1. 16
Approaches to Treatment and Therapy

2. Biological treatments for mental disorders
Biological explanations and treatments are dominant today:
Evidence that some disorders have a genetic component or involve chemical or neurological abnormality
Physicians and pharmaceutical companies have been aggressively promoting biomedical solutions

3. Biological Treatments for Mental Disorders LO16
Biological Treatments for Mental Disorders LO16.1 Describe the four main categories of drugs commonly prescribed for the treatment of mental disorders, and note the side effects of each.
Antipsychotic drugs
Many block or reduce sensitivity of dopamine receptors.
Some increase levels of serotonin, a neurotransmitter that inhibits dopamine activity.
Can relieve positive symptoms of schizophrenia, but can be ineffective for—or even worsen—negative symptoms.

4. Biological Treatments for Mental Disorders LO16
Biological Treatments for Mental Disorders LO16.1 Describe the four main categories of drugs commonly prescribed for the treatment of mental disorders, and note the side effects of each.
Antidepressant drugs
Monoamine oxidase inhibitors (MAOIs): Elevate norepinephrine and serotonin in brain by blocking an enzyme that deactivates these neurotransmitters
Tricyclic antidepressants: Boost norepinephrine and serotonin by preventing reuptake
Selective serotonin reuptake inhibitors (SSRIs): Boost serotonin by preventing reuptake

5. Anti-anxiety drugs (tranquilizers)
Biological Treatments for Mental Disorders LO16.1 Describe the four main categories of drugs commonly prescribed for the treatment of mental disorders, and note the side effects of each.
Anti-anxiety drugs (tranquilizers)
Increase the activity of GABA
Developed for treatment of mild anxiety
Often prescribed inappropriately by general practitioners for any patient mood complaints

6. Biological Treatments for Mental Disorders LO16
Biological Treatments for Mental Disorders LO16.1 Describe the four main categories of drugs commonly prescribed for the treatment of mental disorders, and note the side effects of each.
Lithium carbonate
Used to treat bipolar disorder.
Must be given in right dose, bloodstream levels monitored
Newer treatments include Tegetrol and Depakote.

7. Biological Treatments, cont’ LO16
Biological Treatments, cont’ LO16.2 List six major cautions associated with drug treatments, and give a brief example of each.
Placebo effect
The apparent success of a treatment due to patient’s expectation rather than the treatment itself
Meta-analysis indicates that clinicians consider medication helpful, yet patient ratings in treatment groups were no greater than those in placebo groups.

8. Biological Treatments, cont’ LO16
Biological Treatments, cont’ LO16.2 List six major cautions associated with drug treatments, and give a brief example of each.
High relapse and dropout rate
There may be short-term success, but 50–66% of patients stop taking medication due to side effects.
Individuals who take antidepressants without learning to cope with problems are more likely to relapse.
Appropriate dosage is also affected by metabolic rates, amount of body fat, number and type of drug receptors in the brain, smoking, and eating habits.

9. Biological Treatments, cont’ LO16
Biological Treatments, cont’ LO16.2 List six major cautions associated with drug treatments, and give a brief example of each.
Disregard for nonmedical treatments
The popularity of drugs has been fueled by pressure from managed-care organizations and by drug companies’ marketing and advertising efforts.
Research shows that nonmedical treatments may work as well or even better.

10. Biological Treatments, cont’ LO16
Biological Treatments, cont’ LO16.2 List six major cautions associated with drug treatments, and give a brief example of each.
Unknown risks over time
and drug interations
Antidepressants are assumed to be safe, but no long-term studies have been conducted.
Medication “cocktails” are sometimes prescribed, but the risks and benefits of this approach have not been investigated.

11. Biological Treatments, cont’ LO16
Biological Treatments, cont’ LO16.2 List six major cautions associated with drug treatments, and give a brief example of each.
Untested off-label uses
The use of antipsychotics for nonpsychotic disorders
Antidepressants being used to treat “social phobias”

12. Biological Treatments, cont’ LO16
Biological Treatments, cont’ LO16.3 Identify four forms of direct brain intervention used in treating mental disorders, and discuss the limitations of each.
Direct brain intervention
Prefrontal lobotomy
Never assessed or validated scientifically
Electroconvulsive therapy (ECT)
Procedure used in cases of prolonged and severe major depression.
Brief brain seizure is induced.
The mood-improving effect of ECT is usually short-lived, and the depression almost always returns within a few weeks or months.

