Chapter 15 Treatment of Psychological Disorders

psychotherapy

• generic name givent o formal psychological treatment

• involve interactions between practicioner and client

• limitation: some disorders are characterized by apathy or indifference

• requires engagement from the client

biological therapies

• approaches to disease and illness

• therapies are based in idea that psychological disorders come from abnormalities in body

psychopharmacology

• the use of medications that affect the brain or body to treat psychological disorders

• limitation: long-term success requires indefinite treatment sometimes

Who first developed psychological treatments?

Freud

Free association

• client says whatever is on the come and therapist looks for unconscious conflict

• developed by Freud

dream analysis

• looking for hidden meaning in dreams

• developed by Freud

general goal od psychoanalysis

• to increase clients’ awareness of their own unconscious and how it affects their daily functioning

psychodynamic therapy

• reformulated Freud’s ideas as those were largely ineffective

• aims to help clients examine their needs, defenses, and motives to understand why there is distress

• couch is replaced with chair

features of contemporary psychodynamic therapy

• exploring the clients’ avoidance of distressing thoughts

• looking for recurring themes and patterns in thoughts and feelings

• discussing early trauma experiences

• focusing on interpersonal relations and childhood attachments

• emphasizing the relationship with the therapist

• exploring fantasies, dreams, and daydreams

behavior therapy

• behavior is learned and therefore can be unleaded

• behavior modification

exposure

exposing someone can reduce their anxieties by exposing them to their fears and changing how they think about said fears

cognitive therapy

• based on the theory that distorted thoughts can produce maladaptive behaviors and emotions

cognitive restructuring

• advocated by Aaron T. Beck

• clinician seeks to help a person recogniza maladaptive though patterns and replace them with ways of viewing the world that are more in tune with reality

rational-emotive therapy

• advocated by Albert Ellis

• therapist acts as a teacher explaining the clients errors in thinking and demonstrating adaptive ways to think and behave

maladaptive pattern vs. after cognitive restructuring

• see image

interpersonal therapy

• focuses on circumstances, mainly relationships the client attempts to avoid

• developed out of ideas on how people relate to one another

mindfulness-based cognitive therapy

• created by John Teasdale and colleagues

• people who recover from depression are vulnerable to faulty thinnking

• goals: to help clients become more aware and help them learn to disengage from ruminative thinking through meditation

Cognitive-behavioral Therapy

• uses cognitive and behavior therapy

• goal: correct the client’s faulty cognitions and to train the client to engage in new behaviors

client-centered therapy

• developed by Carl Rogers

• encourages people to pulfill their potentials for personal growth through greater self-understanding

• key ingredient: creation of a safe and comforting setting

• form of humanistic therapy

reflective listening

• therapist repeats clients’ concerns to help them clarify their feelings

motivational interviewing

• uses a client-centered approach over a very short period

• helps clients identify discrepancies between current state and where they would be in their lives

• created by William Miller

systems approach

• individual is part of a larger context

Family therapy

• each person is a part of the larger system

• changing one’s behavior affects the whole system

• family involvement is key

group therapy

• less expensive than individual therapy

• rose in popularity after WW2

• many are organized around a specific problem

• structure varies depending on topic and therapist

psychotropic medications

• act by changing brain chemistry

• may provide relief from symptoms of psychological disorders

• 3 categories: antianxiety drugs, antidepressants, and antipsychotics

Antianxiety drugs

• aka anxiolytics

• one class is benzodiazepines (Xanax and Ativan)

  • induces drowsiness

antidepressents

• Monoamine oxidase (MAO) is the first antidepressent to be discoveres

• second category: tricyclic antidepressents

  • inhibit reuptake of serotonin and norepinephrine

• SSRIs

  • inhibit reuptake of serotonin but to a significantly lesser extent

  • critics say they are overperscribed

How do SSRIs work?

