Treatment of Mental Disorders By Mr. K Compliments of Mr. C What’s difference between a psychiatrist, clinical psychologist, and counselor? How do psychoanalysts treat disorders? How do behaviorists treat disorders? What are classical conditioning techniques to therapy? What is manifest content of dreams? Latent content? What are operant conditioning techniques? What is cognitive therapy? Who is Albert Ellis? Who is Aaron Beck? How do Humanists treat disorders? What are biomedical therapies? Benefits of group therapy? What is a psychiatrist? Psychiatrists are MDs (medical doctors) with a specialty in treating mental disorders, usually with a biomedical therapy (medicine) and some talk therapy. You would see a “shrink” if you have schizophrenia, severe depression, suicidal thoughts, and other severe mental problems that need medication. What is a clinical psychologist? A clinical psychologist has a PhD in psychology (no medical school). They treat fairly serious mental illnesses with “talk” therapies. They might treat personality disorders, anxiety disorders, addictions using insight or “talk” therapy. What is a counselor? A counselor uses “talk” therapy to treat non-mental disorders like improving communication between family members, grief counseling, marital counseling, life strategies. Counselors have a Masters Degree with specialty training. Types of Mental Health Care Professionals Counseling psychologist Clinical psychologist Psychiatrist Psychoanalyst Psychiatric nurse practitioner Clinical social worker Pastoral counselor Professional Title Counseling psychologist Specialty: Clinical psychologist Problems of normal living Psychiatrist Work setting: Psychoanalyst Schools, clinics, other institutions Psychiatric nurse practitioner Credentials: Clinical social worker Master’s in counseling, PhD, EdD, or PsyD Pastoral counselor Professional Title Counseling psychologist Specialty: Clinical psychologist Those with severe disorders Psychiatrist Work setting: Psychoanalyst Private practice, mental health agencies, hospitals Psychiatric nurse practitioner Clinical social worker Pastoral counselor Credentials: PhD or PsyD Professional Title Counseling psychologist Clinical psychologist Psychiatrist Psychoanalyst Psychiatric nurse practitioner Clinical social worker Pastoral counselor Specialty: Severe mental disorders (often by means of drug therapies) Work setting: Private practice, clinics, hospitals Credentials: MD Professional Title Counseling psychologist Clinical psychologist Specialty: Psychiatrist Psychoanalyst Freudian therapy Work setting: Psychiatric nurse practitioner Private practice Clinical social worker Credentials: Pastoral counselor MD Professional Title Counseling psychologist Clinical psychologist Psychiatrist Psychoanalyst Psychiatric nurse practitioner Clinical social worker Pastoral counselor Specialty: Nursing specialty; licensed to prescribe drugs Work setting: Private practice, clinics, hospitals Credentials: RN – plus special training in treating mental disorders and prescribing drugs Professional Title Counseling psychologist Clinical psychologist Psychiatrist Specialty: Social worker with specialty in dealing with mental disorders Psychoanalyst Work setting: Psychiatric nurse practitioner Often employed by government Clinical social worker Pastoral counselor Credentials: MSW Professional Title Counseling psychologist Clinical psychologist Psychiatrist Psychoanalyst Psychiatric nurse practitioner Clinical social worker Pastoral counselor Specialty: Combines spiritual guidance with practical counseling Work setting: Religious order or ministry Credentials: Varies 2. In contrast to a clinical psychologist, a psychiatrist is more likely to a) engage in an eclectic b) use a biomedical/somatic treatment c) recognize the importance of group therapy with patients having the same disorder d) treat clients in community mental health centers exclusively Perspectives on Treatment Psychoanalytic Behavioral Humanistic Cognitive Biophysical Psychoanalytic (5 methods) Dream Analysis Transference Hypnosis Free association Slips of the tongue All 5 rely on exposing unconscious thoughts and interpreting them. VII. Psychoanalysis (psychodynamic): Unconscious thoughts & emotions are brought into awareness to be dealt with. Psychological problems – the result of unconscious processes. Bringing unpleasant unconscious thoughts into to consciousness, produces