Overview of the Day

1. Overview of the Day • Evaluating psychotherapies • Biological treatments • Combined treatments • Preventative approaches • Evolutionary perspective

2. Evaluating Psychotherapies • How can we tell if they work? • What do we mean by “work?” • How people say they feel • What therapists say • Outcomes: changes in behavior or results (frequency of smiling, socializing) • Problems with client testimonials and therapist’s opinions: • Selective perception and biased recall • Cognitive dissonance (convince themselves they didn’t waste money)* • No control group (how many people would have gotten better without therapy)

3. Meta-Analyses • Average client ends up better off than 80% of people on waiting list • 50% of untreated people also get better • Those not undergoing therapy improved, but those who underwent therapy improved more

4. Who Benefits from Therapy? • People who are likely to benefit: • Those with specific, clear-cut problems (e.g., phobia)* • People who are not likely to benefit: • Those with chronic schizophrenia or who want to change their personalities

5. Which Therapy Works Best? • Overall, no one form of therapy is consistently superior to others* • Individual or group therapy makes no difference • Education or training of therapist makes no difference • For specific some problems: • Behavior therapy works best for specific behavioral problems • Cognitive therapy works best for depression

6. Why do Therapies Work? • The belief in the treatment, the client’s expectations that she will get better • Warm caring relationship* • Empathy* • Fresh perspective

7. Biological Treatments • Reflect the view that psychological disorders are a pathology of the brain (particularly of neurotransmitters that carry messages from one neuron to the next) • Involve: medication, electro-convulsive therapy, and psycho-surgery

8. Psychotropic Medicines • How do they work? • Inhibit overly active neurotransmitters (those that are too sensitive) • Increase neurotransmitters that are under-active or are in short supply • Placebo effects (client’s expectation that he will improve by taking the medicine)

9. Anti-Psychotic Medicines • Treat schizophrenia and other psychotic states • Inhibit production of dopamine (e.g., thorazine) • Side effects: twitching (tongue, face, neck) • They are the most effective treatment for schizophrenia

10. Anti-Depressant Medicines • Treat depression and bi-polar syndrome • Increases production norepinephrine and serotonin (prozac; lithium) • Antidepressants tends to work for most depressed people (as long as they take the medicine) • Lithium works for about 80% of those with bi-polar disorder • Side effects: cosmetic psychopharmacology (avoid any distress, some of which may be functional), potentially toxic, can alter diet, make vision blurred, restlessness; short term, can be addictive)

11. Other Biological Approaches • Electric Light therapy • For treating mild depression, particularly seasonal affective disorder (SAD) • Generally works well • Electro-convulsive Therapy • Send electric impulses through brain • Used to treat severe depression • Not sure how it works, but it seems to be effective for treating severe depression • Psychosurgery • Surgically alter part of the brain • Lobotomy (severing tissue in the cerebral lobe) • Not effective in curing psychosis • Any surgery is is risky, and should be used as a last resort

12. Combined Treatments • Standard hospital treatment wards • Custodial care and drug treatment • Milieu therapy wards • Close interaction between staff and patients • Increased respect for patients (residents) • Heightened expectations • Democratic decision-making • Less reliance on drugs

13. Combined Treatments • Social learning therapy wards • Most of the elements of milieu therapy • Plus: directed effort to teach social skills • Success (i.e. live for at least 18 months outside of hospital) rates: • 97% of patients in social learning • 71 % in milieu • 46% in standard hospital ward:

14. Combined Treatments • A combination of therapy and medication is the most effective method for treating: • Depression • Bipolar disorder • Dissociation • Anxiety • Personality disorder

15. Preventive Approaches • Assumes that cause of mental illness resides more in stressful social situations* • Like physical illnesses (smallpox, malaria), mental illness can be solved by good public heath • Example: • Sexual dysfunction due to fatigue associated with dual careers and/or hectic pace of modern life • One study found that 16% of couples fail to have sex at least once a month • Is this a bit utopian? Can we remove stress from life?

16. Evolutionary Perspective • Some mental illnesses may be adaptive • Just as a fever is the body’s way of fighting infection, some mental illnesses are the mind’s way of coping with difficult situations* • Anxiety can prevent accidents • Depression can be a way of gaining new insights on behavior that has not worked

17. Summary of the Day • Evaluating psychotherapies • Biological treatments • Combined treatments • Preventative approaches • Evolutionary perspective