Treatment of Psychological Disorders

Mental and Physical Health: Treatment of Psychological Disorders

5.5.A: Research and Trends in Treatment

  • 5.5.A.1 Effectiveness of Psychotherapies:
    • Meta-analytic studies show psychotherapies are generally effective.
    • Meta-Analytic Studies:
      • Aggregate results from multiple studies to conclude about psychotherapeutic treatments.
      • Statistically combines data to determine efficacy and identify factors influencing therapeutic outcomes.
      • Consistently demonstrate psychotherapy is effective for treating psychological disorders like depression, anxiety, and PTSD.
      • Compare different therapeutic approaches (e.g., CBT, psychodynamic therapy, humanistic therapy) to assess which methods work best for specific conditions.
    • Psychologists use evidence-based interventions to develop treatment plans.
    • Therapists should exhibit cultural humility.
      • Cultural Humility:
        • Emphasizes self-reflection and learning about clients' cultural identities.
        • Therapists recognize their biases and strive to understand the client's background and values.
        • Therapist might engage in continuous education about different cultural practices and seek supervision when working with clients from diverse backgrounds.
        • Ensures therapeutic interventions are culturally sensitive and relevant.
    • Establish a therapeutic alliance with the client to deliver therapy successfully.
      • Therapeutic Alliance:
        • Collaborative and trusting relationship between therapist and client.
        • Critical factor in the success of psychotherapy.
        • Key components include mutual agreement on therapy goals, a strong emotional bond, and collaboration on therapy tasks.
        • A therapist might focus on building a strong therapeutic alliance by actively listening, showing empathy, and involving the client in setting therapy goals.
        • Helps clients feel valued and understood, leading to better adherence to treatment and improved mental health outcomes.

5.5.B: Increased Use and Effectiveness of Psychotropic Medication

  • 5.5.B.1 Deinstitutionalization:
    • Due to the increased use and effectiveness of psychotropic medication therapy, hospitals and asylums deinstitutionalized massive numbers of people in the late 20th century.
    • Therapists now prefer to treat in decentralized ways, often with a combination of medication and psychological therapies.
      • Decentralized Therapy:
        • Mental health treatment models that move away from traditional clinical settings.
        • Leverage technology and community-based approaches to provide therapy in diverse and accessible formats.
        • Includes teletherapy, mobile health (mHealth) applications, online support groups, and community-based interventions.

5.5.C: Ethical Principles in Treatment

  • 5.5.C.1 APA Ethical Principles:
    • Psychologists in clinical or therapeutic situations must follow certain ethical principles as established by the APA, including:
      • Nonmaleficence
        • Ethical principle that mandates avoiding harm to patients.
        • Ensuring therapeutic interventions do not cause physical, emotional, or psychological harm to clients.
        • Involves careful assessment, appropriate treatment planning, and continuous monitoring to prevent any adverse effects from therapy.
      • Fidelity
        • Maintaining trust and loyalty in professional relationships.
        • Being honest with clients, honoring commitments, and establishing a therapeutic alliance based on mutual trust and respect.
        • Ensures that clients feel secure in their therapeutic relationship, which is crucial for effective treatment.
      • Integrity
        • Adhering to moral and ethical principles, ensuring honesty, accuracy, and consistency in professional practice.
        • Requires practitioners to be truthful in their professional interactions, accurately represent their qualifications, and avoid deceptive practices.
      • Respect for People's Rights and Dignity
        • Recognizing and respecting the inherent worth of all individuals.
        • Honoring clients' autonomy, privacy, confidentiality, and cultural diversity.
        • Respecting clients' rights and dignity means acknowledging their ability to make informed decisions about their own care and treating them with compassion and understanding.

