1. Table of Contents STUDY FOR THE QUIZ This quiz will Lorena Bobbit the gentlemen if they are not prepared. To the ladies, imagine something equally horrible. Like childbirth or something. Or having to marry Victor. STUDY! 7/10/2016 1

2. 2 Treatment of Psychological Disorders Chapter 15

3. Table of Contents 7/10/2016 3 Types of Treatment Psychotherapy all the diverse approaches used in the treatment of mental disorder and psychological problems Classifications of Psychotherapy A. Insight therapies “talk therapy” B. Behavior therapies Use of conditioning/behavior modification techniques to change overt behavior C. Biomedical therapies Biological functioning interventions

4. Table of Contents 7/10/2016 4 Did you know… 15% of the U.S. population seeks mental health treatment in a given year? The most commonly presented problem are depression and anxiety.

5. Table of Contents 7/10/2016 5 Therapy Utilization Rates

6. Table of Contents 7/10/2016 6 Did you know… that women are more likely to seek treatment? Does this have it have something to do with not wanting to ask for directions too? I think I see a correlation!

7. Table of Contents 7/10/2016 7 Psychological Disorders & Treatment

8. Table of Contents 7/10/2016 8 Who Provides Treatment? Psychiatrists (M.D.)  Physicians who specialize in treating psychological disorders  * They can prescribe medications,  Tend to see those with the most serious problems Clinical psychologists (Ph.D., Psy.D., or Ed.D.)  expertise in research, assessment, and therapy, supplemented by a supervised internship  About half work in agencies and institutions, half in private practice Counseling psychologists (Ph.D., Psy.D., or Ed.D.)

9. Table of Contents Clinical social workers (Master’s degree)  two-year Master of Social Work graduate program plus postgraduate supervision  offer psychotherapy, mostly to people with everyday personal and family problems Psychiatric nurses (Bachelor’s or Master’s) Counselors (Master’s)  Marriage & family counselors  Pastoral counselors  Abuse counselors 7/10/2016 9

10. Table of Contents 7/10/2016 10 Who’s Providing Therapy?

11. Table of Contents 7/10/2016 11 A. Insight Therapies: verbal interactions intended to enhance clients’ self-knowledge, thus promote healthful changes in personality and behavior. 1. Psychoanalysis Sigmund Freud and followers Goal: discover unresolved unconscious conflicts Therapeutic Process Free association Dream analysis Hypnosis Interpretation Resistance Transference

12. Table of Contents 7/10/2016 12 A Freudian View: The Roots of a Disorder

13. Table of Contents 7/10/2016 13 Insight Therapies (con’t) 2. Humanist Therapies a. Client Centered Therapy insight therapy that emphasizes providing a supportive emotional climate for clients, who play a major role in the pace and direction of their therapy Carl Rogers (1950’s) Goal: restructure self-concept to better correspond to reality (become more congruent) Therapeutic Climate Genuineness Unconditional positive regard (warmth) Empathy Encounter groups

14. Table of Contents 7/10/2016 14 A Rogerian View: The Roots of a Disorder

15. Table of Contents 7/10/2016 15 Insight Therapies (con’t) b. Gestalt Therapy Insight therapy in which client confronts past and present experiences in an attempt to restore a sense of completeness ~ “whole self” More intensive and directed than client-centered therapy

16. Table of Contents 7/10/2016 16 Insight Therapies (con’t ) 3. Cognitive Therapy Insight therapy that emphasizes recognizing and changing negative thoughts and maladaptive beliefs (Note: sometimes called cognitive –behavioral therapy ~ use of behavioral techniques along w/ individual’s perception to change behavior/cognitions) Goal: restructure inappropriate/ “defeatist” thinking Detect and recognize negative thoughts Reality testing Use of behavioral techniques to change behavior

17. Table of Contents 7/10/2016 17 Insight Therapies (con’t ) “The Cognitive Revolution”

18. Table of Contents 7/10/2016 18 Insight Therapy (con’t) a. Beck’s Cognitive therapy Aaron Beck Belief: disorders result from distorted thinking about the “cognitive triad” self world/experiences future Goal: Restructure thinking Early view dealt w/ depression, later expanded to additional disorders

19. Table of Contents 7/10/2016 19 Did you know… people with higher education levels & medical insurance also seek treatment more often? Another correlation!

