Treatment of Disorders

History of Treatment

Ethical Issues in Treatment Deinstitutionalization occurred during the mental health movement of the 1960s Don’t exclude mentally ill from society, but help them function within society Shorten in-patient treatment (only keep in hospital if necessary) More out-patient care APA guidelines 

Who Provides Treatment? Psychiatrists – Medical doctors, MD Psychologists – PhD, PsyD, some MA Clinical Social Workers, MA Marriage/Family Therapists, MA Licensed Professional Counselors, MA Psychiatric Nurses, RN Substance Abuse Counselors, CADC Pastoral Counselors

Psychotherapy – trained therapist uses psychological techniques to help someone to overcome problems or difficulties Biomedical therapy – prescribed medication that acts on nervous system Eclectic approach – use a blend of therapies and approaches

Psychoanalysis Free association Transference Say whatever comes to mind, no censoring of thoughts Overcome resistance (blocking of anxiety-laden material) Transference Patient transfers unconscious feelings towards someone else onto the therapist i.e. patient w/Electra complex has attraction to Freud (transfers attraction to father onto therapist)

Type of Therapy Cause/Problem Aim of Treatment Psychodynamic Unconscious forces & childhood experiences Reduce anxiety through self-insight; analysis & interpretation Client-centered (Humanistic) Barriers to self-understanding & self-acceptance Personal growth through self-insight Behavior Maladaptive behaviors (learned or observed) Extinguish maladaptive behaviors Cognitive Negative, self-defeating thoughts Healthier thinking, positive self-talk Group (Family) Stressful relationships Relationship healing, better communication Biomedical Chemical imbalances or nervous system dysfunction Prescribed medications of medical surgery

Psychodynamic Childhood experiences Enhance self-insight Interpersonal therapy – brief (12-16 session) treatment, effective for depression

Psychoanalysis v. Humanistic Humanistic therapies differ from psychoanalysts in focusing on… 1) Present & future (not past) 2) Conscious rather than unconscious 3) Immediate responsibility 4) Promoting growth instead of curing illness

Client-Centered Therapy (Carl Rogers) Nondirective  Active listening Clarification or “reflect” what has been said back to patient Genuineness, acceptance, empathy Unconditional positive regard  no judgment

Behavior Therapies – Classical Conditioning Counterconditioning Pair feared stimulus w/good outcome Exposure therapy Learn relaxation techniques Systematic desensitization hierarchy Aversive conditioning Pair the undesirable behavior with bad outcome

Behavior Therapy Systematic Desensitization

Behavior Therapy Aversion therapy for alcoholics

Behavior Therapies – Operant Behavior Modification – use reinforcement to increase desired behaviors Token Economy – provide “tokens” each time desired behavior is performed that can be redeemed later for a bigger reward

Cognitive Therapies Cause = irrational thinking patterns Aim = correct habitual thinking errors Aaron Beck’s Cognitive(-Behavioral) Therapy  Cognitive Triad 1) Negative feelings about self “I am a failure” 2) Negative feelings about world “The world is unfair” 3) Negative feelings about future “The future is hopeless, it will never get better”

Beck’s Cognitive Therapy for Depression Over-generalization  drawing general conclusions from a single (usually negative) event. E.g. thinking that failing to be promoted at work means a promotion will never come. Minimalization and Maximization  Getting things out of perspective: e.g. either grossly underestimating own performance or overestimating the importance of a negative event. Dichotomous thinking  Thinking that everything is either very good or very bad so that there are no gray areas. In reality, of course, life is one big gray area.

Cognitive-Behavioral Therapies Albert Ellis’s Rational Emotive Behavior Therapy (REBT) The A-B-C model A= Adversity (anticipating event) B = Belief about “A” C = Consequences (behavioral, emotional)

Evaluating Psychotherapies To whom do people turn for help for psychological difficulties?

Is Psychotherapy Effective? Overestimation Clients enter in crisis (temporary) Want to believe it was worth the effort Placebo effect (expect to get better) Regression toward the mean (the usual state is better than rock bottom, which is where most patients start)

Is Psychotherapy Effective? Those not treated often improve, but those undergoing therapy are more likely to improve No one therapy is best in all cases Evidence-based practice – clinical decision making that integrates best available research w/clinical expertise and patient characteristics

Three Benefits of Psychotherapies Offer expectation that things can and will get better Offers plausible explanation for symptoms and alternative way of thinking Effective therapists are empathetic and seek to understand  builds trust

Evaluating Psychotherapies Poor outcome Good outcome Average untreated person psychotherapy client Number of persons 80% of untreated people have poorer outcomes than average treated person

Biomedical Therapies Psychopharmacology

Antipsychotic Drugs Treats schizophrenia Decrease receptiveness to irrelevant stimuli Block dopamine Thorazine, Haldol, neuroleptics Atypical antipsychotics (Clozapine) Tardive dyskinesia – involuntary movements of face, tongue, limbs

Antianxiety Drugs Depress CNS activity (tranquilizers – benzodiazepines) Boost GABA Xanax, Ativan, D-cycloserine Can lead to psychological and physiological dependence Treats anxiety disorders (PTSD, OCD)

Antidepressant Drugs Increase serotonin & norepinephrine Selective Serotonin Reuptake Inhibitors (SSRIs) Prozac, Zoloft, Paxil Block reabsorption of serotonin from synapse Treat depression, some anxiety disorders (OCD) Tricyclics are more effective (serotonin & norepinephrine)

Lithium Mood stabilizer Treats bipolar disorder Lowers risk of suicide

Brain Stimulation Techniques Electroconvulsive Therapy (ECT) Repetitive transcranial magnetic stimulation (rTMS)

Psychosurgery Removes or destroys brain tissue to change behavior Lobotomy ONLY USED IN EXTREME CASES