5.5.D: Techniques Used with Psychological Therapies

  • 5.5.D.1 Psychodynamic Therapies:
    • Psychodynamic Therapy:
      • Rooted in Freudian psychoanalytic theory, aims to explore unconscious processes and how they influence current behavior.
      • Emphasizes the role of early childhood experiences and internal conflicts in shaping an individual's psychological state.
      • The goal is to bring unconscious thoughts and feelings to conscious awareness, allowing the individual to gain insight and resolve these conflicts.
    • Employ free association.
      • Free Association:
        • Encourages patients to speak freely about whatever comes to mind, without censorship or filtering.
        • Aims to uncover hidden thoughts, feelings, and memories that may be influencing current behavior and emotional states.
    • Dream interpretation to uncover the unconscious mind.
      • Dream Interpretation:
        • Analyzes the content of dreams to uncover unconscious desires, fears, and conflicts.
        • Dreams are seen as a window into the unconscious mind, revealing hidden aspects of the psyche.
  • 5.5.D.2 Cognitive Therapies:
    • Cognitive Therapy (CT):
      • Developed by Aaron T. Beck.
      • Focuses on identifying and changing distorted or unhelpful thinking patterns, beliefs, and attitudes that contribute to emotional distress and maladaptive behaviors.
      • Dysfunctional thinking leads to negative emotions and behaviors, and by altering these thoughts, individuals can achieve more positive outcomes.
    • May employ cognitive restructuring.
      • Cognitive Restructuring:
        • Core component of Cognitive Therapy
        • Techniques that help individuals identify, challenge, and modify distorted thoughts.
        • Recognizing cognitive distortions, evaluating the validity of these thoughts, and developing more realistic and adaptive ways of thinking.
    • Fear hierarchies to combat maladaptive thinking.
      • Fear Hierarchies:
        • Used in exposure therapy to treat anxiety disorders including phobias and PTSD.
        • A graded list of anxiety-provoking situations or stimuli, arranged from least to most frightening.
        • Clients gradually confront these situations in a controlled manner.
        • Each step helps them build confidence and reduce anxiety.
    • Proposes that people should focus on the cognitive triad.
      • Maladaptive Thinking:
        • Refers to patterns of thought that are counterproductive and interfere with daily functioning.
        • Thoughts are often distorted, negative, and self-defeating, leading to emotional distress and unhealthy behaviors.
      • Cognitive Triad:
        • Concept in cognitive therapy that describes three types of negative thoughts common in depression: negative views about oneself, the world, and the future.
        • These negative thought patterns reinforce each other, creating a cycle of depressive thinking.
  • 5.5.D.3 Applied Behavior Analysis:
    • Applied Behavior Analysis (ABA):
      • Therapeutic approach based on the principles of behaviorism.
      • Focuses on improving specific behaviors (social skills, communication, reading, adaptive learning skills) through behavioral principles.
      • Effective in treating individuals with autism spectrum disorder (ASD).
    • Involves applying principles of conditioning to address mental disorders and developmental disabilities.
      • Conditioning:
        • Involves learning associations between stimuli and responses.
        • Two primary types: classical and operant conditioning.
    • Exposure therapies (such as systematic desensitization).
      • Exposure Therapies:
        • Techniques designed to help individuals confront and reduce their fear and anxiety by gradually exposing them to the feared object or situation in a controlled manner.
    • Aversion therapies.
      • Aversion Therapy:
        • Pairs an unwanted behavior with an unpleasant stimulus to reduce the behavior.
        • Based on classical conditioning principles, where the goal is to create a negative association with the behavior.
    • Token economies all employ principles of applied behavior analysis.
      • Token Economies:
        • Type of operant conditioning used in therapeutic settings, particularly in institutions or schools.
        • Earn tokens for engaging in desired behaviors.
        • Tokens can later be exchanged for rewards or privileges.
    • Biofeedback uses principles of conditioning to help clients regulate body systems that contribute to feelings of anxiety or depression.
      • Biofeedback:
        • Teaches individuals to control physiological processes (heart rate, muscle tension, brain wave activity) by providing real-time feedback.
        • Goal is to gain voluntary control over these processes to improve physical and mental health.
  • 5.5.D.4 Cognitive-Behavioral Therapies:
    • Cognitive-Behavioral Therapy (CBT):
      • Widely used, evidence-based therapeutic approach that aims to change maladaptive thinking patterns and behaviors.
      • Operates on the premise that cognitive distortions (inaccurate or irrational thoughts) contribute to emotional distress and behavioral problems.
      • Addressing cognitive distortions and teaching coping skills, CBT helps individuals develop healthier thought patterns and behaviors.
    • Combine techniques from the cognitive and behavioral perspectives to treat mental and behavioral disorders.
    • Examples:
      • Dialectical Behavior Therapy (DBT)
        • Specifically designed for individuals with borderline personality disorder (BPD) and other conditions involving emotional dysregulation.
        • Combines cognitive-behavioral techniques with mindfulness practices and principles of acceptance and change.
        • Techniques:
          • Mindfulness: awareness and acceptance of the present moment, helping reduce impulsive reactions.
          • Distress Tolerance: Building skills to tolerate crises without self-destructive behaviors.
          • Emotion Regulation: Identifying and managing intense emotions, reducing emotional vulnerability.
          • Interpersonal Effectiveness: Enhancing communication and relationship skills.
      • Rational-Emotive Behavior Therapy (REBT)
        • Form of cognitive-behavioral therapy developed by Albert Ellis.
        • Focuses on identifying and changing irrational beliefs that lead to emotional and behavioral issues.
        • Emphasizes the role of rational thinking in emotional well-being.
        • Techniques:
          • Identifying Irrational Beliefs: Recognizing and challenging irrational beliefs that cause emotional distress.
          • Disputing Irrational Beliefs: Actively questioning and disputing irrational beliefs to develop more rational and realistic thoughts.
          • Developing Rational Alternatives: Formulating and adopting healthier beliefs that lead to positive emotions and behaviors.
          • Behavioral Interventions: Engaging in activities that reinforce rational beliefs and promote adaptive behaviors.
  • 5.5.D.5 Humanistic Perspective:
    • Humanistic Perspective:
      • Emphasizes the inherent goodness of people and their natural drive toward self-actualization.
      • Focuses on the individual's subjective experience and the belief that people possess free will and the potential for personal growth.
      • Aims to help individuals understand themselves better and reach their full potential.
    • Therapy from the humanistic perspective.
    • Commonly referred to as person-centered therapy.
    • Employs active listening.
      • Active Listening:
        • Communication technique used in therapy to ensure that the therapist fully understands the client's message.
        • Involves the therapist paying close attention to the client's words, reflecting back what they hear, and providing feedback that shows understanding and empathy.
        • Creates a supportive and validating environment for the client.
    • Unconditional positive regard.
      • Unconditional Positive Regard:
        • Fundamental concept in humanistic therapy, particularly in the client-centered approach developed by Carl Rogers.
        • Involves the therapist accepting and valuing the client without judgment or conditions.
        • Helps clients feel safe to express themselves freely and fosters a sense of self-worth.

