1. Chapter 15: Treatment of Psychological Disorders

2. Chapter 15: Treatment of Psychological Disorders
Who Seeks Treatment?
15% of U.S. population in a given year
Most common presenting problems
Anxiety & Depression
Women more than men
Medical insurance
Education level
Chapter 15: Treatment of Psychological Disorders

3. Therapy Utilization Rates
Chapter 15: Treatment of Psychological Disorders

4. Psychological Disorders & Professional Treatment
Chapter 15: Treatment of Psychological Disorders

5. Who Provides Treatment?
Psychologists. Must earn Doctorate Degree
Clinical psychologists. “Full fledged disorders”, psychological testing, psychotherapy, & research
Counseling psychologists. “Treat everyday problems”, psychological testing, psychotherapy, & research
Psychiatrists. Diagnosis & treatment of disorders including severe (schizo/mood). M.D. degree & Drug Treatment
Other Mental Health Professionals
Clinical social workers. Masters, integrate patients back into society.
Psychiatric nurses. B.A. or Masters, impatient treatment
Counselors. Masters, work in schools, colleges, family planning, rehab & drug counseling
Chapter 15: Treatment of Psychological Disorders

6. Chapter 15: Treatment of Psychological Disorders
Types of Treatment
Psychotherapy
Insight therapies
“talk therapy” (Family/Martial)
Behavior therapies
Changing overt behavior
Biomedical therapies (Drugs)
Biological functioning interventions
Chapter 15: Treatment of Psychological Disorders

7. Insight Therapies: Psychoanalysis
Insight. Verbal interactions intended to enhance self knowledge & promote healthy changes in personality & behavior.
Sigmund Freud & followers
Goal: discover unresolved unconscious conflicts, by probing to find issues using these techniques
Free association. Uncensored spontaneous thoughts
Dream analysis. Symbolic meaning of dreams
Interpretation. Explain the inner significance
Resistance & transference
Chapter 15: Treatment of Psychological Disorders

8. Freud’s View of The Roots of Disorders
Chapter 15: Treatment of Psychological Disorders

9. Insight Therapies: Client-Centered Therapy
Carl Rogers (Humanistic)
Goal: restructure self-concept to better correspond to reality (the problem is incongruence)
Active Listening: empathic listening, echoing, restates, & clasifies
Therapeutic Climate (reduce defenses)
Genuineness. Therapist must be honest
Unconditional positive regard. Complete acceptance
Empathy. Therapist must understand
Therapeutic Process. Must work together & use clarification
Chapter 15: Treatment of Psychological Disorders

10. Rogers’s View of The Roots of Disorders
Chapter 15: Treatment of Psychological Disorders

11. Insight Therapies: Cognitive Therapy
Aaron Beck & Albert Ellis. Focused on recognizing & changing negative thoughts or maladaptive beliefs.
Goals & Techniques. Help clients see how unrealistic their thought are.
Rationale Emotive Therapy: confronting the paitent’s illogical assumptions by emphasizing behavioral homework
Kinship with Behavioral Therapy. HW is common, to engage in responses outside of the office.
Chapter 15: Treatment of Psychological Disorders

12. Beck’s View of The Roots of Disorders
Chapter 15: Treatment of Psychological Disorders

13. Insight Therapy: Group Therapy
Group Therapy. Simultaneous treatment of 4 to 15 people, 8 is ideal.
Participants Role. Function as therapist for each other, describe problems, share experiences & discuss strategies. Provide acceptance & emotional support. They work hard to display healthy changes to win the groups approval
Therapist Role. Selecting participants, setting the goals for the group, initiating & maintaining therapeutic process, protecting clients from harm.
Advantages. Save time & money, patients realize their misery is not alone, & they work on social skills.
Chapter 15: Treatment of Psychological Disorders

14. Evaluating Insight Therapies
Meta-analysis
procedure for statistically combining the results of many different research studies
80% of untreated people
have poorer outcomes than
the average treated person
Number of
persons
Average
psychotherapy
client
untreated
person
Poor
outcome
Good
Chapter 15: Treatment of Psychological Disorders

15. Chapter 15: Treatment of Psychological Disorders
Behavior Therapies
B.F. Skinner & colleagues
Goal: unlearning maladaptive behavior & learning adaptive ones
Flooding extreme
Systematic Desensitization (Joseph Wolpe) Used to reduce phobias through counter conditioning. To relax instead of anxiety.
Classical conditioning
Anxiety hierarchy. Least to Most Fear & client must work through it while remaining relaxed.
Chapter 15: Treatment of Psychological Disorders