see image

antipsychotics

• long-term use sideeffect: tardive dyskinesia (involuntary muscle twitch)

treatment resistant

not all people are treated successfully with therapy , medication or both

trepanning

holes in head to heal from psychological disorder

psychosurgery

• in which areas of the brain were selectively damaged

• credited to Antionio Egas Moniz

  • creator of the lobotomy

electroconvulsive therapy

• involves placing electrodes on a person’s head and administering a strong enough electric current to cause a seizure

• commonly used to treat schizophrenia and depression

transcranial magnetic stimulation

• used to treat severe depression

• interrupts neural function in that region

deep brain stimulation

• mild electricity stimulated the prain much like a pacemaker

• used to treat Parkinson’s OCD and major depression

placebo effect

• improvement based on inert drug or minimal contact

• more complicated for psychotherapy than drug research

David Barlow

• pointed out that medical studies often lead to dramatice treatment practice changes

• John Shedler pointed out that evidence-based treatments can be statistically significant without providing any practical improvement in symptoms (relief might not even be sufficient for patients’ needs)

Providers for mental health and their training requirements

see image

technology-based treatments

• use of minimal contact with therapists and rely on smartphones, computer programs or internet for treatment

• ex. using app to track moods

What does CBT work best to treat

• most adult anxiety disorders

• panic disorders (in some cases more effective than medication)

systematic desensitization

• make a fear hierarchy, expose, fear becomes extinguished

• best for phobias

Effective treatment for OCD

• CBT

• SSRI called clomipramine (not a true ssri but very potent)

• Deep Brain Stimulation might be effective for those with no relief from medication or CBT

Addiction treatment success requirements

1) stop using drugs

2) stay drug free

3) be a productive member of family, society, work, etc.

Addiction treatments

• CBT

• exposure therapy

• family and group therapy

• growing knowledge of medication to help addiction

• challenge: many with addiction also have other psychological disorders

iproniazid

• MAO inhibitor

• in 1957, used to treat depression

alternative threatments

• phototherapy for Seasonal Affective Disorder

gender issues in treating depressive disorders

• women are twice as likely to be diagnosed

• men might be less likely to seek help

John Cade

• found that the urine of manic patients was toxic

• believed uric acid might be causing the symptoms of mania

• using lithium salts to treat manic patients

• lithium is not yet well understood as a treatment

atypical antipsycholotic

• medications have been found to be effective in stabilizing moods and reducing mania

• combination of lithium and atypical antipsycholotics may improve treatment outcomes

SSRIs and bipolar disorder

• generally not recommended

• SSRIs and other antidepressants may trigger manic episodes

reserpine

• used in the 1950s and before to treat symptoms of schizophrenia

• chlorpromazine replaces this

schizophrenia treatment

• atypical antipsychotics are first line

• because of sideeffects most others are only used in severe cases

• schizophrenia treatment must include medications in addition to other therapies

dialectal behavior therapy

• created by Marsha Linehan in 1980s

• combines elements of CBT with a mindfulness approach based on Eastern meditative practices

• patients are seen in both group and individual sessions

• three stages in image

• used for personality disorders

  • no other threatment exists for personality disorders

• DBT is most successful for borderline personality disorder

why is treatment for personality disorders so difficult

• often patients percieve things other than themselves as the problem

• cause is unknown

Treating antisocial personality disorder

• often patients manipulate therapists

• stimulants have been shown to work in short term due to diminished cortical arousal

  • does not work in long term

conduct disorder

• childhood condition known to be a precursor to antisocial PD

Treatment for ADHD

• methyphenidate (Ritalin)

  • only barely increases positive behaviors → significantly decreases negative ones

• Adderall

• parents are often pressured to medicate children

• parents then pressure physicians

• bahvior therapy may be the most effective in the long run

Issues with medication and ADHD

• increased risk of substance abuse issues

• medication effects may not be long-term

Autism spectrum disorder treatment

• ASD children are less likely to respond to rewards

• Applied Behavioral Analysis (AVA)

  • uses operant conditioning

  • requires a minimum of 40 hours per week

• speculation on brain functions which could cause symptoms of autism

subsyndromal disorder

a level below the DSM5 diagnostic criteria but still problemsome