Treatment of Psychological Disorders
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Psychotherapy – Treatment of psychological disorders through psychological methods, such as talking about problems and exploring new ways of thinking & acting ADVANCED PLACEMENT PSYCHOLOGY Chapter 16: Treatment of Psychological Disorders Basics of Therapy Client: The person seeking therapy Inpatient – Treated in a hospital or institution Outpatient – Receive psychotherapy while in the community Therapist: The person giving therapy Psychiatrist – M.D. specialized in mental disorders Psychologist – Ph.D in clinical or counseling (can’t prescribe drugs) Other Professionals Social Workers Family Therapists Counselors Theory: Underlying guidelines & beliefs for treatment of disorders Procedure: Method of treatment that is unique to the theory used Goal: Final outcome of therapy Psychodynamic Psychotherapy An Overview Theory Personality & behavior reflect the efforts of the ego to referee unconscious conflicts among various components of the personality Procedure Psychoanalysis – Therapy aimed at understanding the unconscious conflicts & how they affect the client (Freud) Classical Psychoanalysis Sitting on the Freudian couch Hypnosis – Tried initially to cure somatoform disorders Free Association Saying whatever comes to mind Doesn’t allow for as much self-censorship Freudian Slip – A slip of the tongue that reveals what you’re truly thinking Dream Analysis Manifest Content – What the dream is on the surface Latent Content – What the dream means i.e. You dream that you are a Red Wings hockey player and they drafted you when you were just 14 i.e. You have aspirations for fame & you really like to play hockey Resistance – Resisting the therapist’s efforts Transference – Transfer of feelings & thoughts onto the therapist i.e. Being scared of the therapist because of abuse from parents Freudian slip example (this is actually just a typo, but if it was spoken, it would be a Freudian slip) Contemporary Psychoanalysis Object Relations Therapy Theory Personality & conflicts among its components are derived from the need for supportive human relationships Mother-child relationship becomes the prototype for all future relations Procedure Therapy focuses on developing nurturing client-therapist relationships “Second chance” for forming a good relationship Phenomenological Psychotherapy An Overview Theory People’s perceptions of the world are subjective People are capable of consciously controlling their own actions & taking responsibility for their own responsibilities Behavior is motivated by an innate drive towards growth, not sexual or aggressive instincts Procedure Therapy revolves around providing a sounding board for people to voice opinions & thoughts Assumptions of Phenomenological Psychotherapy Treatment is an encounter of equals, not a cure provided by an expert Clients will improve on their own under the right conditions Ideal conditions promote awareness, acceptance, & expression of client feelings and perceptions Ideal treatment relies on a fully supportive & accepting relationship between client & therapist Allows clients to be more comfortable & act more like themselves Establishes a distinction between the client & the problematic behavior Clients are responsible for choosing how they will think & behave Responsibility increases the client’s confidence & comfort Client-Centered Psychotherapy Unconditional Positive Regard Empathy Listening without interrupting & accepting without evaluation Therapist doesn’t need to approve of everything, but they must accept it External Frame of Reference – looking at the client from the outside Internal Frame of Reference – characterized by empathy (emotional understanding) Active Listening Reflection – Paraphrasing/summarizing what the client just said Congruence [Genuineness] Consistency between the therapist’s feelings & actions Gestalt Therapy Theory People create their own versions of reality People’s natural psychological growth continues as long as they perceive, remain aware of, & act on their true feelings Growth stops & disorders appear when people aren’t aware of all aspects of themselves Procedure Makes clients aware of feelings & impulses that may have been discarded or repressed “Calling them out” Some clarification Behavior Therapy Classical Behavior Modification Operant Conditioning principles Conditioning principles Cognitive-Behavior Therapy Thinking & learned ways of thinking Behavior Psychotherapy Theory Therapy doesn’t revolve around treating disorders, but learning how to change specific thoughts & behaviors. Procedure Listing of the behaviors & thoughts to be changed Establishes specific goals Therapist acts as a teacher by providing learning-based treatments “Homework” to help clients make specific plans to deal with problems Developing a good therapist-client relationship Continuous monitoring & evaluation of the treatment Techniques for Modifying Behavior Systematic Desensitization Desensitization Hierarchy Series of increasingly fear-provoking situations Imagination vs. real life Once clients are able to calmly imagine the fear, they deal with it better later in real life Modeling Desirable behaviors can be taught through watching Client can learn to be more appropriately self-expressive & more comfortable in social situations through assertiveness & social skills training Techniques for Modifying Behavior Positive Reinforcement Using positive reinforcement through contingencies designed to alter problematic behavior & teach new skills Extinction Token Economy System of secondary reinforcers Using operant conditioning to eliminate undesirable behaviors by removing the reinforcers that normally follow a particular response Flooding – person is saturated with fear-provoking stimulus until the anxiety is extinguished Exposure Techniques – systematic desensitization Techniques for Modifying Behavior Aversive Conditioning Punishment Associating physical or psychological discomfort with unwanted behaviors Covert Sensitization Opposite of systematic desensitization Presents the unpleasant stimulus after the undesirable response occurs Overlaps a lot with aversive conditioning Typically used as a last resort when all other treatments fail or when the client’s life is in danger Cognitive-Behavior Therapy Rational-Emotive Behavior Therapy Theory Psychological problems are caused by how people think about events Identifying self-defeating thoughts Replaces these thoughts with more