Intro to Psychology Areas and Applications - Chapter 16: Treatment of psychological disorders

Insight therapies (talk therapy)

A group of therapies where the goal is to discover and solve unresolved unconscious conflicts or restructure self-concept.

Insight therapies (talk therapy) [con’t]

Involve verbal interactions intended to enhance clients’ self-knowledge and thus promote healthful changes in personality and behaviour

Behaviour therapies

Therapies based on the principles of learning, aimed at changing overt maladaptive behaviours without any focus on insight into unconscious factors

e.g. Classical and operant conditioning

Behaviour therapies (con’t)

It’s assumed behaviour is a product of learning and said behaviour can be unlearned

For what reasons do people seek therapy?

They seek therapy for maladaptive issues such as depression and anxiety disorders

How many people seek therapy?

While statistics show that about one in five Canadians suffers from a psychological disorder, only 30 percent of those seek professional treatment; females are more likely to seek therapy

How many people need therapy?

17.8% of Canadians over 12 years of age reported experiencing a need for mental health services in the previous year

Why might people not seek therapy?

Lack of funds and stigma surrounding therapy

How many people have their therapy needs unmet?

2.3 million Canadians who perceived a mental health need reported that those needs were either unmet or only partially met

Psychotherapy

Professional treatment by someone with special training

Clinical psychologist

A professional with a Ph.D. or Psy.D. degree ($5-7\text{ years}$ of education beyond a bachelor's) who performs psychological testing, diagnosis, and treatment of disorders

Counseling psychologist

A professional with a Ph.D., Psy.D., or Ed.D. who focuses on work, career, treatment, and adjustment problems similar to a clinical psychologist.

How many registered psychologists are in Canada?

18,794 registered psychologists in Canada, or 50.8 per 100 000 population

Psychiatrist

A medical doctor ($M.D.$) with $8\text{ years}$ of post-bachelor education who specializes in the diagnosis and treatment of disorders, primarily using biomedical therapies.

Clinical social worker

A professional with an $M.S.W.$ or $D.S.W.$ degree ($2-5\text{ years}$ of post-bachelor education) who provides insight and behaviour therapy, often helping inpatients return to the community.

Psychiatric nurse

A professional with an $R.N., M.A.,\text{ or }Ph.D.$ degree ($0-5\text{ years}$ of post-bachelor education) who provides inpatient care and therapy in hospitals

Counsellors

Specializes in particular types of problems; typically has a master’s degree

e.g. Vocational counselling, marital counselling, rehabilitation counselling, and drug counselling

Psychoanalysis

An insight therapy developed by Sigmund Freud that emphasizes the recovery of unconscious conflicts, motives, and defences through techniques like free association and transference.

Biomedical therapies

Physiological interventions involving biological functioning to treat psychological disorders.

e.g. Drug therapy or electroconvulsive therapy

Biomedical therapies (con’t)

Intended to reduce symptoms associated with psychological disorders

Interpretation

The therapist's attempts to explain the inner significance of the client's thoughts, feelings, memories, and behaviours.

Resistance

Largely unconscious defensive manoeuvres intended to hinder the progress of therapy.

Transference

The phenomenon where clients unconsciously start relating to their therapist in ways that mimic critical relationships in their lives.

Genuineness

A condition in client-centred therapy where the therapist is honest and spontaneous with the client, rather than being defensive or role-playing.

Unconditional positive regard

The nonjudgmental acceptance of the client as a person, provided by the therapist in client-centred therapy.

Empathy

The therapist's ability to understand the world from the client's point of view.

Systematic desensitization

A behaviour therapy developed by Joseph Wolpe used to reduce phobic responses by weakening the association between the conditioned stimulus and the conditioned response of fear.

The steps of systematic desensitization

1. Anxiety hierarchy

2. Deep muscle relaxation training

3. Working through the established hierarchy of stimuli while remaining relaxed

Anxiety hierarchy

A list of feared situations of increasing intensity of Systematic desensitization (ranked from $0$ to $100$) used in systematic desensitization.

Exposure therapies

When clients are gradually confronted in controlled settings with situations they fear so they learn that these situations are really harmless

Aversion therapy

A behaviour therapy in which an aversive stimulus is paired with a stimulus that elicits an undesirable response,

e.g. Alcoholics have had an emetic drug (one that causes nausea and vomiting) paired with their favourite drinks during therapy sessions

Social skills training (SST)

A behaviour therapy designed to improve interpersonal skills that emphasizes modelling, behavioural rehearsal, and shaping.

Behavioural rehearsal

When the client tries to practise social techniques in structured role-playing exercises

Shaping

When clients are gradually asked to handle more complicated and delicate social situations

e.g. A nonassertive client may begin by working on making requests of friends before being asked to tackle standing up to the boss at work.

Cognitive-behavioural treatments

Uses varied combinations of verbal interventions and behaviour modification techniques to help clients change maladaptive patterns of thinking

Cognitive therapy

A treatment developed by Aaron Beck that uses specific strategies to correct habitual thinking errors and change negative thoughts that underlie various types of disorders.

