Psychology - Chapter 7: Treatment

How common are mental illness and mental health treatment?

• About 18.9% of U.S. adults experience a mental illness each year.

• About 14.8% of adults receive mental health treatment annually.

• About 13% of children (ages 8–15) experience a mental illness each year.

How often do children with mental disorders receive treatment? Which disorder is most vs least likely to receive treatment?

About 50.6% of children with a mental disorder receive treatment each year.

Treatment rates vary by disorder:

• Anxiety disorders: Least likely to receive treatment.

• ADHD and conduct disorders: More likely to receive treatment.

How was mental illness viewed and treated in the past? What were common treatments?

Mental illness was often believed to be caused by demonic possession, witchcraft, or angry gods.

Common treatments included:

• Exorcism

• Trephining (drilling a hole in the skull)

• Imprisonment or execution

People with mental illness were often misunderstood and treated cruelly.

What were asylums, and how did Philippe Pinel and Dorothea Dix change mental health care?

• Asylums were institutions created to house people with mental illness, but conditions were often inhumane.

• Philippe Pinel promoted humane treatment by removing chains and treating patients with compassion.

• Dorothea Dix led reforms in the U.S., advocating for better care and helping establish mental hospitals.

What treatments were used in mental hospitals during the 19th and early 20th centuries?

• Cold-water baths

• Early electroshock therapy (now electroconvulsive therapy, ECT)

Conditions in many hospitals remained poor despite reform efforts.

Modern ECT is still used in some cases but is performed under anesthesia with safety measures.

What changes improved mental health care in the mid-1900s?

• Antipsychotic medications (introduced in the 1950s) to treat psychosis.

• Community Mental Health Centers Act (1963), which promoted deinstitutionalization—closing large asylums and treating people in community-based settings.

How is mental health treatment provided today?

Treatment is provided through:

• Community mental health centres

• Psychiatric hospitals

• Private practices

• Schools

• Correctional facilities

Most people with mental illness are treated in the community, not in hospitals.

What were the effects of deinstitutionalization?

Deinstitutionalization closed large psychiatric hospitals and shifted care to community mental health centres.

Problems:

• Community centres were underfunded.

• Staff were often unprepared for severe mental illness.

• Many people lacked housing, food, and job support.

• Increased homelessness and incarceration among people with mental illness.

When are people hospitalized, and what is voluntary vs. involuntary treatment?

• Psychiatric hospitalization is usually short-term (often less than 2 weeks).

• Used mainly when a person is an imminent danger to themselves or others.

Voluntary treatment: Person chooses therapy.

Involuntary treatment: Therapy is required by the legal or child protection system.

What barriers limit access to mental health treatment today?

• Cost (insurance, co-pays, deductibles)

• Long wait times

• Shortage of mental health professionals (especially in rural areas)

• Limited services

• Stigma surrounding mental illness

Mental Health Parity and Addiction Equity Act (2008): Requires insurance coverage for mental health care to be comparable to coverage for physical health care.

What is the difference between psychotherapy and biomedical therapy?

• Psychotherapy: Psychological treatment using therapeutic techniques to help people overcome mental health problems or promote personal growth.

• Biomedical therapy: Uses medications and/or medical procedures to treat psychological disorders.

What are the 6 major types of psychotherapy?

• Psychodynamic: Explores unconscious conflicts and childhood experiences.

• Play therapy: Uses play to help children express emotions.

• Behaviour therapy: Uses learning principles to change behaviour.

• Cognitive therapy: Changes maladaptive thoughts.

• Cognitive-behavioural therapy (CBT): Changes both thoughts and behaviours.

• Humanistic therapy: Promotes self-awareness and personal growth.

What are psychotropic medications, and what are the main types?

Psychotropic medications treat symptoms by altering neurotransmitters.

