Treatment of Psychological Disorders Chapter 11 Treatment of Psychological Disorders McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill (c) 2010 The McGraw-Hill Companies, Inc. All rights reserved.

McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. Psychotherapy: Psychodynamic, Behavioral, and Cognitive Approaches to Treatment Learning Outcomes Explain psychodynamic approaches to therapy Explain behavioral approaches to therapy Explain cognitive approaches to therapy McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill (c) 2010 The McGraw-Hill Companies, Inc. All rights reserved.

McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. Psychotherapy: Psychodynamic, Behavioral, and Cognitive Approaches to Treatment (cont.) Psychotherapy: treatment in which a trained professional (a therapist) uses psychological techniques to help a person overcome psychological difficulties and disorders, resolve problems in living, or bring about personal growth Biomedical therapy: therapy that relies on drugs and other medical procedures to improve psychological functioning Therapists use some 400 different varieties of psychotherapy. Although diverse in many respects, all psychological approaches see treatment as a way of solving psychological problems by modifying people’s behavior and helping them gain a better understanding of themselves and their past, present, and future. McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill (c) 2010 The McGraw-Hill Companies, Inc. All rights reserved.

Psychodynamic Approaches to Therapy Psychodynamic therapy: seeks to bring unresolved past conflicts and unacceptable impulses from the unconscious into the conscious, where patients may deal with the problems more effectively (Sigmund Freud) Psychoanalysis: Freudian psychotherapy in which the goal is to release hidden unconscious thoughts and feelings in order to reduce their power in controlling behavior Psychodynamic approaches are based on Freud’s psychoanalytic approach to personality, which holds that individuals employ defense mechanisms, psychological strategies to protect themselves from unacceptable unconscious impulses. A psychodynamic therapist faces the challenge of finding a way to assist patients’ attempts to explore and understand the unconscious. The technique basically consists of guiding patients to consider and discuss their past experiences, in explicit detail, from the time of their first memory. McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill (c) 2010 The McGraw-Hill Companies, Inc. All rights reserved.

Psychodynamic Approaches to Therapy (cont.) Free association: patient says aloud whatever comes to mind; analyst connects this to the unconscious Dream interpretation: examining dreams for clues to the unconscious Transference: the transfer of feelings to a psychoanalyst of love or anger that had been originally directed to a patient’s parents or other authority figures McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill (c) 2010 The McGraw-Hill Companies, Inc. All rights reserved.

Psychodynamic Approaches to Therapy (cont.) Psychodynamic therapy can be time-consuming, expensive, and it may be difficult to determine effectiveness, but it also may provide solutions to difficult issues, insight, and treatment for psychological disturbance for some people In psychoanalysis, patients may meet with a therapist with considerable frequency, sometimes as much as 50 minutes a day, four to 6 days a week, for several years. Because of the close, almost intimate interaction between patient and psychoanalyst, the relationship between the two often becomes emotionally charged and takes on a complexity unlike most other relationships. McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill (c) 2010 The McGraw-Hill Companies, Inc. All rights reserved.

Behavioral Approaches to Therapy Behavioral treatment approaches: treatment approaches that build on the basic processes of learning; assumes both normal and abnormal behavior are learned Aversive conditioning: reduces the frequency of undesired behavior by pairing an aversive, unpleasant stimulus with that undesired behavior People who act abnormally either have failed to learn the skills they need to cope with the problems of everyday living or have acquired faulty skills and patterns that are being maintained through some form of reinforcement. To modify abnormal behavior, then, proponents of behavioral approaches propose that people must learn new behavior to replace the faulty skills they have developed and unlearn their maladaptive behavior patterns. McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill (c) 2010 The McGraw-Hill Companies, Inc. All rights reserved.

Behavioral Approaches to Therapy (cont.) Systematic desensitization: a behavioral therapy technique in which gradual exposure to an anxiety-producing stimulus is paired with relaxation to extinguish the response of anxiety Hierarchy of fears: a list of the things you associate with your fears, in order of increasing severity Exposure: treatment for anxiety in which people are confronted, either suddenly or gradually, with a stimulus that they fear, but relaxation training is omitted McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill (c) 2010 The McGraw-Hill Companies, Inc. All rights reserved.

