1. P S Y C H O L O G Y T h i r d E d i t i o n by Drew Westen PowerPoint  Presentation C h a p t e r 16 T R E A T M E N T O F P S Y C H O L O G Y D I S O R D E R S John Wiley & Sons, Inc.

2. Lecture Outline n Biological Therapies n Psychotherapies n Evaluating Therapies © 2002 John Wiley & Sons, Inc.

3. The Medical Model n The Medical Model views abnormal behavior as reflecting a biological disorder  Usually localized within the brain  Involving either brain damage or a disruption of the neurotransmitter processes of the brain  Person is viewed as a patient, treated by doctors in a mental hospital  Therapies tend to be physical in nature Drugs (Pharmacotherapy) Surgical alteration of brain (Psychosurgery) © 2002 John Wiley & Sons, Inc.

4. Pharmacotherapy n Psychotropic medications are drugs that act on the brain to alter mental function n Prior to 1956, schizophrenia was virtually untreatable with many patients confined for life in mental hospitals  Chlorpromazine (Thorazine) was found to reduce severity of psychotic thought, allowing people to live outside of mental institutions Reduced size of institutions  The psychotropic actions of many drugs are often accidentally discoveries © 2002 John Wiley & Sons, Inc.

5. Impact of Chlorpromazine on Institutionalization © 2002 John Wiley & Sons, Inc. (Figure adapted from Davis, 1985)

6. Psychotropic Mechanisms of Action n Psychotropic drugs can alter behavior via:  An interaction with neurotransmitters in brain Some release specific transmitters Some block the reuptake of transmitters Some interact with postsynaptic receptors Some may act within neuron cells  A placebo effect Subjects believe in the efficacy of the drug and show an actual change in function (analgesia or relief from pain shows moderate placebo effects) © 2002 John Wiley & Sons, Inc.

7. Neurotransmitter Interactions © 2002 John Wiley & Sons, Inc.

8. Antipsychotic Medications n Schizophrenia can be viewed as composed of:  Positive Symptoms: Presence of hallucinations  Negative Symptoms: Absence of affect n Antipsychotic medications refer to drugs that alleviate schizophrenia  Antipsychotic medications are more effective for the positive symptoms than for negative symptoms of schizophrenia © 2002 John Wiley & Sons, Inc.

9. Dopamine and Schizophrenia n The positive symptoms of schizophrenia reflect too much brain dopamine activity  Antipsychotic drugs are effective antagonists of dopamine receptors (block the action of dopamine)  Drugs such as amphetamine release dopamine from terminals; too much amphetamine exposure can induce a psychotic state in humans n Negative schizophrenic symptoms may reflect brain damage enlarged ventricles) © 2002 John Wiley & Sons, Inc.

10. Antidepressant Medications n Depression reflects a disturbance of mood, sleep, and appetite n Psychotropic antidepressant drugs can lift depression (require 3-4 weeks for effect)  Tricylic antidepressants: Act by blocking the reuptake of norepinephrine and serotonin  Monoamine oxidase (MAO) inhibitors: MAO degrades transmitters; drugs that inhibit MAO allow the transmitter to work for longer periods  Selective serotonin reuptake inhibitors: Prozac blocks the reuptake of serotonin © 2002 John Wiley & Sons, Inc.

11. Antidepressant Medications and Relapse Rates (Figure adapted from Maj et al., 1992) © 2002 John Wiley & Sons, Inc.

12. Antianxiety Medications n Anxiety reflects an intense emotional state of dread and apprehension n Drugs such as Valium increase the activity of the transmitter GABA to dampen the neural activity of the brain  Valium is useful in the short-term treatment of anxiety n Antianxiety medications can result in drug dependence © 2002 John Wiley & Sons, Inc.

13. Electroconvulsive Therapy n Antidepressant drugs require 3-4 weeks to take action on mood; the person may be at risk for suicide or is not responding to drug treatment n Electroconvulsive shock therapy (ECT) refers to the intentional induction of a brain seizure by shock administered to either or both hemispheres  ECT produces immediate improvement in mood (explanation is unknown)  Side effects of ECT include memory loss © 2002 John Wiley & Sons, Inc.

