Chapter 15
Treatment of Abnormal Psych
History of Treatment
Chapter Introduction
 Therapeutic drugs and
community-based
treatments are why many
mental health hospitals
have been empty since
the 1950s.
Therapy
 Psychotherapy
 an emotionally charged,
confiding interaction
between a trained therapist
and someone who suffers
from psychological difficulties
 Eclectic Approach
 an approach to
psychotherapy that,
depending on the client’s
problems, uses techniques
from various forms of therapy
Therapy- Psychoanalysis
 Psychoanalysis
 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
 use has rapidly decreased in
recent years
 Resistance
 blocking from consciousness of
anxiety-laden material
TherapyPsychoanalysis
 Psychoanalytic theory creates less anxious individuals for
their conflicted energy is now released
 Free association is when you say aloud whatever is on your
mind.
TherapyPsychoanalysis
 The latent content of a
dream is the underlying,
but censored meaning.
 A dream analysis is a
suggestion of a dream’s
meaning.
Therapy- Psychoanalysis
 Interpretation
 the analyst’s noting
supposed dream meanings,
resistances, and other
significant behaviors in
order to promote insight
 Transference
 the patient’s transfer to the
analyst of emotions linked
with other relationships
 e.g. love or hatred for a
parent
Psychodynamic Therapy
 Therapy deriving from the
psychoanalytic tradition that
views individuals as
responding to unconscious
forces and childhood
experiences, and that seek
to enhance self-insight
 The goal is to interpret the
patient’s conflict
Humanistic Therapy
 Client-Centered Therapy
 humanistic therapy
developed by Carl Rogers
 therapist uses techniques
such as active listening
within a genuine, accepting,
empathic environment to
facilitate clients’ growth
 Active Listening-empathic
listening in which the
listener echoes, restates,
and clarifies
Humanistic Therapy
 Rogers wanted therapists
to focus on GENUINENESS,
ACCEPTANCE, AND
EMPATHY.
 Unconditional positive
regard: a caring, accepting,
nonjudgmental attitude,
which Carl Rogers believed
to be conducive to
developing self-awareness
& acceptance
Humanistic Therapy
 Insight therapies: aim to
improve the
psychological functioning
by increasing the client’s
awareness of underlying
motives and defenses.
 focuses more on the
present and future more
than the client’s past
Behavior Therapy
 Behavior Therapy
 therapy that applies learning
principles to the elimination
of unwanted behaviors
 Counterconditioning
 procedure that conditions
new responses to stimuli that
trigger unwanted behaviors
 based on classical
conditioning
 includes systematic
desensitization and aversive
conditioning
Behavior Therapy
 Exposure Therapy
 treat anxieties by
exposing people (in
imagination or reality) to
the things they fear and
avoid
Behavior Therapy
 Systematic Desensitization
 type of counterconditioning
 associates a pleasant, relaxed
state with gradually increasing
anxiety-triggering stimuli
 commonly used to treat phobias
 Aversive Conditioning
 type of counterconditioning that
associates an unpleasant state
with an unwanted behavior
 nausea ---> alcohol
Discrimination
 Mary Cover Jones did not
receive the credit she
deserved in psychology
because she was a
woman.
Systematic Desensitization
 Systematic
Desensitization: a type of
exposure therapy that
associates a pleasant
relaxed state with
gradually increasing
anxiety triggering stimuli.
 Commonly used to treat
phobias.
Progressive Relaxation
 Progressive Relaxation:
Relaxing one muscle
group at a time to receive
relaxation and comfort.
Virtual Reality Exposure Therapy
 Virtual Reality Exposure
Therapy: Anxiety
treatment that
progressively exposes
people to stimulations of
their greatest fears such
as airplane flying to public
speaking.
Virtual Reality Exposure Therapy
 This is helpful because
your fear is stimulated to
help people get through
it without a high cost.
 Also, using an avatar lets
you try out new behaviors
in virtual environments
for people suffering a
social phobia.
Aversive Conditioning
 Aversive Conditioning:
type of counterconditioning that
associates an unpleasant
state with an unwanted
behavior.
Aversive Conditioning vs. Systematic
Desensitization
 Aversive Conditioning is
the opposite of
systematic
desensitization.
Aversive Conditioning
 Aversive Conditioning: to
get rid of nail biting, you
could paint your nails
with a nasty tasting nail
polish.
