Therapies for Psychological Disorders Chapter 13 Therapies for Psychological Disorders Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 What is Therapy? Therapy – General term for any treatment process; a variety of psychological and biomedical techniques aimed at dealing with mental disorders or coping with problems of living Copyright © Allyn & Bacon 2007

The Components of Therapy In addition to the relationship between the therapist and the patient, the therapeutic process typically involves: Identifying the problem Identifying the cause of the problem or the conditions that maintain the problem Deciding on and carrying out some form of treatment Copyright © Allyn & Bacon 2007

Freudian psychoanalysis Neo-Freudian therapies Insight Therapies Insight therapies – Psychotherapies in which the therapist helps patients understand (gain insight into) their problems Freudian psychoanalysis Neo-Freudian therapies Humanistic therapies Cognitive therapies Group therapies Copyright © Allyn & Bacon 2007

Insight Therapies: Psychodynamic Therapies Psychoanalysis – The form of psychodynamic therapy developed by Sigmund Freud Analysis of transference – Analyzing the patient’s relationship with the therapist, assuming this relationship mirrors unresolved conflicts in the patient’s past Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 Resistance Interpretation Transference Copyright © Allyn & Bacon 2007

Insight Therapies: Humanistic therapies Humanistic therapies (Carl Rogers) – (aka client-centered therapy) based on the assumption that people can grow and self actualize; people may be blocked by an unhealthy environment Reflection of feeling – Paraphrasing client’s words using active listening to capture the emotional tone expressed Copyright © Allyn & Bacon 2007

Systematic desensitization Contingency management Behavior Therapies Behavior therapy – Therapy based on the principles of behavioral learning, especially operant conditioning and classical conditioning Systematic desensitization Exposure Therapy Aversion therapy Contingency management Participant modeling Token economies Copyright © Allyn & Bacon 2007

Classical Conditioning Therapies Exposure therapy – patient directly confronts the anxiety-provoking stimulus (as opposed to imagining it) – aka flooding Systematic desensitization – anxiety is extinguished by gradually exposing the patient to increasing levels of an anxiety-provoking stimulus (aka graduated exposure therapy) Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 Counterconditioning VR exposure therapy Copyright © Allyn & Bacon 2007

Classical Conditioning Therapies Aversion therapy – Pairing a pleasant and unpleasant stimulus to condition a repulsive reaction UCS (foul odor) UCR (nausea) CR CS (cigarette smoke) Copyright © Allyn & Bacon 2007

Operant Conditioning Therapies Contingency management – changing behavior by altering the consequences, (rewards and punishments) of behavior -e.g. shaping, timeouts, contracts, voucher systems (WDFY), token economies Copyright © Allyn & Bacon 2007

Operant Conditioning Therapies Token economies – Applied to groups (e.g. classrooms, mental hospital wards) involving distribution of “tokens” contingent on desired behaviors; tokens can later be exchanged for privileges, food, or other reinforcers Copyright © Allyn & Bacon 2007

Participant Modeling: An Observational-Learning Therapy Participant modeling – Therapist demonstrates and encourages a client to observe and imitate a desired behavior Copyright © Allyn & Bacon 2007

Insight Therapies: Cognitive therapies Cognitive therapy – (Aaron Beck) Emphasizes rational thinking as the key to treating mental disorder CT for depression/anxiety involves Challenging faulty thinking Testing and modifying beliefs Copyright © Allyn & Bacon 2007

Cognitive-Behavioral Therapy: A Synthesis Rational-emotive behavior therapy – a type of CBT developed by Albert Ellis a person is not affected emotionally by outside things but rather by ‘perceptions and attitudes about outside things.‘ Hamlet: “Nothing is good or bad, but…” Ellis’s style was confrontational, the opposite of Carl Rogers’s Copyright © Allyn & Bacon 2007

Insight Therapies: Group therapies For many issues, couples counseling or family therapy can often be more effective than individual therapy with one individual at a time Copyright © Allyn & Bacon 2007

Cognitive-Behavioral Therapy: A Synthesis Combines cognitive emphasis on thoughts with behavioral strategies that alter reinforcement contingencies Assumes irrational self-statements cause maladaptive behavior Seeks to help the client develop a sense of self-efficacy Copyright © Allyn & Bacon 2007

Insight Therapies: Group therapies Group therapy – Psychotherapy with more than one client Very effective for depression and PTSD Self-help support groups – Groups that provide social support and a forum to share common problems; typically NOT run by professional therapists “Anonymous” groups: AA FAMILY THERAPY Copyright © Allyn & Bacon 2007

Differences between Rogers & Ellis Carl Rogers Albert Ellis Client (person) centered therapy REBT Supportive Confrontational Client has answers Therapist has answers Mostly cognitive Cognitive-behavioral Copyright © Allyn & Bacon 2007

Evaluating the Psychological Therapies Eysenck proposed that people with non-psychotic problems recover just as well with or without therapy Reviews of evidence have shown: That therapy is better than no therapy It is best to match specific therapies with specific conditions—i.e., not all therapies work for all conditions Copyright © Allyn & Bacon 2007

Is psychotherapy effective? Meta-analysis: The bottom line results after looking at many different research studies Evidence-based practice: Making clinical decisions by factoring in research, clinical expertise, and patient characteristics/preferences Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 Therapeutic alliance: Trust and bond between therapist and client. Resilience: Personal strength that helps most people cope with and recover from adversity Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 Quiz What are some differences between psychologists and psychiatrists? What is the difference between group therapy & self-help support groups? What is the main difference between insight and behavioral therapies? Give an example of a behavioral therapy Copyright © Allyn & Bacon 2007