20. Table of Contents 7/10/2016 20 Beck’s View: The Roots of a Disorder

21. Table of Contents 7/10/2016 21 Insight Therapy (con’t) Results: Cognitive therapy for depression

22. Table of Contents 7/10/2016 22 Insight Therapy (con’t) b. Rational-Emotive therapy (RET) Direct (confrontational) therapy in which therapist confront client’s illogical beliefs w/ rational arguments Developed by Albert Ellis Goal: restructure thinking and view environment more realistically Updated to Rational-Emotive Behavioral Therapy (1993)

23. Table of Contents 7/10/2016 23 EXAMPLE: Rational-Emotive therapy (RET) Negative thought: “If I don’t get an A on this paper, my life will be ruined.” Rational Response: “My life will be a lot worse if I keep getting incompletes. It is better to get a B or even a C than to do nothing at all.” Negative thought: “My teacher will think I am an idiot when she reads this, I’ll feel humiliated.” Rational Response: “She’s never accused me of being an idiot before. If she makes some criticisms, I can learn from them and do better next time.”

24. Table of Contents 7/10/2016 24 Did you know… altering any one component of the chemistry-cognition-mood circuit can alter the others?

25. Table of Contents 7/10/2016 25 Insight Therapy (con’t) c. Stress-Inoculation Therapy Use of negative cues to initiate positive self statements d. Social skills training Modeling (based on Bandura’s work)

26. Table of Contents 7/10/2016 26 Insight Therapy (con’t) 4. Family & Group therapy Family Therapy designed to investigate and treat the social network of the family unit along with the individual Group Therapy within a “safe setting” for a group Basic format: self-revelation Note: a self-help group, though therapeutic, is NOT psychotherapy

27. Table of Contents Behavior Therapies 7/10/2016 27

28. Table of Contents 7/10/2016 28 B. Behavior Therapies: the application of learning principles to change/eliminate maladaptive behaviors. B.F. Skinner & colleagues Goal: unlearning maladaptive behavior and learning adaptive ones 1. Counterconditioning A. Systematic Desensitization – client associates a pleasant, relaxed state with gradually increasing anxiety-triggering stimuli Developed by Joseph Wolpe Based on Classical conditioning Uses Mary Cover-Jones’ earlier “reconditioning” experiments, but replaces food w/ relaxation

29. Table of Contents 7/10/2016 29 Behavior Therapy con’t 3 steps: build an anxiety hierarchy (a ranked list of anxiety- arousing stimuli) client is trained in deep muscle relaxation work through the hierarchy, while remaining relaxed “in vivo” desensitization – use of real rather than imagined fear- eliciting stimulus Effective phobia treatment

30. Table of Contents 7/10/2016 30 Conditioned Phobias & Systematic Desensitization

31. Table of Contents 7/10/2016 31 Behavior Therapy con’t B. Aversive Conditioning (aka Aversion Therapy) Type of type of counterconditioning that tries to associate an unpleasant state with an already acquired negative/unwanted behavior Ex: antabuse (alcohol  nausea) Used for Alcoholism, sexual deviance, smoking, etc.

32. Table of Contents 7/10/2016 32 Behavior Therapy con’t 2. Extinction Methods (aka. Exposure Therapy) Use of massive amounts of anxiety in a non-threatening environment to extinguish a behavior, typically a phobia a. Flooding extinction method, used to treat phobias, that exposes the individual to real-life anxiety eliciting stimuli and escape is prevented Based on classical conditioning Explanation: the CS loses it’s ability to elicit the CR (fear) when no longer paired with the US

33. Table of Contents 7/10/2016 33 Behavior Therapy con’t Example: treating fear of flying

34. Table of Contents 7/10/2016 34 Behavior Therapy con’t b. Implosive Therapy Extinction method used to treat phobias in which the fear- eliciting events are presented in imagined form Uses an unrealistic verbal description presented by the therapist Based on classical conditioning (CC) * Extinction methods (Flooding & implosive therapy) differ from desensitization in that the individual works through the anxiety as opposed to avoiding it!

