TREATMENT OF PSYCHOLOGICAL DISORDERS

TREATMENT OF PSYCHOLOGICAL DISORDERS
UNIT 13

Types of Therapists Treatment and Therapies Biomedical Therapy
Counselors Social Workers Psychiatrists Clinical Psychologists Biomedical Therapy Magnetic Impulses Psychosurgery Drugs Psychiatrist Psychotherapy Psychoanalysis Cognitive Therapy Behavioral Therapy Humanistic Family and Group Therapy Electroconvulsive Therapy Psychodynamic

UNIT OVERVIEW The Psychological Therapies Evaluating Psychotherapies
The Biomedical Therapies Preventing Psychological Disorders

HISTORY OF TREATMENT Maltreatment of the insane throughout the ages was the result of irrational views. Many patients were subjected to strange, debilitating, and downright dangerous treatments.

HISTORY OF TREATMENT Philippe Pinel in France and Dorthea Dix in America founded humane movements to care for the mentally sick. Over history we have treated psychological disorders in harsh/strange methods Picture of painting—people used to pay to gawk at mental health patient restrained with chains (like zoon animals) Drilling holes into people’s head, giving warm baths/massages, restraining, bleeding or “beating” out the devil By administering drugs and electric shocks and by talking about childhood experiences/current feeilns Thanks to Philippe Pinel in France and Dorthea Dix in the US, mental hospitals offered more humane treatment, but since the 1950s, therapeutic drugs and community-based treatment programs has emptied mental health hospitals Philippe Pinel ( ) Dorthea Dix ( )

WHO SEEKS TREATMENT? About 15% of population in a given year
Most common: anxiety and depression Women more willing than men Stigma surrounding mental health Who seeks treatment? According to the US Surgeon General’s report on mental health (1999), about 15% of the population uses mental health services in a given year. The two most common presenting problems are anxiety and depression. People vary considerably in their willingness to seek treatment, with women more likely to seek help than men, and people with higher educational levels doing so more frequently. Medical insurance is also related to treatment-seeking; having it increases the likelihood. Many people who need help don’t seek it, and the Surgeon General reports that the biggest roadblock is the “stigma surrounding the receipt of mental health treatment.“

TYPES OF THERAPY Psychotherapy involves an emotionally charged, confiding interaction between a trained therapist and a mental patient. Biomedical therapy uses drugs or other procedures that act on the patient’s nervous system, treating his or her psychological disorders. OBJECTIVE 1| Discuss how psychotherapy, biomedical therapy, and an eclectic approach to therapy differ. Types of therapy Psychotherapy: a trained therapist uses psychological techniques to assist someone seeking to overcome difficulties or achieve personal growth (for phobias)—this is treatment involving psychological techniques Biomedical therapy: a prescribed medication or medical procedure that acts directly on the patient’s nervous system (for schizophrenia) Depending on the client & the diagnosis, many therapists use the biopsychosocial approach & draw from a variety of techniques = eclectic approach—1/2 of all psychotherapists describe themselves using this technique An eclectic approach uses various forms of healing techniques depending upon the client’s unique problems.

THE PSYCHOLOGICAL THERAPIES
Psychology’s major theories: Psychoanalytic, humanistic, behavioral and cognitive---most can be used one-on-one or in groups

Counselors Social Workers Psychiatrists Clinical Psychologists Biomedical Therapy Magnetic Impulses Psychosurgery Drugs Psychiatrist Psychoanalysis Cognitive Therapy Behavioral Therapy Humanistic Family and Group Therapy Psychotherapy We are here Electroconvulsive Therapy Psychodynamic

Counselors Social Workers Psychiatrists Clinical Psychologists Biomedical Therapy Magnetic Impulses Psychosurgery Drugs Psychiatrist Psychoanalysis Cognitive Therapy Behavioral Therapy Humanistic Family and Group Therapy Psychotherapy Electroconvulsive Therapy We are here Psychodynamic

PSYCHOANALYSIS The first formal psychotherapy to emerge was psychoanalysis, developed by Sigmund Freud. Preview Question 1: What are the aims and methods of psychoanalysis, and how have they been adapted in psychodynamic therapy? Sigmund Freud's famous couch

PSYCHOANALYSIS Since psychological problems originate from childhood repressed impulses and conflicts, the aim of psychoanalysis is to bring repressed feelings into conscious awareness where the patient can deal with them. When energy devoted to id-ego-superego conflicts is released, the patient’s anxiety lessens. Psychoanalysis Sigmund Freud’s psychoanalysis was the first of the psychological therapies—few clinicians today practice therapy as Freud did, but his techniques & assumptions survive AIMS: Sought to bring repressed impulses & conflicts to the patients’ conscious awareness Patients then work through the buried feelings and take responsibility for their own growth