catharsis. A. What are Psychoanalytic methods of therapy (4 of them on same card if possible): 1. Free Association – patient reports anything that comes to his/her mind. The psychoanalyst takes whatever you say and treats it like a window into your unconscious mind. B. Dream analysis: Dreams have two types of content: Manifest content- actual events in dream. Latent content – hidden message in dream. (latent = hidden) Freud thought that each dream represents a form of wish fulfillment. The wish may be disguised, but it is always there. C. Transference Feelings of love or other emotions (hatred) are expressed toward the therapist. These feelings are actually unconsciously felt toward others; the patient is projecting these feelings onto the therapist. This provides clues about the client’s feelings about these other people. Hypnosis Hypnosis is a psychoanalytic therapeutic technique. Supposedly reaches into the subconscious Whatever you think, patients report benefits from hypnosis. 5. The goal of psychoanalytical therapy is a) to change maladaptive behavior to more socially acceptable behavior b) to change negative thinking into more positive attributions c) to attain self-actualization d) to bring unconscious conflicts to conscious awareness and gain insight 7. Treating the therapist as though he were a very important person from one’s past, such as a parent, defines a) resistance b) transference c) frustration d) reaction formation Behavioral Therapy Behavioral Therapy Behaviorists believe that mental problems are caused by classical conditioning (for example, phobias), operant conditioning (addictions, depression), and observational learning (we watch our parents and friends suffer so we copy them). Classical Conditioning Therapeutic Techniques Systematic Desensitization – (treats phobias) if you are afraid of snakes, start with worms, calm down, then graduate to having a snake in the next room, calm down, then look at pictures, calm down, then watch movies, calm down, then be in the same room, calm down, then get closer, calm down Classical Conditioning Flooding – (treats phobias) if you are afraid of snakes, therapist will throw you in a pit of snakes. Classical conditioning Aversive conditioning - rids of unwanted behaviors by getting one to associate bad stuff with it. Coyotes are fed poisoned lamb meat so they will stop killing sheep. Alcoholics take pills that make them sick when they drink alcohol. Aversive Conditioning A type of counterconditioning that associates an unpleasant state with an unwanted behavior. How would putting poop on the fingernails of a nail biter affect their behavior? Aversive Conditioning Operant conditioning treatment Token economy – Therapists will reward desirable behaviors with a reward system. This is usually applied to groups like hospital mental wards or classrooms or workplaces. If you don’t kill anyone this week, I’ll give you a nickel. If everyone passes, we’ll have a pizza party. 6. Systematic desensitization is a technique based on a) classical conditioning b) instrumental conditioning c) operant conditioning d) aversive conditioning 12. Antabuse is a drug that, when paired with alcohol in the bloodstream, bring about extreme nausea. For many motivated alcoholics, this has proven to be an effective treatment. Under which umbrella of psychotherapy would it most likely be found? a) insight therapy b) aversive conditioning c) Gestalt therapy d) self-help therapy Humanistic Perspective of Psychology Humanism What is the root word of Humanism? After years of psychoanalysts saying we are a bunch of id-driven animals and years of behaviorists studying rats in a cage, the Humanists came along in the 60s. Who is Carl Rogers? 2 Famous Humanists Who is Carl Rogers? Carl Rogers was the founder of person-centered therapy, reflective listening, unconditional positive regard. The patient/client has all the answers and the means to treat themselves. In clientcentered therapy, the therapist acts as a sounding board for the patient, sometimes rephrasing what the patient says (reflective listening). Empathy is important! Carl Rogers Rogers also said the therapist must have unconditional positive regard. No judgments can be made! The environment must be loving and accepting if the client is to open up to you. Good for patients with self-esteem issues. Abraham Maslow Maslow’s hierarchy of needs Maslow’s hierarchy of needs People cannot