Treatment of Psychological Disorders

Lecture Notes: 12/5/24

Who Provides Therapy?

  • Autism Spectrum Disorder review(missed from last lecture):

    • Sensory sensitivities: over or under-sensitivity to sensory input

      • light, sound texture, etc

    • Restricted interests and repetitive behaviors

    • Divergent social communication: engaging with the world differently

    • Varied presentations: intellectual abilities, average or above-average intelligence

    • no single cause: various genetic, environmental, and neurological factors contribute to the development of these disorders.

    • Early signs: i.e. signs in infanthood, different people diagnosed at different ages

  • Clinical psychologist: PhD or PsyD

  • Psychiatrist: MD or DO

  • counseling: MA, MS, MFT

    • doctorate or masters-level training; often school department, treating less severe disorders(school counselors, for example)

      • marital/family psychologist

  • social worker: BSW, MSW from school

    • doctoral or master level training; emphasized social systems for than psychology; needs a license to practice

  • psychiatric nurse: varies, however usually schools of nursing

  • paraprofessionals

  • Difference between clinical vs psychiatrist

    • Clinical: doctorate level training(Ph.D or Psy.D), must complete research training, dissertation, internship + supervised training, licensed by the state, practices psychotherapy, most DONT prescribe drugs or treatment

    • Psychiatrist: M.D.; CAN prescribe drugs, licensed to practice medicine, trained to give psychotherapy

    • What is a psychoanalyst?

      • someone who practices classic Freudian practices

        • Psychodynamic, psychoanalysis, etc

  • Prescribing Medications?

    • Psychiatrists and psychiatric nurses most often

    • 5 states: clinical psych can

  • Scope of Intervention:

    • individual, familial, community + institutions

  • Treating conditions: psychiatrists and clinical treat the most severe

  • Paraprofessionals: clergy, religious leaders, community mentors, pastor, etc

    • some training; unlicensed, no real training, even if they do help people

    • peer groups: still provide genuine help; life coaches, AAA, Dr. Phil

Psychotherapy?

  • Psychotherapy treats abnormal behavior with interactions between the patient/client and a professional

    • Most fall under:

      • Psychodynamic

      • behavior therapy

      • cognitive therapy

  • Insight: “bringing the unconscious to the conscious”

    • free association

    • interpretation(dreams, projective tests, ink blot test)

    • analysis of resistance and transference(when do you show defense mechanisms?)

    • usually ineffective

  • Behavioral Therapy:

    • Learned through modeling

    • Classical conditioning

      • Baby Albert

    • Operant conditioning

      • Neg/Pos + Reinforcement/Punishment

        • Pavlovs dog

    • “Everything is learned, therefore everything can be unlearned”

    • Exposure therapy: exposing a patient to fear(phobia, for ex), can be very effective

      • OCD: works for OCD so much better in combination with drug

        • Figure 15.14 in Textbook

  • Cognitive Therapy:

    • “How do you think about things?”

      • “What’s the maladaptive behavior?”

    • Cognitive restructuring: recognizing maladaptive behaviors and reframing/looking at them from a new angle

    • Rational-emotive therapy: the therapist acts as the teacher explaining errors in the patient’s way of thinking + introducing new more adaptive ways to think

  • Cognitive Behavioral Therapy: just a combination of both types of therapy

    • Often most effective therapy

Biological Therapies?

  • Three Types:

    • Mechanical(take away parts), Chemical(drugs), Electromagnetic(magnets/electric pulses)

  • treating abnormal behaviors as a product of bodily behavior

    • “The devils literally inside your head”

  • Mechanical interventions: removing parts of the brain causing irregular behavior

    • Lobotomy: surgery to sever the connections to the prefrontal cortex

      • leads to “amotional” behavior(not a typo)

  • Modern Psychosurgery: usually used as a last resort to extreme cases of disorders

    • involves cutting/lesioning fibers inside the limbic structure

    • anterior cingulatemptomy: severing connection between anterior cingulate

  • Psychotropic medications: drugs that affect mental processes

  • Anti-anxiety drugs(tranquilizers): used for treatment of anxiety disorders

    • benzodiazepines

      • increases the activity of GABA

      • induces drowsiness

      • very addictive

    • antidepressants:

      • used for depression, anxiety, bipolar disorder(rarely)

      • MAOI(monoamine oxidase inhibitors)

      • SSRI(selective serotonin reuptake inhibitors)

        • Prozac, Zoloft, Paxil

      • Antipsychotics: psychotropic medications used for the treatment of disorders involving psychosis/neuroleptics

        • schizophrenia

        • Side-effects: dyskinesia

          • involuntary twitching/spasms, usually in the neck and face

  • Psychosocial Treatments:

    • medication alone does not work very well

    • involves the use of social skills training

      • Meds + social skills + family therapy = prevents relapse

      • EX: drugs, family, and social settings most effectively help a person with a disorder involving psychosis

  • Mood Stabilizers: mood swings made much less extreme

    • Lithium: used to be most prescribed for bipolar disorder

  • Anti-convulsants: prevention of seizures

  • TMS(Transcranial Magnetite Stimulation): induces an electrical current in the brain region below the coil, disrupting the region below the coil

    • Single pulse: disruption of brain activity for a brief time

    • Repeated pulse: disruption for an extended period

  • Deep Brain Stimulation: used often for Parkinson’s disease

Knowing What Works?