Cognitive therapy (con’t)

Uses a variety of behavioural techniques

e.g. Modelling, systematic monitoring of one’s behaviour, and behavioural rehearsal

Cognitive therapy process

Clients are taught to detect their automatic negative thoughts and subject these automatic thoughts to reality testing so the therapist can help them see how unrealistically negative the thoughts are.

Cognitive bias modification

Varied procedures that attempt to directly change automatic biases in thinking that are known to contribute to various disorders

e.g. People with anxiety disorders tend to selectively attend to threatening information and to interpret information in overly threatening ways

Self-instructional training

Clients are taught to develop and use verbal statements that help them cope with difficult contexts

Rational-emotive therapy

A form of cognitive therapy developed by Albert Ellis aimed at changing the way clients think.

Mindfulness-based cognitive-behavioural therapy (MBCT)

An approach developed by Zindel Segal that emphasizes:

• Increased awareness

• The present moment

• Self-compassion

• Accepting things as they are

Mindfulness-based cognitive-behavioural therapy (MBCT) [con’t]

Clients are taught to focus on troubling thoughts or emotions and to accept them without judging or elaborating on them

Effectiveness of behaviour therapies

There’s ample evidence attesting to the effectiveness of behaviour therapy

Psychopharmacotherapy

The treatment of mental disorders with medication.

Antianxiety drugs

Psychopharmaceutical drugs that relieve tension, apprehension, and nervousness.

e.g. Valium, Xanax, Buspar, and other drugs in the benzodiazepine family

Side effects of antianxiety drugs

Drowsiness, depression, nausea, withdrawl, and confusion.

Tranquilizers

Drugs exert their effects almost immediately and can be fairly effective in alleviating feelings of anxiety, but their impact is relatively short-lived

Antipsychotic drugs

Drugs used to gradually reduce psychotic symptoms, including hyperactivity, mental confusion, hallucinations, and delusions

e.g. Thorazine, Mellaril, and Haldol.

Antipsychotic drugs (con’t)

Appear to decrease activity at dopamine synapses, although the exact relationship between their neurochemical effects and their clinical effects remains obscure

Antipsychotic drugs side effects

Drowsiness, constipation,cottonmouth, tremors, muscular rigidity, and impaired coordination

Antidepressant drugs

Medications that gradually elevate mood and help bring people out of depression by increase activity at serotonin synapses

e.g. Tricyclics, MAO Inhibitors, and SSRIs.

Tardive dyskinesia

An incurable, neurological disorder marked by involuntary writhing and tic-like movements of the mouth, tongue, face, hands, or feet, which can be a side effect of antipsychotic drugs.

Second-generation antipsychotic drugs

Similar to the first-generation antipsychotics in therapeutic effectiveness, but they offer several advantages

e.g. Helping treatment-resistant patients who do not respond to traditional antipsychotics

Drawbacks of second-generation antipsychotic drugs

Increase patients’ vulnerability to diabetes and cardiovascular problems

Selective serotonin reuptake inhibitors (SSRIs)

Antidepressants that slow the reuptake at serotonin synapses, increasing activity specifically at those sites.

e.g. Prozac, Paxil (paroxetine), and Zoloft (sertraline)

Drawbacks of selective serotonin reuptake inhibitors (SSRIs)

• Nausea

• Dry mouth

• Drowsiness

• Sexual difficulties

• Weight gain

• Feeling emotionally numb

• Agitation

• Increased suicidal thinking

Mood stabilizing drugs

Chemicals used to control mood swings in patients with bipolar mood disorders

e.g. Lithium and Valproic acid.

Drawbacks of mood stabilizing drugs

• High concentrations can be toxic and even fatal.

• Kidney and thyroid gland complications are the other major problems associated with lithium therapy.

Criticsims of drug therapies

• Effects are only temporary, with relapse occurring after discontinuation

• Overprescription and medication

• Damaging side effects of therapeutic drugs are underestimated by psychiatrists, and these side effects are often worse than the illnesses the drugs are supposed to cure

Electroconvulsive therapy (ECT)

A biomedical treatment in which brief electric shocks are introduced to produce a cortical seizure, typically used for major or intractable depression with relative success

Risks of electroconvulsive therapy (ECT)

Memory losses, impaired attention, and other cognitive deficits are common short-term side effects of ECT

Transcranial magnetic stimulation (TMS)

A technique that permits scientists to temporarily enhance or depress activity in a specific area of the brain, such as the prefrontal cortex ($PFC$).

Transcranial magnetic stimulation (TMS) process

A magnetic coil mounted on a small paddle is held over specific areas of the head to increase or decrease activity in discrete regions of the cortex

Deep brain stimulation (DBS)

A procedure where a thin electrode is surgically implanted into the brain and connected to a pulse generator to treat motor disturbances or depression.

