1. Psychological Science, 3rd Edition Michael Gazzaniga Todd Heatherton Diane Halpern

2. Treating Disorders of the Mind and Body 15

3. Questions to Consider: How Are Mental Disorders Treated? What Are the Most Effective Treatments? Can Personality Disorders Be Treated? How Should Childhood and Adolescent Disorders Be Treated?

4. How Are Mental Disorders Treated? Psychotherapy Is Based on Psychological Principles Culture Can Affect the Therapeutic Process Medication Is Effective for Certain Disorders Alternative Biological Treatments Are Used in Extreme Cases Pseudotherapies Can Be Dangerous

5. Learning Objectives Recognize different styles of psychotherapy. Describe the uses, mechanisms, and side effects of common psychotropic medications.

6. Psychotherapy Is Based on Psychological Principles With over 400 psychological therapies available, the precise techniques used by individual therapists may vary widely One factor known to affect the outcome of therapy is: The relationship between the therapist and the client

7. Psychotherapy Is Based on Psychological Principles Psychodynamic therapy focuses on insight: Along with Josef Breuer, Sigmund Freud pioneered the method of psychoanalysis Treatment involved uncovering unconscious feelings and drives that, Freud believed, gave rise to maladaptive thoughts and behaviors Techniques included free association and dream analysis

8. Psychotherapy Is Based on Psychological Principles The general goal of psychoanalysis is to increase clients’ awareness (insight) of these unconscious processes and how they affect daily functioning Over the past few decades, psychodynamic therapy has become controversial due to: Its expense, the length of time required for treatment, and the lack of evidence of effectiveness for most disorders

9. Psychotherapy Is Based on Psychological Principles Humanistic therapies focus on the whole person: Emphasizes personal experience, belief systems and the phenomenology of individuals The goal of humanistic therapy is to treat the person as a whole

10. Psychotherapy Is Based on Psychological Principles Key ingredients of client-centered therapy include: Creating a safe and comforting setting, empathy, reflective listening, and unconditional positive regard Many techniques advocated by Rogers are used currently to establish a good therapeutic relationship between practitioner and client

11. Psychotherapy Is Based on Psychological Principles Cognitive-behavioral therapy targets thoughts and behaviors: Many of the most successful therapies involve trying to change people’s behavior and cognition directly Beck pioneered cognitive restructuring Ellis promoted rational-emotive therapy

12. Psychotherapy Is Based on Psychological Principles Examples of these treatments include: behavior modification, modeling, social skills training, cognitive therapy and cognitive behavior therapy (CBT) Interpersonal therapy integrates insight therapy with cognitive therapy CBT is one of the most effective treatments available for anxiety and mood disorders Exposure is an effective treatment for phobias and relies on classical conditioning processes

13. Cognitive Restructuring

14. Cognitive restructuring involves replacing maladaptive thought patterns with more realistic, positive ones.

15. Psychotherapy Is Based on Psychological Principles Group therapy builds social support: Group and family therapy have become more widespread Group therapy is less expensive than individual therapy Offers the opportunity for practice of social skills and peer learning

16. Psychotherapy Is Based on Psychological Principles Family therapy focuses on the family context: Family therapy reflects an understanding of systems approaches—an individual is part of larger groups that can maintain or exacerbate behavior Negative expressed emotion within families, for example, has been linked to higher relapse rates among those diagnosed with schizophrenia

17. Psychotherapy Is Based on Psychological Principles Confession is good for the spirit: Irrespective of type of therapy, evidence suggests that simply talking about (or writing about) one’s problems can have a positive effect

18. Culture Can Affect the Therapeutic Process Culture impacts the way mental disorders are expressed, which people are likely to recover, and people’s willingness to seek help Stigmas exacerbate the problem because people will often suffer in silence, failing to get the psychotherapy that can help them Stigma varies from culture to culture

19. Culture Can Affect the Therapeutic Process Culture also plays a critical role in: Determining the availability, use, and effectiveness of different types of psychotherapy Psychotherapy and definitions of mental health are based on the dominant cultural paradigm

20. Medication Is Effective for Certain Disorders Drugs that affect mental processes are called psychotropic medications The success of medication in the treatment of mental disorders is largely responsible for the era of deinstitutionalization Scores of patients were discharged from mental hospitals and treated with drugs as outpatients

21. Medication Is Effective for Certain Disorders Most psychotropic medications fall into three categories: Anti-anxiety drugs Antidepressants Antipsychotics

22. Medication Is Effective for Certain Disorders Anti-anxiety drugs Reduce anxiety and promote relaxation, but they also induce drowsiness and are highly addictive They should be used sparingly Antidepressants: There are several classes including MAO inhibitors, tricyclic antidepressants, and the SSRIs

23. Selective Serotonin Reuptake Inhibitors

24. SSRIs, such as Prozac, work by blocking reuptake into the presynaptic neuron, thereby allowing serotonin to remain in the synapse, where its effects on postsynaptic receptors are prolonged.

