psych chapter 17 treatment of psychological disorders

what is the goal of therapy?

• change maladaptive thoughts, feelings, and behaviours

• help clients live happier, more productive lives

what are the two core components of effective treatment?

• therapeutic relationship: quality of connection between client and therapist; major predictor of success

• therapy techniques: specific methods to create change (biomedical like drugs or psychological therapies)

• both components are essential; neither works well alone

what are the types of mental health professionals?

• clinical/counselling psychologists (PhD or PsyD, trained in therapy, assessment, research)

• psychiatrists (medical doctors, can prescribe medication)

• other professionals: psychiatric social workers, marriage/family therapists, pastoral counsellors, abuse counsellors

what is the goal of psychoanalysis and the key techniques?

• achieve insight → conscious awareness of unconscious conflicts to release psychic energy and shift to healthier behaviour

• free association: client says whatever comes to mind; therapist identifies themes, emotional blocks, and sensitive areas

  • dream analysis: dreams reveal hidden desires/impulses

  • resistance: unconscious avoidance of painful material (ex: missing sessions, changing topics)

  • transference: client projects feelings onto therapist (positive: love/dependence, negative: anger/hostility)

what is brief psychodynamic therapy?

• short term (1-2x/week), structured conversation, focus on current problems

• most improvement occurs early (first ten sessions)

• differs from classical psychoanalysis (5x/week, focus on past)

what is interpersonal therapy (IPT) used for?

• focus: relationships and social functioning

• effective for depression and somatic symptom disorders

what is the goal of humanistic therapies?

• humans have free will and self-healing capacity

• disorders = blocked growth

• focus on removing barriers to self-awareness and personal growth

client-centred therapy (Carl Rogers) - three therapist attributes?

• unconditional positive regard: non-judgmental acceptance, trust in client

• empathy: understand client’s perspective, reflect feelings

• genuineness: authentic, consistent therapist

• outcome: self-acceptance, self-awareness, better relationships

Gestalt Therapy (Fritz Perls) - techniques and goal?

• focus on ‘figure” (main awareness) and “background” (hidden feelings)

• goal: bring blocked feelings into awareness, achieve wholeness

• techniques: role-playing, empty-chair, dialogue with imagined person; resolves “unfinished business”

cognitive behaviour therapy (CBT) goals?

• identify and change distorted thoughts; often combined with behavioural strategies

Ellis’s rational-emotive therapy (RET) - ABCD model?

• A: activating event

• B: beliefs

• C: consequences (emotion/behaviour)

• D: dispute beliefs

• key idea: emotions come from beliefs, not events

Beck’s cognitive therapy - focus and effectiveness?

• focus: automatic negative thoughts, cognitive distortions

• most effective for depression; also used for anxiety, anger, eating disorders, personality disorders

what is the core principle of behaviour therapies?

behaviour is learned and can be unlearned (classical conditioning, operant conditioning, modelling)

what is exposure therapy?

• repeated exposure to feared stimulus without negative outcomes to extinguish fear

• flooding: real intense exposure

• implosion: imagined exposure

• effective for phobias, PTSD, and OCD

what is virtual reality therapy?

• immersive, controlled exposure in safe environment

• effective for phobias, PTSD, and social anxiety

• comparable to real exposure

what is systematic desensitization?

• learn relaxation

• create stimulus hierarchy

• gradually imagine/face fears while relaxed → anxiety replaced by relaxation

aversion therapy?

• pair pleasurable stimulus with aversive stimulus → conditioned negative response

• ex: alcohol + nausea drug, sexual deviance + shock

what are token economies?

• tokens given for desired behaviours; exchanged for rewards

• highly effective for severe schizophrenia, schools, prisons, workplaces, homes

what is modelling and social skills training?

• learn by observing/imitating others

• practice behaviour, receive feedback

• enhances self-efficacy → better outcomes

Western therapy assumptions

problems come from thoughts, emotions, internal conflict; emphasis on self-expression and individual responsibility

barriers to therapy for minority groups?

preference for family/spiritual healers, distrust of institutions, language, cost/access, lack of culturally competent therapists

gender issues in therapy?

