Treatment of Mental Disorders

Treatment of Mental Disorders Katie Strebin Psychology 490

Mental Disorders and Psychotherapy A. Early Treatment of Mental Disorders/Changing Viewpoints 1.Devil & Evil Spirits 2. Mental Illness as a Disease a. John Weir-16th Century Physician b. Philippe Pinel & La Bicetre (1745-1826) c. Dorothea Dix (1802-1887) 3. Current View of Mental Illness B. Development of Psychotherapy 1. Franz Anton Mesmer(1734-1815) 2. Jean Martin Charcot (1825-1893) 3. Freud

Types of Therapy

Insight Therapy PROBLEM: Maladaptive behaviors are symptoms of deeper underlying psychological problems CURE: Understanding the causes of problems will lead to a cure INSIGHT INTO PROBLEMS CURES THEM

Types of Insight Therapies 1. Psychoanalysis and Modern Psychodynamic 2. Humanistic Therapies a. Client Centered Therapy b. Gestalt Therapy *Treatments focus on talk between therapist and client as a means to find reasons behind client’s problems

Psychoanalysis • Developed by Sigmund Freud • Unconscious conflicts of the competing demands of the id, superego, and the ego can lead to anxiety • Psychoanalysis is aimed at providing the client insight into his or her unconscious motivations and impulses that is causing the anxiety

So how does the therapist do this??? *Client’s underlying conflicts repressed and revealed into the conscious thoughts through subtle clues. *These clues are revealed in dreams, physical problems, memory, manner of speech, and cognitive and emotional reactions to therapy. The primary function of the psychoanalyst is to interpret the clues about the origins of intrapsychic conflict given by the client

Psychoanalytic Techniques 1. Free Association 2. Dream Interpretation A. Manifest Content B. Latent Content 3. Resistance 4. Transference 5. Countertransference

Modern Psychodynamic Therapy • Psychoanalysis now often referred to as psychodynamic therapy. • Focus on achieving insight into unconscious, less emphasis on sexual factors during development and more upon social and interpersonal experiences. • Focus on present day issues rather than past • Less time consuming

Humanistic Therapy Goal of humanistic therapy is to provide the client with a greater understanding of his or her unique potential for personal growth and self-actualization. Assumption that people are good and have innate worth Psychological Problems reflect some kind of blocking of one’s potential for growth. Humanistic therapy is aimed at realizing this potential

Two Types of Humanistic Therapy Client-Centered Therapy Gestalt Therapy

Client-Centered Therapy Problem: Psychological problems are caused by an incongruence between a client’s real and ideal self Cure: Reduce incongruence by fostering experiences that will make attainment of ideal self possible.

Aspects of Client-Centered Therapy • Client’s thoughts and not therapist’s direct the course of therapy • Therapist’s role is to make the client’s thoughts, perceptions, and feelings more noticeable to client--reflection • Empathy • Unconditional Positive Regard

The therapist shouldn’t manipulate events but should create conditions under which the client can makes his or her own decisions independently

Gestalt Therapy • Fritz Perls • Emphasizes unity of mind and body by teaching the client to “get in touch” with bodily sensations and emotional feelings long hidden from awareness. • Emphasizes present experiences not past

Techniques of Gestalt Therapy Dreams Empty Chair Technique Talking to self and to inanimate objects Confrontational

Behavior and Cognitive Behavior Therapies Assumption: People learn maladaptive behavior in the same way they learn adaptive behaviors. The maladaptive behavior is the problem not a reflection of the problem. Solution: Behavior change is caused by methods based on extensions of classical and operant conditioning

Therapies Based on Classical Conditioning • Neutral stimulus(CS) comes to elicit the same response as a stimulus(UCS) that naturally elicits that response because the CS reliably predicts the UCS • Development of everyday fears, anxieties and phobias

Types of Therapies 1. Systematic Desensitization: Treatment in which the client is trained to relax in the presence of increasingly fearful stimuli 2. Implosion Therapy --in vivo 3. Aversion Therapy--treatment in which the client is trained to respond negatively to a neutral stimulus that has been paired with an aversive stimulus

Therapies Based on Operant Conditioning • Reinforcement of Adaptive Behaviors • Token Economies • Modeling • Assertiveness Therapy • Extinction of Maladaptive Behaviors • Punishment of Maladaptive Behaviors • Covert Sensitization

Maintaining Behavioral Change • Intermittent reinforcement • Self-observation • Train friends and family of the client to become “adjunct therapists”

