Study Guide for Treatment of Psychological Disorders

Deinstitutionalization

The process of moving people with psychological disorders out of institutional facilities.

Psychotherapy

Treatment involving psychological techniques; consists of interactions between a trained therapist and someone seeking to overcome psychological difficulties or achieve personal growth.

Biomedical Therapy

Prescribed medications or procedures that act directly on a person's physiology; includes treatments like anti-depressants and electroconvulsive shock therapy.

Talk Therapies

Approaches to therapy that include psychodynamic, humanistic, behavioral, and cognitive methods.

Philippe Pinel

An 18th-century reformer who advocated for humane treatment of the mentally ill.

Dorothea Dix

A 19th-century reformer who pushed for the construction of mental hospitals and humane treatment.

Electic therapy

A therapeutic approach where therapists use a blend of different therapies.

Deinstitutionalization

The process of moving people with psychological disorders out of institutional facilities.

Psychotherapy

Treatment involving psychological techniques; consists of interactions between a trained therapist and someone seeking to overcome psychological difficulties or achieve personal growth.

Biomedical Therapy

Prescribed medications or procedures that act directly on a person's physiology; includes treatments like anti-depressants and electroconvulsive shock therapy.

Talk Therapies

Approaches to therapy that include psychodynamic, humanistic, behavioral, and cognitive methods.

Philippe Pinel

An 18th-century reformer who advocated for humane treatment of the mentally ill.

Dorothea Dix

A 19th-century reformer who pushed for the construction of mental hospitals and humane treatment.

Electic therapy

A therapeutic approach where therapists use a blend of different therapies.

Goals of Psychoanalysis

Freud believed that people could lead less anxious living by releasing the energy devoted to the id-ego-superego conflicts.

Psychoanalysis

Freud's therapeutic technique. Free associations, resistances, dreams, and transferences - and the therapist's interpretations of them - released previously repressed feelings, allowing the patient to gain self-insight.

Eclectic Approach

An approach to psychotherapy that uses techniques from various forms of therapy.

Resistance

In psychoanalysis, the blocking from consciousness of anxiety-laden material.

Interpretation

The analyst's noting supposed dream meanings, resistances, and other significant behaviors and events in order to promote insight.

Transference

The patient's transfer to the analyst of emotions linked with other relationships (such as love or hatred for a parent).

Psychodynamic Therapy

Therapy deriving from the psychoanalytic tradition; views individuals as responding to unconscious forces and childhood experiences, and seeks to enhance self-insight; client-therapist meetings take place once to twice a week.

What does humanistic therapies (HT) emphasize?

Humanistic Perspective emphasizes people’s innate potential for self-fulfillment

Insight Therapies

therapies that aim to improve psychological functioning by increasing a person’s awareness of underlying motives and defenses.

Person-centered therapy

a humanistic therapy, developed by Carl Rogers, in which the therapists uses techniques such as active listening with an accepting, genuine, empathic environment (AGE) to facilitate client’s growth (Also called person-centered therapy)

Active listening

empathetic listening in which the listener echoes, restates, and clarifies. A feature of Rogers' client - centered therapy.

Unconditional positive regard

a caring, accepting, nonjudgmental attitude, which Carl Rogers believed would help clients to develop self-awareness and self-acceptance.

Behavior Therapy

therapy that applies learning principles to the elimination of unwanted behaviors.

What do behavior therapists usually believe?

Behavior therapists doubt the healing power of self-awareness. Assume the problem behaviors are the problem (not looking for an underlying cause).

Counterconditioning

behavior therapy procedures that use classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors; include exposure therapies and aversive conditioning.

Exposure Therapies

 behavioral techniques, such as systematic desensitization and virtual reality exposure therapy, that treat anxieties by exposing people (in imaginary or actual situations) to the things they fear and avoid.

Systematic Desensitization

 a type of exposure therapy that associates a pleasant relaxed state with gradually increasing anxiety triggering stimuli. Commonly used to treat phobias.

Virtual Reality Exposure Therapy

a counterconditioning technique that treats anxiety through creative electronic simulations in which people can safely face their greatest fears, such as airplane flying, spiders or public speaking.

Aversive Conditioning

 a type of counterconditioning that associates an unpleasant state (such as nausea) with an unwanted behavior (such as drinking alcohol).

Aversion Therapy for alcohol use disorder

After repeatedly imbibing an alcoholic drink mixed with a drug that produces severe nausea, some people at least develop a temporary conditioned aversion to alcohol. (Remember: US is unconditioned stimulus, UR is conditioned response, NS is neutral stimulus, CS is conditioned stimulus and CR is Conditioned Response.

