Chapter 16 TREATMENT OF PSYCHOLOGICAL DISORDERS

 Analyze This and Analyze That - misconceptions  Types of therapies  Insight therapies  “talk therapy”  Behavior therapies  Changing overt behavior  Biomedical therapies  Biological functioning interventions TYPES OF TREATMENT

 15% of U.S population in a given year  Most common presenting problems  Anxiety and Depression  Treatment seeking for various disorders – Figure 15.1  Mood disorders  Utilization rates – Figure 15.2  Women more than men  Medical insurance  Education level  Psychological Disorders and professional treatment – Figure 15.3 WHO SEEKS TREATMENT?

Figure 15-1 – Treatment seeking for various disorders

Figure 15-2 – Therapy utilization rates – Olfson et al. (2002)

XX 15.3

 Clinical psychologists  Counseling psychologists  Psychiatrists  Clinical social workers  Psychiatric nurses  Counselors  On-line treatment? WHO PROVIDES TREATMENT?

INSIGHT THERAPIES: PSYCHOANALYSIS  Sigmund Freud and followers  Goal: discover unresolved unconscious conflicts - Figure 15.4  Free association  Dream analysis  Interpretation  Resistance and transference  Psychodynamic Therapies

INSIGHT THERAPIES: CLIENT CENTERED THERAPY  Carl Rogers  Cause: Figure 15.5  Goal: restructure self-concept to better correspond to reality  Therapeutic Climate  Genuineness  Unconditional positive regard  Empathy

THERAPIES INSPIRED BY POSITIVE PSYCHOLOGY  Martin Seligman  Uses theory and research to better understand the positive, adaptive, creative, and fulfilling aspects of human existence  well-being therapy  positive psychotherapy  can be an effective treatment for depression – F 15.6

Figure 15.6 Positive psychotherapy for depression

OTHER ISSUES  Groups therapy  Group size  Advantages – social dimension of change  Effectiveness of Insight therapies – Figure 15.7  Spontaneous remission  Talk therapies or other approaches?  Common factors contribute to progress in those treated

Figure 15.7 – Recovery as a function of number of therapy sessions

BEHAVIOR THERAPIES  B.F. Skinner and colleagues  Goal: unlearning maladaptive behavior and learning adaptive ones  Systematic Desensitization – Joseph Wolpe  Classical conditioning – Figure 15.8  Anxiety/Fear hierarchy – Figure 15.9  Aversion therapy – Figure  Alcoholism, sexual deviance, smoking, etc.  Social skills training  Modeling  Behavioral rehearsal  Biofeedback  Operant conditioning flooding  Classical conditioning

XXX 15.8

XXX 15.10

COGNITIVE-BEHAVIORAL THERAPY  Aaron Beck  Cognitive therapy  Depression and negative thinking – Figure  Albert Ellis  Rational-emotive therapy  Goal: to change the way clients think  Detect and recognize negative thoughts  Reality testing  Effectiveness of Behavior Therapies  Efficacy of behavioral interventions for a variety of disorders

XXX 15.11

BIOMEDICAL THERAPIES  Psychopharmacotherapy  Antianxiety - Valium, Xanax, Buspar  Antipsychotic - Thorazine, Mellaril, Haldol  Tardive dyskinesia  Atypical antipsychotic – reduce motor effects and other neurotransmitters  Time course – Figure  Antidepressant: - Actions - Figure  Tricyclics – Elavil, Tofranil  Mao inhibitors (MAOIs) - Nardil  Selective serotonin reuptake inhibitors (SSRIs) – Prozac, Paxil, Zoloft – side effects – Table 15.1  Risk of suicide – Figure  Mood stabilizers  Lithium, Valproic acid  Electroconvulsive therapy (ECT)  Transcranial Magnetic Stimulation  Deep brain stimulation

Figure Antidepressant drugs’ mechanisms of action

Figure Deep brain stimulation

CURRENT TRENDS AND ISSUES IN TREATMENT  Managed care  Empirically validated treatments  Blending Approaches to treatment – Figure  Conjunctive therapy – Figure  Multicultural sensitivity  Deinstitutionalization  Dorthea Dix - Figure  Changes in population – Figure  Factors – treatments, legal, service delivery model  Revolving door problem – Slide 26  Homelessness  Increase use of criminal justice system

Figure The leading approaches to therapy among psychologists

Figure – Relapse rates in Reynolds et al. (1999) study

XX 15.19

Slide 26 – Percentage of psychiatric inpatient admissions that are readmissions

 Psychopharmacology  Antipsychotics (thorazine, haldol)  Anti-anxiety (valium, barbiturates, Xanax)  Mood Disorders (serotonin reuptake inhibitors)  Bipolar (lithium) SOMATIC THERAPIES

Electroconvulsive Therapy (ECT)- for depression Psychosurgury - Prefontal lobotomy SOMATIC THERAPY

LOOKING FOR AT THERAPIST  Factors to consider  Sources of services – Table 15.2  Profession  Gender  Theoretical approach  Comparison of approaches for effectiveness - Figure 15.20

Table 15-2, p. 626

Figure Estimates of the effectiveness of various approaches to psychotherapy.