Treatments for Psychological Disorders

1. Treatments for Psychological Disorders Biological and Psychological Based Treatments

2. Early Attempts at Biological Intervention • Coma and convulsive therapies • Insulin coma therapy • Electroconvulsive shock therapy (ECT) • Bilateral ECT and Unilateral ECT • Shock lasting 1.5 Seconds 3 x week (2-4 weeks) • Memory Impairment for Months After • Neurosurgery • Psychosurgery or Neurosurgery • The prefrontal lobotomy • Very, Very Seldom Today Due to Medications

3. Psychopharmacological Methods of Treatment • Note: Keep in mind that the role of neuro-transmitters in mental illness is not well known. The use of medication is based on theory not fact • Psychopharmacology- the science of determining which drugs alleviate which mental disorders and why they do so

4. Antipsychotic MedicationsNeuroleptics or Major Tranquilizers • Traditional Antipsychotics included side effects including Tardive Dyskinesia- a disfiguring disturbance of motor control, particularly of the facial muscles • Atypical Antipsychotics • Zyprexa, Geodon, Risperdal, Clozaril, Seraquil • Side Effects • Include: Dry Mouth, Motor Disturbances, Sedation, Weight Gain, Damage to Liver (blood levels need to be taken), Risperdal (lactation in females) • Effectiveness (20-30% do not respond)

5. Neurotransmitter Functioning

6. Antidepressant Medications • Monoamine oxidase (MAO) inhibitors • Inhibits breakdown of neurotransmitters • Used in depression with hypersomnia • Requires Dietary Supplement • Tricyclic antidepressants (TCAs) • Inhibits reuptake of serotonin & norepinephrine • Cause death with overdose • Selective serotonin re-uptake inhibitors (SSRI) • Prozac, Zoloft, Paxil, Luvox, Lexapro, Celexa • Not as selective as once thought • Should be taken for minimum of 9-12 months

7. Antianxiety MedicationsAnxiolytics or Minor Tranquilizers • Benzodiazepines • Sedative effect • Dependency Issues • Used to Treat Alcohol Withdrawal • High Relapse Rate After Termination of Medication • Probably stimulate GABA an inhibitory neurotransmitter • Side Effects Include: Drowsiness and Lethargy • Lithium for the bipolar mood disorders • Long Term Use Side Effects Include: thyroid dysfunction, kidney damage, memory and motor speed problems

8. Medication and Children • Do anti-depressants increase suicidality? • Natural increase in likelihood to suicide when mood improves • Medications do result in an initial adjustment for the body that can be agitating • Important to monitor the individuals mood in the first 10 days • A client’s response to a medication in the first 10-14 days is often predictive of how effective the medication will be in alleviating antidepressant

9. Psychologically Based Therapies

10. An Overview of Psychological Treatment • Who provides psychotherapeutic services? • Psychologists, Psychiatrists, Social Workers • Educational Backgrounds Vary • Theories of Change Vary (see next slide) • Commonalities in Effective Therapists • Form a Therapeutic Alliance with Their Clients • Focus on Client Goals • Use Research Based Interventions

11. Psychotherapy • Psychotherapy- the treatment of mental disorders by psychological methods. • To Achieve changes a therapist may: • Change maladaptive behavior patterns • Minimize or eliminate influences from the environmental condition • Improve interpersonal skills or other competencies • Resolve disabling conflicts among motives • Modify dysfunctional beliefs • Reduce or remove distressing or disabling emotional reactions. • Foster a clear cut sense of identity

12. An Overview of Psychological Treatment • Why do people seek therapy? • Those in highly stressful situations. • Referred by physician or other professional. • Forced by spouse, parent, or court. • Who has the best prognosis? (YAVIS) • Young, Attractive, Verbal, Intelligent, and Successful Individuals. • Why YAVIS? • Motivation, Cognitive Abilities, Malleable • The client’s contribution to the success of treatment includes his or her motivation and expectation

13. Successful Therapy • Qualities of the client (personality, motivation) • Qualities of the therapist (relational skills) • Qualities of the relationship (therapeutic alliance) • Qualities of the method being used.