Aversive Conditioning
 Aversion is much better in
the short term rather
than long term.
 When coyotes stopped
eating sheep because
there coats were treated
with poison, later they
began to eat the sheep
again.
Aversive Conditioning
 Cognition influences
aversive conditioning.
 After 3 years people
treated with alcohol
aversion, only 33% stayed
away from alcohol.
Behavior Modification
 Behavior Modification:
reinforcing behaviors and
withholding
reinforcement for
undesired behaviors or
punishing them.
Behavior Modification
 Children with disabilities
have learned to care for
themselves.
 People suffering from
Schizophrenia have
learned to behave more
rationally.
Token Economy
 Token Economy: an
operant conditioning
procedure in which
people earn a token of
some sort for exhibiting a
desired behavior and can
later exchange the tokens
for various privileges or
treats.
Token Economy
 Criticisms:
 Will people stop doing
the behaviors when the
rewards stop.
 Is it right to deprive
people of something they
desire and decide which
behaviors to reinforce.
Cognitive Therapies
 Cognitive Therapies:
therapy that teaches
people new, more
adaptive ways of thinking
and acting; based on the
assumption that thoughts
intervene between
events and our emotional
reactions.
Cognitive Therapies
 Cognitive therapists try to
teach new, more
constructive ways of
thinking.
Aaron Beck
 Aaron Beck was originally
trained Freudian but
turned cognitive
therapist.
 Beck tries to reverse
clients’ catastrophizing
beliefs about themselves,
situations, and future.
Stress Inoculation Training
 Meichenbraum’s stress
inoculation training teaches
people to restructure their
thinking in stressful
situations.
 After learning how to
dispute negative thoughts
there was a halved rate of
future depression.
Cognitive Behavior Therapy
 Cognitive Behavior
Therapy: a popular
integrated therapy that
combines cognitive
therapy and behavior
therapy.
Group Therapy
 Economically, group
therapy is good because
it saves time and money.
 It allows people to see
problems similar to their
own and receive
feedback as they try new
ways of behaving.
Family Therapy
 Family therapy: therapy
that treats the family as a
system views an
individuals unwanted
behaviors as influenced
by, or directed at, other
family members.
Family Therapy
 Goals are beneficial
because they open up
communication within
the family or to help
family members.
Group Therapy
 AIDS, anorexia, alcohol,
and hearing loss have
successful support
groups.
 Whereas hypertension,
migraines, ulcers, and
vision loss don’t really
have support groups.
Alcoholics Anonymous
 Worldwide, Alcoholics
Anonymous has over 2
million members in 114,000
groups.
 Their 12 step program, you
need to admit powerless,
seek help from a higher
power, and to share
message with others.
Figure 15.1
Psychotherapy
 Clients testimonials affirm
the use of psychotherapy.
 Criticisms:
 People often enter therapy
in a crisis.
 Clients may need to believe
therapy was worth the
effort.
 Clients generally speak
highly of their therapists.
Placebo Effect Regarding Therapy
 Power or belief in the
treatment, whether or
not it actually is
successful.
Regression Towards the Mean
 Regression Towards the
Mean: tendency for the
extremes to fall back
towards the average, or
what is normal.
Lack of Psychotherapy
 Eysenck said that without
psychotherapy, roughly
66% of people with
depression improved
noticeably.
 Time heals.
 Criticism:
 Sample for testing was
small.
Research of Therapy
 Randomized clinical trials
are the best way to study
outcome research.
 Researchers need to
randomly assign people
to either a therapy group,
or no therapy.
Meta-Analysis
 Meta-Analysis: a
procedure for statistically
combining the results of
many different research
studies.
Smith’s 1980 Research
 Psychotherapists welcomed the first
meta-analysis of some 475 psychotherapy
outcome studies It showed that the
average therapy client ends up better off
than 80 percent of the untreated
individuals on waiting lists. The claim is
modest—by definition, about 50 percent
of untreated people also are better off
than the average untreated person.
Nevertheless, Mary Lee Smith and her
colleagues exulted that “psychotherapy
benefits people of all ages as reliably as
schooling educates them, medicine cures
them, or business turns a profit.”
5 Subsequent studies
 Proved that: Those not
undergoing therapy often
improve, but those
undergoing therapy are
more likely to improve.