Main types:

• Antipsychotics → Schizophrenia

• Antidepressants → Depression (also anxiety)

• Anti-anxiety agents → Anxiety disorders

• Mood stabilizers → Bipolar disorder

• Stimulants → ADHD

Best results are often achieved when medication is combined with psychotherapy.

How do antidepressants and antipsychotics work, and what are their major side effects?

• Antipsychotics: Block dopamine; treat positive symptoms of schizophrenia.
  Side effect: Tardive dyskinesia and Parkinson-like tremors.

• Atypical antipsychotics: Target dopamine and serotonin; treat positive and negative schizophrenia symptoms.
  Side effects: Obesity, diabetes, high cholesterol, constipation, dry mouth, blurred vision, drowsiness, dizziness.

• Antidepressants: Alter serotonin and/or norepinephrine; treat depression and anxiety.
  Side effects: Headache, nausea, weight gain, drowsiness, reduced sex drive; tricyclics may also cause dry mouth, constipation, blurred vision, and increased suicide risk.

• Anti-anxiety medications: Depress central nervous system activity; treat anxiety and agitation.
  Side effects: Drowsiness, dizziness, headache, fatigue, lightheadedness.

• Mood stabilizers: Treat manic and depressive episodes in bipolar disorder.
  Side effects: Excessive thirst, irregular heartbeat, rash, swelling, nausea, loss of appetite.

• Stimulants: Improve focus and attention in ADHD.
  Side effects: Decreased appetite, difficulty sleeping, stomachache, headache.

What are ECT and TMS?

• Electroconvulsive therapy (ECT): Uses electrical currents to induce seizures; mainly for severe depression when other treatments fail. About 85% of patients improve, but memory loss is a possible side effect.

• Transcranial magnetic stimulation (TMS): Uses magnetic fields to stimulate brain cells; approved in 2008 for depression when other treatments are ineffective.

What is an integrative (eclectic) approach to therapy?

An integrative (eclectic) approach combines techniques from multiple forms of therapy, using whichever methods are most appropriate for the individual.

Examples:

• Bipolar disorder: Psychological skills training + medication.

• Major depressive disorder: CBT + antidepressant medication.

What happens during a therapy intake?

An intake is the therapist's first meeting with the client to assess their needs.

During the intake, the therapist:

• Assesses the presenting problem and support system

• Explains confidentiality, fees, and what to expect

• Sets treatment goals and develops a treatment plan

• Discusses how success and treatment length will be measured

Common treatment modalities: Individual, family, couples, and group therapy.

What is individual therapy?

Individual therapy is a one-on-one session between a client and therapist (typically 45–60 minutes, weekly or biweekly).

Goals:

• Explore feelings

• Work through life challenges

• Set goals for change

Treatment may last from a few sessions to a year or longer, depending on the client's needs.

What is group therapy, and what are its advantages and disadvantages?

Group therapy involves one therapist meeting with several clients who have similar problems (typically 5–10 people).

Advantages:

• Reduces isolation and shame

• Provides support from therapist and peers

• Members can give feedback and practice social skills

• More cost-effective than individual therapy

Disadvantages:

• Fear of speaking in front of others

• Personality conflicts

• Confidentiality concerns

What are psychoeducational groups and how can group therapy be organized?

Psychoeducational groups teach members about a specific disorder or problem (e.g., cancer, bullying, anxiety).

Group therapy may be:

• Open or closed

• Structured or unstructured

• Time-limited or ongoing

The therapist ensures all members participate and benefit.

What is couples therapy, and what are its goals?

Couples therapy involves two people in an intimate relationship (dating, partnered, engaged, or married) who are trying to resolve relationship difficulties.

• Primary approach: Cognitive-behavioural therapy (CBT)

• Therapist helps couples:

  • Resolve conflicts

  • Understand how their backgrounds, beliefs, and behaviours affect the relationship

  • Improve communication (listening, arguing constructively, expressing feelings)

• Therapy may help couples strengthen their relationship or decide that separation is the best option.

What is family therapy, and what are its main approaches?

