Over the ages, a mix of treatments & methods have been attempted to treat people with psychological disorders
Treatments have ranged from harsh to gentle
Reformers Philippe Pinel (1745–1826) and Dorothea Dix (1802–1887) pushed for:
Gentler and more humane treatments
Construction of mental hospitals
Since the 1950s, drug therapies & community-based treatment programs have replaced most of the mental hospitals
Psychotherapy A trained therapist uses psychological techniques to assist someone seeking to overcome difficulties or
achieve personal growth.
Biomedical Therapy Offers medications and other biological treatments; prescribed medications or procedures that act
directly on the person’s physiology.
Eclectic Approach Approach to psychotherapy that uses techniques from various forms of therapy.
Psychoanalysis is the first major psychological therapy was developed by Sigmund Freud.
Psychoanalysis: Freud’s therapeutic technique. Freud believed the patient’s free associations, resistances, dreams, and
transferences — and the therapist’s interpretations of them — released previously repressed feelings, allowing the
patient to gain self-insight.
The Goals of Psychoanalysis
To help patients release energy devoted to id-ego-superego conflicts
To bring patients’ repressed feelings into conscious awareness
To give patients insight into origins of their problems
If successful, patients may then achieve healthier and less anxious lives
The Techniques of Psychoanalysis Historical reconstruction of childhood experiences influencing adulthood; initially
through hypnosis and later through free association.
Resistance: the blocking from consciousness of anxiety-laden material.
Interpretation: analyst providing meanings to thoughts, dreams, resistances, and other significant behaviours & events
in order to promote insight.
Transference: occurs when the patient transfers to the analyst emotions linked with other relationships (such as love or
hatred for a parent).
Psychodynamic therapy: therapy deriving from the psychoanalytic tradition; views individuals as responding to
unconscious forces & childhood experiences → seeks to enhance self-insight.
Goal/Purpose: to help people explore and gain perspective on recurring patterns of defended-against thoughts &
feelings. Technique: Client-centered face-to-face meetings — aimed at helping client gain insight into childhood
experience & unconscious dynamics. Theme: emphasis on people’s potential for self-fulfillment. Goals: to reduce inner
conflicts that interfere with natural growth & development; to help clients grow in self-awareness and self-acceptance,
promoting personal growth. Given that humanistic therapies aim to give clients new insights – as is the case with
psychodynamic therapies, – both are often referred to as insight therapies
Difference: Humanistic vs Psychodynamic Therapies
Focus is to foster growth in self-awareness & self-acceptance, not cure illness.
The path to growth is taking responsibility for one’s feelings + actions & focusing on the present & future, rather than the
past; focus on conscious thought.
Rogers’ Client-Centered Therapy:
Non-directive, person-centered therapy that focuses on person’s conscious self-perceptions.
Therapists foster growth by exhibiting genuineness, acceptance, and empathy.
Therapy involves active listening and unconditional positive regard.
Believed that most people possess resources for growth.
Behaviour therapists (unlike those with an insight therapy approach) doubt the healing power of self-awareness,
believing instead that problem-behaviours are the problem
They view learning principles as useful tools for eliminating problematic behaviours
Aim to replace problematic behaviours with constructive behaviors
Constructive behaviours may be learned through classical or operant conditioning
This cluster of behaviour therapies is based on principles developed in Ivan Pavlov’s conditioning experiments.
Posits that maladaptive symptoms are learned through classical conditioning → learning through association.
We can unlearn fear responses through new conditioning. Counterconditioning uses classical conditioning to evoke
new responses to stimuli that trigger unwanted behaviours; includes exposure therapies and aversive conditioning.
Exposure Therapies → treat anxiety via exposure (in actual or imaginary situations) to that which one fears &
avoids; includes systematic desensitization & virtual reality exposure therapy. Systematic desensitization: associates
pleasant, calm state with gradually increasing, anxiety-triggering stimuli.
Aversive Conditioning: a technique that creates a negative (aversive) response to a harmful stimulus (alcohol) or
unwanted behaviour. Goal: transform a positive response to a harmful stimulus to a negative response;
conditioning an aversion to something the person should avoid (alcohol). Technique: unwanted behaviour (drinking;
nail biting) is assoc’td w unpleasant feelings (nausea; disgusting taste) Limits: the ability to discriminate between
aversive conditioning situation in therapy & all other situations can limit treatment effectiveness (one can drink
elsewhere without fear of nausea from Antabuse).Often used in combination w other treatments.
Behaviour modification techniques derive from B. F. Skinner’s operant conditioning principle that voluntary
behaviours are influenced by their consequences. Reinforce desirable behaviours; don’t reinforce (sometimes
punish) undesirable behaviours. Shape desired behaviour progressive +ive reinforcement of behaviour that comes
closer to desired behaviour. In institutional settings, therapists may create a token economy (desired behaviour →
tokens → exchanged for valued rewards); for example, getting out of bed, eating, washing, dressing, brushing their
teeth, etc.
There has been both criticism & support for behaviour modification techniques (eg token economies).
Proponents argue that it’s more humane to reinforce adaptive behaviours using positive rewards, than punish
people or institutionalize them for undesired behaviours.
