Topic 2
Why might it be a good option to combine both medication and talk therapy for a typical psychological disorder such as major depressive disorder?
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TREATMENTS FOR PSYCHOLOGICAL DISORDERS
Key Question
What is Therapy?
Therapy for psychological disorders takes a variety of forms, but all involve
some relationship focused on improving a person’s mental, behavioral, or
social functioning.
What is Therapy
• General term for any treatment process
• In psychology and psychiatry, therapy refers to a variety of psychological and biomedical techniques aimed at dealing with mental disorders or coping with problems of living
Modern Approaches to Therapy
Counseling psychologist
Clinical psychologist
Psychiatrist
Psychoanalyst
Psychiatric nurse practitioner
Clinical social worker
Pastoral counselor
Modern Approaches to Therapy
Modern Therapies –
are based on psychological and biological theories of mind and behavior.
Psychological therapies involve counseling.
Biological therapies focus on altering the underlying biology of the brain usually through medication.
Most disorders benefit from a combination of both treatment modalities.
Key Question
How Do Psychologists Treat Mental Disorders?
Psychologists employ two main forms of treatment: the insight therapies and the behavioral therapies.
Insight Therapies
Insight therapies –
• Psychotherapies in which the therapist helps patients/clients change people on the inside— changing the way they think and feel
• Aim at revealing and changing a patient’s disturbed mental processes through discussion and interpretation.
Insight Therapies
Freudian Psychoanalysis
• Psychodynamic therapies based on the assumption that psychological problems arise from tension created in the unconscious mind by forbidden impulses
• Major goal: To reveal and interpret the unconscious mind’s contents
Insight Therapies: Psychodynamic Therapies
Psychoanalysis –
• The form of psychodynamic therapy developed by Sigmund Freud
• Access to unconscious material through free association
• Help the patient understand the unconscious causes for symptoms
Insight Therapies: Psychodynamic Therapies
Psychoanalysis –
• Ego blocks unconscious problems from consciousness through defense mechanisms
e.g., Transference; Repression
• Analysis of transference – Analyzing and interpreting the patient’s relationship with the therapist, based on the assumption that this relationship mirrors unresolved conflicts in the patient’s past
Insight Therapies: Psychodynamic Therapies
Neo-Freudian psychodynamic therapies
• Therapies developed by psychodynamic theorists who embraced some of Freud’s ideas, but disagreed with others
Treat patients face-to-face
See patients once a week
Shift to conscious motivations
Insight Therapies: Humanistic Therapies
Humanistic therapies –
• Based on the assumption that people have a tendency for positive growth and self actualization, which may be blocked by an unhealthy environment
Client-centered therapy –
• Emphasizes healthy psychological growth through self- actualization (e.g. Carl Rogers )
Reflection of feeling – Paraphrasing client’s words to capture the emotional tone expressed
Unconditional positive regard
Insight Therapies: Cognitive Therapies
Cognitive therapy –
• Emphasizes rational thinking as the key to treating mental disorder and helps patients confront identify and change destructive thoughts
• Beck’s treatment for depression to change negative views of self, situation, and future.
Watch Video in this Module Depressive Thought Processes
Insight and Behavioral Therapies: Cognitive-Behavioral Therapy
Cognitive-behavioral therapy –
• Combines cognitive emphasis on thoughts with behavioral strategies that alter reinforcement contingencies
• Beck’s treatment for depression to change negative views of self, situation, and future.
Even this very cognitive therapy
Includes increasing participation in positive activities to elevate mood as a first step.
Insight Therapies: Group Therapies
Group therapy –
• Psychotherapy with more than one client
Self-help support groups –
• Groups that provide social support and an opportunity for sharing ideas about dealing with common problems; typically organized/run by laypersons – e.g. Alcoholics Anonymous
Pick the image that best represents Carl Rogers’ concept of unconditional positive regard.