25. Medication Is Effective for Certain Disorders Antipsychotics (neuroleptics) Block the effects of dopamine Antipsychotics are not always effective They have significant side effects that can be irreversible Tardive dyskinesia These drugs are not useful for treating the negative symptoms of schizophrenia Such as apathy and social withdrawal

26. Alternative Biological Treatments Are Used in Extreme Cases Alternative biological methods often are used as last resorts because they are more likely to have serious side effects than will either psychotherapy or medication

27. Alternative Biological Treatments Are Used in Extreme Cases Lobotomies: One of the earliest formal procedures used on patients with severe mental illness was psychosurgery Areas of the frontal cortex were selectively damaged These prefrontal lobotomies were used to treat severe mental disorders, including: Schizophrenia, major depression, and anxiety disorders

28. Alternative Biological Treatments Are Used in Extreme Cases Patients who received lobotomies were often listless and had flat affect The procedure often impaired many important mental functions, such as abstract thought, planning, motivation, and social interaction With the development of effective pharmacological treatments in the 1950s, the use of lobotomy was discontinued

29. Alternative Biological Treatments Are Used in Extreme Cases Electroconvulsive therapy (ECT): Common in the 1950s and 1960s to treat mental disorders including schizophrenia and depression ECT now generally occurs under anesthesia with powerful muscle relaxants ECT is particularly effective for some cases of severe depression, although there are some risks to its use

30. Alternative Biological Treatments Are Used in Extreme Cases Transcranial magnetic stimulation and deep brain stimulation are newer techniques that may be promising Especially in relation to depression and OCD

31. In TMS, current flows through a wire coil placed over the scalp area to be stimulated.

32. Deep Brain Stimulation

33. Pseudotherapies Can Be Dangerous Some treatments widely believed to be effective are actually counterproductive: Including encouraging people to describe their experiences following major trauma Scaring adolescents into going straight Having police officers run drug education programs (DARE) Using hypnosis to recover painful memories

34. Pseudotherapies Can Be Dangerous It is important to recognize the difference between evidence-based psychotherapies and “alternative” or “fringe” pseudotherapies The latter can prevent people from getting effective treatment and may even be dangerous

35. What Are the Most Effective Treatments? Treatments That Focus on Behavior and on Cognition Are Superior for Anxiety Disorders Many Effective Treatments Are Available for Depression Lithium Is Most Effective for Bipolar Disorder Pharmacological Treatments Are Superior for Schizophrenia There Are Important Considerations in Selecting a Psychotherapist Critical Thinking Skill: Avoiding the Sunk Costs Fallacy

36. Learning Objectives Identify the therapies most effective for treating specific disorders.

37. What Are the Most Effective Treatments? According to Barlow, three features characterize psychological treatments: They vary according to the client and disorder The techniques used in these treatments have been developed in the laboratory by psychological scientists No overall grand theory guides treatment Treatment is based on evidence of its effectiveness

38. Behavioral and Cognitive Treatments Are Superior for Anxiety Disorders Cognitive-behavioral therapy (CBT) works best to treat most adult anxiety disorders Anxiety-reducing drugs are also beneficial in some cases Although there are risks of side effects and, after drug treatment is terminated, the risk of relapse

39. Behavioral and Cognitive Treatments Are Superior for Anxiety Disorders Specific phobias: Systematic desensitization is most effective Brain imaging data indicate that successful treatment with CBT alters the way the brain processes the fear stimulus

40. Behavioral and Cognitive Treatments Are Superior for Anxiety Disorders Findings suggest that psychotherapy effectively “rewires” the brain Both Prozac and CBT are effective in treating social phobia However, those taking Prozac report more physical complaints, such as a lack of sexual interest