13. Biological Treatments, cont’ LO16
Biological Treatments, cont’ LO16.3 Identify four forms of direct brain intervention used in treating mental disorders, and discuss the limitations of each.
Transcranial magnetic stimulation (TMS)
Involves use of pulsing magnetic coil held to a person’s skull over the left prefrontal cortex
Deep brain simulation
Has been approved for patients with Parkinson’s disease and epilepsy; it requires surgery to implant electrodes into the brain and to embed a small box, like a pacemaker, under the collarbone.

14. Major Schools of Psychotherapy LO16
Major Schools of Psychotherapy LO16.4 Summarize the main elements of psychodynamic therapy.
Major schools of psychotherapy
Psychoanalysis
A method of psychotherapy developed by Sigmund Freud, that emphasizes the exploration of unconscious motives and conflicts.
Transference
In psychodynamic therapies, a critical process in which the client transfers unconscious emotions or reactions, such as emotional feelings about his or her parents, onto the therapist.

15. Schools of Psychotherapy, cont’ LO16
Schools of Psychotherapy, cont’ LO16.5 Describe four methods of behavioral therapy, and provide an example of each.
Behavior and cognitive therapy
Behavior therapy: A form of therapy that applies principles of classical and operant conditioning to help people change self-defeating or problematic behaviors.
Graduated exposure: In behavior therapy, a method in which a person suffering from a phobia or panic attacks is gradually taken into the feared situation or exposed to a traumatic memory until the anxiety subsides.
Flooding: In behavior therapy, a form of exposure treatment in which the client is taken directly into a feared situation until his or her panic subsides.

16. Schools of Psychotherapy, cont’ LO16
Schools of Psychotherapy, cont’ LO16.5 Describe four methods of behavioral therapy, and provide an example of each.
(behavior and cognitive therapy, cont’)
Systematic desensitization: In behavior therapy, a step-by-step process of desensitizing a client to a feared object or experience; it is based on the classical- conditioning procedure of counter conditioning.
Behavioral self-monitoring: In behavior therapy, a method of keeping careful data on the frequency and consequences of the behavior to be changed.
Skills training: In behavior therapy, an effort to teach the client skills that he or she may lack, as well as new constructive behaviors to replace self-defeating ones.

17. Schools of Psychotherapy, cont’ LO16
Schools of Psychotherapy, cont’ LO16.6 Discuss the main techniques used in cognitive therapy.
Cognitive techniques
Cognitive therapy: A form of therapy designed to identify and change irrational, unproductive ways of thinking and, hence, to reduce negative emotions.
Rational emotive behavior therapy (REBT): A form of cognitive therapy devised by Albert Ellis, designed to challenge the client’s unrealistic thoughts.

18. Schools of Psychotherapy, cont’ LO16
Schools of Psychotherapy, cont’ LO16.6 Discuss the main techniques used in cognitive therapy.
Cognitive-behavior therapy (CBT)
Clients learn to explicitly identify and accept whatever negative thoughts and feelings arise, without trying to eradicate them or letting them derail healthy behavior.
More common than behavior or cognitive therapy alone

19. Schools of Psychotherapy, cont’ LO16
Schools of Psychotherapy, cont’ LO16.7 Summarize the similarities and differences between client-centered therapy and existential therapy.
Humanist and existential therapy
Humanist therapy
Based on the philosophy of humanism
Emphasizes people’s free will to change, not past conflicts
Client-centered (nondirective) therapy
Developed by Carl Rogers, which emphasizes the therapist’s empathy with the client and the use of unconditional positive regard.

20. Schools of Psychotherapy, cont’ LO16
Schools of Psychotherapy, cont’ LO16.7 Summarize the similarities and differences between client-centered therapy and existential therapy.
Existential therapy
Helps clients explore the meaning of existence and face with courage the great issues of life such as death, freedom, free will, alienation, and loneliness.

