1. Chapter 16 TREATMENT OF PSYCHOLOGICAL DISORDERS

2.  Analyze This and Analyze That - misconceptions  Types of therapies  Insight therapies  “talk therapy”  Behavior therapies  Changing overt behavior  Biomedical therapies  Biological functioning interventions TYPES OF TREATMENT

3.  15% of U.S population in a given year  Most common presenting problems  Anxiety and Depression  Treatment seeking for various disorders – Figure 15.1  Mood disorders  Utilization rates – Figure 15.2  Women more than men  Medical insurance  Education level  Psychological Disorders and professional treatment – Figure 15.3 WHO SEEKS TREATMENT?

4. Figure 15-1 – Treatment seeking for various disorders

5. Figure 15-2 – Therapy utilization rates – Olfson et al. (2002)

6. XX 15.3

7.  Clinical psychologists  Counseling psychologists  Psychiatrists  Clinical social workers  Psychiatric nurses  Counselors  On-line treatment? WHO PROVIDES TREATMENT?

9. INSIGHT THERAPIES: PSYCHOANALYSIS  Sigmund Freud and followers  Goal: discover unresolved unconscious conflicts - Figure 15.4  Free association  Dream analysis  Interpretation  Resistance and transference  Psychodynamic Therapies

10. INSIGHT THERAPIES: CLIENT CENTERED THERAPY  Carl Rogers  Cause: Figure 15.5  Goal: restructure self-concept to better correspond to reality  Therapeutic Climate  Genuineness  Unconditional positive regard  Empathy

11. THERAPIES INSPIRED BY POSITIVE PSYCHOLOGY  Martin Seligman  Uses theory and research to better understand the positive, adaptive, creative, and fulfilling aspects of human existence  well-being therapy  positive psychotherapy  can be an effective treatment for depression – F 15.6

12. Figure 15.6 Positive psychotherapy for depression

13. OTHER ISSUES  Groups therapy  Group size  Advantages – social dimension of change  Effectiveness of Insight therapies – Figure 15.7  Spontaneous remission  Talk therapies or other approaches?  Common factors contribute to progress in those treated

14. Figure 15.7 – Recovery as a function of number of therapy sessions

15. BEHAVIOR THERAPIES  B.F. Skinner and colleagues  Goal: unlearning maladaptive behavior and learning adaptive ones  Systematic Desensitization – Joseph Wolpe  Classical conditioning – Figure 15.8  Anxiety/Fear hierarchy – Figure 15.9  Aversion therapy – Figure 15.10  Alcoholism, sexual deviance, smoking, etc.  Social skills training  Modeling  Behavioral rehearsal  Biofeedback  Operant conditioning flooding  Classical conditioning

16. XXX 15.8

17. XXX 15.10

18. COGNITIVE-BEHAVIORAL THERAPY  Aaron Beck  Cognitive therapy  Depression and negative thinking – Figure 15.11  Albert Ellis  Rational-emotive therapy  Goal: to change the way clients think  Detect and recognize negative thoughts  Reality testing  Effectiveness of Behavior Therapies  Efficacy of behavioral interventions for a variety of disorders

19. XXX 15.11

20. BIOMEDICAL THERAPIES  Psychopharmacotherapy  Antianxiety - Valium, Xanax, Buspar  Antipsychotic - Thorazine, Mellaril, Haldol  Tardive dyskinesia  Atypical antipsychotic – reduce motor effects and other neurotransmitters  Time course – Figure 15.12  Antidepressant: - Actions - Figure 15.13  Tricyclics – Elavil, Tofranil  Mao inhibitors (MAOIs) - Nardil  Selective serotonin reuptake inhibitors (SSRIs) – Prozac, Paxil, Zoloft – side effects – Table 15.1  Risk of suicide – Figure 15.14  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 – Figure 15.17  Conjunctive therapy – Figure 15.16  Multicultural sensitivity  Deinstitutionalization  Dorthea Dix - Figure 15.18  Changes in population – Figure 15.19  Factors – treatments, legal, service delivery model  Revolving door problem – Slide 26  Homelessness  Increase use of criminal justice system

24. Figure 15.17 The leading approaches to therapy among psychologists

25. Figure 15-16 – Relapse rates in Reynolds et al. (1999) study

26. XX 15.19

27. Slide 26 – Percentage of psychiatric inpatient admissions that are readmissions

28.  Psychopharmacology  Antipsychotics (thorazine, haldol)  Anti-anxiety (valium, barbiturates, Xanax)  Mood Disorders (serotonin reuptake inhibitors)  Bipolar (lithium) SOMATIC THERAPIES

29. Electroconvulsive Therapy (ECT)- for depression Psychosurgury - Prefontal lobotomy SOMATIC THERAPY

30. LOOKING FOR AT THERAPIST  Factors to consider  Sources of services – Table 15.2  Profession  Gender  Theoretical approach  Comparison of approaches for effectiveness - Figure 15.20

31. Table 15-2, p. 626

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