Treatment of Psychological Disorders

Three Essential Features of all Therapies

1) A sufferer who seeks help

2) A trained, socially accepted healer

3) A series of contacts with the goal of changing

attitudes, emotional states, or behaviours

Psychotherapies

Use words and acts to overcome psychological difficulties

Biological Therapies

Drugs and physiological interventions such as surgeries

Who seeks therapy?

• About 20 million North Americans per year

  • More than 3/4 of them seek help with anxiety or depression

• About 2/3 of clients are women, 1/3 are men

  • White individuals more likely to seek treatment than members of other ethnic groups

Who conducts therapy?

• Clinicians

• Clinical psychologists

• Psychiatrists

• Social workers

• Counselors

Stigma

• There has been a significant reduction in the stigma associated with mental illness

• Perceptions of stigma play a role in people’s decisions about whether to acknowledge their mental issues and to seek treatment

Where is treatment conducted?

Public institutions, such as hospitals and clinics, schools, and private offices

Canadian Mental Health Act

Outlines patient rights and conditions for involuntary admittance to hospitals.

The “Crazy House”

• For many, the perception of psychiatric care continues to be something like the treatment received by the patients portrayed in the well-known movie One Flew Over the Cuckoo’s Nest

• The reality is that laws and policies protect Canadians hospitalized with mental illness

Drug Therapy

• Psychotropic drugs (act on the brain)

• Antianxiety drugs

• Antidepressants

• Mood Stabilizers

• Antipsychotics

Type of Medication for Psychosis

Antipsychotics

Type of medication for depression

Antidepressants

Type of medication for mania

Mood stabilizers

Type of medication for treating anxiety

Anxiolitics, antidepressants

Electroconvulsive Therapy (ECT)

used to treat depression by sending an electrical current through the brain, producing a brain seizure

1) Reduces depression in 70% of patients

2) Causes short-term memory problems

3) Developed in the 1930s

4) More traumatic than newer treatments

Vagus Nerve Stimulation

• In this procedure, an implanted pulse generator sends electrical signals to the left vagus nerve

• That nerve then delivers electrical signals to the brain, helping to reduce depression in many people

Transcranial Magnetic Stimulation

• TMS is a non-invasive procedure used to treat depression

• The electromagnetic coil is placed on the patient’s head and sends a current into the prefrontal cortex

Trephining

• The hole in this 5,100-year-old skull indicates that the individual underwent trephining

• Some historians believe that trephination was done to release the evil spirits

Lobotomy

Surgical practice of cutting the connections between the frontal lobe and the lower centres of the brain

Deep Brain Stimulation

Implanted electrodes deliver low doses of electricity, used to treat depression and Parkinson’s Disease

Strengths of Biological Approaches

• Biological treatments often bring relief when other approaches have failed

• Research offers promising options

Criticisms of Biological Approaches

• Undesirable side effects

• Does not consider interaction between biological and non-biological factors such as environment and experience

Psychodynamic Theories

• Focus on past emotional trauma that interrupt personal development

• About 15% of contemporary clinical psychologists

Several Types of Psychodynamic Therapy

• Psychoanalysis

• Short-term psychodynamic therapy

• Relational psychoanalytic therapy

Free association

Discussions initiated by client with therapist probing to uncover relevant unconscious events

Therapist Interpretation

• Resistance

• Transference

Resistance

Block in free associations or change in subject

Transference

Shift feelings for figures from childhood to therapist

Dream Analysis

Unconscious desires/conflicts that bubble to the surface when we dream

Manifest content

Dream symbols/images

Latent Content

Meaning of dream symbols/images

Catharsis

• reliving of past repressed feelings to resolve conflicts

• Must be accompanied by intellectual insight

Working through

Repeatedly examine an issue to improve clarity

Strengths of Psychodynamic Approaches

• First practitioners to demonstrate the value of systematically applying both theory and techniques to treatment

• First to suggest the potential of psychological instead of biological treatment

• Their ideas have served as a starting point for many other psychological treatments

Behavioural Therapy

• Abnormal behaviour is learned in the same way adaptive behaviours are learned

  • Classical conditioning

  • Operant conditioning

  • Modelling

• Goal is to discover specific problem-causing behaviours and replace them with healthy behaviours

• Behavioural therapy is often effective with phobias and anxiety issues

Classical Conditioning Techniques

Change client’s dysfunctional reaction to specific stimuli

Systematic desensitization

effective in treating phobias, PTSD, asthma attacks

Aversion Therapy

Increase anxiety response to harmful stimuli desired by the client

Aversion Therapy

1. Unconditioned stimulus: Nauseating Drug → Unconditioned Response: Nausea

2. Conditioned Stimulus: Alcohol → Unconditioned stimulus: Nauseating Drug

3. Conditioned Stimulus: Alcohol → Conditioned response: nausea

Operant Conditioning Techniques

• Consistently provide rewards for desirable behaviour and withhold rewards for undesirable behaviour

• Successful in hospitalized psychotic patients

• Works best in institutions and schools

• Reward example: token economies

• Punishment example: time out

Modelling Techniques

• Therapists exhibit appropriate behaviours so client can imitate, rehearse, and incorporate the behaviours into their lives

• Social skills training

Social Skills Training

Therapists discuss social deficits and role play social situations with the client. Improve social skills and assertiveness