Cognitive-Behavior Therapies • Goal of therapy is to change the client’s maladaptive thoughts, beliefs, and perceptions • Cognitive Restructuring-process of replacing the client’s maladaptive thoughts with more constructive ways of thinking • Also use methods of behavior therapy

Two Types of Cognitive Behavior Therapy • Rational-Emotive Therapy • Cognitive Therapy for Depression

Rational Emotive Therapy • Albert Ellis--First form of cognitive restructuring • Problems caused not by events but how people view them • Highly directive and confrontational therapy aimed at changing people’s faulty thinking • Therapist tells clients what they are doing wrong and how they should change

Theory behind Rational Emotive Therapy Emotions are the products of cognition (A)Significant activating event (B)Person’s belief system (C)Highly charged emotional consequence *Inappropriate emotions can be abolished only if change occurs in the person’s belief system *Irrational beliefs that are impossible to satisfy create anxiety, self-blame, and self doubt.

Cognitive Therapy for Depression • Aaron Beck • Negative beliefs are seen as conclusions based on faulty logic • Cognitive Triad • Negative view of self, the outside world, and the future • Focus on recognizing faulty logic and finding ways to correct these distortions

Group Therapy and Community Psychology

Group Psychotherapy • Two or more clients meet simultaneously with a therapist to discuss problems • There are four advantages to group therapy that are not found in individual therapy

Advantages of Group Therapy 1. Allows therapist to observe and interpret actual interactions in person--therapist doesn’t have to rely on client’s descriptions 2. A person maybe more receptive to the same message coming from a number of people rather than just the therapist

3. Seeing the causes of maladaptive behavior in others often helps people gain insight about themselves 4. Knowing that other people have problems similar to one’s own can bring comfort and relief.

Family and Couples Therapy • People are products of their environments, and the structure of a person’s family an important part of that environment • Restructuring a client’s relationship with their family members often important in helping the client.

Structural Family Therapy • Salvador Minuchin (1974) • Observe a family’s interactions and draw diagrams of the relationships inferred from the family’s behavior • Restructure the family in a more adaptive way • Effectively functioning marital subsystem leads to healthy family interactions

Community Psychology • A form of treatment and education whose goal is to address psychological problems through an assessment of the sociocultural context in which they develop. • Treat individuals and groups, establish education programs, design programs to promote mental health

Deinstitutionalization and Preventive Psychology Deinstitutionalization: Process of returning previously hospitalized patients to their communities for treatment Preventative Psychology: Attempts to forestall the development of psychological problems 1. Primary Prevention 2. Secondary Prevention

Community Mental Health Centers • Individual and group therapy for members of the community--often in poorer communities • Immediate outpatient care for those who might have difficulty getting help • Many centers are underfunded and understaffed • Generally staffed by psychologists, psychiatrists, social workers, and nurses

Biological Treatments

Drug Therapy or Pharmacotherapy 1. Antipsychotic Drugs--block dopamine receptors in the brain--Thorazine, Clozapine *Tardive Dyskinesia 2. Antidepressant and Antimanic Drugs Antidepression--norepinephrine and serotonin--trycyclics, MAOI, prozac Antimanic -lithium Carbonate 3. Antianxiety-Benzodiazepines(Valium, Xanax)

Electroconvulsive Therapy • Treatment of severe depression • small amounts of electrical current are passed through the brain to produce a seizure • Believed to release higher than normal amounts of GABA, which leads to decreases in brain activity • Side effects--memory loss and cognitive deficits

Psychosurgery • Brain surgery used to relieve the symptoms of psychological disorders • “Ice Pick” Prefrontal Lobotomy • Cingulotomy-surgical destruction of the cingulum bundle; which connects the prefrontal cortex with the limbic system--helps to reduce intense anxiety and the symptoms of OCD

Lack of scientific support Difficult to evaluate Can explain away failures Not appropriate for serious psychological problems This type of therapy can be beneficial for intelligent, articulate individuals Humanistic therapies more affordable and less time consuming than traditional psychoanalysis Insight Therapies

Criticized for focus on symptoms rather than causes Failure to generalize treatment gains Ethical concerns--aversive techniques Can be scientifically evaluated Has been proven effective in treating a wide variety of problems Behavior and Cognitive-Behavior Therapies

Not a good choice those who are reticent about exposing problems to others A less expensive alternative to private therapy Group and Community Psychology

A treatment option not a cure People may not adhere to drug regimen Effective at alleviating the symptoms of certain psychological disorders Biological Treatments

The End

Treatment of Mental Disorders