Introduction to Psychology Treatment of Psychological Disorders

Psychological Therapies Whereas the biological therapies view mental disorders through the medical model, psychological therapies view the roots of abnormal behavior in mental states –Each therapy has its own view as to the cause of mental disorder –Each therapy has its own approach to the treatment of mental disorder

Insight-Oriented Therapy E.g. psychoanalysis, humanistic, gestalt Help person understand the basis of their thinking, behavior, emotions and perceptions Insight into the cause will lead to change Emotion focused therapy or process experiential

Action-Oriented Therapy E.g. Cognitive-Behavioral therapy, Rational-Emotive therapy Encourages individuals to change behavior or thinking Multifaceted and individually tailored Strong therapeutic relationship Behavioral techniques and cognitive restructuring

Varieties of Psychological Treatment Psychodynamic Humanistic Cognitive-behavioral Biological/Biomedical Group therapy Family and marital therapy

Psychodynamic Approach The psychodynamic approach was created by S. Freud –Mental symptoms reflect unconscious conflicts that induce anxiety –Insight refers to the situation in a person comes to understand their unconscious conflicts –Therapeutic change requires an alliance (relationship) between the patient and therapist

Psychodynamic Techniques The goal of psychodynamic therapy is to achieve insight into unconscious conflicts –Free Association refers to a technique in which the patient is encouraged to say whatever comes to mind to reveal the unconscious processes of the patient –Interpretation: Therapist interprets the thoughts, and feelings of the patient in order to reveal the hidden conflicts and motivations –Analysis of transference: Patients bring into therapy their past troubled relationships; these are transferred to the therapist

Humanistic Therapy Roger’s Client-centered therapy Therapeutic Climate 1)Genuineness 2)Unconditional Positive Regard 3)Empathy TherapeuticProcess Guidance, clarification, become more comfortable with genuine self

Behavior Therapies Classical conditioning techniques can alter emotional responses –Systematic desensitization: Patient is encouraged to confront a feared stimulus (snake) while in a relaxed state Therapist trains relaxation Patient constructs an image hierarchy While relaxing, patient imagines the least fearful of the images in their hierarchy (e.g. being on the planet as a snake) –Exposure: Patient is exposed to the stimulus that they fear (locked in a room full of snakes)

Cognitive Therapies Focus of cognitive therapies is on changing dysfunctional thought patterns Rational Emotive Therapy focuses on the hurtful thought patterns of the patient –Ellis’s theory suggests that pathology results when persons adopt illogic in response to life situations –Therapist notes illogical and self-defeating thoughts and teaches alternative thinking that promotes rational thought

Cognitive-Behavioral Therapies Cognitive-behavioral therapies focus on the current behaviors of a person –Emphasis is on the present rather than the past –Cognitive-Behavioral therapists are very directive –Therapy duration is short-term rather than years long –Initial focus is on a detailed behavioral analysis: focus is on the problem behavior and the stimuli associated with it

Cognitive Restructuring Beck or Ellis Irrational beliefs Extreme emotional reactions ABC’s or Rational Emotive Therapy A – activating event B – belief C – consequences (emotional) D – disputing beliefs

Research indicates: Receiving psychotherapy is considerably more effective than no treatment CBT shows a slight but consistent advantage with regards to effectiveness compared to insight-oriented therapy People who do best in therapy are those who have the least problems personality disorders show less benefit

The Medical Model The Medical Model views abnormal behavior as reflecting a biological disorder –Usually localized within the brain –Involving either brain damage or a disruption of the neurotransmitter processes of the brain –Person is viewed as a patient, treated by doctors in a mental hospital –Therapies tend to be physical in nature Drugs (Pharmacotherapy) Surgical alteration of brain (Psychosurgery)

Pharmacotherapy Psychotropic medications are drugs that act on the brain to alter mental function Prior to 1956, schizophrenia was virtually untreatable with many patients confined for life in mental hospitals –Chlorpromazine (Thorazine) was found to reduce severity of psychotic thought, allowing people to live outside of mental institutions Reduced size of institutions –The psychotropic actions of many drugs are often accidentally discoveries

Antipsychotic Medications Schizophrenia can be viewed as composed of: –Positive Symptoms: Presence of hallucinations –Negative Symptoms: Absence of affect Antipsychotic medications refer to drugs that alleviate schizophrenia –Antipsychotic medications are more effective for the positive symptoms than for negative symptoms of schizophrenia

Dopamine and Schizophrenia The positive symptoms of schizophrenia reflect too much brain dopamine activity –Antipsychotic drugs are effective antagonists of dopamine receptors (block the action of dopamine) –Drugs such as amphetamine release dopamine from terminals; too much amphetamine exposure can induce a psychotic state in humans Negative schizophrenic symptoms may reflect brain damage enlarged ventricles)

Antidepressant Medications Depression reflects a disturbance of mood, sleep, and appetite Psychotropic antidepressant drugs can lift depression (require 3-4 weeks for effect) –Tricylic antidepressants: Act by blocking the reuptake of norepinephrine and serotonin –Monoamine oxidase (MAO) inhibitors: MAO degrades transmitters; drugs that inhibit MAO allow the transmitter to work for longer periods –Selective serotonin reuptake inhibitors: Prozac blocks the reuptake of serotonin

Antianxiety Medications Anxiety reflects an intense emotional state of dread and apprehension Drugs such as Valium increase the activity of the transmitter GABA to dampen the neural activity of the brain –Valium is useful in the short-term treatment of anxiety Antianxiety medications can result in drug dependence

Electroconvulsive Therapy Antidepressant drugs require 3-4 weeks to take action on mood; the person may be at risk for suicide or is not responding to drug treatment Electroconvulsive shock therapy (ECT) refers to the intentional induction of a brain seizure by shock administered to either or both hemispheres –ECT produces immediate improvement in mood (explanation is unknown) –Side effects of ECT include memory loss

Common Factors in Psychotherapy Development of a therapeutic alliance Providing a rationale Opportunity for catharsis or venting Acquisition and practice of new behaviors Beneficial therapist qualities (objective, confidential, professional) Patient positive expectations and hope

Eclecticism Involves using different treatments for different clients with different problems Using a reasonable combination of various treatments for the same client (technical eclecticism) - all populations can receive different types of group therapy

Advantages to groups 1.Efficiency 2. Universality 3.Empathy4. Interaction 5. Acceptance6. Altruism 7.Modeling8. Pressure 9. Practice10. Reality testing 11. Transference

Suicide Risk Factors Diathesis psychological disorder (90%) substance use and abuse (25-50%) family history of suicide family breakdown societal breakdown past suicide attempts

Suicide Risk Factors Stress -changes in relationships, academic/work, or financial situation -life event that is shameful or humiliating -significant loss -homosexuality -recent suicide

Suicide Warning Signs -withdrawal -change in eating, sleeping, friends -writing and talking about death -telling statements -agitation followed by calm resignation -giving away valued possessions

What to do as a friend Take suicide threats seriously Don’t be afraid to discuss suicide Recognize the warning signs and the risk factors Don’t leave the person alone Get help

What to do as a therapist Ask directly about suicide Find out if they have a plan Do they feel like they are in control of their behaviour? Develop a safety plan Make a contract Treat the psychological disorder Crisis situation – break confidentiality Grief after suicide...