1. Treatment of Psychological Disorders

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

3. Figure 15.1 Treatment seeking for various disorders.

4. Figure 15.2 Therapy utilization rates

5. Who Provides Treatment?  Clinical psychologists  Counseling psychologists  Psychiatrists  Clinical social workers  Psychiatric nurses  Counselors

6. Psychological Treatment  Inpatient – 24-hour care in a treatment center or hospital  Outpatient – periodic appointments in an office/clinic setting

7. Types of Treatment  Psychotherapy  discussion and specific exercises/techniques that are design to help a client function  Insight therapies  Psychoanalytic, humanistic, and cognitive  Behavior therapies  Changing overt behavior  Biomedical therapies  medication and ECT  Combined – medicine and psychotherapy

8. Insight Therapies: Psychoanalysis  Sigmund Freud and followers  Goal: discover unresolved unconscious conflicts  Free association  Dream analysis  Interpretation  Resistance and transference

9. Insight Therapies: Humanistic or Client- Centered Therapy  Emphasis on how therapist views the person that enters therapy  “Client” instead of “patient”  Client and therapist are equal  Emphasizes free will for the client

10. Client-Centered or Nondirective Therapy  Carl Rogers  Goal: restructure self-concept to better correspond to reality  Therapeutic Climate  Genuineness  Unconditional positive regard  Empathy

11. Gestalt Therapy  Fritz Perls  Goal: continue to grow through insight into feelings  More confrontational  Identify inconsistencies between how they think they act and how they really act

12.  Group therapy  Group of clients experiencing similar problems meet with one or more therapists  Goal: help clients understand they are not alone and identify coping mechanisims  Family therapy  Considers the person within the context of a system and treat the entire system  Goal: to improve the functioning of the family system

13. Cognitive Therapy  Goal: help people change the way that they think about their problems  Develop new strategies (schemas) for approaching one’s experiences and problems  Modeling  Two perspectives  Rational emotive behavior therapy (REBT)  Cognitive therapy

14. Rational Emotive Behavior Therapy (REBT)  Albert Ellis  If people can change their beliefs, produce a change in emotion  Thoughts first, emotions follow  Therapist as teacher to help client develop skills to think more rationally

15. Cognitive Therapy  Aaron Beck  Used in treatment of depression  Detect and recognize negative thoughts  Reality testing  Kinship with behavior therapy

16. Behavior Therapies  Developed from Watson, Pavlov, and Sinner  Goal: unlearning maladaptive behavior and learning adaptive ones  Techniques  Systematic desensitization  Aversion therapy  Extinction  Token economies  Punishment

17. Systematic Desensitization  Mary Cover Jones and Joseph Wolpe  Counter conditioning – extinguishing an unhealthy response and replacing it with a healthy one  Usually with phobias  Anxiety hierarchy – rank order of anxiety- provoking situation from least to most  Relaxation techniques  Pair stimuli in hierarchy with relaxation techniques

18. Aversion therapy  Opposite of systematic desensitization  Increase unpleasant reaction to stimulus  Pairs negative outcome with a previously pleasant stimulus  Alcoholism, sexual deviance, smoking

19. Biomedical Therapies  Psychopharmacotherapy  Antianxiety - Valium, Xanax, Buspar  Antipsychotic - Thorazine, Mellaril, Haldol  Tardive dyskinesia  Clozapine  Antidepressant:  Tricyclics – Elavil, Tofranil  Mao inhibitors (MAOIs) - Nardil  Selective serotonin reuptake inhibitors (SSRIs) – Prozac, Paxil, Zoloft

20. Biomedical Therapies  Psychopharmacotherapy  Mood stabilizers  Lithium  Valproic acid  Electroconvulsive therapy (ECT)  Transcranial magnetic stimulation  Deep brain stimulation

21. Figure 15.13 Antidepressant drugs’ mechanisms of action

22. Figure 15.15 Deep brain stimulation

23. Current Trends and Issues in Treatment  Managed care  Empirically validated treatments  Blending approaches to treatment  Multicultural sensitivity  Deinstitutionalization  Revolving door problem  Homelessness

24. Figure 15.17 The leading approaches to therapy among psychologists

25. Figure 15.19 Declining inpatient population at state and county mental hospitals

26. Figure 15.20 Estimates of the effectiveness of various approaches to psychotherapy.