Treatments of Psychological Disorders

Psychotherapy

  • Treatment used to address emotional, psychological, and behavioral challenges through structured conversations with a trained mental health professional.
  • Meta-analytic studies found psychotherapy is generally effective, especially with evidence-based techniques, cultural humility, and a strong therapeutic bond.
  • Meta-analysis:
    • Research method that combines and analyzes results of multiple independent studies on the same topic.
    • Identifies overall trends, patterns, or effects.
    • Uses statistical methods to calculate an overall effect size.
    • Effect size shows the strength of a relationship between variables.
    • Large effect size: substantial difference between groups.
    • Small effect size: minor difference.
    • Larger effect size = more meaningful results in the real world.

Evidence-Based Interventions

  • Therapists apply approaches most likely to work, rather than relying on untested/outdated techniques.

Cultural Humility

  • Therapist is respectful and open to the client's cultural background, beliefs, and values.
  • Acknowledges and values differences between themselves and the client.

Therapeutic Alliance

  • Trusting, collaborative relationship between therapist and client.
  • Built on open communication, mutual respect, and collaboration on therapy goals.
  • Increases treatment effectiveness.

Medications

  • Mid-20th century: antipsychotic, antidepressant, and anti-anxiety drugs changed treatment.
  • Psychotropic medications manage symptoms that previously kept individuals in long-term psychiatric hospitals/asylums.
  • Psychotropic medications: drugs that affect brain function and alter mood, behavior, emotions, or cognitive processes.
  • Decreased stays in institutions led to the deinstitutionalization movement.
  • Deinstitutionalization movement: closing down/scaling back psychiatric hospitals and moving patients back into communities.
  • Increased client freedom and reintegration into society.
  • Greater focus on community-based support services: outpatient clinics, telehealth platforms, group homes.
  • Treatment plans utilize medications to stabilize/manage symptoms and use psychological therapies to address emotional, behavioral, and social challenges.

Group Therapy

  • Several individuals meeting with a therapist.
  • Members share experiences and provide support under therapist's guidance.
  • Learn from each other's experiences and viewpoints.
  • Creates community and shared understanding.
  • Feedback from peers facing similar struggles.
  • More cost-effective.

Individual Therapy

  • One individual meets with a therapist in private.
  • Focus on client's personal concerns, goals, and treatment plan.
  • One-on-one relationship allows specific feedback and in-depth look at personal issues.
  • More flexible with timing and more private.
  • Allows individual to share more openly, but can be more expensive.

Ethical Principles (American Psychological Association)

  • Non-maleficence: Do no harm.
  • Avoid causing physical, emotional, or psychological harm.
  • Fidelity: Trustworthy and honors professional commitments.
  • Keep information confidential, unless legal/ethical obligation to disclose.
  • Integrity: Fair, honest, and truthful in all professional activities.
  • Honest communication with clients.
  • Provide accurate information about qualifications, treatment methods.
  • Ensure client understands what to expect from therapy.
  • Respect for People's Rights and Dignity
  • Obtain informed consent from the client.
  • Be aware/respect differences in client's culture, religion, gender, sexual orientation, etc.
  • Allow client to make own decisions about their treatment/life, giving the client autonomy.
  • These principles guide professional conduct and ensure high standards of care and respect.

Hypnosis

  • State of focused attention, heightened suggestibility, deep relaxation.
  • Effective in treating pain and anxiety.
  • Helps reduce pain perception by guiding individuals to refocus attention or reframe physical sensations.
  • Not effective at helping an individual remembering past events or having an individual relive earlier experiences in life.
  • Can lead to creation of false memories if used to retrieve a person's memory.
  • Should be conducted by trained therapists who understand benefits and limitations.

Psychological Perspectives and Treatment

Psychodynamic Therapies

  • Rooted in the idea that a person's unconscious mind shapes their thoughts, emotions, and behaviors.
  • Free Association
    • Technique that encourages patients to speak freely about any thoughts, words, or images that come to mind.
    • Reveals underlying themes, conflicts, or emotions.
    • Therapist listens and identifies patterns or clues.
  • Dream Interpretation
    • Therapists analyze the content of dreams.
    • Manifest content: actual storyline of the dream.
    • Latent content: deeper symbolic meaning reflecting hidden desires, fears, or conflicts.
    • Connect symbols in dreams to emotional struggles or past experiences.

Cognitive Therapies

  • Maladaptive thinking causes emotional and behavioral problems.
  • Focus on identifying negative or distorted thoughts and irrational beliefs.
  • Cognitive Restructuring
    • Therapists help client recognize, challenge, and replace maladaptive thoughts with more realistic and positive thoughts.
    • Example: "I am a failure" → "I'm capable of success in many areas, even if I struggle with some tasks."
  • Fear Hierarchies
    • List of anxiety-provoking situations arranged from least to most frightening.
    • Gradually expose the client to their fears while teaching and using coping strategies to reduce anxiety or fear.
  • Cognitive Triad
    • Consists of three components: the self, the world, and the future.
    • self \rightarrow world \rightarrow future
    • Creates a self-reinforcing loop, with negative thoughts from one area feeding into the others.
    • Focuses on developing more positive, realistic thought patterns to break the cycle.