Strengths of Behavioural Approaches

• Widely studied in research and strongly supported

• Effective for numerous problems, including specific fears, social deficits, and intellectual disabilities

Criticisms for Behavioural Approaches

• Changes sometimes require later therapies to sustain

• Not effective with disorders in which distress is non- specific, such as generalized anxiety disorder

Cognitive-behavioural Model

behavioural therapies are usually used along with cognitive therapies

Cognitive Views of Abnormal Behviour

Disorders are caused or worsened by maladaptive thinking

Three kinds:

1) Ellis’s rational-emotive behavioural therapy

2) Beck’s cognitive therapy

3) Second-wave cognitive-behavioural therapies

Ellis’s Rational-Emotive Therapy

goal is to identify irrational assumptions that lead to disordered emotional and behavioural responses

1) Point out irrational assumptions

2) Model the use of alternative

assumptions

3) Uses cognitive restructuring

4) Effective for anxiety and

assertiveness problems

Beck’s Cognitive Therapy

• Widely used for depression

• Therapists help clients identify negative thoughts and perceptions and guide them to apply alternative ways of thinking

• About as effective as drug therapy for depression (2/3 improve)

• Also used for panic disorder and social anxiety disorder

Second-wave Cognitive-Behavioural Therapies

• Recognize problematic thoughts as just thoughts

• Clients accept thoughts rather than try to eliminate them

• Mindfulness requires people to become mindful of their thoughts and worries, when they occur, and accept them as mere events of the mind

• Acceptance decrease how upset and affected one is

Strengths of Cognitive-Behavioural Therapies

• Well supported by research

• Good at treating depression, social anxiety disorder, generalized anxiety disorder, panic disorder, sexual dysfunctions, and other disorders

Criticisms of Cognitive-Behavioural Therapy

• Role of cognition unclear (cause or effect?)

• Unclear whether cognitive features, behavioural features, or combination are effective

Humanists

we are all born with the tools to fulfill our potential

Existentialists

• accept responsibility for our lives and choices

• Emphasize present events, focus on helping clients see themselves accurately and acceptingly

Gestalt Therapy

• guide clients toward self-acceptance by challenging and frustrating them

• Skillful frustration (refusing to meet the clients demands), role playing, rules to ensure clients look at themselves closely (required to use “I” language – I am sad instead of this situation is depressing)

Gestalt Techniques

Guide clients to express their needs and feelings to an extreme through role playing and other exercises. In this session, the client moves from “strangling” a pillow (left) to banging the pillow, to hugging it (right). The pillow may represent a person about whom the client has mixed feelings.

Roger’s Client-Centred Therapy

goal is to create an environment in which clients can see themselves honestly with acceptance

Strengths of Humanistic and Existential Therapy

• Appealing to clinicians

• Emphasize positive human qualities (self acceptance, personal meaning, choice…)

Criticisms of humanistic and existential therapy

• Difficult to research and little research has been done

• But, recent research suggests the therapies are beneficial

Individual Therapy

One on one with therapist and client

Group Therapy

therapist meets with several clients with similar problems simultaneously

Self-help groups

people with similar problems meet for support without guidance from clinician

Assessing group therapy

• Varies and is therefore difficult to assess

• Helps many

Range of Formats of Therapy

Individual therapy used to be the only treatment format for psychological problems. Today, other formats are also used, such as group therapy and couple therapy.

Family Therapy

whole family meets with therapist, who considers family interactions

Family Systems Theory

• each family has own rules, structure, and communication patterns that shape behaviour

• For one person to change, the family system may need to change.

Couple therapy

• two people in a relationship meet together with therapist to consider relationship structure and communication

• Marital therapy – 2/3 show improvement

• 38% of Canadian marriages do not survive past the 13th anniversary and 25% of all treated couples eventually divorce

Community Treatment

• Community mental health treatment allows clients to receive treatment in a familiar environment

• Key principle is prevention

Primary Prevention

• improve community attitudes and policy in order to prevent disorders

•Child care, recreational programs, health fairs

Secondary Prevention

• identify and treat disorders before they become problematic

  • Work with schools, police, etc., to help identify early

signs of dysfunction

• Tertiary prevention—provide treatment as soon as

possible to prevent long-term problems

Tertiary Prevention

Provide treatment as soon as possible to prevent long-term problems

Does Therapy Work and is it effective?

• Empirically supported treatment movement - therapies

supported by research should be used

• More effective than no treatment or placebo

Are particular therapies generally effective?

Each major form helps some; no one form stands out

Effective therapists may share common features

1.) Give feedback to patients

2.) Help patients focus on their own thoughts and behaviour

3.) Pay attention to the way they and their patients are

interacting

4.) Try to promote self-mastery in their patients

Are particular therapies effective for particular problems?

Behavioural: phobias

Cognitive-behavioural: social anxiety disorder, generalized

anxiety disorder, panic disorder, and depression

Drug: schizophrenia and bipolar

Is therapy effective across race and gender?

• Members of ethnic minority groups worldwide seek therapies less and benefit less from them than do majority-group members

• Culture-sensitive therapies take into account cultural value and stresses specific to the group

• Gender-sensitive or feminist therapies acknowledge stressors girls and women face

Summary

• To fully understand a mental process such as “intruding thoughts,” today’s psychologists study the phenomenon at many levels.

• Psychology offers enormous promise for the future understanding of who we are.