5.5.E: Group Therapy

  • Group therapy involves a small group of individuals who meet regularly with one or more therapists to discuss their issues, share experiences, and support each other.
  • Designed to address a range of psychological and emotional challenges, leveraging the dynamics of group interactions to facilitate healing and personal growth.
  • Key Features:
    1. Therapeutic Interactions: Participants benefit from hearing others' perspectives and experiences, which can offer new insights and coping strategies.
    2. Social Skills Development: Group therapy helps individuals practice and improve social skills, such as communication and empathy, in a controlled environment.
    3. Support Network: The group provides a sense of belonging and validation, as individuals realize they are not alone in their struggles.
    4. Cost-Effectiveness: Group therapy can be more cost-effective compared to individual therapy because the therapist’s time and resources are shared among multiple clients.

5.5.F: Effective Uses of Hypnosis

  • 5.5.F.1 Hypnosis:
    • Hypnosis:
      • Psychological state characterized by heightened suggestibility, focused attention, and deep relaxation.
      • Guided into a trance-like state by a trained practitioner, often through verbal suggestions and relaxation techniques.
      • May experience increased receptivity to suggestions and a heightened capacity for concentration.
    • Has shown effectiveness in treating pain and anxiety.
      • Pain Management:
        1. Distraction: Hypnosis can divert attention away from pain by focusing the individual on relaxing or comforting imagery.
        2. Altered Sensory Processing: Hypnosis can modify the way pain is processed in the brain, leading to changes in the sensory and emotional aspects of pain.
        3. Enhanced Relaxation: The deep relaxation achieved during hypnosis can lower physiological stress responses and muscle tension, contributing to pain relief.
      • Anxiety Treatment:
        1. Relaxation and Stress Reduction: Hypnosis promotes deep relaxation and reduces physiological arousal associated with anxiety.
        2. Cognitive Restructuring: Through hypnotic suggestions, individuals can reframe and challenge negative thought patterns and beliefs that contribute to anxiety.
        3. Exposure Therapy: Hypnosis can be used to facilitate controlled exposure to anxiety-provoking situations or thoughts in a safe and supportive environment.
    • Research does not support the use of hypnosis to retrieve accurate memories or regress in age.