41. Behavioral and Cognitive Treatments Are Superior for Anxiety Disorders Panic attacks: Imipramine prevents panic attacks But does not reduce the anticipatory anxiety that occurs when people fear they might have an attack CBT Helps break the learned association between the physical symptoms and the feeling of impending doom Cognitive restructuring addresses ways of reacting to the symptoms of a panic attack

44. Behavioral and Cognitive Treatments Are Superior for Anxiety Disorders In the short term: CBT alone and imipramine alone were effective for treating panic disorder, and they did not differ in results However, six months after treatment had ended: Those who received psychotherapy were less likely to relapse than those who had taken medication

45. Behavioral and on Cognitive Treatments Are Superior for Anxiety Disorders OCD: SSRIs and CBT are effective treatments Researchers imaged the brains of patients with OCD who were being treated either with Prozac or with CBT Patients in both treatment groups showed the same changes in neural activity CBT may be a more effective way of treating OCD than medication, especially over the long term

46. Treatments for OCD can include the drug clomipramine, exposure, and ritual prevention, with varying rates of success.

47. ZAPS: The Norton Psychology Labs Obsessive Compulsive Disorder

48. Behavioral and Cognitive Treatments Are Superior for Anxiety Disorders Deep brain stimulation may be an effective treatment for those with OCD who have not found relief from CBT or medications DBS leads to a clinically significant reduction of symptoms and increased daily functioning in about two-thirds of those receiving treatment

49. Many Effective Treatments Are Available for Depression Pharmacological treatment: Early antidepressant medication – MAO inhibitors and tricyclics: Fairly effective in reducing depression but had serious side effects Prozac, an SSRI, was developed in the 1980s and lacks the serious side effects of earlier antidepressant drugs

50. Many Effective Treatments Are Available for Depression Approximately 60 to 70 percent of patients who take antidepressants experience relief from their symptoms Some evidence suggests that tricyclics might be beneficial for the most serious forms of depression But SSRIs are generally considered first-line medications because they have the fewest serious side effects

51. Many Effective Treatments Are Available for Depression Cognitive-behavioral treatment of depression: Just as effective as biological therapies in treating depression The goal of CBT is to help the client think more adaptively Although CBT can be effective on its own, combining it with antidepressant medication is significantly more effective than either one of these approaches alone

52. Many Effective Treatments Are Available for Depression As with other mental disorders, treatment of depression with psychotherapy leads to changes in brain activation similar to those observed for drug treatments In slightly different areas of the brain

54. Many Effective Treatments Are Available for Depression Alternative treatments: Phototherapy is the treatment of choice for those experiencing SAD Regular aerobic exercise can reduce depression and prevent recurrence

55. Incidence of SAD varies by latitude.

56. Many Effective Treatments Are Available for Depression Electroconvulsive therapy has been effective for some people with major depression Although ECT frequently results in an amelioration of depressed mood, the mechanism by which this occurs is unknown ECT does have some serious limitations, including a high relapse rate (often necessitating repeated treatments), and memory impairments

57. Many Effective Treatments Are Available for Depression Transcranial magnetic stimulation can reduce depressive symptoms A series of studies has demonstrated that TMS over the left frontal regions results in a significant reduction in depression In October 2008, TMS was approved by the U.S. Food and Drug Administration for the treatment of major depression in patients who are not helped by traditional therapies

58. Many Effective Treatments Are Available for Depression Deep brain stimulation: As with OCD, recent case studies indicate that DBS might be valuable for treating severe depression when all other treatments have failed

59. Many Effective Treatments Are Available for Depression Gender issues in treating depression: Female-specific stressors: The way work and family interact to place additional burdens on women The biological realities of reproduction and of menopause Men are reluctant to admit to depression and even more reluctant to seek appropriate therapy Efforts are being made to help men stop masking their depression with alcohol, isolation, and irritability

61. Lithium Is Most Effective for Bipolar Disorder Only about 20% of patients maintained on lithium will experience relapses Lithium seems to modulate neurotransmitter levels Balancing excitatory and inhibitory activities Although lithium is effective in stabilizing mood, it has unpleasant side effects including thirst, hand tremors, excessive urination, and memory problems

62. Lithium Is Most Effective for Bipolar Disorder Because lithium works better on mania than on depression, patients often are treated with both lithium and an antidepressant SSRIs are preferable to other antidepressants because they are less likely to trigger episodes of mania CBT can help increase compliance with medication regimens