Family therapy is a form of group therapy that treats the family as a system, where each member influences and is influenced by the others.

Goal:

• Improve family communication and functioning.

• Help the entire family cope with problems affecting one or more members (e.g., depression, eating disorders, alcohol dependence).

What are the 3 main approaches to family therapy?

• Systems approach: Views the family as an interconnected system.

• Structural family therapy: Examines family roles, boundaries, decision-making, and communication.

• Strategic family therapy: Uses a structured, short-term plan to solve specific family problems.

What happens during the assessment and diagnosis of a psychological disorder?

Treatment begins with a psychological assessment, which includes:

• Clinical interview

• Psychological tests (e.g., MMPI-2, MACI, projective tests)

• Information from family or school when needed

• Medical evaluation to rule out physical causes

The therapist then makes a diagnosis using the DSM-5-TR.

What are the DSM-5-TR diagnostic criteria for ADHD?

A diagnosis requires either:

• ≥6 symptoms of inattention

  • Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities

  • Often has trouble keeping attention on tasks or play activities

  • Often does not seem to listen when spoken to directly

  • Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behaviour or failure to understand instructions)

  • Often has trouble organizing activities

  • Often avoids, dislikes, or doesn’t want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework)

  • Often loses things needed for tasks and activities (e.g., toys, school assignments, pencils, books, or tools)

  • Is often easily distracted

  • Is often forgetful in daily activities

• ≥6 symptoms of hyperactivity/impulsivity

  • Often fidgets with hands or feet or squirms in seat

  • Often gets up from seat when remaining in seat is expected

  • Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless)

  • Often has trouble playing or enjoying leisure activities quietly

  • Is often “on the go” or often acts as if “driven by a motor”

  • Often talks excessively

  • Often blurts out answers before questions have been finished

  • Often has trouble waiting one’s turn

  • Often interrupts or intrudes on others (e.g., butts into conversations or games)

Symptoms must:

• Be present for at least 6 months

• Be developmentally inappropriate

• Cause significant impairment/disruption.

What is psychotherapy? Who provides psychotherapy, and what are the major therapy approaches?

Psychotherapy is the professional treatment of psychological disorders through communication and psychological techniques.

Major therapy approaches:

• Psychodynamic

• Humanistic

• Cognitive-behavioural therapy (CBT)

• Eclectic (integrative)

Treatment providers:

• Psychiatrists (medical doctors who can prescribe medication)

• Clinical psychologists

• Social workers

• Psychiatric nurses

• Couples, marriage, and family therapists

What is psychodynamic therapy (psychoanalysis) and what techniques are used in psychodynamic therapy?

Psychodynamic therapy (psychoanalysis) is based on Freud's and the neo-Freudians' theories. The goal is to help clients gain insight into unconscious conflicts that cause psychological symptoms through interpretation by the therapist.

Common techniques include:

• Free association: Client says whatever comes to mind.

• Dream analysis: Therapist interprets dream symbolism to explore the unconscious.

• Interpretation: Therapist identifies unconscious conflicts.

• Transference: Client redirects feelings from important relationships onto the therapist.

• Resistance: Client unconsciously avoids painful thoughts or feelings.

What is humanistic therapy and person-centred therapy?

Humanistic therapy focuses on a person's ability to grow, achieve self-realization, and fulfill their potential.

Person-centred therapy (Carl Rogers):

• Nonjudgmental environment

• Therapist helps the client grow rather than directing treatment.

What is a therapeutic alliance in person-centred therapy?

A therapeutic alliance is a positive relationship between therapist and client based on:

• Genuineness

• Unconditional positive regard

• Empathy

A strong therapeutic alliance is one of the most important factors in successful psychotherapy.

When are psychodynamic and humanistic therapies most useful?

They are primarily recommended for people with:

• Generalized anxiety disorders

• Mood disorders

They are less appropriate for problems requiring targeted symptom treatment (e.g., phobias, OCD, sexual dysfunction), where present-focused therapies are often preferred.

