Chapter 16 THERAPY AND TREATMENT

THERAPY & TREATMENT

  • Many forms of therapy have been developed to treat a wide array of problems.
  • Example: Ocean Therapy program at Camp Pendleton, which combines learning to surf with group discussions to aid veterans recovering from PTSD.

MENTAL HEALTH TREATMENT

PREVALENCE OF MENTAL ILLNESS

  • Approximately 19% of U.S. adults experience mental illness each year.
  • 13% of adolescents aged 8-15 also experience mental illness.
  • From 2004 to 2008, adults seeking treatment slightly increased; approximately 1/3 to 1/2 of adolescents with mental disorders receive treatment, especially those with behavior-related disorders.

TREATMENT IN THE PAST

SUPERNATURAL PERSPECTIVE
  • Historically, mental illness was attributed to supernatural forces like witchcraft.
  • Cruel treatments were common:
    • Exorcism - Rituals involving prayers and incantations performed by priests.
    • Trephining - Drilling a hole in the skull to release spirits, often leading to death.
    • Execution or Imprisonment - Many were executed for being labeled witches.
ASYLUMS IN THE 18TH CENTURY
  • The first asylums were established to house individuals with psychological disorders:
    • Focus was on ostracizing individuals rather than treating them.
    • Many were kept in harsh conditions, such as windowless rooms and chains.
    • Figure: Painting "The Madhouse" by Francisco Goya.
PHILIPPE PINEL
  • French physician advocating humane treatment of the mentally ill in the late 1700s.
  • Proposed unchaining patients and engaging them in conversation.
  • Implemented changes in Paris in 1975, leading to patient releases and improved care.
DOROTHEA DIX
  • Social reformer in the 19th century advocating for mental health care.
  • Investigated care conditions and highlighted systemic abuse.
  • Pivotal in establishing the first mental asylum in the U.S. through lobbying efforts.
AMERICAN ASYLUM CONDITIONS
  • Facilities often neglected with poor treatment options.
  • Common treatments included:
    • Submersion in cold baths.
    • Electroconvulsive therapy (ECT) to elicit seizures.

20TH CENTURY TREATMENTS

  • 1954: Introduction of antipsychotic medications, effectively treating psychosis symptoms (hallucinations, delusions).
  • 1975: Mental Retardation Facilities & Community Mental Health Centers Construction Act initiated deinstitutionalization, allowing returns to community treatment but faced implementation issues.
  • Issues included:
    • Underfunded community centers.
    • Increased rates of homelessness among former patients.

MENTAL HEALTH TREATMENT TODAY

  • Mental illness is prevalent among the homeless, with about 25% of shelter residents having severe mental illness (HUD, 2011).
  • High numbers of mentally ill individuals are found in correctional institutions.
  • Treatment settings now include:
    • Psychiatric hospitals and community hospitals focused on short-term care (average stay < 2 weeks).
    • Involuntary treatment for some, e.g., counseling as a parole condition.
    • Voluntary treatment where individuals seek help themselves.
    • Sources include community mental health centers, private practitioners, and schools.

TYPES OF TREATMENT

PSYCHOTHERAPY
  • Psychological treatment using various methods to help individuals overcome personal difficulties or promote growth.
BIOMEDICAL THERAPY
  • Involves medical procedures and medications to treat disorders, often combined with psychotherapy.

PSYCHOANALYSIS

  • Developed by Sigmund Freud, focusing on revealing repressed feelings.
  • Techniques include:
    • Free Association: Patient relaxes and shares thoughts; resistance indicates repressed issues.
    • Dream Analysis: Interpretation of underlying meanings in dreams.
    • Transference: Patients project feelings from past relationships onto the therapist.
  • Modern variations include Psychodynamic Psychotherapy, reflecting on unconscious influences on behavior.
PLAY THERAPY
  • Utilizes toys to help children express emotions and resolve difficulties:
    • Techniques include using dolls and figurines for play, observing interactions.
    • Variants include nondirective play therapy (child-driven) and directive play therapy (therapist guided).

BEHAVIOR THERAPY

  • Focuses on changing maladaptive behaviors using learning principles:
CLASSICAL CONDITIONING
  • Methods include:
    • Counterconditioning: Pairing undesired responses with new responses (e.g., aversive conditioning).
    • Aversive Conditioning: Using unpleasant stimuli to curb behaviors (e.g., administering Antabuse for alcoholism).
    • Exposure Therapy: Gradual exposure to feared stimuli to desensitize response.
    • Example: Mary Cover Jones’s work with Peter and rabbits.
OPERANT CONDITIONING
  • Techniques include:
    • Applies Behavior Analysis: Reinforcement for positive behaviors, punishments for undesirable ones (e.g., in autistic children).
    • Token Economy: Using tokens for specific behaviors in controlled environments, prevalent in psychiatric units.

COGNITIVE THERAPY

  • Developed by Aaron Beck, focusing on how thoughts affect feelings. Objectives:
    • Identification of cognitive distortions (e.g., overgeneralizing, polarized thinking).
    • Correction of irrational beliefs and promotion of logical reasoning.

COGNITIVE-BEHAVIORAL THERAPY (CBT)

  • Combines cognitive therapy focusing on thoughts with behavioral therapy focusing on actions.
  • Utilizes the ABC model:
    • A: Activating Event.
    • B: Belief about the event.
    • C: Consequences of the belief.

HUMANISTIC THERAPY

  • Focuses on self-awareness and potential achievement:
    • Rogerian/Client-centered Therapy by Carl Rogers emphasizes self-direction and personal growth.
    • Techniques include active listening and unconditional positive regard.
BIOMEDICAL THERAPIES
  • Include:
    • Psychotropic Medications: Address symptoms without curing disorders.
    • Antipsychotics: Treat symptoms like delusions and hallucinations by blocking dopamine.
    • Antidepressants: Affect serotonin and norepinephrine levels.
    • Anti-anxiety medications: Reduce CNS activity for anxiety disorders.
    • Mood Stabilizers: Manage bipolar disorder symptoms.
    • Electroconvulsive Therapy (ECT): Induces seizures to alleviate severe depression.
    • Transcranial Magnetic Stimulation: Uses magnetic fields to stimulate nerve cells for depression relief.

TREATMENT MODALITIES

INDIVIDUAL THERAPY

  • Involves one-on-one sessions lasting 45 minutes to 1 hour, focusing on personal feelings and goals.

GROUP THERAPY

  • Several clients discuss common issues with a therapist, fostering community support.

COUPLES THERAPY

  • Aims to resolve relationship difficulties using strategies often from cognitive behavioral techniques.

FAMILY THERAPY

  • Focuses on family dynamics and communication strategies.
  • Systems approach views the family as an organized system influencing individual behaviors.
  • Treatment styles include structural and strategic family therapy.

SUBSTANCE-RELATED & ADDICTIVE DISORDERS

ADDICTION

  • Chronic substance use alters neural structures in decision-making areas of the brain, leading to compulsive behaviors.
    NET RETURN TO USE
  • Approximately 40%-60% of individuals relapse post-treatment.

COMORBID DISORDERS

  • Substance abuse often coexists with additional psychiatric disorders, complicating treatment and recovery.

SUBSTANCE-RELATED TREATMENT

  • Long-term, cost-effective treatment is critical, with behavior therapy playing a key role in motivating change and preventing relapse.
EFFECTIVE TREATMENT COMPONENTS
  • Minimum of 3 months for positive outcomes.
  • Holistic approaches considering all aspects of the individual’s life.
  • Group therapy shown to be particularly effective for maintaining sobriety, especially with parental involvement correlated with reduced adolescent use.