Unit 5: Mental and Physical Health Topic 5.5: Treatment of Psychological Disorders Teacher: Kadi Alteini Psychotherapy Effectiveness: What Does the

Unit 5: Mental and Physical Health 

Topic 5.5: Treatment of Psychological Disorders 

Teacher: Kadi Alteini 

Psychotherapy Effectiveness: What Does the Research Say? 

− Psychotherapy works.  

• Meta-analytic studies show that psychotherapy is generally effective in treating mental  disorders. 

o A meta-analysis combines results from many studies to give a clearer picture. These  are used to evaluate which therapies work best and under what conditions. o Example: A meta-analysis might show that CBT is most effective for anxiety  disorders, while another type of therapy might work better for depression. • Studies have shown that those who undergo therapy improve more than 75% of people  who don’t receive any treatment at all. 

− Evidence-Based Practice in Therapy: 

• Therapists don’t just guess what works; they use scientific research to choose the most  effective treatments for each client. This includes reviewing clinical research,  psychological theories, and previous case studies. 

o Example: If CBT has been shown through research to help with OCD, a therapist  might choose it as the treatment plan for a client with OCD. 

− The Therapeutic Alliance:  

• The therapeutic alliance refers to the collaborative relationship between the therapist  and client. 

• It includes: Mutual trust, Empathy, Respect, Genuine regard and Active participation  from both sides. 

• The quality of this relationship often predicts the success of therapy, regardless of the  type of therapy being used. 

• Cultural humility is essential here; therapists must be sensitive to differences in  gender, race, religion, language, and values. 

Describe trends in treatment and the rise of decentralized care 

− The Shift from Asylums to Outpatient Care: Deinstitutionalization 

• In the mid-to-late 20th century, many people were released from psychiatric hospitals  and asylums.  

• This movement was called deinstitutionalization. 

• Why? Because:  

o Psychotropic medications (like antipsychotics and antidepressants) became more  effective.  

o There was growing awareness of inhumane conditions in mental institutions. o New models supported community-based treatment rather than long-term  hospitalization. 

− Decentralized, Integrated Care: 

• Today, therapy is often delivered through outpatient clinics, private practices,  community centers, or online platforms. 

• Integrated treatment plans are now common. This means combining: medication  (biomedical therapy) and psychological therapies. 

• Therapists are now part of multidisciplinary teams, including psychiatrists, social  workers, counselors, and case managers.

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Describe ethical principles in the treatment of psychological disorders − The APA’s Core Ethical Principles for Clinicians or Therapeutic Situations: • Therapists must follow ethical standards established by the American Psychological  Association (APA): 

I. Nonmaleficence: “Do no harm.” 

• Therapists must avoid making the condition worse or causing psychological, emotional,  or physical harm through therapy. 

o Example: A therapist pushing a client to talk about a traumatic event too early in  therapy, this could re-traumatize the client. That would violate nonmaleficence.  o Instead, a therapist following this principle might say: “We’ll only explore this when  you’re ready, and we’ll take it slow. My goal is to support your healing, not  

overwhelm you.” 

II. Fidelity and Responsibility: 

• Therapists should establish trust, be accountable, and maintain professional boundaries.  Following through on appointments, maintaining confidentiality, being dependable. o Example: If a client tells a therapist a deeply personal story, they trust it stays  

between them (unless safety is at risk). The therapist must keep this confidential  and show up consistently to sessions. Breaking trust (e.g., showing up late, canceling  without reason, or sharing private info) would violate fidelity. 

o A therapist following this principle might say: “Our sessions are private. What you  say here stays here, unless you're at risk of harm. And I’ll always show up on time,  just like I ask you to.” 

III. Integrity: 

• Therapists must be honest and transparent with their clients about diagnosis, treatment  plans, risks, and goals. Not pretending to know things they don’t or using harmful  methods. 

o Example: Let’s say a therapist doesn’t specialize in eating disorders, but a client  comes in with that issue.  

o A therapist with integrity would refer the client to someone better qualified rather  than fake it. “I want you to get the best support possible, and I know a colleague who  specializes in this. Would you be open to working with them?” 

