Psychological Theories

Treatment of Psychological Disorders: Past to Present

  • Prior to the late 1700s, mental illness was often attributed to possession by demons or evil spirits, leading to severe treatments.

  • Philippe Pinel and Jean Baptiste Pussin advocated for treating the mentally ill with kindness.

  • Therapy aims to improve well-being and functioning, using psychological theory/techniques or medical interventions.

  • Eclectic approach: using more than one treatment approach

  • Psychotherapy: Talking with a professional to gain insight (Insight therapies) or change behavior directly (Action therapy).

  • Biomedical therapy: Using medical methods to relieve symptoms.

Insight Therapies: Psychodynamic and Humanistic Approaches

  • Insight Therapies include Psychodynamic and Humanistic approaches.

Freud’s Psychoanalysis

  • Psychoanalysis: Revealing unconscious conflicts through dream interpretation (manifest vs. latent content), free association, resistance, and transference.

  • Modern psychodynamic approach: client-centered and more directive.

  • Psychodynamic therapy: Emphasizes transference and briefer, direct therapy.

  • Interpersonal psychotherapy (IPT): Focuses on interpersonal problems and supported for treating depression.

Humanistic Therapy

  • Person-centered therapy: Client-led therapy where the therapist listens.

    • Based on Carl Rogers' work, matching real self to ideal self.

    • Therapist is non-directive, neutral, calm, and non-judgmental.

    • Three elements: Authenticity, Unconditional positive regard, and Empathy.

    • Reflection: therapist restates client's statements.

  • Motivational interviewing (MI): Reduces ambivalence and increases motivation for change.

  • Gestalt therapy: Directive therapy to accept all feelings, focusing on denied past using role-playing.

Action Therapies: Behavior Therapies and Cognitive Therapies

  • Action therapies change behavior directly.

    • Behavior therapies use learning.

    • Cognitive therapies change thought processes.

Behavioral Therapies

  • Behavior therapies: change disordered behavior using classical and operant conditioning principles.

  • Behavior modification: Modifying undesirable behavior using learning techniques.

  • Systematic desensitization: Treats phobias by pairing relaxation with a fear hierarchy.

  • Exposure therapies: Expose individuals to anxiety-related stimuli to promote new learning (In vivo, Imaginal, Virtual, Graded exposure).

  • Flooding: Intense exposure to fear-provoking situations.

  • Prolonged exposure (PE): Treats PTSD with exposure and cognitive-behavioral components.

  • Eye-movement desensitization reprocessing (EMDR): Controversial therapy for PTSD involving eye movements during disturbing memories.

  • Exposure and response prevention (EX/RP): Treats OCD by exposing individuals to stimuli that triggers obsessive thoughts, but not to engage in typical compulsive acts or process

  • Aversion therapy: Pairs undesirable behavior with aversive stimuli.

  • Modeling: Learning through observation.

    • Participant modeling: model demonstrates desired behavior while the client imitates.

  • Reinforcement: strengthens a response with pleasurable consequence.

    • Token economy: using tokens for desired behaviors.

    • Contingency contract: agreement stating goals, reinforcements, and penalties.

  • Extinction: removing a reinforcer to reduce behavior frequency.

    • Time-out: Removing person from reinforcing situations.

  • Behavioral activation: Reintroducing individuals to regular routines to increase positive reinforcement opportunities.

Cognitive Therapies

  • Cognitive therapy: Helping clients recognize and replace distorted thinking with realistic thoughts.

  • Beck’s Cognitive Therapy: Identifies distortions such as:

    • Arbitrary inference: drawing a conclusion without any evidence

    • Selective thinking: focusing on only one aspect of a situation

    • Overgeneralization: drawing sweeping conclusions based on only one incident or event

    • Magnification and minimization: blowing a negative event out of proportion while ignoring relevant positive events

    • Personalization: taking responsibility or blame for events that are unconnected to the person

  • Cognitive-behavioral therapy (CBT): Helps clients overcome problems by thinking rationally and logically.

    • Goals: relieve symptoms/solve problems, develop problem-solving strategies, change irrational thinking.

  • Rational emotive behavior therapy (REBT): Challenges irrational beliefs and restructures thinking into rational statements (Albert Ellis).

Group Therapies

  • Group therapy: Clients with similar concerns meet with a therapist to address issues.

  • Family counseling: Family members meet with a therapist.

  • Self-help group: People with similar problems meet without a therapist for support.

Evaluation of Group Therapy

  • Advantages: low cost, social interaction, support.

  • Disadvantages: shared time, less privacy, intolerance for severe disorders.

Psychotherapy Effectiveness

  • Research indicates psychotherapy is effective.

  • Surveys: 75-90% feel therapy helped; longer therapy correlates with greater improvement.

  • Effective therapy matches client and problem; evidence for psychotherapy is strong.

  • Common factors approach: Therapeutic alliance, safe setting, catharsis, new behaviors, positive experiences.

  • Evidence-based treatment (EBT): Interventions with proven therapeutic changes during research.

  • Telepsychology: Using technology for psychological services. (lower cost, opportunity for therapy for those unable to get to a therapist easily)

  • Address cultural differences for effective therapy.

Biomedical Therapies

  • Biomedical therapies: Affect biological functioning to relieve symptoms.

    • Include drug therapy, shock therapy, surgical treatments, and noninvasive stimulation techniques.

Psychopharmacology

  • Psychopharmacology: Using drugs to control psychological disorder symptoms.

    • Antipsychotic drugs: treat psychotic symptoms by blocking dopamine receptors.

      • First-generation (typical) and second-generation (atypical) types.

    • Antianxiety drugs: calm anxiety reactions (minor tranquilizers).

    • Mood-stabilizing drugs: treat bipolar disorder (lithium).

    • Antidepressant drugs: treat depression and anxiety.

      • Monoamine oxidase inhibitors (MAOIs).

      • Tricyclic antidepressants.

      • Selective serotonin reuptake inhibitors (SSRIs).

  • Combining psychotherapy with medical therapy is more effective approach to treatment of many disorders

ECT and Psychosurgery

  • Electroconvulsive therapy (ECT): Treats severe depression with electric current to induce seizures; side effects include memory disruption.

  • Psychosurgery: Surgery on brain tissue for severe disorders (last resort).

    • Prefrontal lobotomy: severs prefrontal lobe connections.

    • Transorbital lobotomy: severs brain fibers through eye socket.

    • Bilateral anterior cingulotomy: guides electrodes to cingulate gyrus.

Emerging Techniques

  • Noninvasive brain stimulation (NIBS) strategies

    • Repetitive transcranial magnetic stimulation (rTMS): magnetic pulses are applied to the cortex

    • Transcranial direct current stimulation (tDCS): uses scalp electrodes to pass very low amplitude direct currents to the brain

  • Invasive strategies

    • Deep brain stimulation (DBS)

Lifestyle Factors: Fostering Resilience

  • Resiliency: Ability to adapt to challenges and bounce back.

  • Promote mental health and resilience by:

    • Getting enough sleep (8–9 hours).

    • Eating a healthy diet.

    • Spending time in nature (Attention Restoration Therapy, Adventure therapy).

    • Engaging in regular physical activity (2.5+ hours aerobic exercise and muscle-strengthening).

Reducing Stigma of Seeking Help

  • Address stigma related to mental health.

  • Useful resources:

    • National Alliance on Mental Illness (NAMI).

    • American Psychological Association (APA).

    • Association for Psychological Science (APS).

    • Twitter: #CureStigma, #Help_HelpedMe, #StampOutStigma