realistic & beneficial ones Practices Cognitive Restructuring: Replacing upsetting thoughts with alternative thinking patterns Stress Inoculation Training: Imagining being in a stressful situation & practice new cognitive skills to stay calm Cognitive-Behavior Therapy Beck’s Cognitive Therapy Theory: Negative cognitive patterns are maintained by: Errors in logic & erroneous beliefs (“I can’t do anything right”) Thoughts that minimize the value of one’s accomplishments (“Anyone can do that”) Practice Like a scientific investigation Critically testing the hypothesis “I can never do anything right.” “Well, here are the cases where I have done things right.” Group, Family, & Couples Therapy Group, family, & couples therapy is concerned about the subject & setting of the therapy & use many different theories. Group Therapy Therapists can observe clients interact with other people Clients feel less alone (raises expectations of recovery) Increase self-confidence & self-acceptance Clients learn from each other (modeling) Positive group relationships increases willingness to share Family & Couples Therapy Family Therapy A problem in one individual often reflects problems in the entire family’s functioning Treatment cannot focus on an individual in isolation Wife gets over depression & then husband commits suicide because he had gotten so attached to the idea of a “sick wife” Couples Therapy Similar to family therapy, but focuses on just two individuals Behavioral Premarital Intervention – program helps engaged couples prevent marital problems Addressing the “Ultimate Question” Which treatment method will work for me? Details not yet fully mapped out Cognitive-Behavioral Therapies better for: Phobias & other anxiety disorders Eating disorders Child clients Client-Therapist relationships are IMPORTANT Cultural Factors in Psychotherapy Kind of a long section, so here’s the summary… If the culture of the client is different from the culture of the therapist, then there will be PROBLEMS Rules & Rights in the Therapeutic Relationship Ethical Principles of Psychologists & Code of Conduct No sexual relationship between therapist & client Confidentiality Situations Exempt from Confidentiality Client’s condition is used for a civil or criminal defense Suicidal tendencies that require hospitalization Therapist defending against a malpractice suit Reveals information about the abuse of a child or incapacitated adult The therapist believes that the client may commit a violent act against another person Electroconvulsive Therapy (ECT) Psychotherapy in the 1930’s Hungarian physician noticed that schizophrenia & epilepsy rarely co-occurred, & he used drugs to induce seizures in schizophrenics, depression, & mania Later, seizures were induced by electric shock Today, it’s used for depression in those that don’t respond to drugs Side Effects: Varying degrees of memory loss Speech disorders Death due to cardiac arrest (sometimes) Electroconvulsive Therapy (ECT) The modern remix of a classic treatment Modern techniques Focuses shock to right side of the brain Increased oxygen Extreme muscle relaxers Why does it work? No one knows “Reset” button Electric shock improves neurotransmitter function NeuroT’s that help recover from convulsions reduce activity in “depression” areas Psychosurgery “Cut it out!” (literally) Destruction of brain tissue to treat mental disorders Prefrontal Lobotomy Destruction of the frontal lobe to curb emotional reactions in the disturbed Standard treatment for schizophrenia, depression, anxiety, aggressiveness, & OCD Side effects include: Epilepsy, amnesia, flat affect, & death Considered a last resort Psychoactive Drugs Neuroleptics (antipsychotics) Designed to reduce the symptoms of schizophrenia Reduces hallucinations, delusions, paranoid suspiciousness, disordered thinking, & incoherence Produce improvement in 60-70% of patients Negative side effects Dry mouth, blurred vision, dizziness, skin pigmentation Muscle rigidity, restlessness, tremors, slowed movement Tardive Dyskinesia – Extreme muscle spasms Psychoactive Drugs Antidepressants Designed to reduce the symptoms of depression Monoamine Oxidase Inhibitors (MAO-I) Treats depression & some cases of panic disorder Can produce hypertension if mixed with foods with tyramine (aged cheese, red wine, chicken livers, etc.) Tricyclic Prescribed more frequently than MAO-I because they work better Fewer side effects (can still cause sleepiness, dry mouth, dizziness, blurred vision, constipation, & urinary retention) Psychoactive Drugs Lithium Treats mania & bipolar (effective for 80% of patients) Dosage must be exact & carefully controlled Too much = Nausea, vomiting, tremors, fatigue, slurred speech, coma and death Anticonvulsants Alternative to treating mania Fewer side effects, less danger of over dosage, & easier to regulate Psychoactive Drugs Anxiolytics [Tranquilizers] Acts in a manner similar to barbiturate Creates an immediate calming effect Generalized anxiety disorder & posttraumatic stress disorder Side Effects Sedation, lightheadedness, & impaired psychomotor & mental functioning Continued use can cause tolerance & physical dependence Combined with alcohol may have fatal consequences Human Diversity & Drug Treatment Ethnicity Drug strengths vary depending on client ethnicity Caucasians need significantly more psychoactive drugs than Asians to achieve the same effects African Americans show faster responses to tricyclic antidepressants than European Americans Gender Research so far based heavily on males Women maintain higher levels of therapeutic psychoactive drugs in their blood Women are more vulnerable to tardive dyskinesia Evaluating Psychoactive Drug Treatments Drugs may cover up the problem Often times drugs simply mask the symptoms without treating the root causes Leaves the potential for the root causes to continue to get worse Drugs carry the potential for abuse Abuse of psychoactive drugs can create psychological dependence Drugs have undesirable side effects No drug is prefect & without side effects Often times, treatment will involve a lot of weighing the pros of the drug with the side effects Drugs or Psychotherapy? Sometimes psychotherapy is better Cognitive-behavioral & interpersonal therapy were as effective as antidepressants Sometimes drugs are better Severe cases of depression, panic disorder, generalized anxiety disorder, & obsessive-compulsive disorder In most cases, it seems that a combination of drugs & psychotherapy is the best method for treatment