IV. Respect for People’s Rights and Dignity: 

• Respect includes protecting the client’s: Privacy, Cultural background, Gender identity,  Religious beliefs and Autonomy (ability to make their own decisions). 

• Example: If a therapist works with a client who observes a religious fast and says  therapy feels harder that week, the therapist should be respectful, not dismissive. They  could say: “That makes total sense. Your energy is low because of your fast. Let’s adjust  our session to meet you where you are today.” 

Techniques Used With Psychological Therapies 

− Psychodynamic Therapy: 

• Goal: Uncover unconscious conflicts, thoughts, or memories especially from childhood  that may be driving present problems. 

• Techniques: 

A. Free Association: The client says whatever comes to mind without filtering. The  therapist looks for patterns, slips, or recurring topics that might reveal unconscious  material. 

o Example: A client talking randomly suddenly brings up their mother, and the  therapist explores how unresolved parental conflict might be affecting current  anxiety. 

B. Dream Interpretation: Dreams are believed to express unconscious wishes or fears in  a symbolic form. 

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o They have two layers: Manifest content, which is what actually happened in the  dream. Latent content, which is the symbolic, hidden meaning. 

o It helps clients bring unconscious fears into conscious awareness, where they can be  discussed and worked through. The idea is that if you can understand what’s going  on underneath the surface, you can change how you feel or behave in the present. 

o Example: Let’s say a client dreams that they are drowning in an ocean while  everyone ignores their cries for help.  

o Manifest Content: Drowning alone, people nearby not helping.  

o Latent Content: May reflect unconscious feelings of abandonment, helplessness, or  being emotionally overwhelmed by family issues in waking life. 

o The therapist helps the client analyze the imagery and symbols in the dream,  connecting them to unconscious material or childhood conflicts that may be  affecting current behavior or emotions. 

− Cognitive Therapy: 

• Goal: Changing maladaptive or distorted thinking patterns, because the way we think  directly affects how we feel and behave. 

A. Cognitive Restructuring: This is a process where clients are taught to: Recognize  distorted or irrational thoughts, Examine the evidence for and against those thoughts,  Replace them with healthier, more realistic beliefs. 

o It helps people break the cycle of negative thinking that contributes to disorders like  depression or anxiety. 

o Example: A student thinks, “I failed one test. I’m a total failure and will never  succeed. A therapist would help the student question that thought: “Is it true you’ve  never succeeded before?” “Could there be other reasons you didn’t do well?” 

o They may restructure it into: “I didn’t do well on one test, but I can study differently  next time.” 

B. Fear Hierarchies: Though fear hierarchies are traditionally associated with behavioral  therapy, in cognitive therapy, they may still be used when anxiety is driven by irrational  thoughts.  

o A fear hierarchy is a list of anxiety-provoking situations ranked from least to most  terrifying 

o Example: Someone with public speaking anxiety might work through a hierarchy:  Think about giving a speech. Practice a speech in front of a mirror. Speak to a small  group. Present in front of a class. 

o At each step, the therapist helps the client challenge the irrational distorted and  catastrophic beliefs and thinking (“They’ll all laugh at me”) and restructures it  into realistic and rational ones (“Some people might be bored, but others may  actually listen.” “Even if I mess up, people won’t remember it forever.”) 

C. The Cognitive Triad (Aaron Beck): This refers to three types of negative thinking  patterns common in people with depression: 

• Negative thoughts about the self: “I’m worthless.” 

• Negative thoughts about the world: “No one cares about me.” 

• Negative thoughts about the future: “Things will never get better.” 

o Example: Someone going through a breakup may think: “It’s my fault. I’m  unlovable.” (self) “People are cruel.” (world) “I’ll be alone forever.” (future) o Cognitive therapy helps them challenge each part of the triad and replace it with  more balanced thoughts. 

− Behavioral Therapy (Applied Behavior Analysis): 

• Goal: Use conditioning principles (classical and operant) to change problematic  behavior. 

• It is especially useful for mental disorders (like phobias, OCD, ADHD) and  developmental disabilities (like autism spectrum disorder).

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A. Exposure Therapy:  

• Based on Classical Conditioning. 