Applied Behavior Analysis

  • Focuses on identifying how environmental factors (rewards, punishments, reinforcements) influence behavior.
  • Uses concepts to modify or improve an individual's function.
  • Behavior is learned and can be modified through reinforcement and consequences.
  • Exposure Therapies
    • Client slowly exposed to a feared stimulus while practicing relaxation techniques.
    • Uses classical conditioning.
    • Pair the anxious stimulus with feelings of calm.
    • Systematic desensitization: gradually exposed to increasingly intense versions of feared stimuli while learning/practicing relaxation techniques.
  • Aversion Therapy
    • Unwanted behaviors paired with an unpleasant stimulus.
    • Reduce the behavior by creating a negative association.
    • Example: putting things in alcoholic drinks that cause a person to have a disgusting taste in their mouth.
  • Token Economies
    • Clients earn tokens for displaying desired behaviors.
    • Uses operant conditioning.
    • Positive reinforcements for targeted behaviors.
    • Tokens can be used later to gain different rewards.
  • Biofeedback
    • Uses electronic monitoring to convey information about physiological processes.
    • Clients learn to control bodily functions by receiving real-time data.
    • Used with individuals who have anxiety or depression.
    • Can help clients regulate various body systems, including the sympathetic nervous system.
    • Can help clients reduce their activation of the sympathetic system by having the individual focus on relaxation techniques.
    • Can also help activate the parasympathetic nervous system, which helps the body in recovering from stress by promoting relaxation and recovery.
    • Monitoring the client's physiological responses (heart rate, blood pressure, brainwave activity) and displaying that information on a screen.

Cognitive Behavioral Therapies (CBT)

  • Blend of cognitive and behavioral approaches.
  • Cognitive side: identifying and challenging maladaptive thinking and replacing it with more balanced and realistic thoughts.
  • Behavioral side: introducing practical changes to a person's behavior to implement healthier habits and reduce maladaptive actions.

Dialectical Behavior Therapy (DBT)

  • Originally developed to treat borderline personality disorder, now used for disorders involving emotional dysregulation.
  • Focuses on mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness.
  • Helps clients remain in the moment, improve coping skills, manage emotions, and improve communication/relationship skills.
  • Helps individuals manage intense emotions, reduce self-destructive behaviors, and improve their interpersonal skills.

Rational Emotive Behavior Therapy

  • Focuses on disrupting irrational beliefs that lead to negative emotions or self-defeating behaviors.
  • Uses the ABCDE model.
    • A (Activating): external event that causes the client to feel/think a certain way.
    • B (Belief): irrational thought or automatic beliefs about the event, ourselves, or other people.
    • C (Consequence): emotional behavioral result.
    • D (Disputation): irrational belief is challenged.
    • E (Effective New Belief): irrational beliefs have been resisted and a more rational positive perspective is adopted.

Humanistic Therapies

  • Commonly referred to as person-centered therapy.
  • Focus on a person's inherent goodness and potential.
  • Therapist creates a nurturing environment where the client feels safe to explore their thoughts and emotions.
  • Active Listening
    • Communication technique where the therapist fully concentrates on what the client shares.
    • Involves the therapist often paraphrasing what the client says back to them, all to validate the client's feelings and clarify any confusion that may be happening.
    • Goal: encourage the client to feel heard and respected, helping them open up more and allow the therapist to gain insight into the client's thoughts, experiences, and emotions.
  • Unconditional Positive Regard
    • Person gets complete acceptance and support, regardless of what they think, feel, or do.
    • Allows the client to feel safe, to open up, which can lead to more personal growth.
  • Goals
    • Self-actualization: achieve full potential and personal growth.
    • Self-awareness: explore their own thoughts and feelings.
    • Congruence: individual's ideal self and actual experiences are consistent with each other.
    • Seeks to reduce the gap between a client's real self and their ideal self.

Biological Perspective

  • Disorders may come from biological processes: imbalances in neurotransmitters, brain structure abnormalities, or genetic factors.
  • Uses psychoactive medications (substances that alter brain chemistry to manage symptoms).
    • Antidepressants: boost levels of serotonin and norepinephrine to regulate mood. Used for depression, anxiety, etc.
    • Anti-anxiety drugs: enhance the action of GABA, a neurotransmitter that produces a calming effect, thereby reducing anxiety symptoms.
    • Lithium: helps stabilize mood swings. Used to treat bipolar disorder.
    • Antipsychotic medications: block dopamine receptors to reduce excessive dopamine activity. Address symptoms such as delusions or hallucinations common in schizophrenia and related disorders.
  • Side effects: vary depending on the medication and the individual.
  • Tardive dyskinesia: a movement disorder that is characterized by involuntary repetitive body movements, which often stem from long term use of certain antipsychotic medications.

Surgical Interventions

  • Psychosurgery: performing a surgical procedure on the brain to alleviate severe psychiatric symptoms.
    • Lesioning: used to treat severe epilepsy or Parkinson's disease by destroying malfunctioning brain tissue.
  • Lobotomies
    • Surgical procedure that involves severing connections in the brain's frontal lobe.
    • Today, lobotomies are extremely rare due to the significant risks and due to the availability of safer, more effective treatments, such as medications or psychotherapy.
  • Transcranial Magnetic Stimulation (TMS)
    • Non-invasive.
    • Uses magnetic fields to stimulate nerve cells in specific regions of the brain that are typically associated with mood regulation.
    • Often used for depression.
  • Electroconvulsive Therapy
    • Medical treatment where small electrical currents are passed through the brain to trigger a brief seizure.
    • Used for severe depression and it's only performed after other treatments have not worked.
  • Use of psychosurgeries have declined thanks to more effective approaches, such as medications and psychotherapies.