Treating Disorders of
the Mind and Body
Overview of Chapter Questions:

How Is Mental Illness Treated?

What Are the Most Effective Treatments?

Can Personality Disorders Be Treated?

How Should Childhood Disorders Be
Treated?
How Is Mental Illness Treated?

Psychotherapy Is Based on Psychological
Principles

Biological Therapies Are Necessary for
Some Disorders

Common Factors Enhance Treatment
Psychotherapy Is Based on
Psychological Principles





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Psychodynamic therapy focuses on insight
Humanist therapies focus on the whole person
Behavioral therapy focuses on observable
behavior
Cognitive-Behavioral therapy focuses on faulty
cognitions
Group therapy builds social support
Family therapy focuses on family context
Psychodynamic therapy
focuses on insight

Freudian “psychoanalysis” uses free association
and dream analysis to bring unconscious
unresolved conflict into focus

The goal is to produce insight, which leads to
behavior change and symptom improvement

Post-Freudian reformulations are called
“psychodynamic approaches”
Humanist therapies focus on
the whole person

Rogers’ “Client-centered therapy” uses
reflective listening to help persons clarify their
deeply held personal concerns

Rogers’ approach also promotes
“unconditional positive regard” as a therapeutic
element

Rogers’ approach aims to achieve “fullyfunctioning” persons who are “self-actualized”
as described by Maslow
Behavioral therapy focuses on
observable behavior

Behavior is learned and can be unlearned

Behavior Modification uses operant
conditioning

But social learning perspectives are used in
practice (social-skills, modeling, etc)

Exposure treatments, like systematic
desensitization, focus on phobic avoidance
Cognitive-Behavioral therapy
focuses on faulty cognitions

Cognitive therapy sees disorder as rooted in
distorted thoughts

Cognitive restructuring targets maladaptive
thought patterns

Ellis’ Rational-Emotive-Therapy pioneered
cognition as cause and cure

CBT integrates cognitive and behavioral
interventions
Group therapy builds
social support

Group therapies offer specific advantages

Groups vary in structure and orientation

Groups vary in degree of focus on insight,
social support, and cognitive or behavioral
change
Family therapy focuses on
family context

Family systems approaches recognize that
individual change is contextual, so why not
engage the whole system?

Studies of schizophrenic families show that
high levels of expressed emotion (EE) are
associated with risk for relapse, and reducing
EE reduces relapse! (see figure 14.4)
Biological Therapies Are
Necessary for Some Disorders

Psychotropic medications affect
neurotransmitter processes

Anti-anxiety drugs affect GABA
Biological Therapies Are
Necessary for Some Disorders


Antidepressant drugs:

MAO inhibitors

Trycyclics

SSRI’s (see fig 14.5)
Antipsychotic drugs:
Common Factors
Enhance Treatment

Psychotherapy helps, and common
underlying factors contribute to all
psychological approaches:

Caring Therapists

Catharsis and “Confession”
What Are the Most
Effective Treatments?

Treatments That Focus on Behavior and
Cognition Are Superior for Anxiety Disorders

Many Effective Treatments Are Available for
Depression

Lithium Is Most Effective for Bipolar Disorder

Pharmacological Treatments Are Superior for
Schizophrenia
Treatments That Focus on
Behavior and Cognition Are
Superior for Anxiety Disorders

For specific phobias, the sources of anxiety
are better addressed with cognitivebehavioral approaches than with medication

Systematic Desensitization uses “fear
hierarchies” (see fig 14.7) to help people learn
to manage dimensions of fear

Virtual treatments can reduce fear responses
Treatments That Focus on
Behavior and Cognition Are
Superior for Anxiety Disorders

SSRI’s help social phobia, but cognitive and
behavioral methods are treatments of choice

Panic Disorder treatments often combine
medication and CBT, but relapse is less with
CBT
Treatments That Focus on
Behavior and Cognition Are
Superior for Anxiety Disorders

OCD treatments blend medication and CBT
with a focus on “exposure” and “response
prevention” (see fig 14.10)
Many Effective Treatments Are
Available for Depression

MAO-inhibitors, tricyclics, and SSRI’s provide
relief to 60-70% of depressed persons

Cognitive-Behavioral Treatments are just as
effective, and target the automatic irrational
thoughts that accompany depression (see fig
14.11)
Many Effective Treatments Are
Available for Depression

Seasonal Affective Disorder (see fig 14.12)
responds to phototherapy

Exercise helps depression too

Electroconvulsive therapy (ECT) is the single most
effective treatment for severe depression, and it
saves lives, negative public views notwithstanding

Transcranial magnetic stimulation (TMS)
Lithium Is Most Effective
for Bipolar Disorder

Only 20% of bipolar patients who maintain
their medications experience relapse

Lithium stabilizes mood, but the mechanisms
are unclear, and the effect is greater on
mania than depression

But many patients discontinue medication,
perhaps because of the “intoxicating
pleasure” of manic states
Pharmacological Treatments
Are Superior for Schizophrenia

Haloperidol and Chlorpromazine
revolutionized the treatment of schizophrenia

But significant sedative and motor side
effects, resembling Parkinson’s disease,
make treatment unpleasant for many patients

Tardive dyskinesia

Clozapine (see fig 14.15)
Pharmacological Treatments
Are Superior for Schizophrenia

Despite the superiority of pharmacology,
psychosocial treatments improve functioning
beyond drug treatments (see fig 14.16)
Can Personality Disorders
Be Treated?

Dialectical Behavior Therapy Is Most
Successful for Borderline Personality
Disorder

Antisocial Personality Disorder Is Difficult to
Treat (see figure 14.19)
How Should Childhood Disorders
Be Treated?

Children with ADHD Can Benefit from a
Variety of Approaches

Autistic Children Benefit from a Structured
Treatment Approach
Children with ADHD Can Benefit
from a Variety of Approaches

Methylphenidate (ritalin) targets under active
brains and reduces negative behaviors (see fig
14.20)

Side effects and lack of long-term efficacy
limit the utility of ritalin

Behavioral Treatments, though timeconsuming, augment medication and help
social skills, academics, and family
relationships
Autistic Children Benefit from a
Structured Treatment Approach

Generalization of skills must be taught
explicitly

Applied Behavior Analysis (ABA) is time
intensive but raises IQ points by 20 on
average

The long-term prognosis for autism is poor