Unit 13: Treatment of Psychological Disorders
Introduction
 Philippe Pinel, Dorothea Dix: transition from brutal to gentler treatments of psychological disorders
o Constructing mental hospitals to offer more humane methods of treatment
 Therapeutic drugs/community based treatment programs have emptied mental health hospitals
 Psychotherapy: trained therapist uses psychological techniques; assists to overcome difficulties/achieve growth
 Biomedical therapy: prescribed medication or medical procedure that acts directly on patient’s nervous system
 Eclectic approach: psychotherapy that uses techniques from various forms of therapy
Insight Therapies
 Variety of therapies aimed at improving psychological functioning by increasing client’s awareness of underlying
motives/defenses
 Psychoanalysis, psychodynamic therapy, humanistic therapy
Psychoanalysis (therapist’s interpretation of unconscious motives/conflicts from patients’ dreams)
 Aims: bring repressed feelings into patients’ conscious awareness
o Healthier, less-anxious living possible when energy released from id-ego-superego conflicts
 Methods: free association; revealing anything that comes to mind
o Resistance: blocking from consciousness of anxiety-laden material
o Interpretation: analyst’s noting dreaming meanings, resistances, other behaviors to promote insight
o Transference: patient’s transfer to analyst of emotions linked with other relationships (love/hatred)
 Most expensive form of therapy (average of $30,000 per year)
Psychodynamic Therapy (individuals respond to unconscious forces/childhood experiences; seeks to enhance self-insight)
 Therapists try to understand symptoms by looking for reoccurring themes in relationships (childhood, etc.)
 Talk to patient face to face, once a week for only few weeks or months (psychoanalysis more often and longer)
 Interpersonal psychotherapy: focuses on current relationships (not past), helping people improve relationship skill
Humanistic Therapies
 Aim to boost self-fulfillment by helping people grown in self-awareness and self-acceptance
 Focus on present/future, conscious (not unconscious), taking responsibility for feelings/actions, promoting growth
 Client-centered therapy: Carl Rogers; therapist uses active listening in genuine, accepting, empathic environment
o Therapist listens without judging/interpreting; refrains from directing client towards insights
o Active listening: echoing, restating and seeking clarification of what the person expresses
o Most important contribution of therapist is to accept and understand the client
Behavior Therapy (applies learning principles to elimination of unwanted behaviors)
 Maladaptive behaviors are learned behaviors that can be replaced by constructive behaviors
Counterconditioning (uses classical conditioning to pair stimulus with new response instead of fear)
 Exposure therapy: treat anxieties by exposing people to the things they fear and avoid
o Systematic desensitization: associates pleasant relaxed state with progressively anxiety-triggering stimuli;
substitute positive (relaxed) response for negative (fearful) response to harmless stimulus
o Virtual reality exposure therapy: progressively exposes people to simulation of greatest fears
 Aversive conditioning: associates unpleasant state with unwanted behavior
o Substitute negative response for positive response to harmful stimulus (alcohol with nausea causing drug)
Operant Conditioning
 Behavior modification: reinforcing desired behaviors and enacting punishment for undesired behaviors
 Some require attention/praise; others concrete rewards such as food
 Token economy: desired behavior earns token that can be exchanged for various privileges or treats
Cognitive Therapies (teaches new ways to thinking/acting; assumes thoughts intervene between events and reactions)
 Person’s emotional reactions produced not directly by event but by person’s thoughts in response to event
Beck’s Therapy for Depression
 Patients had catastrophizing beliefs about themselves, situations and futures when experienced depression
 Uses gentle questioning and persuasion to reveal irrational thinking and convince that life is not as ruined as seen
 Getting people to change what they say to themselves is effective way to change their thinking
 Stress inoculation training: teaching people to restructure their thinking in stressful situations
Cognitive-Behavioral Therapy (combines cognitive therapy with behavior therapy)
 Aims to alter the way people think about and react to situations
 Replace catastrophizing thinking with realistic appraisals and practice behaviors incompatible with problem
 Ex: OCD people would think “I have compulsive urge” and instead play instrument instead of OCD behavior
Group/Family Therapies
 Saves therapist’s time and client’s money
 Therapist guides interactions of group of people as they engage issues and react to one another
o Individual discover similar thinking in other; feel relief that they are not alone; others share same problem
 Family therapy: treats family as system; individuals behavior is influenced by or directed at other family member
o Individuals struggle to differentiate from family but also connect to them; causes tension and stress
 Most support groups focus on hard to discuss illness (e.g. cancer instead of hypertension or migraines)
Is Psychotherapy Effective?
