TREATMENT OF
PSYCHOLOGICAL
DISORDERS
WEEK 12: JULY 29, 2015
OUTLINE
Historical treatments
Behavioural
Cognitive
Medical
Prevention
Evaluating effectiveness
HISTORICAL TREATMENT
METHODS
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ter the decline of
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earning, art, and
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re especially bad
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s with the devil,
crops. In 1484,
Exorcism. This medieval woodcut illustrates the practice of exorcism,
which was used to expel the evil spirits that were believed to have
possessed people.
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Introduction and Methods of Research
BEDLAM
13
REFORMS IN TREATMENT This chair was designed to have a calming effect on people with mania. Other Reforms in Treatment § Seeing the “insane” as ill instead of “possessed” § Trea2ng them with tenderness, not harshness § Housing them in hospitals rather than locking them up in asylums § Developing psychotherapeu2c treatments, medica2ons, and community supports to allow life outside hospitals The unchaining of inmates at La Bicêtre by 18th-century French reformer Philippe Pinel.
Continuing the work of Jean-Baptiste Pussin, Pinel stopped harsh practices, such as bleeding and
purging, and moved inmates from darkened dungeons to sunny, airy rooms. Pinel also took the
time to converse with inmates, in the belief that understanding and concern would help restore
them to normal functioning.
Current Forms of Therapy
Psychotherapy:
an interactive
experience with a
trained professional,
working on
understanding and
changing behavior,
thinking, relationships,
and emotions
Biomedical therapy:
the use of
medications and other
procedures acting
directly on the body to
reduce the symptoms
of mental disorders
Medica2ons and psychotherapy can be used together, and may help the each other achieve be?er reduc2on in symptoms. GOALS OF
TREATMENT
Reduction of suffering
Maximize independent functioning
Provide/teach skills
BEHAVIOURAL
THERAPY
17-10
•  Therapy that applies principles of classical and
operant conditioning to help people change selfdefeating or problematic behaviours
BEHAVIOURAL
TECHNIQUES
1. Exposure
Graduated exposure (Systematic desensitization):
method where a person suffering from a phobia or
panic attacks is gradually taken into the feared
situation or exposed to a traumatic memory until the
fear subsides
•
Attempt to counteract tendency to avoid feared
object/situation
17-11
•
BEHAVIOURAL
TECHNIQUES
2. Exposure
Flooding: a form of exposure treatment in which the
client is taken directly into the feared situation until
his or her anxiety subsides
17-12
•
BEHAVIOURAL
TECHNIQUES
3. Behavioural self-monitoring
•
•
A method of keeping careful data on the frequency
and consequences of the behaviour to be changed
Identify situation in which behaviour takes place, and
the reinforcers that keep it recurring
Change by removing situational cues and reinforcers
17-13
•
BEHAVIOURAL
TECHNIQUES
4. Skills training
•
An effort to teach the client skills the he or she may
lack, as well as new constructive behaviours to replace
self-defeating ones
Includes:
•  Modelling
•  Role-playing
•  Operant conditioning
17-14
•
BEHAVIOURAL
TECHNIQUES
5. Skills training
Token economy
17-15
•  Behavior modifica2on based on operant condi2oning principles that rewards desired behaviors •  Pa2ent exchanges a token of some sort, earned for exhibi2ng the desired behavior, for various privileges or treats COGNITIVE THERAPY
•  Form of therapy designed to identify and change
irrational, unproductive ways of thinking and,
hence, to reduce negative emotions
•  Teaches people new, more adaptive ways of
thinking.