• women: more depression/anxiety due to poverty, sexism, multiple roles, violence/abuse

• effective therapy: focus on empowerment and life circumstances

what is the specificity question in therapy evaluation?

which therapy, for which client, with which problem, produces what outcome

what are randomized clinical trials (RCTs)?

random assignment, control/placebo, standardized treatment manuals, blind assessments, behavioural outcome measures, follow-up data

factors affecting therapy outcomes?

• client: openness, motivation, self-awareness, problem type

• therapist: empathy, genuineness, experience

• technique: appropriate methods, timing, skill

• therapeutic relationship: trust, supportive, empathic (accounts for 30% of success)

• dose-response: more sessions → better outcomes

anti-anxiety drugs?

• reduce CNS activity via increasing GABA

• risk of dependence, withdrawal, symptom return

antidepressants?

• tricyclics, MAO inhibitors, SSRIs; increase serotonin/norepinephrine

• SSRIs: fewer side effects but insomnia, sexual dysfunction, possible suicide risk

• psychotherapy ≥ drugs; best = combination therapy → lower relapse

antipsychotics?

• reduce dopamine → help hallucinations/delusions; less effective for negative symptoms

• side effect: tardive dyskinesia (irreversible)

  • involuntary, repetitive movements such as grimacing, life-smacking or tongue protrusion

electroconvulsive therapy (ECT)?

• induces controlled seizures; mainly to treat severe depression

• works quickly: 60-70% improve

• modern ECT: safer, fewer treatments, MRI shows no brain damage, may increase hippocampal tissue

• side effects: confusion, memory loss; high relapse up to 85%

psychosurgery?

• past: prefrontal lobotomy - reduced aggression, severe side effects

• modern: cingulotomy - last resort for treatment-resistant disorders

deinstitutionalization?

• shift to community care → humane, normal environments

• problems: underfunded, “revolving door,” homelessness, relapse

prevention - two types?

• situation-focused: target environmental causes (poverty, discrimination, stress)

• competency-focused: build skills (coping, stress management, social skills)

• ex: PSTD prevention reduced rates from 70% → 10%

dissociative disorders

• avoid troubling thoughts/feelings/memories by removing them from conscious awareness

• dissociative amnesia: inability to recall specific events, time, or identity

• dissociative fugue: wanders from home, develops new identity

• dissociative identity disorder (DID): 2+ distinct identities, recurrently take control, amnesia for personal data

DID characteristics and etiology?

• 92% female, normal education, 49% married

• max identities: 100

• co-morbidities: depression 90%, mood swings 70%, hallucinations 30%, somatic symptom 60%

• cause: early emotional crisis, extreme abuse

• rare, mostly in NA, cultural phenomenon?

OCD

• obsessions (persistent thoughts/images/impulses) and compulsions (repetitive behaviours to reduce distress)

• slightly more common in women (2%)

• people unlikely to marry

• obsessions: doubt, fear of prohibited acts, contamination, catastrophic thoughts, lucky/unlucky numbers

• compulsions: counting, checking, cleaning, repeating rituals, avoidance

• causes: genetic (link to Tourette’s), childhood disorder, frontal lobe activity, serotonin deficit

autism spectrum disorder (ASD)

• pervasive developmental disorder; incidence 1 in 150; more common in males with IQ > 35

• impaired social interactions, communication (echolalia), restricted behaviours, rituals

• causes: likely neurological (cerebellum abnormality, Purkinje cell loss), not social or vaccines

savant syndrome

• about half of savants have autism

• excel in narrow abilities: music, math, art, mechanical skills

• very rare (<100 prodigious, 25-50 living), more common in males

• causes:

  • possible eidetic memory (though many blind)

  • sensory deprivation (autism)

  • left hemisphere deficits, right hemisphere compensation