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Abnormal Psych Treatment TREATMENT OF PSYCHOLOGICAL DISORDERS Treating psychological disorders poses one of the biggest problems for psychologists. Important to have a realistic perspective: We can treat the symptoms, but according to most perspectives, we cannot cure the disorders. Historically - very broad array of treatments for mental disorders from super harsh --> super soft. Movement from harsh to soft treatments, pioneered by Philippe Pinel in France & Dorothea Dix in the U.S. Fought: mental patients out of prisons & into mental hospitals. Trend since 1950s: Move patients out of the mental hospitals, back home, & treat them through medication & support groups. Treatments today 2 broad categories: 1. Psychotherapy attacks learning-related disorders, like fears. Trained psychologist uses psych techniques to overcome the disorder. There are 4 main approaches: ★ ★ ★ ★ Psychoanalysis Humanism Behaviorism Cognitive 2. Biomedical therapies - medication Example: schizophrenia Psychologists in the biopsychosocial perspective may try both psychotherapy & medication: Eclectic Approach YouTube: 60 Minutes - Advanced PTSD Therapy Insight Therapies: Involve verbal interactions intended to enhance clients’ self-knowledge & thus promote healthful changes in personality & behavior. 2 types of psychologists may provide therapy: Clinical Psychologists & Counseling Psychologists Clinical psychologists’ training emphasizes treatment of full-fledged disorders. In contrast, counseling psychologists’ training is slanted toward the treatment of everyday adjustment problems. Both types of psychologists must earn a doctoral degree (Ph.D., Psy.D., or Ed.D.). A doctorate in psychology requires about 5-7 years of training beyond a bachelor’s degree. Psychiatrists: physicians who specialize in the diagnosis & treatment of psychological disorders. Many psychiatrists also treat everyday behavioral problems. However, in comparison to psychologists, psychiatrists devote more time to relatively severe disorders (schizophrenia, mood disorders) and less time to everyday marital, family, job, and school problems. Psychiatrists have an M.D. degree. Their graduate training requires 4 years of coursework in medical school and a 4-year apprenticeship in a residency at a hospital. Their psychotherapy training occurs during their residency, since the required coursework in medical school is essentially the same for everyone, whether they are going into surgery, pediatrics, or psychiatry. YouTube: Hank Green - Mass Incarceration in the U.S. YouTube: 60 Minutes - Jails - “New Asylums” DSM Changes Over Time: This figure demonstrates how one diagnosis, that for Autism, has changed with each version since the creation of the DSM in 1952. SOURCE: "Inside the Battle to Define Mental Illness | Wired Magazine | Wired.com." http://www.wired.com/magazine/2010/12/ff_dsmv/all/. Wired Magazine. FREUD’S THERAPEUTIC TECHNIQUE: Goal = help patient uncover unconscious conflicts that give rise to anxiety. Anxiety typically causes a person difficulty in dealing with everyday life. Cause of Anxiety: DeepRooted in conflicts set in the unconscious Variety of techniques: ★ Intensive 1-on-1 Therapy ★ Psychoanalysis Psychotherapy is a term that describes many forms of talk therapy, all of which aim to explore distressing thoughts, feelings & behaviors. FREUD’S THERAPEUTIC TECHNIQUE: Long-term commitment: Typically lasts 1 hour/day, several days/week - possibly several years. Various techniques used to get to unconscious, but set up, according to Freud, is important: ★ Therapist should sit behind a client in a chair ★ the client should lie in a chaise lounge so she can relax. ★ Therapist asks questions & client answers as honestly as possible. Therapy takes so long because the techniques to get to the unconscious cannot be direct. To uncover what is in the unconscious, the therapist must use techniques that require interpretation before the true meaning can be divined. DREAM ANALYSIS: Freud argued that dreams were “Royal Road to the Unconscious” Using dream analysis, therapist could take notes on manifest content (the dream itself) & then interpret latent content (the hidden, underlying symbolic meaning). By using what Freud knew about the symbolism of dreams a therapist can determine some of the potential causes of anxiety. TRANSFERENCE: Freud discovered that some of his patients developed strong feelings about him: ★ some of love ★ some of hate But after contemplation he realized that these patients were experiencing strong emotions for their loved ones & temporarily transferring those to their therapist. Freud had great insight that this transference was an unconscious process - and, indeed, a way that he could illuminate this issue & help the patients see unresolved conflicts with people they were close to. HYPNOSIS: Freud practiced hypnosis early in his career. He believed that hypnosis would ease the grip that the repression had on the unconscious & allow some of those issues to percolate