What are some classical conditioning techniques?

Counter conditioning, Exposure Therapies, systematic desensitation, Virtual reality exposure therapy, and aversive conditioning

What is behavior modification

Behavior therapists practice behavior modification (reinforce behaviors they consider desirable and fail to reinforce or punish behaviors they consider undesirable).

Token economy

an operant conditioning procedure in which people earn a token for exhibiting a desired behavior and can later exchange tokens for privileges or treats.

What do cognitive therapies assume?

Cognitive therapies assume that our thinking colors our feelings. Between an event and our response lies the mind. Self-blaming and overgeneralized explanations feed depression. Anxiety arises from an attention bias to threat. 

Rational Emotive Behavior Therapy (REBT)

 a confrontational cognitive therapy, developed by Albert Ellis, that vigorously challenges people's illogical, self-defeating attitudes and assumptions.

Catastrophizing

relentless, overgeneralized, self-blaming behavior.
 

Dress inoculation training

eaching people to restructure their thinking in stressful situations.

Cognitive Behavioral Therapy (CBT(

 a popular integrative therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior). 

Dialectical Behavior Therapy

newer version of CBT, helps change harmful and even suicidal behavior patterns. Dialectical means opposing and this therapy attempts to make peace between two opposing forces. Therapists create an accepting and encouraging environment, helping clients feel that they have an ally who will offer them constructive feedback and guidance. 

Group Therapy

therapy conducted with groups rather than individuals, providing benefits from group interaction. Not same degree of involvement as other therapies but other benefits:

Family Therapy

therapy that treats people in the context of their family system. Views and individual's unwanted behaviors as influenced by, or directed at, other family members.

Self-Help Groups

more than 100 million Americans have belonged to small, religious, interest or support groups that meet regularly. Emotional support.  Alcoholics Anonymous (AA) reports having 2.1 members worldwide. 12 step program.

 

Client’s Perspectives

Most clients (90%) report feeling very good, good or so-so after entering therapy feeling poor or fair.

Criticisms of Psychotherapies

• People often enter therapy in crisis (normal ebb and flow)

• Clients believe that treatment will be effective (placebo effect)

• Clients generally speak kindly of their therapists

• Clients want to believe that therapy was worth the effort

  

Effort justification

we are prone to selective and biased recall and to make judgments confirming our beliefs. Mass. Study of 500 boys. Intervention in half resulted in 66% having no juvenile record. But control group (no intervention) had 70% with no record.

Clinicans’ perspective

Believe it works. Hear little from clients who seek out other therapists. Vulnerable to cognitive errors such as confirmation bias and illusory correlation.

Conformation Bias

a tendency to search for information that supports our preconceptions and ignore or dismiss contradictory evidence.

Outcome research

Hans Eysenck - 2/3 receiving treatment for disorders other than hallucinations and delusions improved. But so did 2/3 who didn't receive treatment. Time heals. Criticism: Small sample.

Randomized Clinical Trials

 researchers randomly assign people on a wait list to therapy or no therapy. Later evaluate everyone and compare outcomes.

Meta-analysis

 procedure for statistically combining the results of many different research studies.

Cognitive and cognitive behavioral therapies

anxiety, posttraumatic stress disorder, insomnia and depression.

Behavioral Conditioning therapies

pecific behavior problems such as bed-wetting, phobias, compulsions, marital problems and sexual dysfunctions

Psychodynamic therapies

Depression and anxiety

Nondirective

(client-centered counseling) - mild to moderate depression.

Evidence based practice

clinical decision making that integrates the best available research with clinical expertise and patient characteristics and preferences. (Moves away from therapy as art form). Clinicians apply therapies suited to their own skills and with patient preferences and characteristics. Government and Insurers support this model.

Therapeutic Alliance

a bond of trust and mutual understanding between a therapist and a client, who will work constructively to overcome the client's problem.

Paraprofessionals

briefly trained caregivers who may be recovered former clients.

 

Eye movement desensitization and reprocessing

Works better than doing nothing but what is therapeutic is the combination of exposure therapy - repeatedly calling up traumatic memories and reconsolidating them in a safe and reassuring context - and perhaps the placebo effect.

Light Exposure Therapy

as effective as antidepressant or CBT. Brain scans show that light therapy sparks activity in a region that influences the body's arousal and hormone levels.
 

Cultural competence

understanding and respecting different cultural groups' values, beliefs and traditions. If culturally competent, the therapist can better serve their clients.

Clinical psychologists

 Ph.D. or Psy.D supplemented by supervised internship and often post-doctoral training. Half work in agencies or institutions, half in private practice.