A B C
Insight Therapies: Group Therapies
Couples and family counseling
• Learn about relationships
• Can be more effective than individual therapy with one individual at a time
Focused Behavioral Therapies
Behavior therapy –
Any form of psychotherapy based on the principles of behavioral learning, especially operant conditioning and classical conditioning
Systematic desensitization
Contingency management
Aversion therapy
Token economies
Participant modeling
Classical Conditioning Therapies
Systematic desensitization –
• Technique to extinguish anxiety by gradually exposing the client to feared stimuli while teaching client to pair relaxation with increasing levels of fear provoking situations
– e.g. for phobia
Watch Videos in this Module Phobias
Classical Conditioning Therapies
Exposure therapy –
• Desensitization therapy in which patient directly confronts the anxiety-provoking stimulus
– e.g. for PTSD or Obsessive-Compulsive Disorder
Classical Conditioning Therapies
Aversion therapy – Involves presenting individuals with an attractive stimulus paired with unpleasant stimulation in order to condition a repulsive reaction
Operant Conditioning Therapies
Contingency management –
• Approach to changing behavior by altering the consequences of behaviors
• Effective in numerous settings
e.g., families, schools, work, prisons
Often used to treat behavioral problems like Attention Deficit Hyperactivity Disorder (ADHD)
Operant Conditioning Therapies
Contingency management:
Token economies – • Applied to groups (e.g. classrooms, mental hospital
wards)
• Involves distribution of “tokens” contingent on desired behaviors
• Tokens can later be exchanged for privileges, food, or other reinforcers
Participant Modeling: An Observational learning Therapy
Participant modeling –
• Therapist demonstrates and encourages a client to imitate a desired behavior
• Draws on concepts from both operant and classical conditioning
• e.g. therapist pets dog with dog phobic person.
Evaluating the Psychological Therapies
Psychotherapy is effective:
• Therapy is better than no therapy.
• Matching specific therapies with specific conditions helps.
• Client’s desire = motivation to change is very important in predicting success.
• A positive relationship between therapist and client is a key to success.
Key Question
How is the Biomedical Approach Used to Treat Psychological Disorders?
Biomedical therapies seek to treat psychological 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
• E.g., chlorpromazine, haloperidol, and clozapine
• Reduce dopamine transmission, e.g. schizophrenia
• May have side effects:
Tardive dyskinesia or Agranulocytosis
Watch Videos in this Module Schizophrenia
Drug Therapy
Antidepressant drugs
• Tricyclic compounds (Tofranil, Elavil)
• SSRIs (Prozac, Zoloft)
• Monoamine oxidase (MOA) inhibitors
Antibipolar drugs/Mood stabilizers
• Lithium, Depakote (anti-seizure drugs)
Drug Therapy
Antianxiety drugs
• Include barbiturates and benzodiazepines
• May include some antidepressant drugs which work on certain anxiety disorders
• Should not be used to relieve ordinary anxieties of everyday life
• Should not be taken for more than a few days at a time
• Should not be combined with alcohol
Drug Therapy
Stimulants (caffeine, nicotine, cocaine)
• Produces excitement or hyperactivity
• Suppresses activity level in persons with ADHD
• Controversy exists for use of these stimulants for children
Side effects
Growth slowed
Concern for ADHD overdiagnosis of ADHD
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
Used to treat severe depression
• Electroconvulsive therapy (ECT)
Apply an electric current to temples briefly
Patient is put to “sleep”
Side effects = Memory deficits
• Transcranial magnetic stimulation (TMS)
High powered magnetic stimulation to the brain
Also effective for bipolar disorder
• Deep brain stimulation
Surgical implants of a micro electrode directly in the brain
Still highly experimental
Hospitalization and the Alternatives
Therapeutic community
• Designed to bring meaning to patients’ lives
• Hospital setting to help patients cope with the world outside
world
Deinstitutionalization
• Removing patients, whenever possible, from mental hospitals
Community mental health movement
• Effort to deinstitutionalize mental patients and to provide
therapy from outpatient clinics
Key Question
How do the Psychological Therapies and Biomedical Therapies Compare?
While a combination of psychological and medical therapies is better than either alone for treating some (but not all) mental disorders, most people who suffer from unspecified “problems in living” are best served by psychological treatment alone.
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