ch 16 - treatment of psychological disorders

# in # canadians suffer from a mental disorder in any given year

1 in 5

at least # employed people in canada are unable to work due to mental health problems in any given week

half a million

only [a quarter / half / three-quarters] of those receiving treatment for major depression receive potentially adequate care

half

mental health needs were not fully met for # in # who received treatment for major depression

1 in 3

[a quarter / half / three quarters] of children in Canada with mental disorders do not access specialized care

¾

give 3 reasons why individuals fail to seek treatment

1. not realizing they have a mental disorder that can be treated

2. barriers such as beliefs and circumstances

3. structural barriers, physically prevent people from getting treatment

name 2 broad categories of treatment

1. psychological treatment: interacting with clinicians, environment meant to change person’s brain and behaviour

2. biological treatment: brain is treated with drugs/surgery as direct intervention

sometimes both treatment categories are applied

psychotherapy (def + goal)

interaction between clinician and someone suffering from psychological problem

goal: provide support or relief

eclectic psychotherapy

drawing on techniques from different forms of therapy, depending on client and problem

psychodynamic psychotherapies

explores childhood events, encourages individuals to develop insight into their problems

psychoanalysis (sigmund freud)

assumes that humans are born with aggressive, sexual urges repressed during childhood

goal is to understand the unconscious through developing insight

techniques developing insight (4) (and name treatment type category)

(psychological → psychodynamic → psychoanalysis)

• free association (report every thought that comes to mind)

• dream analysis

• interpretation (suggests possible meanings)

• analysis of resistance - reluctance to cooperate with treatment for fear of confronting unpleasant unconscious material

define transferece (and name treatment type, category)

(psychological → psychodynamic → psychoanalysis)

event occurring in psychoanalysis where analyst assumes a major significance in client’s life; patient unconsciously redirects feelings from a person in their past onto the analyst

• it is a therapy tool but may worsen the outcome

interpersonal psychotherapy (IPT)

• def

• goal

• how it differs form classical psychoanalysis

psychotherapy form focusing on helping clients improve current relationships, usually more effective in depressive and anxiety disorder treatment

goal: relief from symptoms and gaining insight

differs from classical psychoanalysis: sitting face to face, less intensive

humanistic therapy

• def and origin

• provide example of a humanistic therapy type

(psychological → psychotherapy)

assume that psychological problems stem from alienation and loneliness; traces feelings to failure of reaching one’s potential

• ex/ person-centered therapy (client-centered)

existential therapy (def and provide example)

(psychological → psychotherapy)

assumes that psychological problems stem from feelings of alienation and loneliness; feelings stem from failure to find meaning in life

• ex/ gestalt therapy

person-centered therapy (provide category/subcategory it is in)

• define

• 3 basic qualities therapists demonstrate

• goal

(psychological → psychotherapy→ humanistic therapy)

assumes all individuals have tendency for growth, facilitated by acceptance

3 basic qualities therapists demonstrate

1. congruence (body/words)

2. empathy (trying to understand)

3. unconditional positive regard (non-judgemental)

goal

understanding and reflecting client experiences supportively, encouraging growth

gestalt therapy (provide category/subcategory it is in)

• define/goal

• qualities therapists demonstrate

• techniques

(psychological → psychotherapy → existential therapy)

helping client become aware of thoughts, behaviours/feelings and owning/taking responsibility for them

qualities therapists demonstrate

• enthusiastic and warm

• reflect their impressions

techniques

• focusing and mindfulness

• empty chair technique

empty chair technique

(psychological → psychotherapy → existential therapy → gestalt therapy)

clients encouraged to imagine another person sitting across from them → client moves from chair to chair roleplaying what he/she would say to person/what they would answer

• used for life coaching, job interviews, etc

behavioural and cognitive therapies

emphasize changing a person’s current thoughts and behaviours to decrease/eliminate psychopathology (manifestations of mental disorders)

behaviour therapy

• what it assumes

• what techniques are based on

• what it tries to change

assumes disordered behaviour is learned, and can be relieved by changing maladaptive behaviours to more constructive behaviours

• techniques based on operant (reinforce/punish) and classical conditioning (ivan pavlov dog ringing bell LR NR)

changes maladaptive behaviour patterns

3 behavioural therapy techniques

1. eliminating unwanted behaviour: operant conditioning

2. promoting desired behaviour: token economy (giving clients tokens for desired behaviour)

3. reducing unwanted emotional responses: exposure therapy (confronting emotion-arousing stimulus directly, repeatedly)

exposure hierarchy for social phobia

exposure therapy where client is gradually accustomed to feared object/situation

• easier situations come first, and client progresses to more difficult/frightening situations