5.5.G.1: Psychoactive Medications

  • Psychoactive Medications:
    • Drugs that affect the central nervous system and alter mood, perception, and behavior.
    • Designed to manage psychological disorders by influencing neurotransmitter activity in the brain.
    • Work by modifying neurotransmitter activity, adjusting neurotransmitter levels or receptor activity to alleviate symptoms.
    • Antidepressants:
      • Used to treat depression and anxiety disorders.
      • Primarily work by altering the levels of neurotransmitters such as serotonin, norepinephrine, and dopamine in the brain.
      • Types and Mechanisms:
        • Selective Serotonin Reuptake Inhibitors (SSRIs): Increase serotonin levels by inhibiting its reuptake into presynaptic neurons. Examples include fluoxetine (Prozac) and sertraline (Zoloft).
        • Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): Increase both serotonin and norepinephrine levels. Examples include venlafaxine (Effexor) and duloxetine (Cymbalta).
        • Tricyclic Antidepressants (TCAs): Affect several neurotransmitters but are less commonly used due to side effects. Examples include amitriptyline and nortriptyline.
        • Monoamine Oxidase Inhibitors (MAOIs): Prevent the breakdown of neurotransmitters like serotonin and norepinephrine. Examples include phenelzine (Nardil) and tranylcypromine (Parnate).
    • Antianxiety Drugs (Anxiolytics):
      • Used to manage symptoms of anxiety disorders.
      • Often work by enhancing the effects of neurotransmitters that have calming effects on the brain.
      • Types and Mechanisms:
        • Benzodiazepines: Enhance the effect of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits neural activity, leading to calming effects. Examples include diazepam (Valium) and lorazepam (Ativan).
        • Non-benzodiazepine Anxiolytics: Include drugs such as buspirone, which acts on serotonin receptors and has a slower onset compared to benzodiazepines.
    • Lithium and Antipsychotic Medications:
      • Used primarily to manage mood disorders and psychotic symptoms, respectively.
      • Lithium:
        • Mechanism: Modulates neurotransmitter activity, particularly affecting serotonin and norepinephrine systems. It helps stabilize mood swings in bipolar disorder.
      • Antipsychotic Medications:
        • Mechanism: Primarily target dopamine receptors to reduce symptoms of psychosis. Second-generation antipsychotics (atypical antipsychotics) also affect serotonin receptors. Examples include risperidone (Risperdal) and olanzapine (Zyprexa).
    • Tardive Dyskinesia:
      • Potential side effect of long-term use of antipsychotic medications, particularly first-generation antipsychotics.
      • Characterized by repetitive, involuntary movements, such as grimacing, lip-smacking, and tongue movements.

5.5.G.2: Psychosurgery

  • Psychosurgery:
    • Involves surgical procedures aimed at altering brain function to treat severe mental disorders.
    • Typically considered when other treatments have failed and the condition is debilitating.
    • Transcranial Magnetic Stimulation (TMS):
      • Non-invasive technique that uses magnetic fields to stimulate nerve cells in the brain.
      • Used primarily to treat depression, especially when traditional treatments are ineffective.
    • Electroconvulsive Therapy (ECT):
      • Involves the application of electrical currents to the brain to induce controlled seizures.
      • Typically used for severe cases of depression, bipolar disorder, and schizophrenia when other treatments have been ineffective.
    • Lobotomy:
      • Involves severing connections in the brain’s prefrontal cortex to alter behavior and reduce symptoms of severe mental disorders.
      • Largely been discontinued due to its significant side effects and ethical concerns.