PSYCHOANALYSIS: METHODS
Dissatisfied with hypnosis, Freud developed the method of free association to unravel the unconscious mind and its conflicts. OBJECTIVE 2| Define psychoanalysis, and discuss the aims, methods, and criticisms of this form of therapy. Methods: Psychoanalysis is historical reconstruction Free association: A patient relaxes, focuses on their own thoughts and feelings and say aloud anything that comes to mind (patient sits on a couch—no face to face interaction) Sometimes your mind may go blank & you may be unable to remember important details = resistance against sensitive material The analyst notes your resistances and then interpret their meaning & provides insight into your underlying wishes, feelings and conflicts—may illuminate what you are avoiding Because patients disclose personal information about themselves, they may find themselves experiencing strong positive/negative feelings towards the analyst = transference Criticisms: Their interpretations cannot be proven or disproven—psychoanalysis is therapy—not science Traditional psychoanalysis takes time—up to several years of several sessions a week & becomes expensive The patient lies on a couch and speaks about whatever comes to his or her mind.

PSYCHOANALYSIS: METHODS
During free association, the patient edits his thoughts, resisting his or her feelings to express emotions. Such resistance becomes important in the analysis of conflict-driven anxiety. Eventually the patient opens up and reveals his or her innermost private thoughts, developing positive or negative feelings (transference) towards the therapist. Sometimes your mind may go blank & you may be unable to remember important details = resistance against sensitive material The analyst notes your resistances and then interpret their meaning & provides insight into your underlying wishes, feelings and conflicts—may illuminate what you are avoiding Because patients disclose personal information about themselves, they may find themselves experiencing strong positive/negative feelings towards the analyst = transference

PSYCHOANALYSIS: CRITICISMS
Psychoanalysis is hard to refute because it cannot be proven or disproven. Psychoanalysis takes a long time and is very expensive. Criticisms: Their interpretations cannot be proven or disproven—psychoanalysis is therapy—not science Traditional psychoanalysis takes time—up to several years of several sessions a week & becomes expensive

PSYCHOANALYSIS: PSYCHODYNAMIC THERAPY
Influenced by Freud Similarities with psychoanalysis Focus on common themes in relationships across life Differences with psychoanalysis Face to face Much shorter in duration – Interpersonal psychotherapy OBJECTIVE 3| Contrast psychodynamic therapy and interpersonal therapy with traditional psychoanalysis. Psychodynamic Therapy Therapists try to understand a patient’s current symptoms by focusing on themes across important relationships (common themes), including childhood experiences and the therapist relationship Also help a person explore and gain perspective on defended-against thoughts & feelings Therapists talk to the patient face to face (instead of the patient laying on a couch with psychanalysis) , once a week and only for a few weeks or months Interpersonal psychotherapy ( a brief session) variation of psychodynamic therapy has been effective in treating depression Aims to help people gain insight into the roots of their difficulties, but its goal is symptom relief in the here and now(not overall personality change) The therapist focuses on primarily current relationships and helps people improve their relationship skills

HUMANISTIC THERAPIES Insight therapies focus more on:
the present rather than the past conscious rather than the unconscious taking immediate responsibility promoting growth instead of curing OBJECTIVE 4| Identify the basic characteristics of the humanistic therapies, and describe the specific goals and techniques of Carl Rogers’ client-centered therapy. Humanistic Therapies Emphasized people’s inherent potential for self-fulfillment Aim to boost self-fulfillment by helping people grow in self-acceptance and self-awareness Attempt to reduce the inner conflicts that are impeding natural development growth by providing clients with new insights (insight therapies) Focus on the present & future, not the past Conscious rather than unconscious thoughts Take immediate responsibility for one’s feelings and actions Promotes growth instead of curing illness—refer to individuals as clients instead of patients Which is more effective for the whole therapeutic relationship?? Carl Rogers developed client-centered therapy—focuses on the person’s conscious self-perceptions