Psychotherapy-cost effective
 Studies show that when people seek
psychological treatment, their search for
other medical treatment drops—by 16
percent in one digest of 91 studies.
 Given the staggering annual cost of
psychological disorders and substance
abuse—including crime, accidents, lost
work, and treatment—this is a good
investment.
 Both reduce long-term costs. Boosting
employees’ psychological well-being, for
example, can lower medical costs,
improve work efficiency, and diminish
absenteeism.
Clinicians experience
 There is little if any
connection between
clinicians’ experience,
training, supervision, and
licensing and their clients’
outcomes.
Behavioral Benefits from therapy
 Behavioral conditioning
therapies, for example,
have achieved especially
favorable results with
specific behavior
problems, such as bedwetting, phobias,
compulsions, marital
problems, and sexual
disorders.
Cognitive Therapy
 And new studies confirm
cognitive therapy’s
effectiveness in coping
with depression and
reducing suicide risk.
Behavioral Optimism
 Behavioral change is most
optimistic with specific
problems (rather than
general problems).
Non-recommended therapies
 Energy therapies
 Recovered-memory
therapies
 Rebirthing therapies
 Facilitated
communication
 Crisis debriefing
Psychology’s Civil War
 But this question—which
therapies get prizes and
which do not?—lies at
the heart of a serious
controversy some call
psychology’s civil war.
Evidence Based Practice
 Clinical decision-making
that integrates the best
available research with
clinical expertise and
patient characteristics
and preferences.
EMDR
 EMDR (eye movement desensitization
and reprocessing) is a therapy
adored by thousands and dismissed
by thousands more as a sham—“an
excellent vehicle for illustrating the
differences between scientific and
pseudoscientific therapy
techniques.”
 James Herbert and seven others
suggested it
 Created when one day while walking
in a park and observing that anxious
thoughts vanished as her eyes
spontaneously darted about.
Francine Shapiro and EMDR
 After she tried this on 22
people haunted by old
traumatic memories, and all
reported marked reductions in
their distress after just one
therapeutic session, the
extraordinary result evoked an
enormous response from
mental health professionals.
 Also noted: To date, nearly
70,000 of them, from more
than 75 countries, have
undergone training for EMDR.
Does it work?
 The treatment need take no
more than three 90-minute
sessions. The Society of Clinical
Psychology task force on
empirically validated treatments
acknowledges that the
treatment is “probably
efficacious” for the treatment of
nonmilitary post-traumatic
stress disorder
 Encouraged by their seeming
successes, EMDR therapists are
now applying the technique to
other anxiety disorders, such as
panic disorder, and, with
Shapiro’s encouragement, to a
wide range of complaints,
including pain, grief, paranoid
schizophrenia, rage, and guilt.
Skeptics
 It seems eye movements are
not the therapeutic
ingredient.
 In trials in which people
imagined traumatic scenes
and tapped a finger, or just
stared straight ahead while
the therapist’s finger
wagged, the therapeutic
results were the same.
Seasonal Affective Disorder (SAD)
 The wintertime blahs
constitute a form of
depression (for especially
women and those living
far from the equator).
Light Exposure Therapy
 After four weeks of treatment, 61
percent of those exposed to
morning light had greatly improved,
as had 50 percent of those exposed
to evening light and 32 percent of
those exposed to the placebo
 Other studies have found that 30
minutes of exposure to 10,000-lux
white fluorescent light produced
relief for more than half the people
receiving morning light therapy and
for one-third receiving evening light
the
Elements in all forms of
psychotherapy
 Hope for demoralized
people
 A new perspective on
oneself and the world
 An empathic, trusting,
caring relationship
Participant’s belief
 This belief, apart from any
therapeutic technique,
may function as a
placebo, improving
morale, creating feelings
of self-efficacy, and
diminishing symptoms.
A new perspective
 Every therapy also offers
people a plausible explanation
of their symptoms and an
alternative way of looking at
themselves or responding to
their world. Armed with a
believable fresh perspective,
they may approach life with a
new attitude, open to making
changes in their behaviors and
their views of themselves.
Effective therapists
 Normally have the
qualities of:





Empathetic
Caring
Trusting
Willing to gain insight
Communicate well
Similarities between psychologists
 Similar characteristics of
cognitive, psychodynamic,
and interpersonal
psychologists:
 At key moments, the
empathic therapists of both
persuasions would help
clients evaluate themselves,
link one aspect of their life
with another, and gain
insight into their
interactions with others.
