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Treatment of Psychological
Disorders
History
Psychological Therapies
Biological Therapies
Effectiveness
Specific Disorder-Treatment Matches
Old-Fashioned Causes & “Cures”
 Possession by demons
 Prehistoric
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Trephination
 In league with Satan
 Up to 1700
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Exorcism
Torture
Starvation
 Humor imbalance
 From Greeks until 1800s
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Bloodletting
Purging
Whirling
 Illness
 Middle ages until 1800’s
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Confinement in asylums,
often dungeon-like
prisons
History: 1800’s to 1950
 Humanitarian Reform Movement (1800’s)
“Inmates” begin to be housed in more standard
living conditions
 Hysteria and general paresis
 Hysteria cured by Freud (1890’s)
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Psychological approach to treatment
General paresis caused by syphilis (1913)
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Neuropsychiatric disorder affecting central nervous system
– Presents with psychotic-like symptoms
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Biological approach to treatment
 Mental hospital inpatient population grows to 600,000
in 1950’s (see slide 5)
History: 1950’s to present
 Discovery of antipsychotics in 1950’s
 Deinstitutionalization begins in
1960’s and continues until today
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40,000 mental hospital inpatients remain
(see slide 5)
 Some reasons for
deinstitutionalization
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Introduction of antipsychotics
 Criticism of mental hospitals
 Community care movement
 Reduce costs to state governments
 Some negative consequences of
deinstitutionalization
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16% - 50% of incarcerated prisoners have
a mental disorder
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The range in percentages depend on criteria for
mental disorder classification
1/3-1/2 of homeless have mental
disorders
 Jack Nicholson in
“One Flew over the
Cuckoo’s Nest”
Antipsychotic Drugs & Inpatients
Psychological Therapies
(Psychotherapy)
Psychodynamic Therapies
Humanistic Therapies
Behavioral Therapies
Cognitive Therapies
Group-Therapy Approaches
Psychodynamic Therapies I
 The goal is to uncover and resolve conflicting
thoughts, feelings, and intentions
 Insight: an understanding of one’s own
psychological processes
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Free association
Dream analysis: manifest vs. latent content
Hypnosis
Analysis of resistance
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Resistance is the barriers to free association and treatment
in general that the patient creates.
 Catharsis: recovery into consciousness of
repressed mental contents causes release of
psychic energy and the melting away of associated
symptoms
Psychodynamic Therapies II
 Therapeutic alliance
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Patient-Therapist relationship
Comfort level
Nonjudgmental and empathetic listener
Transference
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Patients bring enduring interpersonal patterns into
their relationship with their therapist
Positive vs. negative
Countertransference
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Therapists may experience emotional responses to
their patients
Therapist must themselves undergo therapy in order
to detect and handle these feelings
Humanistic Therapies
 Removing impediments to personal growth
 Client-Centered Therapy – Carl Rogers
 Warm and Caring Relationship
 Empathy
 Unconditional Positive Regard
 Reflection
 Gestalt Therapy – Fritz Perls
 Empty chair technique
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Imagine that the person to whom you wish to express
your feelings is sitting in the empty chair
Two chair technique
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Place two sides of a dilemma in two different chairs
and express each side while in that chair
Behavioral Therapies I
 Focus is on altering symptoms rather than
exploring their meaning
 Operant-Conditioning Techniques
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Reward and Punishment
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Biofeedback
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Behavior modification
Token economies
To treat headaches or chronic pain (see next slide)
Skills Training
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Social skills
– Assertiveness training
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ADHD
Biofeedback & Tension Headaches
 Sensors on the
head detect muscle
activity
 System converts
signal to visual
display
 Patient watches the
display, tries to
reduce tension
signal
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Muscle tension
reduced
Behavioral Therapies II
 Classical conditioning techniques are often
used when there is a specific feared object (as
in phobias) or desired object (as in addictions)
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Flooding
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Confronting a fearful stimulus without negative
consequences will lead to extinction of the dysfunctional
conditioned emotional response
Systematic Desensitization
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Associating positive feelings with a feared stimulus
– Relaxation training, construction of fear hierarchy, and gradual
exposure
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Aversive Conditioning: associating negative feelings
with a desirable, but unhealthy, object (see next slide)
Aversion Therapy for Alcoholism
 Alcohol is paired with a chemical that causes
nausea and vomiting
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Straightforward classical conditioning
Cognitive Therapies I
 Rational-Emotive Behavior Therapy
 Albert Ellis
 A form of cognitive therapy in which
people are confronted with their
irrational, maladaptive beliefs.