HUMANISTIC THERAPIES Client-centered therapy – Carl Rogers
Nondirective therapy Genuineness, acceptance, and empathy Active listening Paraphrase Invite clarification Reflect feelings Unconditional positive regard Carl Rogers developed client-centered therapy—focuses on the person’s conscious self-perceptions Nondirective—therapist listens, without judging & seeks to refrain from directing the client toward certain insights Rogers said that one cannot be totally nondirective Encouraged therapists to exhibit genuineness, acceptance and empathy (unconditional positive regard) “Hearing” = active listening—echoing, restating and seeking clarification of what the person expresses and acknowledges the expressed feelings “How do yo u feel about that?” Frequently used in high school and college counseling How to listen more actively: 1. Paraphrase—summarize the speaker’s words in your own words 2. Invite clarification—“What might be an example of this?” 3. Reflect feelings—“It sounds frustrating”—what you’re sensing from the speaker’s body language & intensity

CLIENT-CENTERED THERAPY
Active listening Paraphrase Summarize in own words Invite clarification “What might be an example of this?” Reflect feelings What you’re sensing from speaker’s body language and intensity Unconditional positive regard Hearing” = active listening—echoing, restating and seeking clarification of what the person expresses and acknowledges the expressed feelings “How do you feel about that?” Frequently used in high school and college counseling How to listen more actively: 1. Paraphrase—summarize the speaker’s words in your own words 2. Invite clarification—“What might be an example of this?” 3. Reflect feelings—“It sounds frustrating”—what you’re sensing from the speaker’s body language & intensity

HUMANISTIC vs. PSYCHOANALYTIC
In stark contrast to psychoanalysis, humanistic therapists assume that people are generally good and healthy, but can be negatively affected by pressure from oneself and society. Humanistic therapists accomplish treatment through genuineness, empathy, and unconditional regard and acceptance for their clients.

The behaviors are the problem, so we must change the behaviors!
BEHAVIOR THERAPY Therapy that applies learning principles to the elimination of unwanted behaviors. To treat phobias or sexual disorders, behavior therapists do not delve deeply below the surface looking for inner causes. The behaviors are the problem, so we must change the behaviors! Preview Question 3: What are the assumptions and techniques of the behavior therapies? Behavior Therapy Doubt the healing power of self-awareness They assume that problem behaviors are the problems and the application of learning principles can eliminate them Behaviorists view symptoms (phobias/anxiety disorders) as learned behaviors that can be replaced by constructive behaviors

CLASSICAL CONDITIONING TECHNIQUES
Counterconditioning is a procedure that conditions new responses to stimuli that trigger unwanted behaviors. It is based on classical conditioning and includes exposure therapy and aversive conditioning. OBJECTIVE 5| Explain how the basic assumption of behavior therapy differs from those of traditional psychoanalytic and humanistic therapies, and describe the techniques used in exposure therapies and aversive conditioning. Classical Conditioning Ivan Pavlov: We learn various emotions & behaviors through classical conditioning O.H. Mowrer thought reconditioning of responses could be a solution Bed-wetting (child sleeps on a liquid-sensitive pad connected to an alarm—moisture on the pad triggers the alarm, which wakes the child 3 out of 4 cases this treatment was effective

EXPOSURE THERAPY Expose patients to things they fear and avoid. Through repeated exposures, anxiety lessens because they habituate to the things feared. The Far Side © 1986 FARWORKS. Reprinted with Permission. All Rights Reserved. Exposure therapy Exposing the client to the fears in gradual instances of a relaxed state (exposing a child who fears furry objects to a rabbit slowly as he is eating lunch) Joseph Wolpe created exposure therapy—one of the most widely used behavior therapies Exposes people to what they would normally avoid—people can become less anxiously responsive to things that once petrified them Cheaper, less embarrassing methods = virtual reality exposure therapy—wearing a head-mounted display unit that projects a 3D virtual world (fear of flying) - Sheldon

Exposing the client to the fears in gradual instances of a relaxed state (exposing a child who fears furry objects to a rabbit slowly as he is eating lunch)

SYSTEMATIC DESENSITIZATION
A type of exposure therapy that associates a pleasant, relaxed state with gradually increasing anxiety-triggering stimuli commonly used to treat phobias. Extreme form: Flooding Systematic desensitization—associates a pleasant relaxed state with gradually increasing anxiety-triggering stimuli (commonly used to treat phobias) Trick is to proceed gradually Fear of speaking—therapist may ask you to create a hierarchy of anxiety-triggering speaking situations Then using progressive relaxation—the therapist would train you to relax one muscle group after another until you are completely relaxed—then imagine a mild-anxiety arousing situation (imagine the scene, elevate the anxiety, then turn off the anxiety in their head)—repeated until the client feels no anxiety After a few session, the therapist would progress up to actual situations Extreme/controversial form = flooding…in flooding patients are immersed in the object or situation that they fear (Imagine being thrown into a swimming pool if you fear the water or having roaches crawl all over you if you fear them) Rationale=no reason to fear the item