Therapeutic Alliance
 The emotional bond
between therapist and
client (is a key aspect of
effective therapy).
Paraprofessional
 That all therapies offer
hope through a fresh
perspective offered by a
caring person is what also
enables paraprofessionals
(briefly trained
caregivers) to assist so
many troubled people so
effectively.
People who don’t need therapy
 They empathize, reassure,
advise, console, interpret,
or explain. Such qualities
may explain why people
who feel supported by
close relationships—who
enjoy the fellowship and
friendship of caring
people—are less likely to
need or seek therapy.
What therapy wants to enhance




Sensitivity
Openness
Personal
Responsibility
Culture
 Clients who are immigrants
from Asian countries, where
people are mindful of others’
expectations, may have
trouble relating to therapies
that require them to think only
of their own well-being.
 Such differences help explain
the reluctance of some
minority populations to use
mental health services.
Asian-American view points
 Asian-American clients
matched with counselors
who shared their cultural
values (rather than
mismatched with those
who did not) perceived
more counselor empathy
and felt a stronger
alliance with the
counselor.
Albert Ellis
 Rational-Emotive Therapy
 Assumed that “no one and
nothing is supreme,” that
“self-gratification” should
be encouraged, and that
“unequivocal love,
commitment, service, and…
fidelity to any interpersonal
commitment, especially
marriage, leads to harmful
consequences.”
Bergin and Ellis
 Bergin and Ellis disagreed more
radically than most therapists on
what values are healthiest. In so
doing, however, they agreed on a
more general point:
Psychotherapists’ personal beliefs
influence their practice.
 Assumed that “no one and nothing
is supreme,” that “self-gratification”
should be encouraged, and that
“unequivocal love, commitment,
service, and… fidelity to any
interpersonal commitment,
especially marriage, leads to harmful
consequences.”
Bio Medical Therapy
 Bio Medical Therapy:
Prescribed medications or
medical procedures that act
directly on the patient’s
nervous system
 Psychotherapy is to
psychological disorders and
biomedical therapy is to
serious disorders
 Only psychiatrists (as
medical doctors) offer
biomedical therapies.
Psychopharmacology
 The study of the effects of drugs on mind and
behavior.
Diminishing Enthusiasm
 Almost any new treatment,
including drug therapy, is
greeted by an initial wave of
enthusiasm as many people
apparently improve.
 Decline in enthusiasm is due to:
 (1) normal recovery among
untreated persons
 (2) recovery due to the
placebo effect, which arises
from the positive
expectations of patients and
mental health workers alike.
Testing the drug
 To test the legitimacy of a
drug, scientists use the
double blind procedure.
 Double Blind: Half the
patients get the drug, and
the other half get a similarappearing placebo. Neither
the staff nor the patients
know who gets which.
Psychoses
 Disorders in which
hallucinations or
delusions indicate some
loss of contact with
reality
 When drugs were found
for this it was accidental
Antipsychotic Drugs
 Drugs used to treat
schizophrenia and other forms
of severe thought disorder
 Examples: Chlorpromazine
which dampened
responsiveness to irrelevant
stimuli
 Mimics dopamine; goal of
molecule is to occupy its
receptor sites and block its
activity
 This finding reinforces the idea
that an overactive dopamine
system contributes to
schizophrenia. Antipsychotics
are powerful drugs
Tardive Dyskinesia
 Involuntary movements
of the facial muscles,
tongue, and limbs; a
possible neurotoxic side
effect of long-term use of
antipsychotic drugs that
target certain dopamine
receptors.
Treating Positive vs. Negative symptoms
 Positive: antipsychotic drugs
such as Thorazine are used to
dampen responsiveness to
irrelevant stimuli and aiding is
the prevention of
hallucinations and delusions
 Negative: atypical
antipsychotics are used such as
Clozaril. These drugs target
both dopamine and serotonin
receptors this helps alleviate
negative symptoms and “
awakens” patients.
