Treatment of psychological disorders Chapter 16

Types of Treatment Analyze This and Analyze That - misconceptions Types of therapies Insight therapies “talk therapy” Behavior therapies Changing overt behavior Biomedical therapies Biological functioning interventions

Who Seeks Treatment? 15% of U.S population in a given year Most common presenting problems Anxiety and Depression Treatment seeking for various disorders – Figure 15.1 Mood disorders Utilization rates – Figure 15.2 Women more than men Medical insurance Education level Psychological Disorders and professional treatment – Figure 15.3

Figure 15-1 – Treatment seeking for various disorders

Figure 15-2 – Therapy utilization rates – Olfson et al. (2002)

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Who Provides Treatment? Clinical psychologists Counseling psychologists Psychiatrists Clinical social workers Psychiatric nurses Counselors On-line treatment?

Insight Therapies: Psychoanalysis Sigmund Freud and followers Goal: discover unresolved unconscious conflicts - Figure 15.4 Free association Dream analysis Interpretation Resistance and transference Psychodynamic Therapies

Insight Therapies: Client Centered Therapy Carl Rogers Cause: Figure 15.5 Goal: restructure self-concept to better correspond to reality Therapeutic Climate Genuineness Unconditional positive regard Empathy

Therapies Inspired by Positive Psychology Martin Seligman Uses theory and research to better understand the positive, adaptive, creative, and fulfilling aspects of human existence well-being therapy positive psychotherapy can be an effective treatment for depression – F 15.6 - well being: seeks to find clients self acceptance, purpose in life, freedom and personal growth - Positive psychotherapy: recognize strengths, appreciate blessings, savor positive experiences, forgive those who have wronged them and find meaning in life

Figure 15.6 Positive psychotherapy for depression

Other issues Groups therapy Group size Advantages – social dimension of change Effectiveness of Insight therapies – Figure 15.7 Spontaneous remission Talk therapies or other approaches? Common factors contribute to progress in those treated Usually about 12 6 to 8 being ideal Research shows that they should be diverse Advantages: Provide acceptance Emotional support Value one another and hope to win approval from group Save time and money Others are experiencing the same thing Work on social skills - If spontaneous recovery occurs than one can not assume that treatment was the answer to recovery Talk therapy: Equal to drug therapies Better than placebo or no formal treatment 50% show meaningful recovery after 20 sessions and 20% after 40

Figure 15.7 – Recovery as a function of number of therapy sessions

Behavior Therapies B.F. Skinner and colleagues Goal: unlearning maladaptive behavior and learning adaptive ones Systematic Desensitization – Joseph Wolpe Classical conditioning – Figure 15.8 Anxiety/Fear hierarchy – Figure 15.9 Aversion therapy – Figure 15.10 Alcoholism, sexual deviance, smoking, etc. Social skills training Modeling Behavioral rehearsal Biofeedback Operant conditioning flooding Classical conditioning Insight therapy believes symptoms are clues of the underlying problem. Behavioral believe symptoms are the problem Systematic: step one create an anxiety hierarchy, two is deep relaxation and step 3 learning to remain relaxed with each stimulus in the hierarchy Social skills training: promising results in schizophrenia, anxiety and ADD

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Cognitive-Behavioral Therapy Aaron Beck Cognitive therapy Depression and negative thinking – Figure 15.11 Albert Ellis Rational-emotive therapy Goal: to change the way clients think Detect and recognize negative thoughts Reality testing Effectiveness of Behavior Therapies Efficacy of behavioral interventions for a variety of disorders cognitive: Blame setbacks on themselves Focus on negative events and ignore positive Pessimistic projections Negative conclusions about ones worth Cognitive behavioral therapists would give “homework assignments” Effectiveness: misleading to make global statements of behavioral tendencies Cannot use for certain disorders

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Biomedical Therapies Psychopharmacotherapy Antianxiety - Valium, Xanax, Buspar Antipsychotic - Thorazine, Mellaril, Haldol Tardive dyskinesia Atypical antipsychotic – reduce motor effects and other neurotransmitters Time course – Figure 15.12 Antidepressant: - Actions - Figure 15.13 Tricyclics – Elavil, Tofranil Mao inhibitors (MAOIs) - Nardil Selective serotonin reuptake inhibitors (SSRIs) – Prozac, Paxil, Zoloft – side effects – Table 15.1 Risk of suicide – Figure 15.14 Mood stabilizers Lithium, Valproic acid Electroconvulsive therapy (ECT) Transcranial Magnetic Stimulation Deep brain stimulation Valium, xanax also known as tranquilizers. Effects last a few hours. Side effects: drowsiness, lightheaded, dry mouth, nausea, depression, constipation, and confusion. Antipsychotic: used for schizophrenia. Recovery occurs in 70% of patients and begin to show after 1 to 3 week. Side effects are drowsiness, constipation, cotton mouth, muscle tremors, impaired motor coordination, tardive dyskinesia Atypical: could lead to diabetes and cardiovascular problems Antidepressants: most frequently prescribed drugs in the US. Tricyclics fewer side effects. SSRI also valuable with anxiety disorders Mood stabilizers: side effects kidney and thyroid gland complications Criticisms: side effects out weigh pros, overdependence, temporary relief, research is exagerrated

Figure 15.13 Antidepressant drugs’ mechanisms of action

Figure 15.15 Deep brain stimulation

Current Trends and Issues in Treatment Managed care Empirically validated treatments Blending Approaches to treatment – Figure 15.17 Conjunctive therapy – Figure 15.16 Multicultural sensitivity Deinstitutionalization Dorthea Dix - Figure 15.18 Changes in population – Figure 15.19 Factors – treatments, legal, service delivery model Revolving door problem – Slide 26 Homelessness Increase use of criminal justice system

Figure 15.17 The leading approaches to therapy among psychologists

Figure 15-16 – Relapse rates in Reynolds et al. (1999) study

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Looking for at therapist Factors to consider Sources of services – Table 15.2 Profession Gender Theoretical approach Comparison of approaches for effectiveness - Figure 15.20

Table 15-2, p. 626

Figure 15.20 Estimates of the effectiveness of various approaches to psychotherapy.