AVERSIVE CONDITIONING
A type of counterconditioning that associates an unpleasant state with an unwanted behavior. With this technique, temporary conditioned aversion to alcohol has been reported. Aversive Conditioning (goal is substituting a negative (aversive) response for a positive response to a harmful stimulus Reverse of systematic desensitization—seeks to condition an aversion to something the person should avoid Associates an unwanted behavior with unpleasant feelings To prevent nail biting = paint your fingernails with nasty tasting polish To prevent alcohol dependency = therapist offers the client an appealing drink laced with a drug that produces severe nausea Cognition influences conditioning—people know outside the therapist’s office they can drink without fear of nausea—therapists use aversive conditioning in combination with other treatments

BEHAVIOR THERAPIES: AVERSION THERAPY
Aversive Conditioning (goal is substituting a negative (aversive) response for a positive response to a harmful stimulus Reverse of systematic desensitization—seeks to condition an aversion to something the person should avoid Associates an unwanted behavior with unpleasant feelings To prevent nail biting = paint your fingernails with nasty tasting polish To prevent alcohol dependency = therapist offers the client an appealing drink laced with a drug that produces severe nausea Cognition influences conditioning—people know outside the therapist’s office they can drink without fear of nausea—therapists use aversive conditioning in combination with other treatments

A number of withdrawn, uncommunicative
OPERANT CONDITIONING Operant conditioning procedures enable therapists to use behavior modification, in which desired behaviors are rewarded and undesired behaviors are either unrewarded or punished. A number of withdrawn, uncommunicative 3-year-old autistic children have been successfully trained by giving and withdrawing reinforcements for desired and undesired behaviors. Operant Conditioning—voluntary behaviors are strongly influenced by their consequences Therapists can practice behavior modification—reinforcing desired behaviors and withholding reinforcement or enacting punishment for undesired behaviors Has been used with children with an intellectual disability, socially withdrawn children with autism—learning to interact Therapists use positive reinforcers to shape behavior in a step-by-step manner, rewarding closer and closer approximations of the desired behavior In institutionalized settings, therapists may create a token economy (when people display appropriate behavior (getting out of bed, washing, dressing, eating, talking coherently, cleaning up their rooms)—they receive a token or plastic coin as a positive reinforce—later they exchange their tokens for a reward (candy, TV time, trips to zoo)

TOKEN ECONOMY In institutional settings, therapists may create a token economy in which patients exchange a token of some sort, earned for exhibiting the desired behavior, for various privileges or treats. Operant Conditioning—voluntary behaviors are strongly influenced by their consequences Therapists can practice behavior modification—reinforcing desired behaviors and withholding reinforcement or enacting punishment for undesired behaviors Has been used with children with an intellectual disability, socially withdrawn children with autism—learning to interact Therapists use positive reinforcers to shape behavior in a step-by-step manner, rewarding closer and closer approximations of the desired behavior In institutionalized settings, therapists may create a token economy (when people display appropriate behavior (getting out of bed, washing, dressing, eating, talking coherently, cleaning up their rooms)—they receive a token or plastic coin as a positive reinforce—later they exchange their tokens for a reward (candy, TV time, trips to zoo)

CRITICISMS OF BEHAVIOR MODIFICATION
How durable are the behaviors? Will people become dependent upon extrinsic rewards? Is it right for one human to control another’s behavior? Critics of behavior modification How durable are the behaviors?—long-lasting? Will people become so dependent on extrinsic rewards? Supporters argue that therapists shift to other intrinsic rewards (social approval) Is it right for one human to control another’s behavior? Authoritarian control/communist/totalitarian state which controls people’s behavior They decide what behaviors to reinforce Behavioral advocates reply that some patients request the rewards therapy

COGNITIVE THERAPY Teaches people adaptive ways of thinking and acting based on the assumption that thoughts intervene between events and our emotional reactions. Preview Question 4: What are the goals and techniques of the cognitive therapies?