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Common beliefs that are irrational and selfdefeating
– I have to be liked by everyone
– I have to be perfect at what I do
– Everyone gets what they deserve
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Therapeutic devices
– Step out of character
– “How to refuse to be ashamed of anything”
– Try new behaviors to see that these behaviors won’t
bring your life crashing down around you
Cognitive Therapies II
 A-B-C’s of Emotional Distress
 Disorders often occur because of self-
defeating beliefs
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Activating Event - Beliefs - Consequences
 Rational-emotive therapy helps people
change these beliefs
Cognitive Therapies III
 Cognitive Therapy
 Aaron Beck
 A form of psychotherapy in which people are
taught to think in more adaptive ways.
 Address cognitive distortions
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Catastrophizing: belief that was has happened was so awful or what will
happen will be so terrible that you won’t be able to stand it
 Overgeneralization: seeing a single negative event as a never-ending pattern
of defeat
 Address negative triad (world, self, future) in depression
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World: interpret events unfavorably
 Self: Does not like themselves
 Future: Regard future pessimistically
 Therapeutic devices
Asking “What’s the evidence?” “Are these facts or interpretation?” “Is there
another way to look at the situation?”
 Triggering distress during therapy so that it can be interpreted
 Keeping diaries or logs and doing reading assignments
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Group Therapy Approaches
 4 to 10 people meet with one or two
therapists usually once a week for 2 hours
 Successful group members can instill hope in
newcomers
 Discovering that others have similar problems
can relieve shame and guilt
 Group members talk about individual
problems, but also gain insight from group
processes in that people often interact with
others in such a way that it is revealing
Biological Therapies
Drug Therapies
(uses psychotropic medications)
(also known as Psychopharmacology)
Antianxiety Drugs
 “Tranquilizers”
 Can treat generalized anxiety
 Barbituates
 Work, but are highly addictive
 Benzodiazepines
 Increase activity of GABA, an inhibitory neurotransmitter
 Examples (trade names in parentheses)
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Diazepam (Valium)
Chlordiazepoxide (Librium)
Alprazolam (Xanax)
Negative side effects
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Drowsiness; dangerous when combined with alcohol
After stopping, two-week rebound period of greater anxiety
Can be psychologically and physically addictive
Can cause memory loss
 Buspirone (Trade name: BuSpar)
Antidepressants
 Tricyclic antidepressants
 Block reuptake of serotonin and norepinephrine
 Improvement of 40-50% over placebo
 Imipramine (Trade name: Tofranil)
 Placebo: Any medical intervention designed to work
through the power of suggestion
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A pill that does not contain any medically active ingredients
can reduce symptoms by 20-40%
 MAO (monoamine oxidase) inhibitors
 MAO is an enzyme that breaks down serotonin
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So, if you inhibit this enzyme, you will increase the amount
of serotonin in the brain
Effective when personality disorders are also present
 Selective serotonin reuptake inhibitors (SSRI’s)
 Fluoxetine (Trade name: Prozac)
Antipsychotic Drugs
 “Major tranquilizers”
 Known as this because of sedating effects
 Also known as “neuroleptics”
 Reduce positive symptoms, like hallucinations and
delusions
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By inhibiting dopamine
Do not do much for negative symptoms
 Examples (trade name in parentheses)
 Chlorpromazine (Thorazine)
 Haloperidol (Haldol)
 Clozapine (Clozaril)
 Risperidone (Risperdal)
 Side effects of thorazine: tardive dyskinesia
 Involuntary twitching in tongue, face, neck, and jaw
 Occurs in patients who have taken Thorazine for several
years
 Irreversible
Other Medical Interventions
 Electroconvulsive Therapy (ECT)
 Electric-shock treatments that often relieve
severe depression by triggering seizures in the
brain.
 Psychosurgery
 The surgical removal of portions of the brain
for the purpose of treating psychological
disorders.
 After, antipsychotic medications were
introduced, psychosurgery was no longer a
serious consideration
 Lobotomy
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Severing tissue in a cerebral lobe, typically the
frontal lobe
Produced severe side effects (see Phineas Gage)
Treatment Effectiveness
Psychotherapy
Disorder-Treatment matches
Usefulness of Psychotherapy
 Two ways to evaluate the usefulness of
psychotherapy
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Effectiveness studies (this slide) vs. efficacy studies (next
slide)
 Effectiveness studies
 Assessment of treatment outcomes under relatively less
controlled conditions
 1994 Consumer Reports Survey (N=2900)
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2004 Consumer Reports Survey (N=3000)
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Somewhat improved to much improved – 86%
Fairly satisfied to highly satisfied – 89%
28% rise in the use of psychological medications
Medication plus psychotherapy produces the best outcome,
followed by psychotherapy alone, and then drug therapy
alone
Reasons to be critical of the use of effectiveness studies
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Subjective measure
No comparison to group that had problems but did not
receive treatment
Efficacy studies
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Assessment of treatment outcomes under controlled conditions
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Random assignment of subjects to conditions
Therapists trained to adhere to manual
Standardized length of treatment
Summary of 475 efficacy studies (Smith et al., 1980)
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The figure below shows that the average psychotherapy patient is
better off than 80% of untreated patients
Are some psychotherapies better?