16. The Logic Underlying Systematic Desensitization
Chapter 15: Treatment of Psychological Disorders

17. Chapter 15: Treatment of Psychological Disorders
Behavior Therapies
Counterconditioning
Token Economy operant conditioning (rewards for behavior)
Aversion therapy (last resort therapy)
Aversive stimulus is paired a stimulus that elicits an undesirable response
Alcoholism, sexual deviance, smoking, etc.
Social skills training. To improve interpersonal skills
Modeling
Behavioral rehearsal
Shaping
Chapter 15: Treatment of Psychological Disorders

18. Evaluating Behavioral Therapies
Not effective globally
Only effective for Phobias, OCD, Sexual Dysfunctions, Schizophrenia, Drug Problems & Eating Disorders
Chapter 15: Treatment of Psychological Disorders

19. Biomedical Therapies: Treatment with Drugs
Psychopharmacotherapy (Drug Therapy)
Antianxiety Drugs- Relieves tension, apprehension & nervousness. Valium, Xanax, Benzodizepine(tranquilizer)
-Side Effects: Drowsiness, depression, nauseam confusion, drug dependence, overdose, withdrawal symptoms.
2. Antipsychotic Drugs- Treat Schizophrenia/mood disorders it gradually reduces psychotic symptoms including hyperactivity, mental confusion, hallucinations & delusions, decrease dopamine. Schizophrenia patients are placed on it indefinitely. Thorazine, Mellaril, Haldol Side Effects include: Drowsiness, constipation, cotton mouth, tremors
<Tardive dyskinesia % of long term use. Ticks
<Clozapine. Atypical drug when patients do not respond
Chapter 15: Treatment of Psychological Disorders

20. Chapter 15: Treatment of Psychological Disorders
Biomedical Therapies
3. Antidepressant Drugs- Elevate mood, helps 2/3 of people
Tricyclics – Elavil, Tofranil
Mao inhibitors (MAOIs) - Nardil
Selective serotonin reuptake inhibitors (SSRIs) – Prozac, Paxil, Zoloft
Side Effects include: Suicide, Homicide, weight gain, sleep problems & sexual dysfunctions
4. Mood stabilizers
Lithium. Used to control mood swings (bipolar) it prevents future episodes
Valproic acid. Treats bipolar with less adverse effects
Side Effects include: Toxic blood, kidney & thyroid gland complication
Chapter 15: Treatment of Psychological Disorders

21. Antidepressant Drugs’ Mechanisms of Action
Chapter 15: Treatment of Psychological Disorders

22. Electroconvulsive therapy (ECT)
Came from the idea that epilepsy & schizophrenia could not coexist. So it was used to cure schizophrenia by inducing seizures with electric shock.
Electric Shock produced cortical seizures accompanied by convulsions. Shock the right hemisphere for 1 second & triggers seizures for 30 seconds, patients are given light anesthesia 1 or 2 hours following treatment.
Patients were confused, disorientated & nausea. Memory loss are common short term effects. Only 8% of psychiatrist administer ECT (100,000 people yearly)
Effectiveness: Over 50% relapse within 6 to 12 months
Chapter 15: Treatment of Psychological Disorders

23. Chapter 15: Treatment of Psychological Disorders
Biomedical Therapies
Comparing Treatments for Depression
Cognitive Antidepressant Electroconvulsive
Therapy Drugs Therapy
Percent marked
Improvement % % %
Relapse rate moderate moderate to high moderate to high
Side effects none moderate severe
Time scale months weeks days
Overall very good useful to very good useful to very good
Chapter 15: Treatment of Psychological Disorders

24. Current Trends & Issues in Treatment
Managed care.
Fee for Service System. Medicaid/Medicare, Prepaid plan with co-pay (HMO).
Empirically validated treatments. Solid research based attesting to their effectiveness.
Blending Approaches to treatment. Blending 2 or more perspectives.
Multicultural sensitivity. Cultural, language, access & institutionalization barriers
Chapter 15: Treatment of Psychological Disorders

25. Declining Inpatient Population at State & County Mental Hospitals
Chapter 15: Treatment of Psychological Disorders

26. Institutional Treatment in Transition
Mental Hospital. A mental institution providing inpatient care for psychological disorders.
Disenchantment with Mental Hospitals. Underfunded, overcrowded & understaffed. Untrained & overworked contribute to developing more disorders.
Deinstitutionalization. Transferring the treatment from inpatient to outpatient.
Revolving door problem
Homelessness
1/3 of homeless people suffer from a mental disorder, 1/3 suffer from alcohol or drug abuse.
Chapter 15: Treatment of Psychological Disorders

27. Percentage of Psychiatric Inpatient Admissions that are Re-Admissions
Chapter 15: Treatment of Psychological Disorders