BECK’S THERAPY FOR DEPRESSION
Aaron Beck (1979) suggests that depressed patients believe that they can never be happy (thinking) and thus associate minor failings (e.g. failing a test [event]) in life as major causes for their depression. OBJECTIVE 6| Contrast cognitive therapy and cognitive-behavior therapy, and give some examples of cognitive therapy for depression. Cognitive Therapies Our thinking brings light to our feelings If a person has self-blaming/overgeneralized explanations of bad events  depression Try to teach people new, more constructive ways of thinking (optimistic thinking)

BECK’S THERAPY FOR DEPRESSION
Beck believes that cognitions such as “I can never be happy” need to change in order for depressed patients to recover. This change is brought about by gently questioning patients. GOAL IS TO REVERSE CATASTROPHIZING BELIEFS Stress inoculation training Aaron Beck—said negativity extends into therapy—clients recall/rehearse their feelings & worst impulses and continues the negative cycle Goal is to reverse catastrophizing beliefs about themselves, their situations, their futures (tries to remove the dark glasses) To relieve stress anxiety—use Donald Meichenbaum’s stress inoculation training—teaching people to restructure their thinking in stressful situations As simple as saying positive comments to yourself before taking a test—“you have prepared well for this test, you will do fine.” After several sessions, depression-prone children, teens and college students exhibit a greater reduced rate of future depression

COGNITIVE-BEHAVIOR THERAPY
Cognitive therapists often combine the reversal of self-defeated thinking with efforts to modify behavior. Cognitive-behavior therapy aims to alter the way people act (behavior therapy) and alter the way they think (cognitive therapy). Cognitive-Behavioral Therapy Aims not only to alter the way people think (cognitive therapy), but also to alter the way they act (behavioral therapy) Seeks to make people aware of their irrational negative positive approach in everyday situations Effective treatment for anxiety/mood disorders is to train people to replace their catastrophizing thinking with more realistic appraisals and to practice behaviors that are incompatible with their problem Instead of giving in to compulsive urges, a person could spend 15 minutes in an enjoyable, alternative behavior (taking a walk)—helps to “unstick/relabel” the brain by shifting attention and engaging other

GROUP & FAMILY THERAPIES
Group therapy normally consists of 6-9 people attending a 90-minute session that can help more people and costs less. Clients benefit from knowing others have similar problems. Preview Question 5: What are the aims and benefits of group and family therapy? Effective for saving therapists’ time and clients’ money by doing small group sessions Used for family conflicts or whose behavior is distressing to others 90 minute sessions—therapist serves as a facilitator of the group Benefits—allows clients to see they are not alone and others have similar problems Popular support groups = hard-to-discuss illness (AIDS patients, alcoholism, anorexia), divorce, bereavement (mourning), religious affiliation, self-help

FAMILY THERAPY Family therapy treats the family as a system. Therapy guides family members toward positive relationships and improved communication. OBJECTIVE 7| Discuss the rationale and benefits of group therapy, including family therapy. One type = family therapy Assumes that no person is an island—we live & grow in relation to others Some of the problem behaviors arise from the tension between family members Family therapists work with other family members to heal relationships , help family members to discover their role within the family Therapists attempt to open up lines of communication and help family members discover new ways of resolving conflicts

COMPARISION OF PSYCHOTHERAPIES

EVALUATING PSYCHOTHERAPIES

IS PSYCHOTHERAPY EFFECTIVE?
Regression toward the mean Client’s perceptions Clinician’s perceptions Outcome research Meta-analysis Placebo treatments Evaluating Psychotherapies 89% of clients were at least “fairly well satisfied” with mental health professionals But difficult to measure the effectiveness of psychotherapies because of the different effectiveness measurement (How does the therapist feel about the patient’s progress? How does our family/friends feel about it?) Critics remain skeptical of the effectiveness of treatment—but not all benefits are in the client’s head—can be effective People often enter therapy in crisis—crisis will end eventually Clients may need to believe the therapy was worth the effort/money Client generally speak kindly of their therapists Clinicians Perceptions: Most only hear about praise and compliments from successful clients—not those whose treatment was not effective Outcome research Psychologists have turned to controlled research studies to determine psychotherapy’s effectiveness Hans Eysenck summarized studies that 2/3 of those receiving psychotherapy for nonpsychotic disorders improved drastically (optimistic estimate, but no one has refuted it) Eysench also summarized similar effectiveness in untreated persons (time was the healer) Best are randomized clinical trials—which researchers randomly assign people on a waiting list to therapy or no therapy (placebo effect) and later evaluate everyone—using tests and the reports of people who don’t know whether therapy was given—this is the “gold standard” for outcome research The results are digested by a means of meta-analysis—a statistical procedure that combines the conclusions of a large number of different studies Found that the average client ends up better off than 80% of untreated individuals on waiting lists Those not undergoing therapy often improve, but those undergoing therapy are more likely to improve Psychotherapy—on average—is somewhat effective---refers to no one therapy in particular

