1. Treatment of Psychological Disorders
Chapter 13
Treatment of Psychological Disorders

2. MODULE 40: Psychotherapy: Psychodynamic, Behavioral, and Cognitive Approaches to Treatment
What are the goals of psychologically- and biologically-based treatment approaches?
What are the psychodynamic, behavioral, and cognitive approaches to treatment?

3. Introduction
Psychotherapy: Psychological techniques are used to help a person overcome psychological difficulties
Biomedical therapy: Relies on drugs and other medical procedures to improve psychological functioning

4. Psychodynamic Approaches to Therapy
Seek to bring unresolved past conflicts and unacceptable impulses from the unconscious into the conscious
Defense mechanisms
Repression - Pushes threatening and unpleasant thoughts and impulses back into the unconscious
Neurotic symptoms

5. Psychoanalysis: Freud’s Therapy
The goal is to release hidden unconscious thoughts and feelings in order to reduce their power in controlling behavior
Free association
Dream interpretation
Manifest content - Surface description
Latent content - Underlying meaning

6. Psychoanalysis: Freud’s Therapy
Resistance - Inability or unwillingness to reveal particular memories, thoughts, or motivations
Transference: Transfer of feelings to a psychoanalyst that had been originally directed to a patient’s parents or other authority figures

7. Contemporary Psychodynamic Approaches
Less emphasis on a patient’s past history, concentrating instead on current relationships and specific complaints
Shorter duration
3 months or 20 sessions

8. Evaluating Psychodynamic Therapy
Criticisms
Time consuming and expensive
Less articulate patients may not do as well as more articulate ones
Difficulty in determining effectiveness of the therapy
Bias
Subjective interpretation

9. Behavioral Approaches to Therapy
Make use of the basic processes of learning, such as reinforcement and extinction, and assume that normal and abnormal behavior are both learned

10. Classical Conditioning Treatments
Aversive conditioning: Reduces the frequency of undesired behavior by pairing with an aversive stimulus
Systematic desensitization: Gradual exposure to an anxiety-producing stimulus is paired with relaxation
Hierarchy of fears

11. Classical Conditioning Treatments
Exposure treatments: People are confronted either suddenly or gradually with a stimulus that they fear
Graded exposure

12. Operant Conditioning Techniques
Rewards a person for desired behavior with a token
Token system
Agreement is drawn stating the behavioral goals the client hopes to achieve
Contingency contracting
Behavior of other people is modeled, to systematically teach people new skills
Observational learning

13. Dialectical Behavior Therapy
Focus is on getting people to accept who they are, regardless of whether it matches their ideals
Teaches behavioral skills that help people behave more effectively and keep their emotions in check

14. Cognitive Approaches to Therapy
Cognitive-behavioral approach
Therapists attempt to change the way people think as well as their behavior
Therapy is highly structured and focuses on concrete problems

15. Evaluating Behavior Therapy
Benefits
Criticisms
Eliminates anxiety disorders
Treats phobias and compulsions
Establishes control over impulses
Helps in learning complex social skills to replace maladaptive behavior
Insight into thoughts and expectations cannot be gained due to the changing external behavior

16. Cognitive Approaches to Therapy
Cognitive treatment approaches: Teach people to think in more adaptive ways by changing their dysfunctional cognitions about the world and themselves
Cognitive-behavioral approach: Incorporates basic principles of learning to change the way people think

17. Cognitive Approaches to Therapy
Rational-emotive behavior therapy
Albert Ellis
Attempts to restructure a person’s belief system into a more logical set of views by challenging dysfunctional beliefs
Aaron Beck
Cognitive appraisal - Evaluation of situations, in terms of one’s memories, values, beliefs, thoughts, and expectations

18. Figure 4 - Rational-Emotive Behavior Therapy

19. Evaluating Cognitive Approaches to Therapy
Benefits
Criticisms
Deals with a broad range of disorders
Willingness of cognitive therapists to incorporate additional treatment approaches
Changing one’s assumptions to make them more reasonable and logical may not always be helpful

20. What are the humanistic approaches to treatment?
MODULE 41: Psychotherapy: Humanistic, Interpersonal, and Group Approaches to Treatment
What are the humanistic approaches to treatment?
What is interpersonal therapy?
How does group therapy differ from individual types of therapy?
How effective is psychotherapy, and which kind of psychotherapy works best in a given situation?

