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

Copyright © Allyn & Bacon 2007 What is Therapy? Therapy for psychological disorders takes a variety of forms, but all involve some relationship focused on improving a person’s mental, behavioral, or social functioning. Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 What is Therapy? Therapy – General term for any treatment process; in psychology and psychiatry, therapy refers to 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/client, 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

Contemporary Approaches to Therapy Psychological therapies – Based on psychological principles (rather than biomedical approach). The psychological therapies are often collectively called psychotherapy. Copyright © Allyn & Bacon 2007

Contemporary Approaches to Therapy Biomedical therapies – Treatments that focus on altering the brain, especially with drugs, psychosurgery, or electroconvulsive therapy. 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: Problems of normal living Work setting: Schools, clinics, other institutions Credentials: Master’s in counseling, PhD, EdD, or PsyD 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: PhD or PsyD Clinical psychologist Psychiatrist Psychoanalyst Psychiatric nurse practitioner Clinical social worker Pastoral counselor Copyright © Allyn & Bacon 2007 29

Severe mental disorders (often by means of drug therapies) Professional Title Counseling psychologist Specialty: Severe mental disorders (often by means of 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 MD Counseling psychologist Clinical psychologist Specialty: Freudian therapy Work setting: Private practice Credentials: MD 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

How Do Psychologists Treat Mental Disorders? Psychologists employ two main forms of treatment: the insight therapies and the behavioral therapies. 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

Copyright © Allyn & Bacon 2007 Insight Therapies Talk therapies – Psychotherapies that focus on communicating and verbalizing emotions and motives to understand their behavior. Psychodynamic therapies – Insight therapies based on the assumption that mental disorder is caused by powerful (dynamic) mental forces and conflicts. Copyright © Allyn & Bacon 2007

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

Insight Therapies: Humanistic Therapies Humanistic therapies – Techniques based on the assumption that people have a tendency for positive growth and self actualization, which may be blocked by an unhealthy environment. Insight Therapies: Humanistic Therapies Copyright © Allyn & Bacon 2007

Insight Therapies: Humanistic Therapies Client-centered therapy – Emphasizes healthy psychological growth through self-actualization. - developed by Carl Rogers Reflection of feeling – Paraphrasing client’s words to capture the emotional tone expressed. (page 534) Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 Reflection of Feeling Example: The patient says, "I get sick of working so much overtime!" The therapist might respond, "I hear you feeling angry and resentful at being asked to work so much overtime." Feeling reflections are perhaps the most difficult active listening responses to make. Not only do you actively listen to what is being said but you also actively listen for what is being felt. Copyright © Allyn & Bacon 2007

Insight Therapies: Cognitive Therapies Cognitive therapy – Emphasizes rational thinking as the key to treating mental disorder. Aaron Beck’s cognitive therapy for depression (page 536) Proven to be as effective as medication Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 Cognitive Therapy Example: When walking down the hallway at work, John says hello to the company CEO. The CEO does not respond and keeps walking. John interprets this as the CEO’s lack of respect for him. He gets demoralized and feels rejected. However, the CEO’s behavior may have nothing to do with John. He may have been preoccupied about an upcoming meeting, or had a fight with his wife that morning. If John considered that the CEO’s behavior may not be related to him personally, he is likely to avoid this negative mood. Copyright © Allyn & Bacon 2007

Insight Therapies: Group Therapies Group therapy – Psychotherapy with more than one client. Self-help support groups – Groups that provide social support and an opportunity for sharing ideas about dealing with common problems; typically organized/run by laypersons (not professional therapists). 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. Therapist helps them to perceive the issues or patterns that are creating problems. Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007

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

Classical Conditioning Therapies Systematic desensitization – Technique in which anxiety is extinguished by exposing the patient to an anxiety-provoking stimulus. Exposure therapy – Desensitization therapy in which patient directly confronts the anxiety-provoking stimulus (as opposed to imagining it). Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 Big Bang Theory https://www.youtube.com/watch?v=Z3z_yZ1G1Og Sheldon’s Compulsive Closure Therapy Copyright © Allyn & Bacon 2007