  • Efficacy vs Effectiveness

    • treatments that work in a controlled environment(efficacy) and treatment that work in the real world(effectiveness)

  • Comorbidity

    • overlap among disorders and mental illnesses

  • Compliance

    • people are or are not going to follow through with the treatment

      • missing days of drugs, etc

  • iatrogenic effects(side effects)

    • adverse effects and complications

    • things that make the condition worse

    • might help the majority, might harm the minority

    • not usually tested in behavioral treatment

      • ex: making a depressed person mindful through meditation, they might figure out a way to commit suicide

  • “Regression to The Mean”

    • when looking at two variables, they tend to be more extreme on one and less extreme on the other

    • ex: Sports Illustrated Curse:

      • Ducks went undefeated in 2013, got a cover page on the magazine

      • After: lost to Stanford

      • Results: After doing extremely well, you can’t go anywhere but down

    • Related to Psych how?

      • Results of treatments may look deceivingly good(undefeated ducks) due to CHANCE and after moving closer to less extreme(losing once), often blame the uncorrelated source(“sports illustrated curse”)

        • Skewed results due to chance

          • medical oils, faith healers, etc

  • Randomized Clinical Trial

    • people are randomly assigned to two groups to make findings objective

      • Control group vs Treatment group

  • Evidence-Based treatments:

    • Anxiety disorders: CBT

    • Depression: Drugs, CBT, or both

    • Schizophrenia: drugs for acute symptoms, psychosocial treatment for recovery + relapse

Types of Treatments, Drugs, and Their Uses

1. Psychotherapy

  • Psychodynamic Therapy: Engaging the unconscious.

    • Techniques: Free association, interpretation, analysis of resistance and transference.

  • Behavioral Therapy: Learning through modeling and conditioning.

    • Techniques: Classic conditioning (e.g., Baby Albert), operant conditioning (reinforcement/punishment), exposure therapy.

  • Cognitive Therapy: Focusing on changing thought patterns.

    • Techniques: Cognitive restructuring, rational-emotive therapy, Cognitive Behavioral Therapy (CBT).

2. Biological Therapies

  • Mechanical Therapies: Surgical interventions.

    • Purpose: Removing parts of the brain (e.g., lobotomy).

  • Chemical Therapies: Psychotropic medications.

    • Anti-anxiety Drugs (e.g., benzodiazepines): Treat anxiety disorders, increase GABA activity, induce drowsiness (addictive).

    • Antidepressants: Treat depression and anxiety.

      • Types: MAOI, SSRI (e.g., Prozac, Zoloft).

    • Antipsychotics: Used for psychosis (e.g., schizophrenia).

      • Side-effect: Dyskinesia (involuntary movements).

  • Electromagnetic Therapies: Inducing electrical currents.

    • Transcranial Magnetic Stimulation (TMS): Disrupts brain activity.

    • Deep Brain Stimulation: Often used for Parkinson’s disease.

3. Psychiatric Treatments

  • Mood Stabilizers: Reduce mood swings.

    • Lithium: Prescribed for bipolar disorder.

    • Anti-convulsants: Help prevent seizures.

4. Additional Supportive Treatments

  • Involves using social skills training, and family therapy for better outcomes (meds + social skills).

Key Terms

  • Efficacy: Treatments that work in a controlled setting.

  • Effectiveness: Treatments that work in the real world.

  • Comorbidity: Overlap among disorders.

  • Iatrogenic Effects: Adverse effects from treatment.

  • Regression to The Mean: Extreme outcomes tend to return towards the average.

  • Randomized Clinical Trial: Objective findings through random assignments.

  • Psychoanalyst: A professional who practices classic Freudian psychoanalysis.

  • Clinical Psychologist: Holds a PhD or PsyD; provides psychotherapy but typically does not prescribe medication.

  • Psychiatrist: Has an MD or DO; licensed to prescribe medication and conduct psychotherapy.

  • Counselor: Holds a master's degree (MA, MS, MFT); often treats less severe disorders; may work in school settings.

  • Social Worker: Holds a BSW or MSW; focuses on social systems; requires a license to practice.

  • Paraprofessionals: Individuals with some training but not licensed, such as clergy or community mentors.

  • Psychotherapy: Treatment of abnormal behavior through interaction between patient and professional.

  • Compliance: The extent to which patients follow through with treatment recommendations.

  • Ineffectiveness: Treatment not achieving desired outcomes; may be linked to random chance.

  • Evidence-Based Treatments: Interventions supported by research, proving effectiveness in clinical settings.

  • Comorbidity: The presence of multiple disorders in a patient.

  • Iatrogenic Effects: Side effects or complications arising from medical treatment.