Treatment of Psychological Disorders

1. Treatment of Psychological Disorders Unit 3 (Chapter 15)

2. Types of Treatment • Types of therapies • Insight therapies • “talk therapy”

3. Types of Treatment • Types of therapies • Behavior therapies • Changing overt behavior through use of conditioning

4. Types of Treatment • Types of therapies • Biomedical therapies • Alter the biological functioning using drugs or mild electric shocks

5. Who Seeks Treatment? • 15% of U.S population in a given year • Most common presenting problems • Anxiety and Depression • Treatment seeking for various disorders – • Mood disorders

6. Who Seeks Treatment? • Utilization rates • Women more than men • Medical insurance • Education level • Psychological Disorders and professional treatment

7. Who Provides Treatment? • Clinical psychologists – PhD in psychology • Counseling psychologists – PhD in psychology • Psychiatrists – medical doctors (only ones that can give medication) • Clinical social workers • Psychiatric nurses • Counselors

8. The Early Days of Therapy • Historically, people with severe mental illnesses were often thought to be possessed by demons • “treatment” was severe and often deadly

9. The Early Days of Therapy • First reform took place in England • Bethlehem Hospital “Bedlam” was converted into an asylum • Little more than prisons • Beatings, ice baths

10. The Early Days of Therapy • 1793 real efforts made to treat the mentally ill with kindness and guidance • Philippe Pinel (France)

11. Psychoanalysis • Sigmund Freud and followers • Goal is to discover unresolved unconscious conflicts, urges and desires that are assumed to cause disorders • Used techniques such as dream interpretation and free association

12. Dream Interpretation • Freud believed that repressed material surfaced in dreams in symbolic form • Manifest content – actual dream/events • Latent content – hidden, symbolic meaning • If correctly interpreted this would reveal conflicts creating the nervous disorder

13. Free Association • Devised by Josef Breuer and adopted by Freud • Freely say whatever comes into your mind • As patients talked they reveal things that were loosely associated with their flow of ideas

14. Resistance • Point in which the patient becomes unwilling to talk about certain topics • Freud believed that resistance meant he was getting close to repressed material

15. Transference • Therapist becomes a symbol of parental authority • At first the patients would transfer positive feelings and then over time transfer negative feelings

16. Evaluation of Psychoanalysis • People who are withdrawn or have severe issues are not good candidates, best for those who are fairly intelligent and verbally expressive • Flaws are: • Lack of scientific research to support claims • Unwillingness to believe things that did not fit into Freud’s world view • Obsessed with linking everything back to sex

17. Psychoanalysis Today • The couch is gone • Now known as clients instead of patients • Psychologist is far more directive (asking questions, etc.) • Less focus on id, more on ego

18. Humanistic Therapy • Focuses on the importance of choices made by individuals and the potential to change one’s own behavior • Dominant type is Client-Centered Therapy founded by Carl Rogers

19. Client Centered Therapy • Therapist provides unconditional positive regard that has been missing and helps the person recognize discrepancies between their real and ideal selves • Very nondirective, meaning the client does all the work and the therapist is a sounding board

20. Client Centered Therapy • 4 basic elements • Reflection – therapist just restates what the client says • Unconditional positive regard – creates a warm, accepting atmosphere • Empathy – listens closely and carefully and try to feel what they feel • Authenticity – must be genuine and not hide behind the role of therapist

21. Evaluation • Clients must be intelligent and verbal • Wide range of applications • Very little chance of misunderstanding • One flaw is that it lacks scientific backing

22. Group Therapy • Expanded use after the introduction of Client-Centered Therapy • Group size: 6-8 • Major advantage is that it adds a social component (support groups)

23. Behavior Therapies • B.F. Skinner and colleagues • Goal: unlearning maladaptive behavior and learning adaptive ones • Action based • Change behavior because it is not a symptom of anything else, it is the problem

24. Behavior Therapies • Classical Conditioning Therapies • Stimulus causes response • Pair neutral item with stimulus to get the response • Remove stimulus and then the neutral item causes the response

25. Systematic Desensitization • Series of steps to reduce fear • Relax through deep muscle relaxation training • List of fears made (from least to greatest) • Along with the therapist, the client begins to confront fears by starting with the least fearful on the list

26. Aversion therapy • Uses classical conditioning to create anxiety • Pairs unpleasant stimulus with a unwanted behavior • Example is overeating • Pair bad smells with eating fast food • You begin to associate the two and eventually do not eat fast food because of this

27. Flooding • For phobias • Exposure to fearful items in a rapid manner, also removing the avoidance response

28. Operant conditioning Therapies • Modeling – learning through observing others and imitating behaviors • Reinforcement – strengthening a response by following with something pleasant (positive reinforcement) or removing an unpleasant stimulus (negative reinforcement) • Extinction – removing the reinforcer to remove the behavior

29. Evaluation • Not good for extreme cases such as severe depression or schizophrenia, geared more toward mild behaviors • Effective in quickly reducing or eliminating unwanted behaviors so an individual can function better in society

30. Cognitive Therapies • Developed by Aaron Beck • Focused on helping people change their ways of thinking • Distorted thinking and unrealistic beliefs lead to maladaptive behavior

31. Cognitive-Behavioral Therapy (CBT) • Focuses on present, not past • Assumes disorders come from illogical, irrational thoughts • Aim is to change thinking patterns • Uses behavioral techniques (positive reinforcement) • People need to come to grips with negative beliefs

32. Rational-Emotive Behavior Therapy (REBT) • Created by Albert Ellis • Version of CBT • Very directive and challenging • Same goals as CBT

33. Evaluation • Less expensive because these therapies take less time • Deal with short term behaviors instead of long term, underlying issues • Success in treating many types of disorders • Scientifically backed

34. Biomedical Therapies • Directly affecting the biological functioning of the body and/or brain • Drug therapy (psychopharmacology) • Shock therapy (electroconvulsive therapy) • Surgical treatments

35. Psychopharmacology • Antianxiety drugs • Reduce anxiety and produce relaxation by lowering sympathetic activity of the brain • Valium, Xanax • Antipsychotic drugs • Diminish or eliminate symptoms of schizophrenia by decreasing dopamine activity • Neuroleptics, major tranquilizers • Tardive dyskinesia can develop long term

36. Psychopharmacology • Antidepressant drugs • Treat depression by inhibiting the reuptake of serotonin • Prozac • Mood stabilizers • Treat manic and depressive episodes (bipolar) • Lithium

37. Electroconvulsive therapy (ECT) • Electrodes placed on the outside of your head and a mild current is passed through the brain • Used to treat serious cases of depression • Fast, so used for suicidal patients

38. Psychosurgery • Involves cutting into the brain to remove or destroy brain tissue for the purpose of relieving symptoms of mental disorders • Bilateral cingulotomy used today • Electrode used to destroy brain cells in the cingulate gyrus