maximize their potential unless their more basic needs are met. If a family’s home just got destroyed by a tornado, can they focus on their communication skills? If you are hungry, can you worry about your self esteem? Do these people have self esteem issues? Which Simpsons character is at the bottom of Maslow’s Hierarchy of Needs? Which character has safety needs? Who has love and belonging needs? Who has esteem needs? Are any Simpsons characters self actualizing? Depends on the episode The Simpsons aren’t real people, but in some episodes, Homer and Lisa are. Even Grandpa has his day. Humanistic Therapy Humanists are really touchy-feely, but without them we are just rats in a cage. Rogers and Maslow put the “human” element back into psychology and therapy. Their philosophy: We are all humans striving to maximize our potential. A therapist’s job is to remove obstacles to self-actualization. 8. Vic is encouraged to take charge of the therapy session and his therapist uses an active listening approach to mirror back the feelings he hears from him. Which therapy is most likely being described? a) client-centered therapy b) cognitive therapy c) psychodynamic therapy d) existential therapy Cognitive Therapy The words cognitive, cognition have a root that means “to know” or “to think” Cognitive skills are thinking skills. Cognitive therapy Cognitive therapy focuses on changing how the client/patient thinks. It can be confrontational The therapist focuses on changing/fixing the irrational thoughts of the patient Cognitive therapy also “educates” the client, teaches him/her proper behaviors/thoughts Cognitive Therapy We are depressed because we are irrational. Our expectations are too high and misplaced. We want everyone to love us and accept us. We want every thing to go our way. We stay angry about stuff that happened a looong time ago. WE MUST CHANGE THE WAY WE THINK TO BE HAPPY AND SUCCESSFUL. Cognitive Therapy Albert Ellis Rational Emotive Therapy vigorously challenges people’s illogical, self-defeating attitudes and assumptions; a confrontational therapy Rational Emotive Therapy: Ellis A-B-C theory of dysfunctional behavior A – Activating event B – Belief C – emotional Consequence based on that belief. Example of Rational Thinking A= fail a midterm examination B=It’s unfortunate that I failed-I did not study hard enough and I must make sure that I study harder for the final C=no consequences (no emotional disturbance) Example Irrational Thinking: leads to Emotional Disturbance A= Fail exam B= I’m stupid, I’ll never be able to pass this course and I will fail this course C=depression Ellis’ List of Common Irrational Ideas I absolutely must have sincere love and approval almost all the time from all the significant people in my life I must be thoroughly competent, adequate and achieving in all respects, or I must at least have real competence or talent at something important; otherwise I am worthless. People who harm me or who do a bad thing are uniformly bad or wicked individuals, and I should severely blame, damn, and punish them for their sins and misdeeds Ellis’ List of Common Irrational Ideas (continued) When things do not go the way I would like them to go, life is awful, terrible, horrible, or catastrophic Unhappiness is caused by external events over which I have almost no control. I also have little ability to control my feelings or rid myself of feelings of depression and hostility. Rational Emotive Therapy Identify patient’s irrational beliefs Add “D” and “E” to A-B-C theory Teach the patient to Dispute the beliefs and substitute logical and rational beliefs Evaluate the effects of disputing their irrational beliefs CBT: Effective for Which Disorders? Empirically supported treatment for Depression Generalized anxiety disorder Obsessive compulsive disorder Panic disorder Group Therapy Group Therapy Is cheap, effective. (only 1 professional is needed) It allows people to gain insight into their own behaviors and thoughts People don’t feel like they are the only one with their problem; they can witness the therapist treat others with similar problems. You can cure yourself while curing others. 