© Kip Smith, 2003 Treating mental illness - Outline History and careers Psychological treatment = therapy Does therapy work? Psychological testing Bio-medical treatment

© Kip Smith, 2003 History Grim Bedlam Rosenhan 1973 Pseudopatients in mental wards Less than 7 min/day with trained staff Dehumanizing contact with staff

© Kip Smith, 2003 Careers in psychology as a treatment provider Psychiatrist - MD Nurse - BS, MS Clinical / counseling psychologist - PhD Counselors - MS in Psychology Social workers - MS in Social Work

© Kip Smith, 2003 Treatment: Two general kinds Psychological Structured interaction between a trained professional and a patient Bio-medical Drugs, allopathic intervention, directly acting on the nervous system

© Kip Smith, 2003 Different approaches to therapy and assessment Cognitive - habitual patterns of expression and thinking Behavioral - behaviors and settings Humanistic - conscious perceptions and beliefs Psychoanalytic - repressed thoughts as important as expressed thoughts

© Kip Smith, 2003 Cognitive therapy Focus on habitual patterns of expression and thinking

© Kip Smith, 2003 Cognitive Therapy Central assumption: Neurosis derived from cognitive failure, e.g. irrational thinking, overgeneralization of pessimism etc. The patient is not acting rationally Therapy Teaching instructive ways of thinking Many different styles of therapist-patient interaction

© Kip Smith, 2003 Cognitive Therapy Example You are depressed. The therapist asks you to: Take an issue that you’re depressed about Think about other explanations for why the event is happening E.g., Not your fault

© Kip Smith, 2003 Behavioral therapy Focus on behaviors and the settings that elicit them

© Kip Smith, 2003 Behavior Therapy Central assumption: Condition is learned The product of Classical or Operant Conditioning Therapy Systematic desensitization Undoing the link between the conditioned stimulus and the conditioned response Aversive conditioning Transform a positive conditioned response into a negative conditioned response Positive reinforcement Token economies

© Kip Smith, 2003 Behavioral Therapy Example You are depressed. The therapist Isolates what making you depressed Exposes you to it incrementally More customarily used for anxiety Phobias

© Kip Smith, 2003 Humanistic = person- centered therapy Focus on the patient’s conscious perceptions and beliefs

© Kip Smith, 2003 Person-Centered Therapy Central assumption: The person is a client, not a patient, with potential for self-actualization Client’s self-perceptions are accurate Conversation is fruitful Therapy Active Listening = echoing, restating, seeking clarification.

© Kip Smith, 2003 Person-Centered Example You are depressed. The therapist listens what you have to say: Conversation without judgment, interpretation, or direction. Therapist looks for an opportunity for the client’s growth Most group therapy is person-centered AA is person-centered

© Kip Smith, 2003 Psychoanalytic therapy Repressed thoughts as important as expressed thoughts

© Kip Smith, 2003 Psychoanalysis Central assumption: Possible and desirable to discovering what hidden feelings/memories underlie the problem There is tension between the ID and SUPEREGO that therapy can resolve Therapy Free association Say whatever comes to mind Dream interpretation A window to the subconscious

© Kip Smith, 2003 Psychoanalysis Example You are depressed. The therapist asks you to: Freely associate about e.g. your family Would not ask about a specific event because you (by assumption) don’t know what you are depressed about

© Kip Smith, 2003 Does therapy work? Client’s Perceptions 89% of therapy consumers were at least “fairly well satisfied” with the results (Consumer Reports) 9 of 10 who recalled feeling “fair” or “very poor” at beginning reported feeling “very good” “good” or at least “so-so” at end.

© Kip Smith, 2003 Skepticism about therapy Placebo effect Regression to the mean People often enter therapy in crisis. Clients may need to believe that therapy was worth it. Clients generally like their therapists.

© Kip Smith, 2003 Clinician’s Perceptions Resounding “yes” case studies, feedback from clients, etc. However, they know of “failures” by other clinicians. Not particularly reliable.

© Kip Smith, 2003 Outcome Research Controlled research has looked at how well therapy works People who are NOT in therapy get better People in therapy get more better

© Kip Smith, 2003 Commonalities Hope for demoralized people A new perspective An empathic, trusting, caring relationship

© Kip Smith, 2003 Psychological testing MMPI-2 Projective tests Behavioral monitoring Neuroimaging

© Kip Smith, 2003 MMPI-2 Minnesota Multiphasic Personality Inventory 567 true / false questions Scored on 27 different scales Clinical Content Validity: lying and faking

© Kip Smith, 2003 MMPI examples Q: The world seems hopeless to me A: True Score a point to the scale for Depression Q: I never get angry A: True Score a point to the scale for Lying

© Kip Smith, 2003 Other Projective tests Rorschach inkblots Thematic apperception (TAT) Behavioral monitoring Ward staff counts positive and negative interactions with other patients and staff Self-monitoring

© Kip Smith, 2003 Bio-medical treatment == Drugs Used to treat Neurosis AND Psychosis Drugs Anti-psychotic Anti-anxiety Anti-depressant Other Electroconvulsive Therapy Psychosurgery

© Kip Smith, 2003 Anti-psychotic drugs Their effects: Dampen responsiveness to irrelevant stimuli Help decrease the positive symptoms of schizophrenia (e.g., hallucinations, paranoia) These work by: blocking dopamine receptors Examples: Thorazine, Clozaril

© Kip Smith, 2003 ± Anti-psychotics drugs + Reduce positive symptoms Fewer hallucinations and delusions Able to live at home - Fail to touch negative symptoms Patients still lack motivation A zest-less life Yucky side-effects Parkinson’s disease Tardive dyskinesia

© Kip Smith, 2003 Anti-anxiety drugs Tranquilizers: Reduce tension and anxiety These work by Depressing central nervous system activity (by augmenting the action of the neurotransmitter GABA) Examples: Valium, Librium

© Kip Smith, 2003 ± Anti- tranquilizers Habit forming! Serious addiction problems Interact with alcohol to make a lethal tonic

© Kip Smith, 2003 Anti-Depressant Drugs Their effects: Help to elevate arousal and mood These work by Increasing the availability of serotonin and norepinephrine

© Kip Smith, 2003 Tricyclic anti-depressants Examples: Tofranil, Elavil Block the reuptake of serotonin and norepinephrine into the presynaptic neuron Prolong the effects of the neurotransmitters Side-effects Dry mouth, fatigue

© Kip Smith, 2003 SSRI anti-depressants Selective serotonin reuptake inhibitors Example: Prozac Alter personality, mood becomes more elevated Few side-effects but not as effective as tricyclics for severe depression

© Kip Smith, 2003 Electroconvulsive Therapy (ECT) Its effects: Decreases disabling depression Used only: in rare cases for severe depression in patients not responding to drug treatments It works by: Sending a brief electric current through the brain of the anesthetized patient

© Kip Smith, 2003 ECT Continued How does it work? We don’t know for sure; Maybe it releases neurotransmitters, Maybe causes seizures that calm neural centers Are there any problems? Causes memory loss for the duration of the treatment Otherwise, there appears to be no resulting brain trauma