THE RELATIVE EFFECTIVENESS OF DIFFERENT THERAPIES
Evidence-based practice Relative Effectiveness of Different Therapies Difficult to pinpoint any one type of therapy to be more effective than another—especially when the behavior is clear-cut—the greater hope to help the client Disorder Therapy Depression Behavior, Cognition, Interpersonal—they benefit in short-term, but may relapse later Anxiety Cognition, Exposure, Stress Inoculation—benefit in short-term, but may relapse later Bulimia Cognitive-behavior Phobia Behavioral (conditioning)—can hope for improvement Bed Wetting Behavior Modification (conditioning)

EVALUATING ALTERNATIVE THERAPIES
Eye movement desensitization and reprocessing (EMDR) Light exposure therapy Seasonal affective disorder (SAD) Evaluating Alternative Therapies Herbal medicines, massage, spiritual healing to treat depression/anxiety EMDR (Eye Movement Desensitization and reprocessing)—Developed by Francine Shapiro (1989, 2007)—anxious thoughts vanished as her eyes spontaneously darted about while walking in a park She had people imagine traumatic scenes while she triggered eye movements by waving her finger in front of their eyes (supposedly enabling them to unlock & reprocess previously frozen memories) Only takes 3 90-minute sessions—helps nonmilitary PTSD patients EMDR therapists apply this technique to panic disorders, pain, grief, paranoid schizophrenia, rage & guilt Critics argue that a combination of exposure therapy & EMDR is more effective than just EMDR Light Exposure Therapies Seasonal affective disorder—especially women and those living far from the equator experience the “winter blues”—a form of depression—but not listed in the DSM-IV or V SAD people were given a timed daily dose of intense light (especially fluorescent light) and they reported feeling better Morning bright light does dim SAD symptoms for most people

COMMONALITIES AMONG PSYCHOTHERAPIES
Hope for demoralized people A new perspective An empathic, trusting, caring relationship Commonalities Among Psychotherapies Three elements shared by all forms of psychotherapy Hope for demoralized people, a new perspective on oneself and the world & an empathetic, trusting, caring relationship with their therapist Hope: things can get better if they believe in it and commit to it Perspective: (new way of thinking about themselves & the world)—allows them to approach life with a new attitude, open to making changes in their behaviors & views of themselves Relationship: An effective therapist is empathetic who communicate their care & concern to their client & who earn their client’s trust and respect through active listening (Carl Rogers), reassurance and advice Empathetic therapists help clients evaluate themselves, link one aspect of their life with another and gain insight into their interactions with others Emotional bond between the therapist & the client = therapeutic alliance Also common in self-help & support groups **Effectiveness of the client-therapist relationship is based on the client’s cultural and religious values. Clients feel they can trust therapists more who are from their similar cultural or religious backgrounds.

CULTURES AND VALUES IN PSYCHOTHERAPY
Similarities between cultures Differences between cultures **Effectiveness of the client-therapist relationship is based on the client’s cultural and religious values. Clients feel they can trust therapists more who are from their similar cultural or religious backgrounds.

Types of Therapists We are here Treatment and Therapies

TYPES OF THERAPISTS Therapists & their Training
Counselors: Pastoral counselors or abuse counselors work with problems arising from family relations, spouse and child abusers and their victims, and substance abusers. Clinical or Psychiatric Social Worker: They have a Masters of Social Work. Postgraduate supervision prepares some social workers to offer psychotherapy, mostly to people with everyday personal and family problems. Clinical psychologists: They have PhDs mostly. They are experts in research, assessment, and therapy, all of which is verified through a supervised internship. Cannot prescribe medication. Psychiatrists: They are physicians who specialize in the treatment of psychological disorders. Not all psychiatrists have extensive training in psychotherapy, but as MDs they can prescribe medications.

TYPES OF THERAPISTS Counselors: Pastoral counselors or abuse counselors work with problems arising from family relations, spouse and child abusers and their victims, and substance abusers.

TYPES OF THERAPISTS Clinical or Psychiatric Social Worker: They have a Masters of Social Work. Postgraduate supervision prepares some social workers to offer psychotherapy, mostly to people with everyday personal and family problems.

TYPES OF THERAPISTS Clinical psychologists: They have PhDs mostly. They are experts in research, assessment, and therapy, all of which is verified through a supervised internship. Cannot prescribe medication.

TYPES OF THERAPISTS Psychiatrists: They are physicians who specialize in the treatment of psychological disorders. Not all psychiatrists have extensive training in psychotherapy, but as MDs they can prescribe medications.