63. ZAPS: The Norton Psychology Labs Bipolar Disorder

64. Pharmacological Treatments Are Superior for Schizophrenia Pharmacological treatments: Early antipsychotic drugs such as haloperidol and chlorpromazine allowed those suffering from psychotic disorders to be released from hospitals These drugs, however, created major side effects and only addressed the positive symptoms of the patients

65. Pharmacological Treatments Are Superior for Schizophrenia Clozapine is different from previous antipsychotic medications in a number of ways: Acts not only on dopamine receptors but also on those for serotonin, norepinephrine, acetylcholine, and histamine Beneficial in treating the negative as well as the positive symptoms of schizophrenia No signs of Parkinson’s symptoms or of tardive dyskinesia appeared in any of the patients taking the drug

66. Pharmacological Treatments Are Superior for Schizophrenia Clozapine’s side effects are serious: Seizures, heart arrhythmias, substantial weight gain, a fatal reduction in white blood cells More recently, second-generation antipsychotics have been introduced that do not reduce white blood cell counts

68. Pharmacological Treatments Are Superior for Schizophrenia Psychosocial treatments: Medication does not substantially affect patients’ social functioning Social skills training is an effective way to address some deficits in schizophrenics Initial studies using CBT indicate that it is more effective than other psychological treatments in reducing symptoms

70. Pharmacological Treatments Are Superior for Schizophrenia Prognosis in schizophrenia: One long-term study followed participants for an average of 32 years: Between half and two-thirds were recovered or had considerable improvement in functioning on follow-up The prognosis for schizophrenic patients depends on factors including age of onset, gender, and culture

71. There Are Important Considerations in Selecting a Psychotherapist The major types of specialized mental health practitioners include the following: Clinical psychologists Psychiatrists Counseling psychologists Psychiatric social workers Psychiatric nurses Paraprofessionals

73. There Are Important Considerations in Selecting a Psychotherapist The right therapist must have the appropriate training and experience for the specific mental disorder, and the person seeking help must believe the therapist is trustworthy and caring

74. Critical Thinking Skill Avoiding the sunk cost fallacy People often stick with something because they have already invested so much in it, even if it’s not working The investment is gone, you cannot get it back Instead, you should focus on deciding what is the best option for the future

75. Can Personality Disorders Be Treated? Dialectical Behavior Therapy Is Most Successful for Borderline Personality Disorder Antisocial Personality Disorder Is Difficult to Treat

76. Learning Objectives Explain why personality disorders are difficult to treat.

77. Dialectical Behavior Therapy and Borderline Personality Disorder The most successful treatment approach to date for borderline personality disorder was developed by Marsha Linehan in the 1980s Dialectical behavior therapy (DBT) combines elements of the behavioral, cognitive, and psychodynamic approaches

78. Dialectical Behavior Therapy and Borderline Personality Disorder Therapy proceeds in three stages: In the first stage, the therapist targets the patient’s most extreme and dysfunctional behaviors Replacing these behaviors with more appropriate ones In the second stage, the therapist helps the patient explore past traumatic experiences that may be at the root of emotional problems In the third stage, the therapist helps the patient develop self-respect and independent problem- solving skills

79. Dialectical Behavior Therapy and Borderline Personality Disorder Those undergoing DBT are more likely to remain in treatment and less likely to be suicidal than are patients in other types of therapy SSRIs are often prescribed along with DBT to treat feelings of depression

80. Antisocial Personality Disorder Is Difficult to Treat Therapeutic approaches for antisocial personality disorder Stimulants prescribed to normalize arousal levels Evidence indicates that these drugs are beneficial in the short term but not the long term

81. Antisocial Personality Disorder Is Difficult to Treat Anti-anxiety drugs may lower hostility levels somewhat, and lithium has shown promise in treating the aggressive, impulsive behavior of violent criminals who are psychopathic Overall, however, psychotropic medications have not been effective in treating this disorder

82. Antisocial Personality Disorder Is Difficult to Treat Behavioral approaches Seems to work best when the therapist controls reinforcement, the client cannot leave treatment, and the client is part of a group Cognitive approaches have also been tried for antisocial personality disorder with some promising results