Side effects of Antipsychotic drugs
 Antipsychotic drugs can
increase one’s risk of
obesity and diabetes
Benefits
 Combined with life skill
programs and family
support, the most
positive gain form
antipsychotic drugs ate
that thousands of
schizophrenics have
returned to near normal
life
Anti-anxiety drugs
 Anti anxiety drugs: drugs
that are used to control
anxiety and agitation
 Example: Xanax or Ativan
 These drugs depress
central nervous system
activity
Negative side effects
 “popping” Xanax can lead to…






Psychological dependence
Reinforce repeated behavior
Physiological dependence
Anxiety
Insomnia
Other withdrawal symptoms
Antidepressants
 Antidepressant drugs: drugs used to treat
depression; also increasingly prescribed for anxiety.
Different types alter different neurotransmitters.
 Antidepressants can work
on obsessive compulsive disorder
Antidepressants
 Work on increasing the
availability of nor
epinephrine and
serotonin,
neurotransmitters that
elevate arousal and mood
and appear scarce during
depression
Prozac
 Prozac blocks the reabsorbsion and removal of
serotonin from synapses
SSRI’s
 SSRI: selective serotonin
reuptake inhibitors
 Zoloft
 Paxil
 Prozac
Administering drugs
 Most successful method:
administering by a patch
or bypassing the
intestines and liver; helps
to reduce side effects.
Prevalence
 After SSRI’s were introduced in 1987, 70% of
depressed patients received them
 In 2001, this jumped to 89%
 11% of women and 5%
of men take an SSRI
Other ways to relieve depression
 Aerobic exercise can often
lift our spirits and gradually
cure us of depression due to
the release of endorphins
 Cognitive therapy can also
help depressed patients sort
through their thoughts in
order to beat depression
Effects of SSRI’s
 Full effects do not take
place for a few weeks;
you do not wake up the
next morning saying “it’s
a beautiful day!”
 This is because increase
of serotonin promotes
neurogenesis
 Side effects may include
diminished sexual desire
Relieving depression
 Attacking depression
from above and below
 Use antidepressants
along (bottom up) with
cognitive therapy (top
down)
Antidepressant Facts
 Only the most severe
patients should be
treated using
antidepressants
 Adolescent SSRI use has
no effect on suicide rates
 There is no link between
antidepressants and
suicide rates
Mood stabilizing drugs
 Lithium
 A simple salt that is an
effective mood stabilizer for
those with emotional highs
and lows of bipolar disorder
 7 in 10 people benefit from
the long term use of lithium
 The suicide rate of those
with bipolar disorder taking
lithium is about 1/6 the rate
of those who are not
Electroconvulsive Therapy
 ECT: a biomedical therapy
for severely depressed
patients in which a brief
electric current is sent
through the brain of an
anesthetized person
 Introduced in 1938
 Patient remembers nothing
of the treatment after
 80% of patients reported
improved moods
Repetitive Transcranial Magnetic
Stimulation
 rTMS: the application of
repeated pulses of magnetic
energy to the brain; used to
stimulate of suppress brain
activity
 No memory loss or other
detrimental side effects
 Half of depressed Israelis
that received rTMS showed
improvement
ECT Study
 Mayberg found that a
brain region overactive in
a depressed patient
becomes calm after the
administration of ECT or
antidepressants
 This area became known
as the “depression
switch”
Psychosurgery
 Psychosurgery: surgery
that removes or destroys
brain tissue in an effort to
change behavior
 Not used frequently
 Used in the most extreme
cases as a last resort
Lobotomies
 Lobotomy: a now-rare
psychosurgical procedure once
used to calm uncontrollably
emotional or violent patients.
The procedure cuts the nerves
connecting the frontal lobes to
the emotion-controlling
centers of the inner brain
 Rosemary Kennedy :
 Famous recipiant of
 a lobotomy
Characteristics of a lobotomy
 Decreased a person’s
misery and tension
 Produced lethargic,
immature, uncreative
people
 Became more obsolete
1950’s when new drugs
were developed and
perfected
Therapeutic lifestyle change
 Includes one with
strenuous physical
activity, strong
community ties, sunlight
exposure, and plenty of
sleep
 The Amish are a good
example of people who
live a therapeutic lifestyle
Reducing depression
 The Llardi team believes
that depression can be
reduced by
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Aerobic exercise
Adequate sleep
Light exposure
Social connections
Anti-rumination
Nutritional supplements
“It is better to prevent than
cure”
What do you think?