THE BIOMEDICAL THERAPIES
Used with very serious disorders—biomedical therapy—physically changes the brain’s functioning by altering its chemistry with drugs, or affecting its circuitry with electroconvulsive shock (shock therapy), magnetic impulses or psychosurgery---primarily psychiatrists (medical doctors) offer biomedical therapies

INTRODUCTION Biomedical therapy Drugs - psychopharmacology
Electroconvulsive therapy – shock treatment Magnetic impulses - rTMS Psychosurgery - lobotomy Psychiatrists psychopharmacology (study of drug effects on mind & behavior) Shock treatment = electroconvulsive therapy (ECT) Repetitive Transcranial Magnetic Stimulation (rTMS)—repeated pulses surge through a magnetic coil held close to a person’s skull Psychosurgery - surgery that removes or destroys brain tissue—most drastic & least-used biomedical intervention for changing behavior Psychiatrists: They are physicians who specialize in the treatment of psychological disorders. Not all psychiatrists have extensive training in psychotherapy, but as MDs they can prescribe medications.

DRUG THERAPIES Psychopharmacology
Factors to consider with drug therapy Normal recovery rate of untreated patients Placebo effect Double blind procedure Drug Therapies –Most widely used biomedical treatments today Since 1950s psychopharmacology (study of drug effects on mind & behavior) has liberated people from hospital confinement—however release leads to homelessness

DRUG THERAPIES

DRUG THERAPIES: ANTIPSYCHOTIC DRUGS
Psychoses Chlorpromazine (Thorazine) Dopamine Tardive dyskinesia Atypical antipsychotics (Clozaril) Positive and negative symptoms Antipsychotic Drugs Certain drugs calmed patients with psychoses (disorders in which hallucinations (false perceptions) or delusions (false beliefs) indicate some loss of contact with reality) Classical antipsychotic drugs: Similar to dopamine’s blocking of receptor sites to prevent activity—ex: Thorazine Some antipsychotic drugs can produce sluggishness, tremors, and twitches similar to patients with Parkinson’s disease (marked by too little dopamine) Long-term use of medications can produce tardive dyskinesia (involuntary movements of the facial muscles, tongue and limbs Increases the risk for obesity & diabetes Newer atypical antipsychotics (clozapine—aka Clozaril)—target both dopamine & serotonin receptors Helps patients to alleviate the negative symptoms of schizophrenia (apathy & withdrawal)---enabling “awakenings” in individuals Newer drug to help reduce the symptoms of schizophrenia with fewer side effects = stimulates receptors for amino acid glutamate

DRUG THERAPIES: ANTIANXIETY DRUGS
Xanax, Ativan, D-cycloserine Physiological dependence Antianxiety Drugs Xanax, Ativan—depress the central nervous system activity and tension by elevating the levels of the Gamma-aminobutyric acid (GABA) —often used in combination with psychological therapy New antianxiety = antibiotic D-cycloserine—acts upon a receptor that facilitates the extinction of learned fears Enhances the benefits of exposure therapy & helps relieve the symptoms of PTSD & OCD Criticism: Can produce psychological dependence—clients want immediate relief by taking the drug when anxious & can produce physiological dependence—go through withdrawal symptoms, insomnia, increased anxiety when clients stop taking it

DRUG THERAPIES: ANTIDEPRESSANT DRUGS
Use with mood and anxiety disorders Fluoxetine (Prozac), Paxil Selective-serotonin-reuptake inhibitors (SSRIs) Neurogenesis Side effects of antidepressants Antidepressant drugs In past years, this was named for the ability to lift people up from a state of depression Antidepressants work by increasing the availability of norepinephrine or serotonin—appear scarce during depression Fluoxetine = Prozac—partially blocks the reabsorptions and removal of serotonin from synapses (see visual) Prozac, Zoloft, Paxil = selective-serotonin-reuptake-inhibitors (SSRIs)—they slow the synaptic vacuuming up of serotonin Other antidepressants block the reabsorption and break down of both norepinephrine & serotonin Full psychological effect often requires four weeks)—one reason for the delay = increased serotonin promotes neurogenesis—the birth of new brain cells Other forms of lifting depression = aerobic exercise, Cognitive therapy, Cognitive-behavioral therapy Depression is a cyclic disorder—patients suffer from relapses—in the long run patients attempted fewer suicides if treated with antidepressants

DRUG THERAPIES: ANTIDEPRESSANT DRUGS

DRUG THERAPIES: MOOD-STABILIZING MEDICATIONS
Lithium Depakote Mood-Stabilizing Medications The simple salt lithium carbonate can be an effective mood-stabilizer for those suffering the emotional highs and lows of bipolar disorder It moderates the levels of norepinephrine and glutamate neurotransmitters. 70% of people with bipolar disorder benefit from a long-term daily dose of this cheap salt—risk of suicide is 1/6 of the chance