Behavioral Approaches to Therapy (cont.) Operant conditioning techniques: treatment based on reward and punishment Token system: reward a person for a desired behavior with a token that can be exchanged for something the person wants Dialectical behavior therapy: focus is on getting people to accept who they are, regardless of whether it matches their ideal McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill (c) 2010 The McGraw-Hill Companies, Inc. All rights reserved.

Behavioral Approaches to Therapy (cont.) Behavior therapy works well for anxiety disorders, phobias and compulsions, impulse control, and learning complex social skills to replace maladaptive behavior; however, people do not necessarily gain insight about their maladaptive behavior McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill (c) 2010 The McGraw-Hill Companies, Inc. All rights reserved.

Cognitive Approaches to Therapy Cognitive treatment approaches: teach people to think in more adaptive ways by changing their dysfunctional cognitions about the world and themselves Cognitive-behavioral approach: incorporates basic principles of learning to change the way people think Cognitive approaches to therapy have proved successful in dealing with a broad range of disorders. The willingness of cognitive therapists to incorporate additional treatment approaches, such as combining cognitive and behavioral techniques, has made this approach particularly effective. The success of cognitive approaches has made it one of the most frequently employed therapies. McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill (c) 2010 The McGraw-Hill Companies, Inc. All rights reserved.

Cognitive Approaches to Therapy (cont.) Rational-emotive behavior therapy: attempts to restructure a person’s belief system into a more realistic, rational, and logical set of views by challenging dysfunctional beliefs that maintain irrational behavior Cognitive therapy: also aims to change people’s illogical thoughts about themselves and the world, but is less confrontational than REBT (Aaron Beck) McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill (c) 2010 The McGraw-Hill Companies, Inc. All rights reserved.

Cognitive Approaches to Therapy (cont.) Cognitive therapy has been successful for a wide range of disorders, and combining it with other approaches makes it particularly effective; however, being more reasonable and rational may not always be helpful McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill (c) 2010 The McGraw-Hill Companies, Inc. All rights reserved.

Psychotherapy: Humanistic and Group Approaches to Treatment Learning Outcomes Discuss the humanistic approaches to therapy Illustrate interpersonal therapy Explain group therapy, family therapy and self-help groups Assess the effectiveness of psychotherapy McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill (c) 2010 The McGraw-Hill Companies, Inc. All rights reserved.

McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. Humanistic Therapy Humanistic therapy: underlying rationale is that people have control of their behavior, can make choices about their lives, and are essentially responsible for solving their own problems; emphasizes self-responsibility Person-centered therapy (a.k.a., client-centered therapy): goal is to reach one’s potential for self-actualization As you know from your own experience, a student can’t master the material covered in a course without some hard work, no matter how good the teacher and the textbook are. The responsibility for your success in the course is yours alone. This philosophical perspective of self-responsibility is the basis of humanistic therapy. We have control of our own behavior; we can make choices about the life we want to live; and it is up to us to solve the difficulties we encounter in our daily lives. McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill (c) 2010 The McGraw-Hill Companies, Inc. All rights reserved.

Humanistic Therapy (cont.) Unconditional positive regard: expressing acceptance and understanding, regardless of the feelings and attitudes the client expresses; does not mean therapist shows approval of everything the client says or does, just that the therapist is nonjudgmental and empathetic (understanding of a client’s emotional experiences) Humanistic approaches provide a supportive environment for therapy and can help clients discover solutions, but they are not very precise and are the least scientifically and theoretically developed type of treatment McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill (c) 2010 The McGraw-Hill Companies, Inc. All rights reserved.

Interpersonal Therapy Interpersonal therapy (IPT): short-term therapy that focuses on the context of current social relationships, such as conflicts with others, social skills issues, role transitions, or grief McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved.

Group Therapy, Family Therapy, and Self-Help Groups Group therapy: people meet with a therapist to discuss problems with a group Family therapy: focuses on the family (as a unit) and its dynamics Self-help therapy: people with similar problems get together to discuss their shared feelings and experiences (ex.: bereavement support groups; Alcoholics Anonymous) McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill (c) 2010 The McGraw-Hill Companies, Inc. All rights reserved.