 Clients’ perceptions: people enter therapy in crisis/low point: will feel improvement; need to believe therapy was
worth effort/money; clients speak well of therapists even when problems remain: therapists tried to help them
 Clinicians’ perceptions: treasure compliments but hear little from those not helped; think therapy always works
 Outcome research: Eysenck 2/3 of people improve with/without treatment, regression towards the mean
o Meta-analysis: procedure for statistically combining the results of many different research studies
o Those not undergoing therapy often improve but those undergoing therapy more likely to improve
o For those that seek psychological treatment, search for other medical treatment drops
Relative Effectiveness of Different Therapies
 Not one type of therapy is superior to another
 The more specific the problem the greater the chance of therapy working
 Evidence-based practice: clinical decision-making comprised of clinical expertise, best available research and
patient’s values, characteristics, preferences, circumstances
Eye Movement Desensitization and Reprocessing (EMDR)
 People imagine traumatic scenes while therapist triggers eye movements by waving finger in front of patient eyes
 Proven to be somewhat effective when compared with no treatment
Light Exposure Therapy
 Seasonal affective disorder: form of depression occurring during the winter
 Sparks activity in brain region influencing body’s arousal/hormones; works as effectively as antidepressants
Commonalities among Psychotherapies
 Hope for demoralized people; new perspective on oneself/world and empathic, trusting, caring relationship
Culture/Values in Psychotherapy
 Clients matched with therapists that shared cultural values perceived more empathy and stronger alliance
 Ellis/Bergin: therapists differ sharply; differences can affect their view of healthy person
Biomedical Therapy (prescribed medications/medical procedures that act directly on patient’s nervous system)
Psychopharmacology (study of drug effects on mind and behavior)
 Enthusiasm for new drug diminishes after researchers subtract rates of:
o Normal recovery among untreated persons
o Recovery due to placebo effect
Antipsychotic Drugs (treat schizophrenia and other forms of severe thought disorder)
 Chlorpromazine: dampens responsiveness to irrelevant stimuli; block dopamine receptors
 Tardive dyskinesia: involuntary movements of facial muscles, tongue, limbs, produced by long-term use
 Clozapine: targets dopamine and serotonin receptors to alleviate negative symptoms
Antianxiety Drugs (drugs used to control anxiety and agitation)
 Xanax/Ativan: depresses central nervous system activity
 Criticism: reduce symptoms without resolving underlying problems; can cause psychological dependence on drug
Antidepressants (used to treat depression; now increasingly prescribed for anxiety)
 Increase availability of norepinephrine/serotonin (elevate arousal/mood; scarce during depression)
o Prozac, Zoloft, Paxil: blocks reabsorption and removal of serotonin from synapses
o Selective-serotonin-reuptake-inhibitors (SSRIs)
 Administering thought patch reduce side effects (dry mouth, weight gain, hypertension)
 Drugs influence neurotransmission within hours but require weeks for full psychological effect
 Aerobic exercise has same effect and better benefits for those with mild-moderate depression
 Antidepressant medications: biggest improvement in those that are severely depressed (only prescribed for them)
Mood-Stabilizing Medications
 Depakote and Lithium: effective mood stabilizers for those suffering emotional high and low of bipolar disorder
Electroconvulsive Therapy (ECT) (biomedical therapy for severely depressed patients; electric current sent through brain)
 General anesthetic/muscle relaxant to prevent injury from convulsions before delivered electrical current to brain
 Some memory loss for treatment period but no discernible brain damage
Repetitive Transcranial Magnetic Stimulation (rTMS) (repeated pulse of magnetic waves to brain; effective in depression)
Psychosurgery (surgery that removes or destroys brain tissue)
 Moniz: lobotomy (cuts nerves connecting frontal lobes to emotion-controlling centers of brain; rare)
 Decreased person’s misery/tension but produced permanently lethargic, immature and uncreative person
Therapeutic Life-Style Change
 Strenuous physical activity, strong community ties, sunlight exposure, plenty of sleep = no depression
 12 week training program to reduce depression: aerobic exercise, adequate sleep, light exposure, social
connection, anti-rumination (positive thinking), nutritional supplements for healthy brain functioning
Preventing Psychological Disorders
 Resilience: personal strength that helps most people cope with stress and recover from adversity and trauma
 Prevent problem by fixing bad situation and developing coping abilities than wait for problem to arise and treat it
 Albee: poverty, meaningless work, criticism, unemployment, racism, sexism undermine people’s sense of
competence, personal control and self-esteem; should support programs that alleviate demoralizing situations