14. Psychosurgery n Psychosurgery refers to the intentional damage of the brain to alter behavior  In contrast to neurosurgery, which refers to alteration of the brain to alter a known medical issue (e.g. remove a tumor or a blood clot) n Trephining: Ancient skulls show evidence of holes drilled as if to release evil spirits n Lobotomy: Surgical procedure used by Egas Moniz to “calm” agitated patients  Side effects include loss of frontal lobe function © 2002 John Wiley & Sons, Inc.

15. Psychological Therapies n Whereas the biological therapies view mental disorders through the medical model, psychological therapies view the roots of abnormal behavior in mental states  Each therapy has its own view as to the cause of mental disorder  Each therapy has its own approach to the treatment of mental disorder © 2002 John Wiley & Sons, Inc.

16. Varieties of Psychological Treatment © 2002 John Wiley & Sons, Inc. n Psychodynamic n Cognitive-behavioral n Humanistic n Family and marital n Biological

17. Psychodynamic Approach n The psychodynamic approach was created by S. Freud  Mental symptoms reflect unconscious conflicts that induce anxiety  Insight refers to the situation in a person comes to understand their unconscious conflicts  Therapeutic change requires an alliance (relationship) between the patient and therapist © 2002 John Wiley & Sons, Inc.

18. Psychodynamic Techniques n The goal of psychodynamic therapy is to achieve insight into unconscious conflicts  Free Association refers to a technique in which the patient is encouraged to say whatever comes to mind to reveal the unconscious processes of the patient  Interpretation: Therapist interprets the thoughts, and feelings of the patient in order to reveal the hidden conflicts and motivations  Analysis of transference: Patients bring into therapy their past troubled relationships; these are transferred to the therapist © 2002 John Wiley & Sons, Inc.

19. Cognitive-Behavioral Therapies n Cognitive-behavioral therapies focus on the current behaviors of a person  Emphasis is on the present rather than the past  Cognitive-Behavioral therapists are very directive  Therapy duration is short-term rather than years long  Initial focus is on a detailed behavioral analysis: focus is on the problem behavior and the stimuli associated with it © 2002 John Wiley & Sons, Inc.

20. Behavior Therapies n Classical conditioning techniques can alter emotional responses  Systematic desensitization: Patient is encouraged to confront a feared stimulus (snake) while in a relaxed state Therapist trains relaxation Patient constructs an image hierarchy While relaxing, patient imagines the least fearful of the images in their hierarchy (e.g. being on the planet as a snake)  Exposure: Patient is exposed to the stimulus that they fear (locked in a room full of snakes) © 2002 John Wiley & Sons, Inc.

21. Cognitive Therapies n Focus of cognitive therapies is on changing dysfunctional thought patterns n Rational Emotive Therapy focuses on the hurtful thought patterns of the patient  Ellis’s theory suggests that pathology results when persons adopt illogic in response to life situations  Therapist notes illogical and self-defeating thoughts and teaches alternative thinking that promotes rational thought © 2002 John Wiley & Sons, Inc.

22. Gestalt Therapies n Gestalt therapists emphasize that losing touch with ones feelings in order to meet social obligations is the root of mental disorder  Focus of gestalt therapy is to have people focus on their current feelings  Empty-chair technique: Therapist places an empty chair next to the client and asks them to imagine that the object of their emotion is actually sitting in the chair. The client then is asked to direct their conversation to the chair © 2002 John Wiley & Sons, Inc.

23. Eclectic Therapy and Schizophrenia (Figure adapted from Herz et al., 2000, p 280.) © 2002 John Wiley & Sons, Inc.

24. Evaluation of Therapies n Pharmacotherapy  Drug therapies for depression, anxiety, and schizophrenia can be effective in a number of patients; focus is on long-term treatment (years)  Issues are related to side effects of the drugs and to the high relapse rate when the drugs are stopped  Continued use of certain drugs can minimize relapse of mental disorder © 2002 John Wiley & Sons, Inc.

25. Copyright Copyright 2002 by John Wiley & Sons, Inc., New York, NY. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission of the copyright owner. © 2002 John Wiley & Sons, Inc.