Treatments for disorders

Biological Treatments for Disorders

• Biological, medical, or biochemical approaches.
• Psychotherapies and medication are used.

Psychotherapy - Freud's Psychoanalysis

• Developed by Freud and colleagues.
• Talking about psychological disorders can lead to improvement.
• Novel idea in the early 20th century.
• The past is important, especially childhood.
• Unconscious feelings, urges, desires, and memories affect conscious behavior.
• Goal: make unconscious things conscious.
• Techniques:
  • Free association:
    • Lying back and relaxing.
    • Thinking about whatever comes to mind.
    • The therapist is non-directive.
  • Analysis of dreams:
    • The unconscious mind works on conscious life during sleep.
    • Dreams aren't always clear.
    • Manifest content: the story of the dream as you tell it.
    • Latent content: what the dream actually represents; the underlying meaning.
• Transference:
  • The therapist is an authority figure.
  • Patients transfer feelings from other authority figures (e.g., parents) onto the therapist.
• Limitations:
  • Making unconscious things conscious doesn't always resolve the disorder.
  • It takes a long time and costs a lot of money.
  • Other approaches are faster and cheaper.
  • Not commonly used today.

Practical Considerations of Psychoanalysis

• Strict psychoanalysis involves sessions four to five times a week for four to five years.
• Very time-consuming.
• Expensive, costing around $200 per session.
• Limited insurance coverage.
• Non-directive, expensive, and not always effective.
  *It is more useful for insight and self discovery.

Psychodynamic Psychotherapy

• Broader than psychoanalysis.
• Interested in the past and the unconscious.
• De-emphasizes sexual aspects.
• Focuses more on current relationships.
• Sessions are typically once a week.
• No lying on the couch.
• Shorter duration, around six months.
• The therapist provides an assessment and a plan.
• Psychotherapy hour is typically 45-50 minutes.

The Psychotherapy Hour

• Typically 45-50 minutes long, not a full 60 minutes.
• Allows the therapist time for notes and preparation.
• Therapists want eye contact and connection with the patient.
• They may jot down phrases but avoid constant writing.

Behavioral Therapy

• Disorders are learned behaviors.
• Goal: unlearn those behaviors or learn new, adaptive behaviors.
• Uses classical and operant conditioning.
• Classical Conditioning:
  • Counterconditioning: learn a new response to a previously undesirable behavior.
    • Aversion therapy: using something unpleasant to stop a behavior.
      • Examples:
        • Snapping a rubber band on the wrist before smoking.
        • Lighters that give a mild electric shock.
        • Antabuse: a drug that makes you violently ill if you drink alcohol.
    • Exposure therapy: used for fear and anxiety.
      • Phobias: get plenty of exposure to the feared object or situation.
      • Combine with cognitive approaches.
• Case Example: Snake Phobia
  • A woman with a severe snake phobia was treated in a 3-hour session.
  • The therapist spent one hour discussing what she thought would happen around a snake.
  • She believed she had a 70-80% chance of dying from a heart attack if near a small, non-poisonous snake.
  • The therapist exposed her to a snake for two hours, gradually getting closer.
  • After the treatment, she posed for pictures with the snake and reported no further problems.
• Exposure response prevention: often used for OCD related to germs and cleanliness.

History of Exposure Therapies

• Watson and Little Albert
• Watson and Mary Cover Jones
  • Paired cookies, candy, and milk with a rabbit to remove fear in a boy named Peter.
• Joseph Wolpe
  • Systematic desensitization
  • Fear and relaxation are incompatible.
    • Train relaxation (progressive muscle relaxation, breathing exercises, visualizations).
    • Create a hierarchy of fear related to the phobia.

Systematic Desensitization

• Treatment used for things like phobias.
• 1st the patient is trained in relaxation techniques using a 20-40 minute exercise.
• 2nd a hierarchy of fear is agreed upon.
• For instance relating to snake phobia this hierarchy might go from: 1. A drawing of a snake, 2. a photograph, 3. then a video, 4. a snake in a room, closer each time, 5. eventually up to the therapist holding the snake and the patient touching it.

Are you going to figure out why you ever had a fear of snakes to begin with?

• You're probably not.
• But we've got some ways that relatively quickly, we're gonna take that fear away.

Virtual Reality Exposure Therapy

• Used in the military and VA systems for PTSD.
• Used increasingly for anxiety and fear.

Operant Conditioning

• Reinforcement and punishment.
• Extinction (if behaviors are not reinforced).
• Applied behavior analysis (for kids with autism).
• Rewards (stickers, candy).
• Time-outs.
• Token economy (psychiatric hospitals, rehab centers).
• Tokens (poker chips) can be exchanged for privileges (TV time, overnight pass).

Cognitive Approaches to Therapy

• Aaron Beck (depression).
• How you think determines how you feel and act.
• Focus on how thoughts lead to distress.
• Emotional reactions result from thoughts about a situation.
• Encourage logical and positive thinking.
• Identify cognitive distortions.
  • Overgeneralization.
  • Polarized thinking (black and white thinking; all or none thinking).
  • Jumping to conclusions.
• Collect data to challenge dysfunctional thinking.

Cognitive Behavioral Therapy (CBT)

• Combines cognitive and behavioral approaches.
• Focuses on the present, not the past.
• Rational Emotive Behavior Therapy (REBT).
• Albert Ellis.
• Change cognitive distortions and self-defeating behaviors.
• The ABC Model:
  • A (Activating Event or Antecedent).
  • B (Belief - often illogical).
  • C (Consequence).
• Challenge the belief system.
  *In one example if "A," failing an exam, leads to "B," the belief "I'm worthless and stupid," we can challenge the belief system to not be depressed, and if we change "B" to "I didn't study enough I'm going to do better next time then our patient can change "C" to not becoming depressed.

Humanistic Perspective

• Achieving full potential and self-awareness.
• Carl Rogers (Rogerian; client-centered; person-centered therapy).
• Non-directive; no advice or interpretation.
• Help clients identify conflicts and understand feelings.
• Active listening (reflection or mirroring).
• Unconditional positive regard.
• Genuineness, empathy, and acceptance.
• Rogers changed the name from patients to clients.

Biological/Medical/Biomedical Therapies

• Medication is the primary treatment (99.5% of the time).
• Psychotropic medications treat symptoms but don't cure.
• Often, symptoms return when medication is stopped.
• Antipsychotics: treat psychotic behavior (schizophrenia).
• Lessen or eliminate positive symptoms (hallucinations, delusions).
• Block dopamine.
• Deinstitutionalization: shifted care from state hospitals to community mental health centers.
• Led to an increase in the homeless population with severe psychological disorders.
• Antipsychotics can cause tardive dyskinesia (involuntary movements).
• Atypical antipsychotics have fewer side effects and better effects on negative symptoms.
• Antidepressants:
  • Affect serotonin and norepinephrine.
  • Treat depression and anxiety disorders.
  • SSRIs are commonly used for anxiety.
• Mood stabilizers: treat mania in bipolar disorder.
  • Lithium.
• ADHD: psychostimulants have a paradoxical effect and help.
• Combine medication and psychotherapy.

Other Biological Treatments

• Electroconvulsive Shock Therapy (ECT): used for severe depression.
• Transcranial Magnetic Stimulation (TMS): uses magnets to stimulate the brain in severe depression.
• Surgery:
  • Lobotomies (historical; horrific).
  • Lesions for severe OCD (electrode to the interior cingulate).