BRAIN STIMULATION: ELECTROCONVULSIVE THERAPY
Procedure Severe depression Problems/side effects Brain Stimulation Shock treatment = electroconvulsive therapy (ECT) First introduced in 1938—patient was strapped down and jolted with 100 volts of electricity to the brain—producing raking convulsions and brief unconsciousness Today the patient receives a general anesthetic & a muscle relaxant (to prevent injury from convulsions) before a psychiatrist delivers seconds of electrical current to the patient’s brain—the aim of ECT is to produce a seizure in the brain—similar to that which occurs with epilepsy After 3 sessions each week for 2-4 weeks, 80% of people receiving ECT improve drastically—showing some memory loss for the treatment period, but no discernible brain damage Bad rap over the year—“One flew over the cuckoo’s nest” with Jack Nicholson—he is administered ECT as a way to control him, not treat him Today—ECT is only used for patients whose depression is so deep they do not respond positively to other treatments –ECT jump starts neural communication—leading to improved mood

BRAIN STIMULATION: ELECTROCONVULSIVE THERAPY

BRAIN STIMULATION: ALTERNATIVE NEUROSTIMULATION THERAPIES
Magnetic Stimulation Repetitive transcranial magnetic stimulations (rTMS) Deep-Brain Stimulation Alternative Neurostimulation Therapies Some patients with chronic depression have found relief through a chest implant that intermittently stimulates the vagus nerve (which sends signals to the brain’s mood-related limbic system) Repetitive Transcranial Magnetic Stimulation (rTMS)—repeated pulses surge through a magnetic coil held close to a person’s skull The magnetic energy only penetrates to the brain’s surface Painless procedure-which produces no seizures, memory loss or other side effects Deep Brain Stimulation Helen Maybergy & her colleagues focused on a cortex area that bridges the thinking frontal lobes to the limbic system This area becomes calm when treated by ECT or antidepressants—she wanted to draw upon deep-brain stimulation technology sometimes used to treat Parkinson’s tremors—research is still being done to conclude results

BRAIN STIMULATION: ALTERNATIVE NEUROSTIMULATION THERPAIES

PSYCHOSURGERY Psychosurgery Lobotomy History Procedure Side effects
Use today Psychosurgery Surgery that removes or destroys brain tissue—most drastic & least-used biomedical intervention for changing behavior 1930s: Egas Moniz—developed the lobotomy—cut the nerves connecting the frontal lobes with the emotion-controlling centers of the inner brain calmed uncontrollably emotional and violent patients Neurosurgeon would shock the patient into a coma, hammer an icepick like instrument through each eye socket into the brain, then wiggle it to sever connections running up to the frontal lobes Effects usually decreased a person’s misery or tension, but also produced a permanently lethargic, immature, uncreative person 1950s—calming drugs were introduced & psychosurgery is only used in extreme cases Modern methods use stereotactic neurosurgery and radiosurgery (Laksell, 1951) that refine older methods of psychosurgery.

PREVENTING PSYCHOLOGICAL DISORDERS

PREVENTING PSYCHOLOGICAL DISORDERS
Resilience Preventing psychological disorders Preventing Psychological Disorders Therapeutic life-style changes can help reverse some of the symptoms of psychological disorders (aerobic exercise 30 minutes/3x a week, adequate sleep—7-8 hours a night, light exposure—30 minutes in the morning, social connection, positiveness, nutritional supplements Helps to build an individual’s resilience Psychological disorders are often responses to disturbing and stressful society Preventative mental health seeks to prevent psychological casualties by identifying and alleviating the conditions that cause them George Albee (1986)—there is abundant evidence of poverty, meaningless work, constant criticism, unemployment, racism, and sexism which undermines people’s sense of competence, personal control & self esteem

THERAPEUTIC LIFE-STYLE CHANGE
Integrated biopsychosocial system Therapeutic life-style change Aerobic exercise Adequate sleep Light exposure Social connection Anti-rumination Nutritional supplements Therapeutic life-style changes can help reverse some of the symptoms of psychological disorders (aerobic exercise 30 minutes/3x a week, adequate sleep—7-8 hours a night, light exposure—30 minutes in the morning, social connection, positiveness, nutritional supplements Helps to build an individual’s resilience

TREATMENT OF PSYCHOLOGICAL DISORDERS

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TREATMENT OF PSYCHOLOGICAL DISORDERS

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Presentation on theme: "TREATMENT OF PSYCHOLOGICAL DISORDERS"— Presentation transcript:

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