What is play therapy, and what are its two main types?

Play therapy is used primarily with children, allowing them to express hopes, fantasies, and traumas through play. It can also help therapists diagnose emotional or behavioural problems by observing how children interact with toys.

Types:

• Nondirective play therapy: Child plays freely while the therapist observes.

• Directive play therapy: Therapist provides structure by suggesting activities, asking questions, or participating in play.

What is behaviour therapy?

Behaviour therapy uses principles of learning (classical and operant conditioning) to change undesirable behaviours rather than exploring unconscious conflicts. Mary Cover Jones is considered the mother of behaviour therapy

It is commonly used to treat:

• Phobias

• Anxiety disorders

• Bedwetting

• Autism

Based on the idea that learned behaviours can be relearned or modified.

What are the main classical conditioning techniques used in behaviour therapy?

Counterconditioning: Learning a new response to a stimulus that previously caused an unwanted behaviour.

Two main techniques:

• Aversive conditioning: Pairs an unwanted behaviour with an unpleasant stimulus (e.g., Antabuse for alcoholism).

• Exposure therapy: Gradually exposes clients to feared objects or situations until anxiety decreases.

What is systematic desensitization and virtual reality exposure therapy?

• Systematic desensitization: Gradually pairs relaxation with increasingly anxiety-provoking situations until the fear response is eliminated.

• Virtual reality exposure therapy (VRET): Uses simulated environments to treat fears such as public speaking, flying, claustrophobia, and PTSD.

How is operant conditioning used in behaviour therapy?

Operant conditioning changes behaviour by reinforcing desirable behaviours and reducing reinforcement for unwanted behaviours.

Example:

• Applied Behavior Analysis (ABA): Used to help children with autism by identifying reinforcers and teaching more appropriate behaviours.

What is a token economy?

A token economy is an operant conditioning technique in which individuals earn tokens for desirable behaviours.

Tokens can be exchanged for rewards or privileges.

Often used in psychiatric hospitals to encourage positive behaviours such as hygiene, socializing, and cooperation.

What is cognitive therapy?

Cognitive therapy (developed by Aaron Beck) focuses on how thoughts influence emotions and behaviour.

The therapist helps clients:

• Identify cognitive distortions

• Challenge irrational beliefs

• Replace them with more logical, realistic thoughts

What is cognitive-behavioural therapy (CBT)?

CBT combines cognitive therapy and behaviour therapy.

It focuses on present problems by changing:

• Cognitive distortions (negative thoughts)

• Self-defeating behaviours

CBT is effective for:

• Depression

• Anxiety disorders

• PTSD

• Eating disorders

• Bipolar disorder

• Substance abuse

What is the ABC model in CBT?

The ABC model explains how thoughts affect emotions and behaviour:

• A – Action (Activating event)

• B – Belief about the event

• C – Consequence (emotional/behavioural response)

Key idea: It is the belief, not the event itself, that determines the consequence.

What are common cognitive distortions?

• Overgeneralization: Turning one negative event into a broad conclusion.

• All-or-nothing thinking: Seeing situations in black-and-white extremes.

• Jumping to conclusions: Assuming negative outcomes without evidence.

What is an integrative (eclectic) approach to therapy?

An integrative (eclectic) approach combines techniques from multiple therapies, selecting the methods that best fit the client's needs.

May include:

• Biomedical therapy (medication)

• Person-centred therapy (building trust/therapeutic alliance)

• Psychodynamic therapy (exploring unconscious conflicts)

• CBT (changing thoughts and behaviours)

The therapist continually adjusts treatment as the client progresses.

What is Dialectical Behaviour Therapy (DBT)?

Dialectical Behaviour Therapy (DBT) is an eclectic form of CBT that is especially effective for Borderline Personality Disorder (BPD).