• Used for anxiety disorders, especially phobias, OCD, and PTSD. These therapies are  based on classical conditioning and help people unlearn the connection between a  feared stimulus and an anxious response. 

• Systematic desensitization is a structured form of exposure therapy that pairs gradual  exposure with relaxation training. The goal is to replace the fear response (CR) with a  calm response by gradually increasing exposure while maintaining relaxation. o Example: Someone with arachnophobia (spider phobia). Each step only happens  when the client feels calm. 

✔ Step 1: Starts by imagining a spider. 

✔ Step 2: Then looks at a photo. 

✔ Step 3: Then watches a video. 

✔ Step 4: Then sees a spider in a cage. 

✔ Step 5: Might hold a harmless spider. 

B. Aversion Therapy: Pairs an unwanted behavior with an unpleasant stimulus to reduce or  eliminate the behavior. 

• Based on Classical Conditioning 

o Example: Someone trying to overcome alcohol dependence takes a medication (like  Antabuse) that causes nausea when they drink alcohol. Eventually, drinking  becomes associated with sickness, reducing the desire to drink. Or a person trying  to quit smoking might take a medication that causes nausea if they smoke. 

C. Token Economies: Positive behavior is reinforced with tokens (stickers, points, chips) that  can later be exchanged for rewards such as snacks or privileges.  

• Based on Operant Conditioning. 

• Used in classrooms (especially for kids with ADHD or ASD) and inpatient psychiatric  hospitals. 

o Example: A child with ADHD earns a token every time they complete a class activity  without distraction. After five tokens, they can trade them for extra playtime. D. Biofeedback: Teaches clients how to control involuntary body functions such as heart rate,  muscle tension or skin temperature by showing them real-time feedback about their body’s  responses. 

• Goal: To teach clients to take control of stress-related physical symptoms, increasing  their sense of control and reducing anxiety symptoms. 

• Based on operant conditioning: the brain is rewarded when it learns to calm or control  the body. 

• Used to regulate the autonomic nervous system  

o Sympathetic nervous system  

o Parasympathetic nervous system 

• How it works: 

o Sensors are attached to the client (e.g., fingers, scalp). 

o A machine provides visual or auditory feedback (e.g., beeps, graphs). 

o The client practices techniques like deep breathing, progressive muscle relaxation,  or guided imagery to change their bodily responses. 

o Over time, clients learn to self-regulate without the machine. 

• Used for: Anxiety disorders, PTSD and ADHD. 

o Lana has GAD and experiences muscle tension and racing heartbeat before exams.  Through biofeedback, she sees her heart rate spike on a screen. She uses slow  breathing to lower it and sees the visual feedback improve. Over time, she learns to  self-calm without the machine. 

− Cognitive-Behavioral Therapy (CBT):

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• Goal: To treat mental and behavioral disorders by combining both cognitive and  behavioral techniques. It helps clients recognize and change both their thoughts and  behaviors, which are often linked in a cycle that maintains psychological distress. A. Dialectical Behavior Therapy (DBT): 

• A type of cognitive-behavioral therapy designed originally for Borderline Personality  Disorder (BPD), but now used for other disorders like PTSD, eating disorders, and  depression. 

• Core Goal: To help clients manage intense emotions, reduce self-destructive behaviors,  and improve relationships by teaching acceptance and change at the same time. • "Dialectical" means learning to hold two opposite ideas at the same time, so balancing  acceptance “I am doing my best” with change “I need to improve”. 

• Skills taught: 

o Mindfulness: stay present and observe emotions without judgment. Helps reduce  rumination and emotional overwhelm. Example: a person with PTSD uses mindful  breathing when they notice a flashback coming on. 

o Distress tolerance: cope with emotional crises without making things worse.  Example someone with BPD uses cold water or a grounding objective instead of self harming 

o Emotion Regulation: Learn strategies to understand and manage intense feelings.  Example A person with bipolar disorder tracks moods and uses calming strategies  during high-stress days. 

o Interpersonal effectiveness: communicate clearly and set healthy boundaries.  Example: a teen with social struggles learns how to say no respectfully.  