COGNITIVE THERAPIES
•  Identify irrational assumptions and biases
•  Examine evidence (reality-test)
•  Consider other interpretations for other people’s
behaviour
17-17
•  Reward for replacing irrational assumptions with
realistic beliefs
ROLE-PLAYING
EXERCISE
Volunteer(s)
play the role of someone who is suffering from depression
speak with a depressive explanatory style
Class
play the role of therapist
offer challenges to unrealistic assumptions
underlying this pattern of thinking
DEPRESSIVE EXPLANATORY STYLE Problema2c event: Assump2ons about the problem The problem is: The problem is: The problem is: Mood/result that goes along with these views: E.G. PROCRASTINATION
Failure to accept limitations leads to
impossible standards (rather than
rational responses)
17-20
Many procrastinators are
perfectionists (if you can’t do it
perfectly, then don’t do it at all)
BIOMEDICAL
TREATMENTS
Drug treatments
Direct brain interventions
TRANQUILIZERS
Drugs commonly prescribed for treatment of anxiety
Increases activity of gamma aminobutyric acid (GABA)
Not for long term use, and does not treat underlying
cause, only symptoms
17-22
E.g. Valium, Xanax
ANTIDEPRESSANTS
Drugs used primarily in the treatment of mood disorders,
especially depression & anxiety
Produce unpleasant physical reactions: dry mouth,
headache, constipation, nausea, gastrointestinal problems,
weight gain, decreased sexual desire
Three classes of antidepressants:
17-23
•  Monoamine oxidase inhibitors (MAOIs)
•  Tricyclic antidepressants
•  Selective serotonin reuptake inhibitors (SSRIs)
ANTIPSYCHOTIC
DRUGS
Used in treatment of schizophrenia & other psychotic
disorders (also prescribed for severe depression,
impulsivity, dementia, bipolar disorder)
Reduces the sensitivity of dopamine brain
Reduces agitation, delusions, and hallucinations
Does not provide relief from jumbled thoughts,
difficulties with concentration, emotional flatness
17-24
Side effects such as muscular rigidity, tremors, and
involuntary muscle movements (tardive dyskinesia)
LITHIUM
17-25
•  Treatment for bipolar disorder
•  Moderates norepinephrine & stops overstimulation from
glutamate
•  Side effects include muscle tremors, kidney damage
17-26
DRUG TREATMENTS
CAUTIONS ABOUT
DRUG TREATMENTS
The placebo effect
•  Positive effects due to expectations about the effect of the
drug
•  Approx 50% depressed patients respond to
antidepressants; 40% of the responsive patients are
actually responding to the drug
17-27
High relapse and dropout rates
•  Approx 50% to 70% of patients put on medication stop
taking them, and relapse, often due to negative side
effects
CAUTIONS ABOUT
DRUG TREATMENTS
Dosage problems (therapeutic window)
•  Appropriate amount that alleviates symptoms, but not toxic
•  The same dose of a drug may be metabolized differently in
men and women, old people and young people, and different
ethnic groups.
Unknown long-term risks
DIRECT BRAIN
INTERVENTION
Psychosurgery
17-29
•  Any surgical procedure that destroys selected areas of the
brain believed to be involved in emotional disorders or violent,
impulsive behaviour (e.g., prefrontal lobotomy)
•  Last resort treatment for OCD and epilepsy
•  No controlled studies to assess effectiveness
ELECTROCONVULSIVE THERAPY (ECT)
•  Electroconvulsive therapy [ECT] induces a mild seizure that disrupts severe depression for some people. •  This might allow neural re-­‐wiring, and might boost neurogenesis. REPEATED TRANSCRANIAL
MAGNETIC STIMULATION
Another opJon is repeated deep-­‐
brain sJmulaJon using implanted electrodes. Like ECT, these techniques may disrupt depressive electrochemical brain pa?erns. BIOLOGICAL & CBT TREATMENTS
OF DEPRESSION
PET scans indicate that both medical and therapeutic
interventions are influencing the brain, but perhaps in
different ways & regions
17-32
Mood regulation
PREVENTION:
LIFESTYLE CHANGES
20-30 minutes of moderate exercise (walking, gardening,
moving stuff)
•  reduces onset of depression
•  promotes better emotion regulation abilities in response to
stress
•  decreases duration of feelings of anxiety
•  reduces risk of dementia
•  reduces symptoms of ADHD in children (comparable to drugs)
EVALUATING THERAPY
How do we know if it works?
Randomized controlled trials = gold standard for evaluation
17-34
•  People with a given problem or disorder are randomly assigned
to one or more treatment groups or to a control group; designed
to evaluate effectiveness of new medication or form of therapy
EVALUATING THERAPY
Critical Incident Stress Debriefing (CISD) used as an intervention
immediately following disasters to decrease rates of PTSD
17-35
Found that highly
emotional
reactions to
incidents + CISD
showed higher
stress symptoms
WHEN THERAPY
HARMS
Risks to clients increase under these conditions:
17-36
1.  The use of empirically unsupported, potentially
dangerous techniques (e.g., rebirthing, recovered
memory therapies)
2.  Prejudice or cultural ignorance on the part of the
therapist
3.  Inappropriate or coercive influence, which can create
new problems for the client
17-37
PROBLEMATIC
TECHNIQUES
17-38
FACTORS IN
SUCCESSFUL THERAPY