DBT:

• Builds a strong therapeutic alliance

• Accepts and validates the client's feelings while encouraging healthier behaviours

• Uses both individual and group therapy

• Teaches:

  • Interpersonal effectiveness

  • Emotion regulation

  • Distress tolerance

What are biomedical therapies?

Biomedical therapies treat psychological disorders by influencing the central nervous system (CNS).

They include:

• Drug therapy

• Electroconvulsive therapy (ECT)

• Transcranial magnetic stimulation (TMS)

• Psychosurgery

Drug therapy is the most common biomedical treatment and is often combined with psychotherapy.

How are stimulants used to treat ADHD? (common stimulants, side effects, etc)

Common stimulants:

• Ritalin

• Adderall

• Dexedrine

They improve:

• Inattention

• Impulsivity

• Hyperactivity

Key point: In low doses, stimulants improve attention and decrease hyperactivity.

Side effects:

• Decreased appetite

• Weight loss

• Sleeping problems

• Irritability

• Slightly reduced growth rate in children

How do antidepressants work?

Antidepressants treat:

• Depression

• Anxiety

• Phobias

• OCD

They increase the availability of neurotransmitters such as:

• Serotonin

• Norepinephrine

• Dopamine

Best results are often achieved when combined with psychotherapy.

What are the main types of antidepressants, Tricyclic antidepressants, MAOIs and SSRIs?

• Tricyclic antidepressants (e.g., Tofranil, Elavil)

• MAOIs

  • Increase serotonin, norepinephrine, and dopamine.

  • Can cause serious side effects (e.g., high blood pressure) and require dietary restrictions.

• SSRIs (e.g., Prozac, Paxil, Zoloft)

  • Block serotonin reuptake.

  • Safer and have fewer side effects than tricyclics and MAOIs.

What are the side effects and limitations of antidepressants?

SSRI side effects:

• Dry mouth

• Constipation

• Blurred vision

• Headache

• Agitation

• Drowsiness

• Reduced sexual enjoyment

Other key points:

• May increase suicide risk in some teens and young adults early in treatment.

• Can take weeks to months to become effective.

• Finding the best medication often involves trial and error.

How is bipolar disorder treated?

Treatment often includes:

• Mood stabilizers

• Antipsychotics

• Antidepressants

Lithium is the most common mood stabilizer:

• Treats mania

• Reduces the frequency and severity of manic episodes

Side effects:

• Frequent blood tests required

• Loss of coordination

• Slurred speech

• Frequent urination

• Excessive thirst

• Risk of hypercalcemia and hyperparathyroidism

How do antianxiety medications work?

Antianxiety medications increase GABA activity, producing a calming effect.

Common benzodiazepines:

• Ativan

• Valium

• Xanax

Side effects:

• Addiction and tolerance

• Drowsiness

• Dizziness

• Withdrawal symptoms

• Dangerous when combined with alcohol

How do antipsychotic medications work?

Antipsychotics treat schizophrenia and other psychotic disorders.

Examples:

• Thorazine

• Haldol

• Clozaril

• Risperdal

• Zyprexa

Mechanism:

• ↓ Dopamine → reduces positive symptoms

• ↑ Serotonin effects → improves negative symptoms

Side effects:

• Restlessness

• Muscle spasms

• Dizziness

• Blurred vision

• Tardive dyskinesia (long-term, involuntary movements)

Key point: Newer antipsychotics treat more symptoms with fewer side effects

What is Electroconvulsive Therapy (ECT)?

ECT uses controlled electrical currents to trigger a brief seizure to treat severe depression when other treatments have failed.

Key facts:

• Patient receives general anesthesia and muscle relaxants

• About 80% improve after treatment

• Reduces suicidal thoughts

Limitations:

• Relapse is common

• May cause short-term memory loss or cognitive impairment

What is Transcranial Magnetic Stimulation (TMS)?

TMS is a noninvasive treatment that uses a pulsing magnetic coil to stimulate the prefrontal cortex.