83. Antisocial Personality Disorder Is Difficult to Treat The prognosis for antisocial personality disorder: The prognosis that patients will change their behaviors as a result of therapy is poor Fortunately for society, antisocial individuals without psychopathy typically improve after age 40 But many continue to commit crimes and exhibit the callousness and manipulativeness characteristic of this disorder

84. For this longitudinal study, the percentage of participants in prison during each five-year period is shown.

85. How Should Childhood and Adolescent Disorders Be Treated? The Use of Medication to Treat Adolescent Depression Is Controversial Children with ADHD Can Benefit from Various Approaches Critical Thinking Skill: Evaluating Alternatives in Decision Making Autistic Children Benefit from a Structured Treatment Approach

86. Learning Objectives Explain key arguments in the debate about prescribing medication to children with depression and ADHD. Understand that sometimes behavioral treatments are best for biological disorders such as autism.

87. The Use of Medication to Treat Adolescent Depression Is Controversial Fewer than 30 percent of children who have mental health problems receive any type of treatment Twice as many of those taking SSRIs reported having suicidal thoughts (4 percent) as those taking a placebo (2 percent) None of the children or adolescents committed suicide

88. The Use of Medication to Treat Adolescent Depression Is Controversial The FDA voted in 2004 to require manufacturers to add to their product labels a warning that antidepressants increase the risk of suicidal thinking and behavior in depressed children and adolescents

89. The Use of Medication to Treat Adolescent Depression Is Controversial The Treatment of Adolescents with Depression Study provides clear evidence that the SSRI Prozac is effective in treating adolescent depression Although the combined group had the best outcomes (86% improvement), improvement with CBT alone (81%) was similar to that with Prozac alone (81%)

90. The Use of Medication to Treat Adolescent Depression Is Controversial All treatment groups experienced a reduction in thoughts of suicide compared with the baseline Participants in the Prozac group were twice as likely to have serious suicidal thoughts or intentions compared with those undergoing other treatments Although prescribing drugs without CBT might be cost effective, it may not be in the best interests of depressed children

93. Children with ADHD Can Benefit from Various Approaches Pharmacological treatment of ADHD The most common treatment is a central-nervous- system stimulant, Ritalin Children on Ritalin experience an increase in positive behaviors and a decrease in negative behaviors Side effects include sleep problems, reduced appetite, body twitches, and temporary growth suppression

95. Children with ADHD Can Benefit from Various Approaches Evidence indicates that although stimulants are beneficial in the short term, their benefits may not be maintained over the long term In addition, there is a very real risk of abuse Numerous cases of children and adolescents buying and selling these stimulants

96. Children with ADHD Can Benefit from Various Approaches Behavioral treatment of ADHD: Aims to reinforce positive behaviors and ignore or punish problem behaviors Medication plus behavioral therapy is more effective than either approach alone. Medications may be important in the short term; psychological treatments may produce superior outcomes that last

97. Critical Thinking Skill Evaluating alternatives in decision making: The first step to good decision making is to frame the question that needs deciding Then evaluate each alternative along many dimensions Putting the process on paper allows you to consider multiple alternatives without being limited by working memory

99. Autistic Children Benefit from a Structured Treatment Approach Behavioral treatment for autism: Applied behavioral analysis (ABA) Developed by Ivar Lovaas and his colleagues One of the best-known and perhaps most effective treatments for autistic children Based on principles of operant conditioning This very intensive approach requires a minimum of 40 hours of treatment per week

100. Autistic Children Benefit from a Structured Treatment Approach Although the ABA program has been demonstrated to be effective, it has some drawbacks: Time commitment Financial and emotional drains on the family Other children may feel neglected or jealous because of the amount of time and energy expended on the disabled child

101. Autistic Children Benefit from a Structured Treatment Approach Biological treatment for autism: SSRIs have been tried as a treatment for autism because: SSRIs such as Prozac reduce compulsions in patients diagnosed with obsessive-compulsive disorder Autism involves compulsive and repetitive behavior Some evidence indicates abnormal serotonin metabolism in autistic children

102. Autistic Children Benefit from a Structured Treatment Approach Indeed, in some autistic children Prozac reduces repetitive motor behavior and self-injury and improves social interactions More recent research has focused on oxytocin

103. Autistic Children Benefit from a Structured Treatment Approach Prognosis for children with autism: Long-term prognosis is poor Studies indicate that nearly three-quarters of adults with autism had severe social difficulties and were unable to live and work independently

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