21. Humanistic Therapy
People have control of their behavior, can make choices about their lives, and are essentially responsible for solving their own problems
Self-actualization - State of self fulfillment in which people realize their highest potentials in their own unique way

22. Person-Centered Therapy
Goal is to reach one’s potential for self- actualization
Client-centered therapy
Unconditional positive regard
Expressing acceptance and understanding, regardless of the feelings and attitudes the client expresses
Empathetic

23. Evaluating Humanistic Approaches to Therapy
Criticisms
Treatments lack specificity
Not very precise
Least scientifically and theoretically developed
Works only for highly verbal client who profits most from psychoanalytic treatment

24. Interpersonal Therapy (IPT)
Short-term therapy that focuses on the context of current social relationships
Focuses on interpersonal issues such as conflicts with others, social skills issues, role transitions, or grief
Lasts only for weeks

25. Group Therapies
Therapy in which people meet in a group with a therapist to discuss problems
Often centers on a common difficulty
Example - Alcoholism
More economical means of therapy compared to individual therapy
Criticism - Shy and withdrawn individuals may not receive required attention

26. Group Therapies Family therapy: Focuses on the family and its dynamics
Involves two or more family members, one (or more) of whose problems led to treatment
Self-help therapy
Does not involve a professional therapist
People with similar problems get together to discuss their shared feelings and experiences
Bereavement support group
Alcoholics Anonymous (AA)

27. Evaluating Psychotherapy: Does Therapy Work?
Hans Eysenck published a study challenging the effectiveness of therapy
Spontaneous remission - Recovery without treatment
Meta-analysis - Data from a large number of studies are statistically combined, yields similar general conclusions

28. Effectiveness of Psychotherapy
For most people it is effective
Psychotherapy does not work for everyone
No single form of therapy works best for every problem, and specific types of treatment are better for specific types of problems
Most therapies share several basic similar elements
Client has a positive relationship with therapist
Client receives explanation of symptoms
Client is able to confront negative emotions

29. Figure 1 - Estimates of the Effectiveness of Different Types of Treatment

30. MODULE 42: Biomedical Therapy: Biological Approaches to Treatment
How are drug, electroconvulsive, and psychosurgical techniques used today in the treatment of psychological disorders?

31. Drug Therapy Control of psychological disorders through drugs
Works by altering the operation of neurotransmitters and neurons in the brain

32. Figure 1 - Classes of Drugs Used to Treat Psychological Disorders

33. Drug Therapy
Antipsychotic drugs: Temporarily reduce psychotic symptoms such as agitation, hallucinations, and delusions
Chlorpromazine
Risperidone
Olanzapine
Paliperidone
Symptoms reappear when the drug is withdrawn
Long-term side effects

34. Drug Therapy
Antidepressant drugs: Medications that improve a severely depressed patient’s mood and feeling of well-being
Work by changing the concentration of specific neurotransmitters in the brain
Tricyclic drugs
MAO inhibitors
Selective serotonin reuptake inhibitors (SSRIs)
Lexapro or Prozac

35. Drug Therapy
Mood stabilizers: Drugs used to treat mood disorders that prevent manic episodes of bipolar disorder
Bipolar disorder treatment
Lithium
Depakote
Tegretol
Can be a preventive treatment, blocking future episodes of manic depression

36. Drug Therapy
Antianxiety drugs: Reduce the level of anxiety a person experiences essentially by reducing excitability and increasing feelings of well-being
Alprazolamand
Valium
Produce a number of potentially serious side effects
When taken in combination with alcohol, some antianxiety drugs can be lethal

37. Electroconvulsive Therapy (ECT)
Procedure used in the treatment of severe depression
Electric current of 70 to 150 volts is briefly administered to a patient’s head
Causes loss of consciousness and seizures
Transcranial magnetic stimulation (TMS)
Alternative to ECT
Directs a precise magnetic pulse in a specific area of the brain

38. Psychosurgery
Brain surgery in which the object is to reduce symptoms of a mental disorder
Prefrontal lobotomy
Cingulotomy
For rare cases of OCD
Tissue is destroyed in the anterior cignulate
Gamma knife surgery
Radiation is used to destroy areas of the brain related to OCD

39. Biomedical Therapies in Perspective
Gene therapy
Specific genes may be introduced to particular areas of the brain
May reverse or prevent biochemical events that give rise to disorders
Critics state that therapies merely provide relief of the symptoms and not the underlying problems
New symptoms may be formed

40. Community Psychology: Focus on Prevention
Prevent or minimize the incidence of psychological disorders
Deinstitutionalization: Transfer of former mental patients out of institutions and into the community