to consciousness. He later argued, however, that it was far less effective than he once believed. Crash Course Clip FREE ASSOCIATION: Freud’s preferred method of therapy. A person says the 1st thing that comes to mind when a therapist says something. If a person does this fast enough, according to Freud, the first thing he says can be a “glimpse” into the unconscious. By getting such a glimpse, the therapist can determine the causes of the anxiety. http://educationportal.com/academy/lesson/psychoanalytictherapy-free-association-dream-analysis-andtransference-resistance.html#lesson Biomedical Therapies Electroconvulsive Therapy (ECT) therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized patient Clip Psychosurgery surgery that removes or destroys brain tissue in an effort to change behavior lobotomy now-rare psychosurgical procedure once used to calm uncontrollably emotional or violent patients Electroconvulsive Therapy Crash Course Biomedical Therapies DRUG THERAPY 1st course of treatment for many psychological disorders is to provide relief of the symptoms. Drugs are often the most effective strategy for immediate relief of symptoms. DRUGS: Freud also believed that a variety of drugs (including cocaine) could be used to alleviate anxiety. It is interesting to note that Freud did not spend much of the therapeutic situation practicing these techniques but, rather, collecting detailed histories of his clients. He believed that small details of one’s childhood could be critical in explaining how the anxiety had developed. After years of intensive therapy and after much of the unconscious has been laid bare through the treatment, the client is presumably “cured.” Other forms of psychoanalysis also focused on determining the cause of the anxiety in the unconscious but used different techniques. The underlying assumption is that therapy should uncover the issues in the unconscious that are the root of anxiety. Drug Therapy + Talk Therapy: Drug therapy is typically combined with “talk therapy” to alleviate symptoms overall and to help the afflicted person handle the disorder more effectively. Of the various “talk therapies,” the techniques of Sigmund Freud have served as the face of psychology. What is interesting about this is that Freud offered some of the least testable techniques of any of the therapies. DEPRESSION: Antidepressants, including the selective serotonin reuptake inhibitors, such as Prozac, Wellbutrin, Zoloft. ANXIETY DISORDERS Anxiolytics, such as Xanax or Paxil. Biomedical Therapies SCHIZOPHRENIA Early antipsychotics included drugs that caused side effects such as tardive dyskinesia. dyskinesia - disorder resulting in involuntary, repetitive body movements that can be tardive, having a slow or belated onset. The most well-known of these drugs was chlorpomazine (Thorazine). More recent drugs, such as Zeprexa and Risperdal, reduce the effects on the muscle systems. Humanistic Therapy Client-Centered Therapy humanistic therapy developed by Carl Rogers therapist uses techniques such as active listening within a genuine, accepting, empathic environment to facilitate clients’ growth Humanistic Therapy Active Listening-empathic listening in which the listener echoes, restates, and clarifies Behavior Therapy Behavior Therapy therapy that applies learning principles to the elimination of unwanted behaviors Counterconditioning procedure that conditions new responses to stimuli that trigger unwanted behaviors based on classical conditioning includes systematic desensitization and aversive conditioning Behavior Therapy Exposure Therapy treat anxieties by exposing people (in imagination or reality) to the things they fear and avoid Behavior Therapy Systematic Desensitization type of counterconditioning associates a pleasant, relaxed state with gradually increasing anxiety-triggering stimuli commonly used to treat phobias Aversive Conditioning type of counterconditioning that associates an unpleasant state with an unwanted behavior nausea ---> alcohol Behavior Therapy Systematic Desensitization Behavior Therapy Aversion therapy for alcoholics Behavior Therapy Token Economy an operant conditioning procedure that rewards desired behavior patient exchanges a token of some sort, earned for exhibiting the desired behavior, for various privileges or treats Cognitive Therapy Cognitive Therapy teaches people new, more adaptive ways of thinking and acting based on the assumption that thoughts intervene between events and our emotional reactions Cognitive Therapy The Cognitive Revolution Cognitive Therapy A cognitive perspective on psychological disorders Cognitive Therapy Cognitive therapy for depression Cognitive Therapy Cognitive-Behavioral Therapy a popular integrated therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior) Group and Family Therapies Family Therapy treats the family as a system views an individual’s unwanted behaviors as influenced by or directed at other family members attempts to guide family members toward positive relationships and improved communication