Psychiatrists

MDs. Can prescribe medication. Specialize in the treatment of psychological disorders.

Clinical or psychiatric social workers

 Two year Master of social work graduate program plus postgraduate supervision

Counselors

Marriage and family counselors. Clergy. Abuse counselors

Beneficence and nonmaleficence

Seek to benefit you (beneficence) and do you no harm (nonmaleficence).

Fidelity and responsibility

Establish a feeling of trust and a defined role as your therapist, uphold a professional standard of conduct, and be of service to the therapeutic community.

Integrity

Be honest, truthful, and accurate

Justice

Be fair and promote justice for you and others, helping everyone to have access to the benefits of therapy

Respect for people’s rights and dignity

Respect the dignity and worth of you and others, recognizing the right to privacy, confidentiality, and self-determination.

Psychopharmacology

the study of the effects of drugs on mind and behavior.

Evaluate effectiveness of drugs by:

Antipsychotic drugs

rugs used to treat schizophrenia and other forms of severe thought disorder. Thorazine - first generation drug - dampened responsiveness to irrelevant stimuli.  Molecules of antipsychotic drugs similar to molecules of neurotransmitter dopamine to occupy its receptor sites and block its activity. Reinforces idea that overactive dopamine system contributes to schizophrenia. Long term use of antipsychotic drugs can produce tardive dyskinesia (involuntary movements of the facial muscles, tongue and limbs. Newer antipsychotic drugs (risperidone and olanzapine) work with fewer side effects.

Antianxiety drugs

used to control anxiety and agitation. Xanax or Ativan depress the central nervous system activity.  Criticism: antianxiety drugs may reduce symptoms without resolving underlying problems.

Antidepressant Drugs

drugs used to treat depression, anxiety disorders, obsessive-compulsive disorder and posttraumatic stress disorder. (Several widely used antidepressants drugs are selective serotonin reuptake inhibitors.)  Many work by increasing the availability of neurotransmitters such as norepinephrine and serotonin. Because they are used to treat more than depression - often called SSRIs. Does not take effect immediately. Often four weeks or more.

Depakote

originally used to treat epilepsy. Also effective in controlling manic episodes associated with bipolar disorder. Lithium also effectively controls the highs and lows of this disorder.

Electroconvulsive Therapy (ECT)

 a biomedical therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized person.  Used to treat severe depression in treatment resistant patients.

Transcranial Electrical Stimulation

- a weak 1 to 2 milliamp current to the scalp. May alleviate depression.

Repetitive Transcranial Magnetic Stimulation (rTMS)

the application of repeated pulses of magnetic energy to the brain; used to stimulate or suppress brain activity. Treatment for depression. Possibly energizes the brain's left frontal lobe, which is relatively inactive during depression.

Deep-Brain Stimulation (DBS)

experimental treatment. Plant electrodes in a brain area that functions as the neural sadness center. Questionable whether placebo effect is driving the positive responses (also some negative responses).

Psychosurgery

surgery that removes or destroys brain tissue in an effort to change behavior.

Lobotomy

a psychosurgical procedure once used to calm uncontrollably emotional or violent patients. The procedure cut the nerves connecting the frontal lobes to the emotion-controlling centers of the inner brain. Between 1936-1954, tens of thousands of severely disturbed people were lobotomized. Mostly history. Only now for severe seizures, OCD.

Hypnosis

 a social interaction in which one person (the hypnotist) suggests to another (the subject) that certain perceptions, feelings or thoughts, or behavior will spontaneously occur.

Posthypnotic suggestion

 a suggestion, made during a hypnosis session, to be carried out after the subject is no longer hypnotized; used to control undesired symptoms and behaviors.

Nicholas Spanos

"the overt behaviors of hypnotic subjects are well within normal limits" (so no divided consciousness). People aren't faking hypnosis but are caught up in the social role playing - hypnotized people are acting out the role of the good subject by following directions given by an authoritative figure.

Ernest Hilgard

believes hypnosis involves social influence and divided consciousness.

Dissociation

 a split in consciousness, which allows some thoughts and behaviors to occur simultaneously with others.

Preventive Mental Health

seeks to prevent psychological casualties by identifying and alleviating the conditions that cause them. Some examples: poverty, meaningless work, constant criticism, unemployment, racism, and sexism undermine people's sense of competence, personal control and self-esteem. 

Resilience

the personal strength that helps most people cope with stress and recover from adversity and even trauma.

Posttraumatic Growth

positive psychological changes as a result of struggling with extremely challenging circumstances and life crisis.