• important

cognitive therapy (def)

helps client identify, correct distorted thinking about oneself, therapy, or teh world

techniques used in cognitive therapy (2), and give definitions for each

cognitive restructuring - teaching clients to question automatic beliefs that lead to negative thinking using realistic, positive beliefs

mindfulness meditation - teaches individual to be fully present, be aware of thoughts/feelings to detect symptoms before they become a problem

cognitive-behavioural therapy

blending of cognitive and behavioural therapeutic strategies; problem-focused and action oriented

positive effects for GAD, panic disorder, PTSD, social phobia

advantages and disadvantages of group therapy

advantages:

• clients are not alone, shared insight and problem solving is used

disadvantages:

• one member could hijack discussions

• less individual attention

group therapy types (2) and their treatment goals

• couples therapy: married/dating couple working on problems within relationship - goal to break repetitive dysfunctional patterns

• family therapy: entire family is the client - tries to identify how interactions between individuals can make problems arise

group therapy treatments and their disadvantage

self-help, support groups

• run by peers struggling with same issues

could also encourage countertherapeutic behaviours

historic substances used as biological treatments (2)

• theriac - results probably arose from opium ingredient

• cocaine

most common biological approach to treating psychological disorders

drugs targeting specific neurotransmitters

antipsychotic mediations (what disorder they most commonly treat)

schizophrenia

one of the first antipsychotic drugs & what it led to

chlorpromazine - led to deinstitutionalization of hundreds of thousands of people

provide the fraction of people decreased from being in psychiatric hospitals after the introduction of antipsychotic drugs

decreased by more than 2/3rd

describe how antipsychotic and atypical antipsychotic mediations exert their effects

• block dopamine receptors (works for positive symptoms, but not negative ones) in areas of brain such as mesolimbic pathway (pathway with dopamine neurons extending to nuclei in basal ganglia)

• possibly exerts side effects

atypical antipsychotic

• blocks both dopamine and seratonin receptors; works for both positive and negative symptoms

antianxiety medications (def) (what it does)

drugs helping reduce person’s experience of fear/anxiety

• inhibits

2 most commonly used antidepressants

• SSRIs - selective serotonin reuptake inhibitors

• SNRIs - serotonin and norepinephrine reuptake inhibitor

describe how antidepressant drugs work

act on neurotransmitters serotonin, dopamine, and norepinephrine by inhibiting breakdown and blocking reuptake

antidepressants vs placebo effects on:

• severe depression

• mild/moderate

severe - antidepressants are more effective in improvements

mild/moderate - antidepressants did not work any better than placebo

name the disorder mood stabilizers are most commonly used for

bipolar disorder

most effective mood stabilizer available, and its risks

lithium - possible long-term kidney/thyroid problems

alternative medications

easily available OTC; includes herbal vitamins

phototherapy (def, what disorder it is used to treat)

form of biological treatment - natural treatment

• repeated exposure to bright lights

• used for SAD, depression

name the region of the brain showing reduced activity when social phobia is treated with CBT and SSRIs

amygdala-hippocampus region - affect brain regions associated with threat reactions

electroconvulsive therapy (ECT)

• what it is

• what it may be used to treat

• main side effect

inducing mild seizures by delivering electrical shocks to the brain

• may be used to treat severe depressions, manias, mental disorders not responding to treatment

• short-term memory impairment

transcranial magnetic stimulation (TMS)

• definition

• what it may used to treat

places powerful pulsed magnetic wand over person’s scalp, altering neuronal brain activity

• can be used to treat depression

psychosurgery

• what it is

• what it can treat

surgical destruction of brain areas

• treats severe unresponsive disorders (ex/ severe OCD)

cingulotomy

?? may not need to know idk, probs not important

• destroys part of corpus callosum

deep brain stimulation (DBS)

• what it is

• what it has successfully worked for

involves insertion of battery-powered electrodes delivering electrical pulses to brain areas believed to be causing mental disorder

• successful for OCD treatment

name 3 treatment illusions

1. natural improvement

2. placebo effects

3. reconstructive memory

natural improvement

(treatment illusion)

tendency for symptoms to return to average level (you would have improved anyway)

placebo effect

(treatment illusion)

substance/procedure has not been applied, but expectation that healing response will occur (just knowing it will work actually helps)

reconstructive memory

(treatment illusion)

client’s motivation to get well causes memory errors for original symptoms

the typical psychotherapy client is better off than [fraction] of untreated individuals

[3/4]

iatrogenic illness

disorder/symptom occurring as result of medical/psychotherapeutic treatment

• therapy leading clients to develop beliefs and cause harm