B. Rational-Emotive Behavior Therapy (REBT): 

• Core idea: Emotional distress comes not from the events themselves but from irrational  beliefs we hold about those events. REBT uses cognitive and behavioral techniques to  replace irrational thoughts with rational ones. 

• It uses the ABC Model: 

o A: Activating event (what happened e.g., getting rejected from a job) 

o B: Belief that is irrational about the event (your thought or interpretation e.g., “I’m a  total failure, and I’ll never be successful”) 

o C: Consequence (how you feel and act e.g., depression, hopelessness, giving up) o The therapist challenges the belief (B) “have you never succeeded at anything  before?” “Is one job rejection proof that you will never succeed?” and helps replace  it with a rational belief“ I did not get this job, but that doesn’t mean I’m a failure.  Many successful people face rejection. I can improve and apply again. 

• REBT calls out “The Big 3” irrational thinking styles: 

1. Awfulizing (Catastrophizing): Blowing events out of proportion. 

o “If I get rejected, my life is over.” 

o Therapist might exaggerate it: So you're saying one 'no' ruins your future forever? o This shows how extreme the thinking is. 

2. Musturbation (Ellis’s term – we’ll say “Toxic Musts”): Rigid rules that demand  perfection. 

o I must succeed at everything. People must like me. 

o When these expectations aren’t met → emotional collapse. 

3. Global Labeling: Judging the entire self or others based on one behavior. o “I made a mistake → I’m a failure.” 

o “Someone ignored me → I’m unlovable.” 

• Behavioral Follow-Up: After challenging irrational thoughts, the therapist assigns  behavioral tasks to reinforce the new rational belief.

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o Example: Client updates their resume and applies to two new jobs after being  rejected from one. 

− Humanistic Therapy (Person-Centered Therapy) 

• Core idea: focuses on helping individuals grow, heal, and reach their full potential by  creating a safe, supportive environment. It’s about helping people understand  themselves better, align with their true self, and find meaning. The patient determines  the course of therapy. 

• Key Techniques of Humanistic Therapy: 

A. Unconditional Positive Regard: 

• The therapist accepts the client completely, no matter what they say or feel. o Example: A teen opens up about intrusive thoughts they’re ashamed of. Instead of  judging, the therapist listens and affirms: “You are not your thoughts. It’s okay to  talk about them.” This helps the teen feel safe enough to explore deeper feelings. B. Active Listening: 

• The therapist listens without judgment, interruption, or trying to “fix” the problem. They  paraphrase or reflect back what the client says to help the client hear themselves more  clearly, and ask open-ended questions that encourage exploration. The purpose isn’t  advice, it’s understanding. 

o Example: A client says: “I keep trying to hold everything together, but I feel like I’m  falling apart inside.” The therapist responds: “You’ve been trying so hard to stay  strong for everyone else, but inside, it feels like you’re carrying more than you can  handle. Can you tell me what part of that feels the heaviest right now?” This  reflection helps the client slow down, connect with their own emotions, and feel  truly heard which is often the first step to healing. 

C. Empathy and Genuineness: 

• The therapist doesn’t act like an expert or a blank wall they show real emotion, care, and  presence. This models authenticity and creates a human-to-human connection. o Example: A grieving client says, “I feel like no one gets it. I don’t even want to talk  

anymore.” The therapist quietly says: “You’re not alone in that feeling. I don’t want  to rush you or fix it, I just want you to know I’m here. I care, and I’ll sit with you in  this.” That moment of genuine emotional presence often creates a sense of human  

connection that words can’t fully describe and that’s where real healing begins. D. Self-Concept and Ideal Self: 

• Clients explore their self-concept (how they see themselves) and how it may be out of  sync with their ideal self (how they wish to be). Mental distress happens when there’s a  large gap between these two, therapy helps bridge that gap. 

Group Therapy vs. Individual Therapy 

− Both are forms of talk therapy but differ in structure, setting, and interpersonal dynamics. − Group Therapy:  

• Multiple clients meet together under the guidance of a trained therapist.    • Used for a wide range of issues like grief, anxiety, depression, addiction, or social  struggles.    