35. Table of Contents 7/10/2016 35 Behavior Therapy con’t 3. Token Economy (B.F. Skinner)  an operant conditioning procedure that rewards desired behavior  patient exchanges a secondary reinforcer, earned for exhibiting the desired behavior, for various privileges or treats

36. Table of Contents 7/10/2016 36 C. Biomedical Therapies: physiological interventions intended to reduce symptoms associated with psychological disorders 1. Psychopharmacotherapy (drug therapy) A. 3 Major Categories 1. Antianxiety Compounds Relieve tension, apprehension, nervousness Early compounds were barbiturates 1960’s - benzodiazepines introduced (ex: Valium, Xanax) New compound : Buspar

37. Table of Contents 7/10/2016 37 Biomedical Therapies con’t 2. Antipsychotics (a.k.a neuroleptics) Reduce psychotic symptoms, including hyperactivity, mental confusion, hallucinations, and delusions Decreases activity @ the dopamine synapse Examples: Thorazine, Mellaril, Haldol Side effects Tardive dyskinesia (an incurable neurological disorder marked by tics and spasms) Parkinson’s disease Newer compound: Clozapine (less motor side effects)

38. Table of Contents 7/10/2016 38 Biomedical Therapies con’t 3. Antidepressants: Tricyclics Purpose: block neurotransmitter reuptake Examples: Elavil, Tofranil Mao inhibitors (MAOIs) MAO: enzymes that breaks down monoamine neurotransmitters (i.e.norepinephrine, dopamine, serotonin) in the synaptic cleft MAO I s reduce MAO, therefore, transmitters stay in cleft longer Example: Nardil Selective serotonin reuptake inhibitors (SSRIs) Operate on the serotonin synapse Examples: Prozac, Paxil, Zoloft Most frequently prescribed

39. Table of Contents 7/10/2016 39 Various Antidepressants & their Synaptic Impact

40. Did you know… chocolate contains tetrahydro-beta- carbolines which affects the central nervous system in several ways: 1. They are mild inhibitors of a MAO. 2. They inhibit the reuptake of the serotonin. 3. They inhibit the binding of benzodiazepines on their receptors resulting in a decrease in the level of the neurotransmitter GABA. Nueroscience for Kids Website

41. Table of Contents 7/10/2016 41 Biomedical Therapies con’t B. Mood stabilizers Not in the 3 major categories, but important for “bipolar” treatment Examples Lithium (can be toxic, requires monitoring) Valproic acid

42. Table of Contents 7/10/2016 42 Biomedical Therapies con’t 2. Electroconvulsive therapy (ECT) administration of a bilateral or unilateral electric shock to produce a cortical seizure Used w/ unipolar and bipolar disorders may increase responsiveness, therefore, allowing use of other treatments Noted side effects: memory loss hippocampus and amygdala damage in animals peaked in 40s and 50s; a recent resurgence

43. Table of Contents 7/10/2016 43 Biomedical Therapies con’t 3. Psychosurgery surgery designed to alter the behavior of profoundly disturbed patients by lesioning a portion of the brain Example: prefrontal lobotomy Historic case: Phineous Gage 1848 Psychosurgery roots Trephining

44. Table of Contents 7/10/2016 44 Science “off track” Transorbital or "ice pick" lobotomy – a crude and destructive brain- scrambling operation performed on thousands of psychiatric patients between the 1930s and 1960s Touted as a cure for mental illness. Walter J. Freeman performs a lobotomy in 1949. (Bettmann/corbis) By Sandra G. BoodmanSandra G. Boodman Washington Post Staff Writer January 15, 2008

45. Table of Contents 7/10/2016 45 Hollywood Hank “The Lobotomist” Clip (In class)

46. Table of Contents 7/10/2016 46 II. Current Trends & Issues in Treatment Managed care Empirically validated treatments Blending Approaches to treatment Multicultural sensitivity Deinstitutionalization (1963) Revolving door problem Homelessness

47. Table of Contents 7/10/2016 47 Inpatient Population @ State and County Facilities

48. Table of Contents 7/10/2016 48 Readmission Rate @ Various Facilities

49. Table of Contents 7/10/2016 49 THE END! Finish your cards & study for the test! 100 multiple choice questions & a free response