Behaviour therapies are more appropriate for specific fears & behaviours than for a vast range of behaviours ( eg
depression) or wide-ranging anxiety.
Cognitive therapies.Teach people new, more adaptive ways of thinking.
Assumes that thoughts intervene between events and our emotional reactions. [events → thoughts → emotions]
Anxiety-provoking thoughts are usually negative (self-blaming/ defeating beliefs/rumination, pessimistic explanatory
style)
Cognitive therapy aims to change negative thoughts to perceiving/interpreting events in a new & constructive way.
Aaron Beck: Changing one’s –ive thinking (loss/rejection/ abandonment) can change their –ive functioning.
Gentle questioning seeks to reveal irrational thinking.
Persuade people to change their perceptions (negative, dark, pessimistic) to be more positive (e.g., self-talk).
Catastrophizing: relentless rehearsal of overgeneralized, self-blaming thoughts of depressed persons.
People trained to recognize and modify negative self-talk, and to restructure their thinking in stressful situations (using
stress inoculation training; Meichenbaum).
The benefits of positive self-talk are not restricted to depressed people; we all talk to ourselves. Studies show the
effectiveness of self-talk that is positive, not negative.
Cognitive-Behavioral Therapy (CBT) is an integrative therapy that combines cognitive therapy (changing self-defeating
thinking) with behaviour therapy (changing behaviour).
Aims to alter the way clients act AND they way they think.
Helps people learn to replace their catastrophizing thinking with more realistic appraisals and to practice behaviours
that are incompatible with their problem.
For example, those who fear social situations might learn to restrain the negative thoughts surrounding their social
anxiety and practice approaching people.
A newer CBT variation, Dialectical Behavior therapy (DBT), helps change harmful, even suicidal, behaviour patterns:
Aims to teach both acceptance and change.Combines cognitive training with emotion regulation
Behavior therapies: phobias, compulsions, bed-wetting, marital problems & sexual dysfunctions
Psychodynamic therapy: depression and anxiety
Cognitive & cognitive-behavioral therapies: anxiety, depression, and posttraumatic stress disorder
Client-Centered Therapy: mild to moderate depression
Therapy is most effective when problems are clear-cut
Evidence-based practice is a clinical decision-making approach that integrates 1) best available research with 2)
clinicians’ expertise & 3) patient’s characteristics, preferences and circumstances (see next slide)
Aerobic exercise (30m/day, 3X/week).Adequate sleep (7-8 hours/night). Light exposure (15-30m morning). Social
engagement (at least 2 connections/week). Outdoor activity in nature
Mimics certain neurotransmitters (e.g., blocking activity of dopamine— DA). These drugs (eg Thorazine) reduce
overreaction to irrelevant stimuli such as hallucinations & delusions).
First-generation antipsychotic drugs such as Thorazine may produce sluggishness, tremors, twitches, and tardive
dyskinesia (stiff, jerky involuntary facial/body movements).
Newer-generation antipsychotics (risperidone, olanzapine) have fewer side effects (increase risk of obesity/diabetes*).
Successfully used with life-skills programs & family support to treat schizophrenia, allowing many patients to leave
hospitals and live near-normal lives (e.g., work).
Antianxiety drugs: drugs (Xanax, Ativan, Valium) used to control anxiety and agitation; help one overcome feelings of
nervous apprehension and an inability to relax.
Anxiety is increasingly treated NOT by antianxiety drugs, but by antidepressants (Prozac, Paxil, Zoloft, Cipralex).
Several widely used antidepressant drugs are selective serotonin reuptake inhibitors — SSRIs. Example: Prozac, Zoloft,
Paxil . Many increase availability of norepinephrine or serotonin, which elevate arousal and mood.
Increased serotonin promotes neurogenesis, the birth of new brain cells (reverses stress-induced loss of neurons).
Effectiveness questioned due to spontaneous recovery & placebo effect (75% of drug effect), especially for those with
milder symptoms (Kirsch, 2016); consider other Tx’s
Treats mania & prevent the return of both manic & depressive episodes in BD (& depressed mood in schizophrenia).
Stabilizes mood-swings, impulsivity & self-harm behaviours
Depakote, Tegretol (anticonvulsants): originally used to treat epilepsy; found useful for controlling manic episodes
Lithium (Lithobid): simple salt that levels out emotional highs & lows of bipolar disorder. Effects associated with
reductions in suicide risk for BD patients. reductions in crime rates (when in water supply)
Pharmacodynamics: thought to modulate neurotransmitters (dopamine, glutamate, GABA—gamma-aminobutyric acid)
in brain regions that are involved in mood regulation
Deep Brain Stimulation (DBS)
Another neural stimulation technique used to treat depression, via links of frontal lobe & limbic system
Involves the placement of neurostimulator (referred to as a “brain pacemaker”), which sends high-frequency electrical
impulses through implanted electrodes deep in the brain to specific brain areas (anterior cingulate cortex—emotional
regulation & reward mechanism centre) responsible for the symptoms. Result: calms brain activity & depression.
Evidence for efficacy is limited; current more trials.
In addition to the depressed patients, DBS has been used for Parkinson’s, OCD, drug & alcohol addictions