Comprehensive Study Guide on Psychological Treatment and Therapy and Biological Treatments
Student Perspectives on Specialized Treatments
Taking Medication for Brain Chemistry: * Grayson: Argued that targeting specific elements like neurotransmitters is acceptable if the treatment is targeted correctly to provide a necessary "oomph" to the brain. * Grace: Noted that while medications help certain symptoms, they often come with significant side effects that might require even more medication to fix, creating a tradeoff some are unwilling to accept. * Carly: Pointed out that medication is often more convenient for busy adults compared to the time commitment of therapy sessions. * Instructor Note: The instructor observed that medication often serves as an "easier entry level" for treatment, noting that as people age, they often rely on pill sorters (e.g., morning and nighttime sorters).
Exposure to Phobias: * Natalie: Discussed the willingness to undergo exposure therapy depending on the type of phobia (e.g., social phobia versus spiders) and how much it impacts the individual's life. * Bianca: Suggested that the gradual nature of the process makes it more appealing, as the patient can move at their own pace toward comfort.
Mild Electrical Brain Stimulation: * Maya: Expressed a general reluctance, stating it simply "doesn't seem like the thing" for her, despite the stimulation being labeled as "mild." * Ellie: Questioned the efficacy of electrical stimulation, comparing it to medications that may not work, making the effort and time investment seem potentially futile. * Gretchen/Instructor Response: The instructor clarified that electrical brain stimulation is used for serious disorders like major depression because the brain is essentially an electrical device that is "misfiring." While it is effective for some, the specific mechanism of why it works is not fully understood.
General Effectiveness and Evidence-Based Treatment
The Big Claim: Treatment for psychological disorders is generally effective when psychotherapies are used correctly.
Definition of Effectiveness: Effectiveness does not imply a cure rate or guaranteed improvement for every individual. Instead, it means that the statistical outcomes for those receiving treatment are better than the outcomes for those receiving no treatment at all.
Meta-Analysis: This finding is supported by years of meta-analysis, which is the process of "studying studies." It looks at multiple types of research over various groups and years to demonstrate that treatment is more effective than non-treatment.
Evidence-Based Treatment Pillars: Good treatment is an intersection of three key pieces: * Research-Based Evidence: Utilizing medications or techniques backed by scientific research. * Experienced Clinician: Working with a trained therapist or psychologist. * Client Preference: The patient must be willing and invested. If a client does not want to be there (e.g., being forced to treat a fear of spiders they are comfortable having), treatment efficacy drops.
Therapeutic Alliance: A strong level of trust, collaboration, and a feeling of being heard between the clinician and the client. The quality of this relationship has a direct impact on the success of the support.
Cultural Humility: Recognizing that different cultures and lifestyles have diverse ways of thinking about and functioning with mental disorders.
Historical Context and Institutionalization
The Institutional Era: In the past, individuals with mental disorders were often placed in institutionalized care or state mental hospitals for long-term hospitalization and inpatient treatment. * Conditions: Typically overcrowded and under-resourced. * Case Study: The instructor shared a family anecdote regarding her grandmother, Joyce, who suffered from bipolar disorder. Joyce would enter a state mental hospital system miles away from home during episodes, removing her from her family environment.
The Modern Shift: There is now a focus on community-based care. * Goal: Treat individuals while keeping them integrated into their daily lives as much as possible. * Outpatient Treatment: Patients attend treatment and then return home to live their lives outside the hospital. * Multimodal Approach: Combining biological treatments (medication) with individual therapy, group therapy, or alternative options like equine therapy.
Ethical Principles in Psychological Care
APA (American Psychological Association): The professional group responsible for the DSM and establishing ethical guidelines.
Non-malfeasance: A fancy term for "do no harm." The goal is to avoid leaving the patient worse off than they were found.
Fidelity: Establishing a pillar of trust and confidentiality between the doctor and patient. * Caveats to Confidentiality: Confidentiality is breached if the patient intends to harm themselves, harm someone else, or if there is a specific court order. * Confidentiality in Children: Ethical standards of trust often extend to children. The instructor noted that a therapist seeing her daughter provided only "generalized updates" to the parents to maintain the child's trust in the therapeutic relationship.
Integrity: Practicing with honesty and avoiding the misleading, falsifying, or manipulation of information.
Respect: Acknowledging the dignity and independence of every person, including respecting different cultural values.
Major Therapeutic Perspectives
Psychodynamic Approach: * Key Figure: Sigmund Freud. * Assumption: Behavior and emotions are harmed by hidden and unconscious conflicts rooted in the past. * Technique: Free Association: The patient says whatever comes to mind without censorship (e.g., responding to "apple" with "blood") to reveal reoccurring themes or triggers. * Technique: Dream Interpretation: Analyzing dreams as the unconscious mind's way of communicating. * Critique: Difficult to test scientifically because unconscious processes are hard to measured.