Evaluating Psychotherapy: Does Therapy Work? Research shows that, generally, therapy brings about greater improvement than does no treatment at all; spontaneous remission (recovery without treatment) is fairly low For most people, psychotherapy is effective… …but it doesn’t work for everyone The question of whether therapy is effective is complex. In fact, identifying the single most appropriate form of treatment is a difficult, and still unresolved, task for psychologists specializing in psychological disorders. Most psychologists agree: Therapy does work. However, as many as 10% of people treated show no improvement or actually deteriorate. No single form of therapy works best for every problem. Using an eclectic approach (using a variety of techniques) to treat a person’s problem can sometimes be best. McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill (c) 2010 The McGraw-Hill Companies, Inc. All rights reserved.

Evaluating Psychotherapy: Does Therapy Work? (cont.) No single form of therapy works best for every problem, and certain specific types of treatment are better for specific types of problems Most therapies share several basic similar elements (positive relationship with the therapist, explanation of the client’s symptoms, and confrontation of negative emotions) Eclectic approach: therapist integrates several approaches to therapy in order to treat the client McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill (c) 2010 The McGraw-Hill Companies, Inc. All rights reserved.

Biomedical Therapy: Biological Approaches to Treatment Learning Outcomes Discuss options for drug therapy Explain electroconvulsive therapy Offer perspective on biomedical therapies Discuss the community psychology movement McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill (c) 2010 The McGraw-Hill Companies, Inc. All rights reserved.

McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. Drug Therapy Drug therapy: control of psychological disorders through the use of drugs Antipsychotic drugs: temporarily reduce psychotic symptoms such as agitation, hallucinations, and delusions (which may be present in schizophrenia) Atypical antipsychotics: fewer side effects Most antipsychotics work by blocking dopamine receptors at the brain’s synapses Drug therapy works by altering the operation of neurotransmitters and neurons in the brain. Some drugs operate by inhibiting neurotransmitters or receptor neurons, reducing activity at particular synapses. Other drugs do just the opposite: they increase the activity of certain neurotransmitters or neurons, allowing particular neurons to fire more frequently. McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill (c) 2010 The McGraw-Hill Companies, Inc. All rights reserved.

McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. Drug Therapy (cont.) Antidepressant drugs: medications used for severe depression to improve the patient’s mood; sometimes used for anxiety disorders and bulimia Tricyclic drugs: increase norepinephrine at the synapses in the brain MAO inhibitors: prevent monoamine oxidase (enzyme) from breaking down neurotransmitters Selective serotonin reuptake inhibitors (SSRIs): increase serotonin at the synapses in the brain McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill (c) 2010 The McGraw-Hill Companies, Inc. All rights reserved.

McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. Drug Therapy (cont.) Mood stabilizers: used to treat mood disorders; prevent manic episodes of bipolar disorder Antianxiety drugs: reduce the level of anxiety a person experiences, essentially by reducing excitability and increasing feelings of well-being McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill (c) 2010 The McGraw-Hill Companies, Inc. All rights reserved.

McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. Drug Therapy (cont.) McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill (c) 2010 The McGraw-Hill Companies, Inc. All rights reserved.

Electroconvulsive Therapy (ECT) Electroconvulsive therapy (ECT): a procedure used in the treatment of severe depression; an electric current of 70 to 150 volts is briefly administered to a patient’s head Transcranial magnetic stimulation (TMS): an alternative to ECT; a precise magnetic pulse is directed to a specific area of the brain McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill (c) 2010 The McGraw-Hill Companies, Inc. All rights reserved.

Biomedical Therapies in Perspective Biomedical therapies have been revolutionary to the field of mental health A current promising experimental treatment is gene therapy: specific genes introduced to particular regions of the brain may then reverse or prevent biochemical events that lead to disorders May sometimes only treat the symptoms of the disorder; can also have side effects Often used in conjunction with psychotherapy In some respects, no greater revolution has occurred in the field of mental health than biological approaches to treatment. New forms of biomedical therapy are promising, such as gene therapy. However, despite their current usefulness and future promise, biomedical therapies do not represent a cure-all for psychological disorders. Although it’s considered a major step in the right direction, biomedical treatment may not solve the underlying problem. Still, biomedical therapies have permitted millions of people to function more effectively. McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill (c) 2010 The McGraw-Hill Companies, Inc. All rights reserved.

Community Psychology: Focus on Prevention Community psychology: a branch of psychology that focuses on the prevention and minimization of psychological disorders in the community Deinstitutionalization: transfer of former mental patients from institutions to the community McGraw-Hill ©2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill (c) 2010 The McGraw-Hill Companies, Inc. All rights reserved.