Classical Conditioning Therapies Aversion therapy – Involves presenting individuals with an attractive stimulus paired with unpleasant stimulation in order to condition a repulsive reaction. UCS (foul odor) UCR (nausea) CR CS (cigarette smoke) Copyright © Allyn & Bacon 2007

Operant Conditioning Therapies Contingency management – Approach to changing behavior by altering the consequences, especially rewards and punishments, of behavior. 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

Observational-Learning Therapies Participant modeling – Therapist demonstrates and encourages a client to imitate a desired behavior. Copyright © Allyn & Bacon 2007

Cognitive-Behavioral Therapy Cognitive-behavioral therapy (CBT) 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

Cognitive-Behavioral Therapy Rational-emotive behavior therapy (REBT) – Based on the idea that irrational thoughts and behaviors are the cause of mental disorders. “Don’t ‘should’ on yourself.” - Albert Ellis 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: Therapy is better than no therapy! It appears advantageous to match specific therapies with specific conditions. Quality of relationship between therapist and client is important. Copyright © Allyn & Bacon 2007

Most Effective Therapies? Behavior Therapy Specific Phobias OCD Alcoholism Cognitive-Behavioral Therapy (CBT) Depression Eating Disorders Insight Therapy Couples Counseling Relationship Problems Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 THERAPY Biomedical Psychotherapy Copyright © Allyn & Bacon 2007

How Is the Biomedical Approach Used to Treat Mental Disorders? Biomedical therapies seek to 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 Psychopharmacology – The prescribed use of drugs to help treat symptoms of mental illness to ensure that individuals are more receptive to talk therapies. Drug Therapy Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 Drug Therapy Antipsychotic drugs – medicine that diminishes psychotic symptoms, usually by their effect on the dopamine pathways in the brain. Reduce positive symptoms of psychosis May have side effects Tardive dyskinesia – Incurable disorder of motor control, especially involving muscles of the face, resulting from long-term use of antipsychotic drugs. Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 Drug Therapy Antidepressants – medicines that affect depression, usually by their effect on serotonin and/or norepinephrine. Mood stabilizers: Lithium carbonate – highly effective in dampening extreme mood swings (effective against bipolar disorder) In high concentrations lithium can be toxic! *The use of antidepressants to deal with general feelings of unease is highly controversial. Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 Drug Therapy Antianxiety drugs - drugs that diminish feelings of anxiety. Include barbiturates and benzodiazepines. Valium and Xanax Should not be used to relieve ordinary anxieties of everyday life. Should not be combined with alcohol! Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 Drug Therapy Stimulants – drugs that increase activity level by encouraging communication among neurons in the brain. Stimulants actually suppress activity level in persons with ADHD. There is controversy from concern that the causes and boundaries of ADHD are vague and the potential exists for overdiagnosis. Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 Psychosurgery Psychosurgery – the general term for surgical intervention in the brain to treat psychological disorders. Prefrontal lobotomy – involves severing the nerve fibers connecting the frontal lobe with deep brain structures, especially the thalamus and hypothalamus. Split-brain operation - Severing the corpus callosum can reduce life-threatening seizures. Copyright © Allyn & Bacon 2007

Brain-Stimulation Therapies Electroconvulsive therapy (ECT) - A treatment used primarily for depression and involving the application of an electric current to the head, producing a generalized seizure (called shock treatment). Copyright © Allyn & Bacon 2007

Brain-Stimulation Therapies Transcranial magnetic stimulation (TMS) A treatment that involves magnetic stimulation of specific regions of the brain (an alternative to ECT). - Can be used for the treatment of depression, schizophrenia, and bipolar disorder. Copyright © Allyn & Bacon 2007

Copyright © Allyn & Bacon 2007 Mental Hospitals Prior to the 1950s: Understaffed Poorly funded Prisonlike FEW PATIENTS EVER LEFT! Copyright © Allyn & Bacon 2007

Deinstitutionalization The removal of patients from mental hospitals. Advances in psychotic drugs and psychotherapy. Provide the least restrictive care. Receive outpatient care. Copyright © Allyn & Bacon 2007

Hospitalization and the Alternatives Community mental health movement – Effort to deinstitutionalize mental patients and to provide therapy from outpatient clinics. Copyright © Allyn & Bacon 2007