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Transcript
Treating Psychological Disorders Chapter 15 Who Seeks Treatment? 15% of U.S. population in a given year Most common presenting problems Anxiety and Depression Demographics 4.5 million people Women more than men Education level Barriers to Treatment Medical insurance Who Provides Treatment? Clinical psychologists Counseling psychologists Psychiatrists Clinical social workers Psychiatric nurses Counselors Types of Treatment Psychotherapy Insight therapies Psychodynamic 24% Behavior therapies “talk therapy” Cognitive 8% Changing overt behavior Clientcentered 6% Biomedical therapies Biological functioning interventions Behavioral 11% Eclectic 35% Other 16% Psychoanalysis Focuses on uncovering unconscious conflicts resulting from fixations at early developmental stages Uses techniques such as... To minimize Resistance and facilitate Free association Dream analysis Interpretation Transference Goal is to rebuild personality Client-Centered Treatment Believes disorders result from incongruence between self-concept and reality or dependence on acceptance from others. Uses techniques such as Unconditional positive regard Empathy Genuineness Reflection Goal is to increase client self-acceptance (minimize incongruence) Behavioral Therapies Believe disorders are maladaptive patterns of behavior that have been learned. Use techniques such as Conditioning (Classical & Operant) Aversion Systematic Desensitization Social Skills Training Biofeedback To eliminate maladaptive behavior and replace with adaptive behavior. Behavior Therapies B.F. Skinner and colleagues Goal: unlearning maladaptive behavior and learning adaptive ones Systematic Desensitization – Joseph Wolpe Classical conditioning Anxiety hierarchy Aversion therapy Alcoholism, sexual deviance, smoking, etc. Figure 15.7 The logic underlying systematic desensitization Behavior Therapy B.F. Skinner and colleagues Social skills training Modeling Behavioral rehearsal Cognitive-Behavioral Therapy Aaron Beck Cognitive therapy Use techniques such as Believe disorders result from irrational assumptions and negative, self-defeating thoughts. Thought stopping Recording automatic thoughts Refuting negative thinking Reality testing Homework Goal is to detect negative, irrational thinking and replace with realistic thinking Cognitive-Behavioral Therapy Martin Seligman Learned helplessness and depression Difficult to establish helplessness-depression link Cognitive-Behavioral Therapy Martin Seligman Explanatory style a person’s habitual way of explaining events, typically assessed along three dimensions: internal/external, stable/unstable, and global/specific % Remaining after 1 year 70 60 50 40 30 20 10 0 Bottom Bottom 25% 50% Top 50% ASQ Top 25% Biomedical Therapies Type Example Positive Effects Adverse Effects Antianxiety Drugs Valium, Xanax Quick acting Reduces anxiety Nausea, drowsiness, confusion Decrease psychotic symptoms Tardive dyskinesia Reduce depressive symptoms Dry mouth, Blurred vision, Constipation, Drowsiness Prevents mood swings Reduces depressive symptoms Kidney and Thyroid damage Memory loss, Impaired attention Thorazine, Haldol Elavil, Nardil, Antidepressant Drugs Prozac, Paxil, Zoloft Antipsychotic Drugs Bipolar Treatment ECT Lithium Biomedical Therapies Psychopharmacotherapy Antianxiety - Valium, Xanax, Buspar Antipsychotic - Thorazine, Mellaril, Haldol Tardive dyskinesia Clozapine Antidepressant: – Elavil, Tofranil Mao inhibitors (MAOIs) - Nardil Selective serotonin reuptake inhibitors (SSRIs) – Prozac, Paxil, Zoloft Tricyclics Figure 15.12 Antidepressant drugs’ mechanisms of action Biomedical Therapies Psychopharmacotherapy Mood stabilizers Lithium Valproic acid Electroconvulsive therapy (ECT) Current Trends and Issues in Treatment Managed care Empirically validated treatments Blending Approaches to treatment Multicultural sensitivity Deinstitutionalization Revolving door problem Homelessness