14. Stages of Change • Prochaska’s Levels of Change • Pre-contemplation • Contemplation • Preparation • Action • Maintenance • Termination • Customer or not a customer

15. Psychodynamic Therapies:Freudian psychoanalysis • Four Basic Techniques • Free association • Analysis of dreams • Manifest content • Latent content • Analysis of resistance • An unwillingness or inability to talk about certain thoughts, motives or experiences • Analysis of transference • Transference- the process whereby clients project onto the therapist attitudes and feelings they had in a past relationship with a parent or other person close to them • Countertransference- the process in which the therapist reacts in accord with the client’s transferred attributions rather than objectively

16. Psychodynamic Therapies:Since Freud • Interpersonal therapy • Object relations • Self psychology • Other interpersonal variations • Psychodynamic therapies tend to be time consuming and expensive • They suggest that past issues need to be resolved for change to occur • Efficacy vs Effectiveness of of Psychodynamic Approaches

17. Behavior Therapy • Guided exposure • Systematic desensitization • Graduated scenes • Require an inconsistent bx from the client while exposed (real or imagined) to the feared stimuli • In Vivo Exposure • Aversion therapy • Use of Punishment (antabuse) • Driving Movie • Pornography and Children Walking In • Modeling, Imitation, and Role Playing

18. Behavior Therapy • Systematic Use of Reinforcement • Also referred to as Contingency Management • Response Shaping- a behavior therapy technique using positive reinforcement to establish by gradual approximation a response that is actively resisted or is not initially in a person’s behavioral repertoire • Remove Reinforcements or Add Reinforcements • Super-Nanny • Token Economies • Behavioral Contracting (marital tx and social exchange) • Biofeedback Treatment • Monitor Physical, Convert to Signal, Prompt Feedback

19. Cognitive & Cognitive-Behavioral Tx • Rational emotive behavior therapy (REBT) • Focus on changing core irrational beliefs • See table 3.5 • Stress-inoculation therapy (SIT) • Three stages include: cognitive preparation, skill acquisition & rehearsal, and application and process. • Beck’s cognitive therapies • Focus on illogical thinking about self, world, and future.

20. Humanistic-Experiential Therapies • Client-Centered (person-centered) therapy • Nondirective • Unconditional Positive Regard • Self-actualization • Existential Therapy • The human predicament • Focus on here and now • Therapist is to be authentic • Gestalt Therapy • Integration of thought, feeling, and action into one’s self-awareness

21. Therapy for Interpersonal Relationships • Couples Counseling (Marital Therapy) • Family Systems Therapy • Systemic Recursiveness • Identified Patient • Homeostasis • Structural Family Therapy (Salvador Minuchin) • Family Rules and Boundaries

22. Eclecticism and the Integration of the Psychotherapies • How do they all fit together?

23. How Does One Measure Success in Psychotherapy? • Objectifying and quantifying change • Would change occur anyway? • Can therapy be harmful?

24. Psychotherapy and Society • Social values and psychotherapy • Psychotherapy and cultural diversity

25. EVALUATING PSYCHOTHERAPIES • Is psychotherapy effective • Client perceptions • indicates that 3 out of 4 are satisfied while 1 in 2 are very satisfied. • Reports may be inaccurate due to crisis effect, effort effect, and liking the therapist • Clinician’s Perceptions • Most testify to therapy success (big surprise) • Outcome Research • Indicates that the average therapy outcome for clients who receive treatment surpasses that of the client who remains untreated. • “Those not undergoing therapy often improve, but those undergoing therapy are more likely to improve.” • On average psychotherapy is somewhat effective (it depends on the diagnosis obviously) • Psychotherapy has been shown to decrease medical costs. • Contrary to Myer’s presentation, some treatment approaches have been proven to be more effective than others.

26. UNRESOLVED ISSUES • Efficacy versus effectiveness