1. Treatment of psychological disorders
Chapter 16

2. 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

3. 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

4. Figure 15-1 – Treatment seeking for various disorders

5. Figure 15-2 – Therapy utilization rates – Olfson et al. (2002)

6. XX 15.3

7. Who Provides Treatment?
Clinical psychologists
Counseling psychologists
Psychiatrists
Clinical social workers
Psychiatric nurses
Counselors
On-line treatment?

9. 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

10. 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

11. 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
- well being: seeks to find clients self acceptance, purpose in life, freedom and personal growth
- Positive psychotherapy: recognize strengths, appreciate blessings, savor positive experiences, forgive those who have wronged them and find meaning in life

12. Figure 15.6 Positive psychotherapy for depression

13. 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
Usually about 12
6 to 8 being ideal
Research shows that they should be diverse
Advantages:
Provide acceptance
Emotional support
Value one another and hope to win approval from group
Save time and money
Others are experiencing the same thing
Work on social skills
- If spontaneous recovery occurs than one can not assume that treatment was the answer to recovery
Talk therapy:
Equal to drug therapies
Better than placebo or no formal treatment
50% show meaningful recovery after 20 sessions and 20% after 40

14. Figure 15.7 – Recovery as a function of number of therapy sessions

15. 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 15.10
Alcoholism, sexual deviance, smoking, etc.
Social skills training
Modeling
Behavioral rehearsal
Biofeedback
Operant conditioning flooding
Classical conditioning
Insight therapy believes symptoms are clues of the underlying problem. Behavioral believe symptoms are the problem
Systematic: step one create an anxiety hierarchy, two is deep relaxation and step 3 learning to remain relaxed with each stimulus in the hierarchy
Social skills training: promising results in schizophrenia, anxiety and ADD

16. XXX 15.8

17. XXX 15.10

18. Cognitive-Behavioral Therapy
Aaron Beck
Cognitive therapy
Depression and negative thinking – Figure 15.11
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
cognitive:
Blame setbacks on themselves
Focus on negative events and ignore positive
Pessimistic projections
Negative conclusions about ones worth
Cognitive behavioral therapists would give “homework assignments”
Effectiveness: misleading to make global statements of behavioral tendencies
Cannot use for certain disorders

19. XXX 15.11

20. Biomedical Therapies Psychopharmacotherapy
Antianxiety - Valium, Xanax, Buspar
Antipsychotic - Thorazine, Mellaril, Haldol
Tardive dyskinesia
Atypical antipsychotic – reduce motor effects and other neurotransmitters
Time course – Figure 15.12
Antidepressant: - Actions - Figure 15.13
Tricyclics – Elavil, Tofranil
Mao inhibitors (MAOIs) - Nardil
Selective serotonin reuptake inhibitors (SSRIs) – Prozac, Paxil, Zoloft – side effects – Table 15.1
Risk of suicide – Figure 15.14
Mood stabilizers
Lithium, Valproic acid
Electroconvulsive therapy (ECT)
Transcranial Magnetic Stimulation
Deep brain stimulation
Valium, xanax also known as tranquilizers. Effects last a few hours. Side effects: drowsiness, lightheaded, dry mouth, nausea, depression, constipation, and confusion.
Antipsychotic: used for schizophrenia. Recovery occurs in 70% of patients and begin to show after 1 to 3 week. Side effects are drowsiness, constipation, cotton mouth, muscle tremors, impaired motor coordination, tardive dyskinesia
Atypical: could lead to diabetes and cardiovascular problems
Antidepressants: most frequently prescribed drugs in the US. Tricyclics fewer side effects. SSRI also valuable with anxiety disorders
Mood stabilizers: side effects kidney and thyroid gland complications
Criticisms: side effects out weigh pros, overdependence, temporary relief, research is exagerrated

21. Figure 15.13 Antidepressant drugs’ mechanisms of action

22. Figure 15.15 Deep brain stimulation

23. Current Trends and Issues in Treatment
Managed care
Empirically validated treatments
Blending Approaches to treatment – Figure 15.17
Conjunctive therapy – Figure 15.16
Multicultural sensitivity
Deinstitutionalization
Dorthea Dix - Figure 15.18
Changes in population – Figure 15.19
Factors – treatments, legal, service delivery model
Revolving door problem – Slide 26
Homelessness
Increase use of criminal justice system

24. Figure 15.17 The leading approaches to therapy among psychologists

25. Figure 15-16 – Relapse rates in Reynolds et al. (1999) study

26. XX 15.19

27. 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

28. Table 15-2, p. 626

29. Figure 15.20 Estimates of the effectiveness of various approaches to psychotherapy.