Advantages:

• No anesthesia

• No seizures

• No memory loss

• May be as effective as ECT

Also used to treat:

• Parkinson's disease

• Schizophrenia

What is vagus nerve stimulation (VNS)?

Vagus nerve stimulation (VNS) involves implanting a device in the chest that stimulates the vagus nerve.

It is used for chronic, treatment-resistant depression by activating brain regions that are underactive in depression.

What is psychosurgery?

Psychosurgery removes or destroys brain tissue to treat severe psychological disorders and is used only as a last resort.

Key facts:

• Prefrontal lobotomy: Historical procedure that damaged connections in the prefrontal cortex and often caused severe disability.

• Modern procedure: Cingulotomy, a much more targeted form of psychosurgery.

• Modern neuroimaging has improved the precision of these procedures.

Why is addiction considered a chronic disease?

• Chronic substance use changes the prefrontal cortex (decision-making and judgment).

• Drug use may begin voluntarily but can become compulsive.

• Relapse occurs in about 40–60% of individuals.

• Treatment is typically long-term, similar to treatment for chronic diseases like diabetes or hypertension.

What makes substance-related treatment effective?

• Lasts at least 3 months

• Combines behavioural therapy and/or medication

• Is holistic, addressing:

  • Stress management

  • Communication

  • Relationships

  • Parenting

  • Vocational and legal issues

• Focuses on relapse prevention and reducing cravings

What therapies are commonly used to treat substance-related disorders?

• Group therapy is the most common treatment because it provides:

  • Support

  • Identification

  • Accountability

  • Motivation to maintain sobriety

• Individual therapy is also used.

• Family therapy is especially important for adolescents.

• The primary goal is abstinence or a significant reduction in substance use.

• Medications may be used for detoxification, withdrawal symptoms, seizure prevention, and relapse prevention.

What are comorbid disorders in addiction?

Individuals fall into the category of mentally ill and chemically addicted (MICA). Comorbid disorders are two or more co-occurring diagnoses, such as:

• Substance use disorder + depression

• Bipolar disorder

• Schizophrenia

• Anxiety disorders

Treatment:

• Treat both disorders simultaneously

• Usually combines behaviour therapy, psychotherapy, and psychotropic medications (e.g., bupropion).

What is the sociocultural perspective in therapy?

The sociocultural perspective considers how a person's culture, ethnicity, religion, and social background influence their behaviour, symptoms, and treatment.

Key concepts:

• Cultural competence: Therapists understand and address cultural, racial, and ethnic differences.

• Multicultural counseling: Tailors treatment to the client's cultural values and life experiences.

• Can be used in individual, group, family, or couples therapy.

What are barriers to mental health treatment?

• Research has shown that ethnic minorities are less likely to access mental health services than their White middle-class American counterparts

• Lack of insurance

• Transportation and time

• Stigma and shame

• Concerns about confidentiality

• Belief that therapy is ineffective

• Preference for self-reliance or spiritual support

• Fear of discrimination or hospitalization

• Language barriers

• Lack of culturally appropriate or bilingual services

Why is cultural competence important in mental health treatment?

Cultural competence helps therapists:

• Understand clients' cultural beliefs and values

• Adapt treatment to different cultural backgrounds

• Reduce disparities in mental health care

• Improve communication, trust, diagnosis, and treatment effectiveness

Why do many people not seek mental health treatment?

The biggest barrier is stigma and misconceptions about mental illness.

Common reasons include:

• Fear of judgment or rejection

• Negative public perceptions

• Shame

• Misunderstanding of mental illness

• Fear of disclosing a diagnosis

How can we support people with mental health disorders?

Ways to reduce stigma and support mental health:

• Talk and listen openly about mental health

• Avoid assumptions and judgment

• Use respectful, non-stigmatizing language

• Treat mental illness like physical illness

• Encourage people to seek professional help

• Promote awareness, education, compassion, and equality