10. All of the following are potential benefits of group therapy EXCEPT a) it is often more economical than 1:1 treatment b) it does not require the services of a mental health professional c) clients with similar problems can provide helpful insight and feedback to peers d) group members can see how their problems might impact others How Is the Biomedical Approach Used to Treat Mental Disorders? Biomedical therapies seek to treat mental disorders by changing the brain’s chemistry with drugs, its circuitry with surgery, or its patterns of activity with pulses of electricity or powerful magnetic fields Drug Therapy Antipsychotic drugs alleviate the symptoms of severe disorders such as schizophrenia; Examples:Thorazine, Clozapine many work by blocking dopamine receptor sites can produce sluggishness, tremors, and twitches similar to those of Parkinson’s disease Drug Therapy Psychopharmacology – The prescribed use of drugs to help treat symptoms of mental illness ostensibly to ensure that individuals are more receptive to talk therapies Drug Therapy Antidepressants and mood stabilizers Include Prozac, monoamine oxidase (MOA) inhibitors, and lithium carbonate (effective against bipolar disorder) Treat depression and bipolar disorder Usually affect serotonin and/or norepinephrine The use of antidepressants to deal with general feelings of unease is highly controversial Drug Therapy Antianxiety drugs work by depressing central nervous system activity Most common side effect - drowsiness highly addictive, can be fatal when mixed with alcohol sudden cessation after long-term use can result in severe withdrawal symptoms, including seizures, increased anxiety, and in rare cases, death Xanax, Paxil Drug Therapy in ADHD Stimulants suppress activity level in persons with attentiondeficit/hyperactivity disorder (ADHD) There is controversy from concern that the causes and boundaries of ADHD are vague and the potential exists for overdiagnosis 4. The MOST commonly cited side effect associated with anti-anxiety drugs is a) insomnia b) blurred vision c) drowsiness d) tachycardia 9. Prozac and other modern antidepressant medications work to a) block dopamine receptors b) decrease the level of acetylcholine c) break down the MAO enzymes d) block the reuptake of seratonin 11. Valium is a) an antidepressant drug b) an MAO inhibitor c) an antipsychotic drug d) an antianxiety drug 13. Andre suffers from mood swings, alternating from wild episodes of euphoria and spending sprees to motionless staring and hopelessness. If someone from the biomedical approach were to treat his condition, the prescription most likely would be a) Lithium carbonate b) Haldol c) Xanax d) Thorazine Psychosurgery Psychosurgery – The general term for surgical intervention in the brain to treat psychological disorders The infamous prefrontal lobotomy is no longer performed Severing the corpus callosum, however, can reduce life-threatening seizures Brain-Stimulation Therapies Electroconvulsive therapy is used for the treatment of severe depression Transcranial magnetic stimulation, a possible alternative to ECT, can also be used for the treatment of depression, schizophrenia, and bipolar disorder 1930’s-1950’s Frontal lobotomy Became Prefrontal lobotomy Muniz won Nobel prize for procedure Procedure eventually banned Destruction of personality Replaced in 1954 by first antipsychotic: Thorazine A. B. C. D. Matt enters therapy to talk about some issues that have been causing him distress. The therapist has earned a PhD and uses a variety of techniques to alleviate some of Matt’s distressing symptoms. Matt is most likely seeing a _____ Psychiatrist Clinical psychologist Psychiatric social worker Clinical counselor A. B. C. D. The aim of cognitive-behavioral therapy is to _____ Discover unconscious motives for behavior Change the way people behave Change the way people think and behave Change people’s negative thinking patterns A. B. C. D. Ann is suffering from depression and no psychological or drug therapies are working to alleviate her symptoms. The biomedical technique of ____ may be used as a last resort. Flooding Systematic desensitization Electroconvulsive therapy psychosurgery Modern antidepressants, such as Prozac, work to block the reuptake of which neurotransmitter? A. Dopamine B. Serotonin C. Acetylcholine D. GABA A. B. C. D. E. ________ therapy does NOT use the services of a trained therapist. Biomedical Cognitive-behavioral Behavioral Humanistic Self-help A. B. C. D. E. John is a 12-year-old who is having trouble dealing with his family’s relocation to a new city. He most likely first sees a ______ Psychiatrist Counselor Clinical psychologist Registered nurse Psychoanalyst