Chapter 15 Treatment of Psychological Disorders

n Psychotherapy  Insight therapies “Talk therapy”  Behavior therapies Changing overt behavior  Biomedical therapies Biological functioning interventions Types of Treatment

n 15% of U.S population in a given year n Most common presenting problems  Anxiety and Depression n Women more than men n Medical insurance n Education level Who Seeks Treatment?

Figure 15.3 Who people see for therapy. Based on a national survey by Olfson and Pincus (1994), this pie chart shows how therapy visits were distributed among psychologists, psychiatrists, other mental health professionals (social workers, counselors, and such) and general medical professionals (typically physicians specializing in family practice and internal medicine). As you can see, psychologists and psychiatrists account for about 62% of outpatient treatment.

n Clinical psychologists n Counseling psychologists n Psychiatrists n Clinical social workers n Psychiatric nurses n Counselors Who Provides Treatment?

n Sigmund Freud and followers  Goal: discover unresolved unconscious conflicts Free association Dream analysis Interpretation  Resistance and transference Insight Therapies: Psychoanalysis

Figure 15.4 Freud’s view of the roots of disorders. According to Freud, unconscious conflicts between the id, ego, and superego sometimes lead to anxiety. This discomfort may lead to pathological reliance on defensive behavior.

Figure Signs of resistance. Resistance in therapy may be subtle, but Ehrenberg and Ehrenberg (1986) have identified some telltale signs to look for.

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

Figure 15.5 Rogers’s view of the roots of disorders. Rogers’s theory posits that anxiety and self-defeating behavior are rooted in an incongruent self-concept that makes one prone to recurrent anxiety, which triggers defensive behavior, which fuels more incongruence.

n Aaron Beck  Cognitive therapy n Albert Ellis  Rational-emotive therapy n Goal: to change the way clients think  Detect and recognize negative thoughts  Reality testing  Kinship with behavior therapy Insight Therapies: Cognitive Therapy

Figure 15.6 Beck’s view of the roots of disorders. Beck’s theory initially focused on the causes of depression, although it was gradually broadened to explain other disorders. According to Beck, depression is caused by the types of negative thinking shown here.

n B.F. Skinner and colleagues  Goal: unlearning maladaptive behavior and learning adaptive ones Systematic Desensitization – Joseph Wolpe  Classical conditioning  Anxiety Hierarchy Aversion therapy  Alcoholism, sexual deviance, smoking, etc. Social skills training  Modeling  Behavioral rehearsal Biofeedback Behavior Therapies

Figure 15.7 The logic underlying systematic desensitization. Behaviorists argue that many phobic responses are acquired through classical conditioning, as in the example diagrammed here. Systematic desensitization targets the conditioned associations between phobic stimuli and fear responses.

Figure 15.9 Aversion therapy. Aversion therapy uses classical conditioning to create an aversion to a stimulus that has elicited problematic behavior. For example, in the treatment of drinking problems, alcohol may be paired with a nausea-inducing drug to create an aversion to drinking.

n Psychopharmacotherapy  Antianxiety - Valium, Xanax, Buspar  Antipsychotic - Thorazine, Mellaril, Haldol Tardive dyskinesia Clozapine  Antidepressant: Tricyclics – Elavil, Tofranil Mao inhibitors (MAOIs) - Nardil Selective serotonin reuptake inhibitors (SSRIs) – Prozac, Paxil, Zoloft  Lithium n Electroconvulsive therapy (ECT) Biomedical Therapies Launch Video

Figure The time course of antipsychotic drug effects. Antipsychotic drugs reduce psychotic symptoms gradually, over a span of weeks, as graphed here. In contrast, patients given placebo pills show little improvement. (Data from Cole, Goldberg, & Davis, 1966; Davis, 1985)

Figure Antidepressant drugs’ mechanisms of action. The three types of antidepressant drugs all increase activity at serotonin synapses, which is probably the principal basis for their therapeutic effects. However, they increase serotonin activity in different ways, with different spillover effects (Marangell et al. 1999). Tricyclics and MAO inhibitors have effects at a much greater variety of synapses, which presumably explains why they have more side effects. The more recently developed SSRIs are much more specific in targeting serotonin synapses.

n Managed care n Empirically validated treatments n Blending Approaches to treatment n Multicultural sensitivity n Deinstitutionalization Current Trends and Issues in Treatment

Figure Percentage of psychiatric inpatient admissions that are readmissions. The extent of the revolving door problem is apparent from these figures on the percentage of inpatient admissions that are readmissions at various types of facilities. (Data from the National Institute of Mental Health)