

Table of Contents Looking for at therapist Factors to consider –Sources of services – Table 15.2 –Profession –Gender –Theoretical approach Comparison of approaches for effectiveness - Figure 15.20

Table of Contents Table 15-2, p. 626

Table of Contents Figure Estimates of the effectiveness of various approaches to psychotherapy.