How might each approach view treatment? Cognitive Psychodynamic Humanistic Behavioral Sociocultural Biological Evolutionary Copyright © Allyn & Bacon 2007

How Is the Biomedical Approach Used to Treat Mental Disorders? Biomedical therapies treat mental disorders by changing the brain’s chemistry with drugs, its circuitry with surgery, or its patterns of activity with pulses of electricity or powerful magnetic fields Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 Drug Therapy Psychopharmacology – Using prescription drugs to treat mental disorders (often to make people more receptive to talk therapies) Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 Drug Therapy Antipsychotic drugs Include Thorazine, Haldol, Risperdal, Clozapine Usually affect dopamine pathways May have side effects Tardive dyskinesia – Incurable disorder of motor control resulting from long-term use of antipsychotic drugs Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 Drug Therapy Antianxiety drugs Include [rarely] barbiturates (CNS depressants) and benzodiazepines (Valium and Xanax) Should not be: taken for more than a few days at a time combined with alcohol Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 Drug Therapy Antidepressants (in order of usage) SSRIs like Prozac, Paxil, Celexa, Lexapro (inhibit serotonin reuptake) Include tricyclics like Elavil (inhibit reuptake) monoamine oxidase (MOA) inhibitors like Nardil (inhibit reuptake of norepinephrine) Mood stabilizers (for bipolar disorder): Lithium (carbonate) Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 Drug Therapy Stimulants (Ritalin and Adderall) suppress activity level in persons with attention-deficit/hyperactivity disorder (ADHD) Copyright © Allyn & Bacon 2007

Brain-Stimulation Therapies Electroconvulsive therapy is used for the treatment of severe depression Peter’s ECT session Transcranial magnetic stimulation, a possible alternative to ECT, can also be used for the treatment of addiction, depression, schizophrenia, and bipolar disorder Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 Psychosurgery Psychosurgery – The general term for surgical intervention in the brain to treat psychological disorders The infamous prefrontal lobotomy is no longer performed Severing the corpus callosum, however, can reduce life-threatening seizures Copyright © Allyn & Bacon 2007

Hospitalization and the Alternatives Deinstitutionalization – Policy of removing patients, whenever possible, from mental hospitals Community mental health movement – Effort to deinstitutionalize mental patients and to provide therapy from outpatient clinics Copyright © Allyn & Bacon 2007

Let’s practice identifying therapies http://bcs.worthpublishers.com/gray/content/psychsim5/Mystery%20Therapist/MysteryTherapist.htm Copyright © Allyn & Bacon 2007

Let’s look at the diagnosis chart Identify the likely disorder, and speculate about what the best course of therapy would be. Copyright © Allyn & Bacon 2007

Types of Mental Health Care Professionals Counseling psychologist Clinical psychologist Psychiatrist Psychoanalyst Psychiatric nurse practitioner Clinical social worker Pastoral counselor Copyright © Allyn & Bacon 2007 29

Counseling psychologist Professional Title Specialty: Adjustment disorders Work setting: Schools, clinics, other institutions Credentials: At least a Master’s in counseling Counseling psychologist Clinical psychologist Psychiatrist Psychoanalyst Psychiatric nurse practitioner Clinical social worker Pastoral counselor Copyright © Allyn & Bacon 2007 29

Clinical psychologist Professional Title Counseling psychologist Specialty: Those with severe disorders Work setting: Private practice, mental health agencies, hospitals Credentials: PsyD Clinical psychologist Psychiatrist Psychoanalyst Psychiatric nurse practitioner Clinical social worker Pastoral counselor Copyright © Allyn & Bacon 2007 29

Severe mental disorders (often uses drug therapies) Professional Title Counseling psychologist Specialty: Severe mental disorders (often uses drug therapies) Work setting: Private practice, clinics, hospitals Credentials: MD Clinical psychologist Psychiatrist Psychoanalyst Psychiatric nurse practitioner Clinical social worker Pastoral counselor Copyright © Allyn & Bacon 2007 29

Professional Title Freudian therapy Private practice PhD Counseling psychologist Clinical psychologist Specialty: Freudian therapy Work setting: Private practice Credentials: PhD Psychiatrist Psychoanalyst Psychiatric nurse practitioner Clinical social worker Pastoral counselor Copyright © Allyn & Bacon 2007 29

Psychiatric nurse practitioner Professional Title Specialty: Nursing specialty; licensed to prescribe drugs Work setting: Private practice, clinics, hospitals Credentials: RN – plus special training in treating mental disorders and prescribing drugs Counseling psychologist Clinical psychologist Psychiatrist Psychoanalyst Psychiatric nurse practitioner Clinical social worker Pastoral counselor Copyright © Allyn & Bacon 2007 29

Clinical social worker Professional Title Counseling psychologist Specialty: Social worker with specialty in dealing with mental disorders Work setting: Often employed by government Credentials: MSW Clinical psychologist Psychiatrist Psychoanalyst Psychiatric nurse practitioner Clinical social worker Pastoral counselor Copyright © Allyn & Bacon 2007 29

Combines spiritual guidance with practical counseling Professional Title Counseling psychologist Specialty: Combines spiritual guidance with practical counseling Work setting: Religious order or ministry Credentials: Varies Clinical psychologist Psychiatrist Psychoanalyst Psychiatric nurse practitioner Clinical social worker Pastoral counselor Copyright © Allyn & Bacon 2007 29

Copyright © Allyn & Bacon 2007 End of Chapter 13 The worst therapy ever Copyright © Allyn & Bacon 2007