21. Schools of Psychotherapy, cont’ LO16
Schools of Psychotherapy, cont’ LO16.8 List the hallmarks of the family-systems perspective, and describe how they apply to family and couples therapy.
Family and couples therapy
Assumes that problems develop in the context of family, that they are sustained by family dynamics, and that any changes will affect whole family
Can look for patterns of behavior across generations and create a family tree of psychologically significant events

22. Schools of Psychotherapy, cont’ LO16
Schools of Psychotherapy, cont’ LO16.8 List the hallmarks of the family-systems perspective, and describe how they apply to family and couples therapy.
Family-systems perspective
Therapy with individuals or families by identifying how each family member forms part of a larger interacting system.

23. Schools of Psychotherapy, cont’ LO16
Schools of Psychotherapy, cont’ LO16.8 List the hallmarks of the family-systems perspective, and describe how they apply to family and couples therapy.
Family-systems perspective
Therapy with individuals or families by identifying how each family member forms part of a larger interacting system.

24. Schools of Psychotherapy, cont’ LO16
Schools of Psychotherapy, cont’ LO16.8 List the hallmarks of the family-systems perspective, and describe how they apply to family and couples therapy.
Evaluating psychotherapy
Therapeutic alliance
The bond of confidence and mutual understanding established between therapist and client, which allows them to work together to solve the client’s problems

25. Schools of Psychotherapy, cont’ LO16
Schools of Psychotherapy, cont’ LO16.8 List the hallmarks of the family-systems perspective, and describe how they apply to family and couples therapy.
Therapist-client “match”
When there is a cultural match, clients and psychotherapists are more likely to share perceptions of what the client’s problem is, agree on the best way of coping, and have the same expectations about what therapy can accomplish.

26. Compare schools of therapy
Schools of Psychotherapy, cont’ LO16.8 List the hallmarks of the family-systems perspective, and describe how they apply to family and couples therapy.
Compare schools of therapy

27. Evaluating Psychotherapy LO16
Evaluating Psychotherapy LO16.9 Define the scientist-practitioner gap, and explain how it contributes to dilemmas in the practice of psychotherapy.
The scientist-practitioner gap
Some psychotherapists believe that evaluating therapy using research methods is futile.
Scientists find that therapists who do not keep up with empirical findings are less effective and can even harm clients.
Economic pressures require empirical assessment of therapies.

28. Evaluating Psychotherapy LO16
Evaluating Psychotherapy LO16.9 Define the scientist-practitioner gap, and explain how it contributes to dilemmas in the practice of psychotherapy.
Problems assessing therapy
Justification of effort
This is just one example of the difficulties in assessing therapeutic results.
Randomized controlled trials
E.g. Some trials suggest that Critical Incident Stress Debriefing (CISD) may delay recovery in survivors of a traumatic event.

29. Evaluating Psychotherapy, cont’ LO16
Evaluating Psychotherapy, cont’ LO16.10 Identify some of the problems associated with assessing the effectiveness of therapy.
Posttraumatic interventions

30. Evaluating Psychotherapy, cont’ LO16
Evaluating Psychotherapy, cont’ LO16.11 Provide three examples of areas in which cognitive and behavioral therapies have shown themselves to be particularly effective.
When therapy helps
Depression
Cognitive therapy
Anxiety disorders
Exposure techniques
Anger and impulsive violence
Health problems
Cognitive and behavior therapies
Childhood and adolescent behavior problems
Behavior therapy

31. Evaluating Psychotherapy, cont’ LO16
Evaluating Psychotherapy, cont’ LO16.12 Discuss four ways in which therapy has the potential to harm clients, and give an example of each.
When therapy harms
Use of empirically unsupported, potentially dangerous therapeutic techniques
Inappropriate or coercive influence, which can create new problems for the client
Prejudice or cultural ignorance on the part of the therapist
Unethical behavior, especially sexual intimacy, on the part of the therapist

32. The value and values of psychotherapy
The Value and Values of Psychotherapy LO16.13 List some benefits that effective psychotherapy can have for a client, and some limitations to what psychotherapy can do for a client.
The value and values of psychotherapy
Psychotherapy can:
Help you make decisions and clarify your values and goals
Teach you new skill and new ways of thinking
Help you get along better with your family
Get you through bad times
Teach you how to manage depression, anxiety, and anger