 On average, across all disorders, all
therapies are equally effective (Sloane et al.,
1977; Elkin et al., 1989)
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However, for some disorders, certain types of
therapy tend to be more successful than others
 Two common, nonspecific factors at work in
all types of psychotherapy
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Supportive relationship with caring therapist gives
patients reason for hope
The opportunity for a patient to open up can have
healing power
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Pennebaker
Anxiety Disorder & Treatment Match
 For specific phobias
 The sources of anxiety are better addressed with cognitivebehavioral therapy (CBT) than with medication
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Systematic Desensitization
Virtual treatments can reduce fear responses
 For social phobia
 SSRI’s help, but CBT is better
 For panic disorder
 Treatments often combine medication and CBT, but relapse
is less with CBT
 For obsessive-compulsive disorder (OCD)
 For tic-related OCD, SSRI’s and dopamine receptor blockers
 For non-tic-related OCD, oxytocin regulation
 Exposure and response prevention therapy
Exposure & Response Prevention
 Another type of
behavioral therapy
 Woman with handwashing
compulsion
 Baseline Instruction Response
prevention cycle
 After a few cycles,
the woman was
washing less often
and getting fewer
urges to wash
Hand
washing
Urges
Depression & Treatment Match
 Psychological medications
 MAO-inhibitors, tricyclics, and SSRI’s provide relief to 6070% of depressed persons
 Cognitive-behavioral therapy (CBT)
 Just as effective psychological medications
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Targets the automatic irrational thoughts that accompany
depression
 Medication plus CBT is most effective
 Seasonal Affective Disorder
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Responds to phototherapy
 Exercise helps depression too
 Electroconvulsive therapy (ECT)
 The single most effective treatment for severe depression, and it
saves lives, negative public views notwithstanding
 Transcranial magnetic stimulation (TMS)
Bipolar Disorder & Treatment Match
 Lithium is “indispensable” for the treatment of bipolar
disorder
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Reduces bipolar mood swings
Especially effective at calming mania
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Less effective in reducing the severity of the depressive mood
swings
– For this reason, an antidepressant is often prescribed in addition to
lithium
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Takes awhile (3-4 weeks) to “kick in”
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Side effects are unpleasant during this period
Highly toxic
 Only 20% of bipolar patients who maintain their
medications experience relapse
 But many patients discontinue medication, perhaps
because of the “intoxicating pleasure” of manic states
Schizophrenia & Treatment Match
 Antipsychotic medications are indispensable
for the treatment of schizophrenia
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But significant sedative and motor side effects,
resembling Parkinson’s disease, make treatment
unpleasant for many patients
 In addition, patients show little improvement in
social skills
 Psychosocial treatments
 Improve functioning beyond drug treatments
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Social skills training
 Most schizophrenic patients improve as they
get older
Professionals Involved in Therapy
 Clinical Psychologists
 Psychiatrists
 Psychiatric (or clinical) social worker
 Psychiatric nurse
 Counseling Psychologists
 Psychoanalysts
 Others offering therapy (paraprofessionals)
 Crisis intervention
 Pastoral Counselors
 Community outreach
Where People Turn for Help
Orientations of Psychotherapists
Can Personality Disorders Be Treated?
 Dialectical Behavior Therapy Is Most
Successful for Borderline Personality
Disorder
 Antisocial Personality Disorder Is
Difficult to Treat
The Use of Medication to Treat
Adolescent Depression Is Controversial
 Fewer than 30 percent of children who have mental
health problems receive any type of treatment
 Twice as many of those taking SSRIs reported having
suicidal thoughts (4 percent) as those taking a
placebo (2 percent)
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None of the children or adolescents committed suicide
 The FDA voted in 2004 to require manufacturers to
add to their product labels a warning that
antidepressants increase the risk of suicidal thinking
and behavior in depressed children and adolescents
The Use of Medication to Treat
Adolescent Depression Is Controversial
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The previous slide displayed the results of
the TADS study
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All treatment groups experienced a reduction in
thoughts of suicide compared with the baseline
However, participants in the Prozac group were
twice as likely to have serious suicidal thoughts
or intentions compared with those undergoing
other treatments
Although prescribing drugs without CBT
might be cost effective, it may not be in the
best interests of depressed children
Children with ADHD Can Benefit
from a Variety of Approaches
 Methylphenidate (ritalin) targets under active brains
and reduces negative behaviors (see Fig. 14.29 and
Fig. 15.23)
 Side effects and lack of long-term efficacy limit the
utility of ritalin
 Behavioral Treatments, though time-consuming,
augment medication and help social skills,
academics, and family relationships
Autistic Children Benefit from a
Structured Treatment Approach
 Generalization of skills must be taught
explicitly
 Applied Behavior Analysis (ABA) is time
intensive but raises IQ points by 20 onaverage
 The long-term prognosis for autism is poor