• Benefits:      

o Peer Support: Clients realize they are not alone, reducing isolation. 

o Shared Experience: Hearing others’ stories can provide hope and insight. o Interpersonal Skill Building: Safe environment to practice assertiveness, active  listening, and communication. 

o Cost-effective: Often more affordable than individual therapy.    

• Disadvantages: 

o Less Privacy: Sensitive issues may be difficult to share openly in a group.

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o Group Dynamics: Conflicts between group members or dominant personalities can  interfere with progress. 

o Not for Everyone: Some people may feel overwhelmed or unsafe in a group setting,  especially early in treatment. 

− Individual Therapy:  

• One-on-one session between therapist and client. 

• Highly personalized, allowing deeper exploration of personal issues. 

• Benefits:    

o Tailored Focus: Therapy is adapted entirely to the client’s pace and needs. o Privacy and Confidentiality: Can address issues that may be too sensitive for a  group. 

o Flexible: Used for anything from trauma to anxiety to personal growth.     • Disadvantages: 

o More Expensive: Usually costs more than group therapy. 

o Limited Peer Feedback: The client doesn’t benefit from hearing others’ experiences  or practicing group-based social interactions. 

o Can Feel Isolating: For people who feel alone in their struggles, individual therapy  may lack the sense of community that group therapy offers. 

Hypnosis 

− A state of focused attention and heightened suggestibility, often used as a therapeutic tool. • The validity of hypnosis as a treatment lacks empirical support for its efficacy. − What It Can Do: 

• Effective for reducing pain and anxiety especially chronic pain and anxiety. o Example: A person with chronic pain from fibromyalgia uses hypnosis sessions to  reduce their perception of pain and anxiety. 

o Example: A person with panic disorder uses guided hypnosis to calm their breathing  and reduce the severity of panic attacks. 

• Can be used for habit change, like quitting smoking or reducing compulsive behaviors. • Used in conjunction with other therapies not a standalone cure. 

− What It Cannot Do:    

• Not effective for retrieving accurate repressed memories. Studies show recovered  memories under hypnosis may be distorted or false. 

•   Age regression therapy is not supported by research. The idea of mentally “returning”  to a younger age may create false memories. 

Biological Treatments (Interventions Derived from the Biological Perspective) − Psychoactive Medications: Drugs that alter brain chemistry to relieve symptoms of  psychological disorders. They work by interacting with neurotransmitters in the central  nervous system to address possible biochemical causes of mental disorders. A. Antidepressants  

• Used for: Depression, anxiety, OCD 

•   Targets: Increase serotonin, sometimes norepinephrine 

o Example: A person with MDD takes an SSRI to boost serotonin levels and improve  mood and energy. 

B. Antianxiety Drugs  

• Used for: Generalized anxiety disorder, panic disorder 

• Targets: Increase GABA (an inhibitory neurotransmitter that calms activity in the  brain) 

C. Antipsychotics  

• Used for: Schizophrenia 

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• Targets: Block dopamine receptors to reduce hallucinations and delusions • Risk: Long-term use may cause tardive dyskinesia (a movement disorder with  involuntary facial or body movements). 

D. Mood Stabilizers (such as Lithium)   

• Used for: Bipolar disorder 

• Effect: Reduces the intensity and frequency of manic and depressive episodes. − Surgical or Invasive Interventions: 

A. Electroconvulsive Therapy (ECT):    

• Used for: Severe, treatment-resistant depression 

• Involves: Sending controlled electric currents through the brain to cause a brief seizure • Side Effect: Can cause temporary memory loss 

• Example: A person with suicidal depression who hasn’t responded to medications  undergoes ECT and sees improvement in mood. 

B. Transcranial Magnetic Stimulation (TMS):   

• Non-invasive method that uses magnetic fields to stimulate nerve cells in the brain • Used for: Depression, especially when other treatments don’t work 

• No seizure or anesthesia required unlike ECT 

− Psychosurgery: 

• Involves removing or damaging brain tissue 

o Example: Lobotomy (cutting connections in the frontal lobe) was once used to treat  schizophrenia but is now considered unethical and is no longer practiced •   Modern psychosurgery is rarely used (if ever) but may be considered for extreme cases  (e.g., severe OCD not responsive to any other treatment)