Cultural barriers

When some cultural groups are reluctant to turn to formal, professional sources of assistance during times of stress due to their customers

Language barriers

Communication problems that make it awkward and difficult for many ethnic group members to explain their problems and to obtain the type of help that they need

Institutional barriers

When therapists aren’t familiar with the cultural backgrounds and unique characteristics of various ethnic groups which leads to misunderstandings, ill-advised treatment strategies, and reduced rapport.

How can we improve mental health services for ethnic and cultural minority groups

• Provide adequate training

• Hire professionals from diverse backgrounds

• Develop behaviours that reflect an understanding of how cultural factors shape individuals’ worldviews and health behaviours (Cultural competence)

• Have an accurate view of one’s limitations and be other-oriented rather than self-centred with an air of superiority (cultural humility)

Technology and the delivery of clinical services

Using methods such as the internet, over-the-phone and videoconferencing to deliver services as a means of alleviating availability and other similar restrictions

Success of technology and the delivery of clinical services

Has similar results and satisfaction to that of in-person services

Deinstitutionalization

A trend in institutional treatment that involves transferring the treatment of mental illness from inpatient institutions to community-based facilities.

Deinstitutionalization (con’t)

Enables patients to return to society quickly, avoid unnecessary hospitalization and receive mental health services

How was deinstitutionalization made possible

1. The emergence of effective drug therapies for severe disorders

2. The deployment of community mental health centres to coordinate local care

Drawbacks of deinstitutionalization

Patients sometimes ad no families, friends, or homes to return to, nor skills

Disenchantment with mental hospitals

When hospitals were causing pathology instead of curing it due to reasons such as:

• Underfunding

• Inadequate training of staff

• Patients were isolated from their community

Community mental health movement

A movement which emphasized:

1. Local, community-based care

2. Reduced dependence on hospitalization

3. The prevention of psychological disorders

Revolving door problem

The phenomenon where patients are briefly hospitalized, released into communities that lack adequate support, and then quickly re-hospitalized.

Common indicators of mental disorders

• Irritability

• Lack of motivation

• Low energy levels

• Mood swings

• Negative thought patterns

• Persistent negative thought patterns

• Prolonged sadness

Common indicators of mental disorders (con’t)

• Increased substance use

• Self-harm

• Suicidal ideations

• Withdrawal from social contact

• Extreme distress

• Changes in eating habits (overeating or undereating)

• Changes in sleeping habits (insomnia or oversleeping)

Psychotherapy (talk therapy)

A collaborative partnership between a trained mental health professional and a client aimed at improving emotional well-being and mental health.

Initial assessment

The therapist gathers information about the client's mental health, personal history, current issues, and goals

Diagnosis

When a formal mental health diagnosis is given.

Goal setting

When the therapist and client agree on the goals of therapy

e.g. Reducing anxiety, improving relationships, processing trauma

Cognitive Behavioral Therapy (CBT)

A therapeutic approach that focuses on changing unhelpful thought patterns and behaviours by addressing the present using techniques such as thought tracking and cognitive restructuring.

Psychodynamic Therapy

A therapy based on Freud’s theories that explores unconscious patterns rooted in early experiences and focuses on the past using techniques such as free association and dream analysis

Humanistic Therapy

A therapy focused on self-awareness, self-acceptance, and personal growth, utilizing techniques such as empathic listening and unconditional positive regard.

Dialectical Behavior Therapy (DBT)

A treatment designed for managing intense emotions and emotion dysregulation, commonly used for borderline personality disorder.

Dialectical Behavior Therapy (DBT) [con’t]

Is done through mindfulness, distress tolerance, emotion regulation.

EMDR (Eye Movement Desensitization and Reprocessing)

A therapy for processing trauma that involves recalling memories while engaging in bilateral stimulation, such as eye movements.

EMDR (Eye Movement Desensitization and Reprocessing) [con’t]

Is done through guided eye movements while recalling traumatic memories

Trust and Confidentiality

A strong, trusting relationship is key. Sessions are confidential (within legal limits)

Empathy and Non-judgment

Therapists offer a safe, supportive space to explore difficult feelings and experiences

Short-Term or Long-Term

Therapy might last a few sessions or continue for years

Regular Sessions

Often weekly, typically 45–60 minutes

Monitoring Progress

Regular check-ins to review progress toward goals, with adjustments to approach if needed.

Randomized Control Trial (RCT)

A study where participants are randomly assigned to different groups to test a treatment’s effect, intended to reduce bias and ensure evidence-based conclusions.

Meta-analysis

A statistical technique that combines results from multiple studies on the same topic to identify overall trends and increase statistical power.

Umbrella Review (review of reviews)

A systematic review that synthesizes findings from other systematic reviews and meta-analyses

Effect Size

A quantitative estimate of the magnitude or strength of a relationship or difference between variables; in psychotherapy research, small is $0.2$, medium is $0.5$, and large is $0.8$.