Humanistic Perspective: * Key Figure: Carl Rogers. * Assumption: People possess the capacity for growth and self-improvement. * Unconditional Positive Regard: Accepting the client without judgment, creating a safe space for radical honesty (though not necessarily approving of all actions). * Active Listening: Focusing on reflections, paraphrasing, and clarifications. The therapist acts as a supportive friend rather than a detached authority figure to aid in "self-actualization."
Cognitive Perspective: * Key Figure: Aaron Beck. * Assumption: Disordered thinking patterns distort behavior. * Cognitive Triad (Depression): Negative thoughts about the , the , and the create a cycle that reinforces depression. * Cognitive Restructuring: Challenging faulty thought patterns (e.g., moving from "I failed a test, I am stupid" to "I failed because I was unprepared, and I can change my study habits"). The goal is accurate, non-distorted thinking rather than simple "positive thinking."
Behavioral Therapy: * Assumption: Rooted in learning, using operant and classical conditioning to change behavior rather than exploring thoughts. * Exposure Therapy: Gradually confronting feared objects in a safe environment. * Systematic Desensitization: Combining exposure with relaxation techniques using a "fear hierarchy." * Token Economies: Used often in schools (e.g., PBIS, "Warrior Bucks," or "Rocket Bucks"). Positive behaviors are rewarded with tokens that can be exchanged for reinforcements. * Aversion Therapy: Stopping unwanted behaviors through an unwanted stimulus (e.g., putting hot sauce, vinegar, or foul-tasting nail polish on fingers to stop nail-biting).
Cognitive Behavioral Therapy (CBT): * Status: The most popular and widely researched therapy today. * Approach: Combines cognitive and behavioral strategies; it is present-focused, goal-oriented, and highly structured. * REBT (Rational Emotive Behavioral Therapy): Identifying and challenging irrational beliefs to solve emotional/behavioral problems. * DBT (Dialectical Behavior Therapy): Adds mindfulness, emotional regulation, and distress tolerance to traditional CBT.
Biological and Pharmacological Treatments
Pharmopsychotic Drugs (Classifications): * Antidepressants: Targeted at serotonin. Common examples include SSRIs (Selective Serotonin Reuptake Inhibitors) like Prozac and Cymbalta. * Anti anxiety Meds: Work quickly to reduce panic/tension. Examples include Xanax. They can be habit-forming if overused. * Stimulants: Used for ADHD to increase attention/impulse control by affecting dopamine and neuro-epinephrine. Examples include Adderall and Ritalin. * Mood Stabilizers: Often used for bipolar disorder. The most common example is Lithium. * Antipsychotics: Used for hallucinations or delusions (e.g., Schizophrenia) by reducing dopamine activity. Examples include Risperidal and Zyprexa.
General Limits of Medication: Medication reduces symptoms but does not "cure" the disorder like an antibiotic kills a germ. It is highly recommended to pair medication with therapy to change behavioral patterns.
Side Effects: * Stimulants: Loss of appetite, lack of weight gain/growth in children. * Antidepressants: Lowered sexual drive. * Antipsychotics: Feeling "numb." * Tardive Dyskinesia: A serious long-term side effect of antipsychotics involving involuntary movements of the face and tongue.
Advanced Biological Interventions
Electroconvulsive Therapy (ECT): * History: First used in . Early versions caused full-body seizures and bone breaks. * Modern Procedure: Performed under general anesthesia with muscle relaxants. A mild electrical pulse causes a brief, controlled seizure in the brain (evidenced only by a twitching foot). Sessions typically occur times per week for several weeks. * Efficacy: High for treatment-resistant major depression or suicidal patients. It triggers the release of neurotransmitters and hormones. * Side Effects: Aching, fatigue, nausea, and short-term memory loss (e.g., forgetting what was for dinner the night before).
Transcranial Magnetic Stimulation (TMS): A newer, non-invasive procedure using magnetic pulses to stimulate brain regions. It has fewer side effects than ECT.
Psychosurgery: Extremely rare and a "last resort" as it permanently alters brain tissue. * Lobotomy: An outdated and unethical practice of removing parts of the brain.
Therapy Formats and Hypnosis
Group Therapy: * Pros: Supportive environment (realizing others struggle with the same grief, addiction, or trauma), cost-effective. * Cons: Less privacy. * Effectiveness: Peers can often provide feedback that is more easily accepted than feedback from a professional alone.
Individual Therapy: * Pros: Personalized one-on-one attention. * Cons: Expensive.
Hypnosis: * Definition: A state of focused attention and increased suggestibility; not mind control. * Uses: Legitimate for pain management, anxiety, and stress reduction alongside other therapies. * Myths: Research does not support memory recovery or "age regression" (literally reliving memories). Hypnosis can actually increase the risk of false memories.