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PSYCHOLOGY
Fourth E d i t i o n
by
Robin Kowalski & Drew Westen
PowerPoint  Presentation
C h a p t e r 16
TREATMENT OF
PSYCHOLOGY DISORDERS
John Wiley & Sons, Inc.
Lecture Outline
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Biological Therapies
Psychotherapies
Evaluating Therapies
© 2004 John Wiley & Sons, Inc.
The Medical Model
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The Medical Model views abnormal
behavior as reflecting a biological disorder
 Usually localized within the brain
 Involving either brain damage or a disruption
of the neurotransmitter processes of the brain
 Person is viewed as a patient, treated by
doctors in a mental hospital
 Therapies tend to be physical in nature
• Drugs (Pharmacotherapy)
• Surgical alteration of brain (Psychosurgery)
© 2004 John Wiley & Sons, Inc.
Pharmacotherapy
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Psychotropic medications are drugs that
act on the brain to alter mental function
Prior to 1956, schizophrenia was virtually
untreatable with many patients confined
for life in mental hospitals
 Chlorpromazine (Thorazine) was found to
reduce severity of psychotic thought, allowing
people to live outside of mental institutions
• Reduced size of institutions
 The psychotropic actions of many drugs are
often accidentally discoveries
© 2004 John Wiley & Sons, Inc.
Impact of Chlorpromazine on
Institutionalization
© 2004 John Wiley & Sons, Inc.
(Figure adapted from Davis, 1985)
Psychotropic Mechanisms of
Action
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Psychotropic drugs can alter behavior via:
 An interaction with neurotransmitters in brain
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Some release specific transmitters
Some block the reuptake of transmitters
Some interact with postsynaptic receptors
Some may act within neuron cells
 A placebo effect
• Subjects believe in the efficacy of the drug and
show an actual change in function (analgesia or
relief from pain shows moderate placebo effects)
© 2004 John Wiley & Sons, Inc.
Neurotransmitter Interactions
© 2004 John Wiley & Sons, Inc.
Antipsychotic Medications
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Schizophrenia can be viewed as composed
of:
 Positive Symptoms: Presence of hallucinations
 Negative Symptoms: Absence of affect
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Antipsychotic medications refer to drugs
that alleviate schizophrenia
 Antipsychotic medications are more effective
for the positive symptoms than for negative
symptoms of schizophrenia
© 2004 John Wiley & Sons, Inc.
Dopamine and Schizophrenia
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The positive symptoms of schizophrenia
reflect too much brain dopamine activity
 Antipsychotic drugs are effective antagonists
of dopamine receptors (block the action of
dopamine)
 Drugs such as amphetamine release
dopamine from terminals; too much
amphetamine exposure can induce a
psychotic state in humans
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Negative schizophrenic symptoms may
reflect brain damage enlarged ventricles)
© 2004 John Wiley & Sons, Inc.
Glutamate and Schizophrenia
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Both positive and negative symptoms of
schizophrenia can be replicated by
altering glutamate receptors
 Drugs such as PCP (Angel Dust) alter
glutamate sensitivity at terminals in a way
that leads to the symptoms of schizophrenia
 A new drug that reduces brain levels of the
chemical glutamate prevents schizophrenialike symptoms in mice.
© 2004 John Wiley & Sons, Inc.
Antidepressant Medications
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Depression reflects a disturbance of mood,
sleep, and appetite
Psychotropic antidepressant drugs can lift
depression (require 3-4 weeks for effect)
 Tricylic antidepressants: Act by blocking the
reuptake of norepinephrine and serotonin
 Monoamine oxidase (MAO) inhibitors: MAO
degrades transmitters; drugs that inhibit MAO
allow the transmitter to work for longer periods
 Selective serotonin reuptake inhibitors: Prozac
blocks the reuptake of serotonin
© 2004 John Wiley & Sons, Inc.
Antidepressant Medications and
Relapse Rates
(Figure adapted from Maj et al., 1992)
© 2004 John Wiley & Sons, Inc.
Antianxiety Medications
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Anxiety reflects an intense emotional state
of dread and apprehension
Drugs such as Valium increase the activity
of the transmitter GABA to dampen the
neural activity of the brain
 Valium is useful in the short-term treatment of
anxiety
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Antianxiety medications can result in drug
dependence
© 2004 John Wiley & Sons, Inc.
Electroconvulsive Therapy
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Antidepressant drugs require 3-4 weeks to take
action on mood; the person may be at risk for
suicide or is not responding to drug treatment
Electroconvulsive shock therapy (ECT) refers to
the intentional induction of a brain seizure by
shock administered to either or both
hemispheres
 ECT produces immediate improvement in mood
(explanation is unknown)
 Side effects of ECT include memory loss
© 2004 John Wiley & Sons, Inc.
Psychosurgery
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Psychosurgery refers to the intentional damage
of the brain to alter behavior
 In contrast to neurosurgery, which refers to alteration of
the brain to alter a known medical issue (e.g. remove a
tumor or a blood clot)
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Trephining: Ancient skulls show evidence of
holes drilled as if to release evil spirits
Lobotomy: Surgical procedure used by Egas
Moniz to “calm” agitated patients
 Side effects include loss of frontal lobe function
© 2004 John Wiley & Sons, Inc.
Psychological Therapies
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Whereas the biological therapies view
mental disorders through the medical
model, psychological therapies view the
roots of abnormal behavior in mental
states
 Each therapy has its own view as to the
cause of mental disorder
 Each therapy has its own approach to the
treatment of mental disorder
© 2004 John Wiley & Sons, Inc.
Varieties of Psychological
Treatment
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Psychodynamic
Cognitive-behavioral
Humanistic
Family and marital
Biological
© 2004 John Wiley & Sons, Inc.
Psychodynamic Approach
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The psychodynamic approach was created
by S. Freud
 Mental symptoms reflect unconscious conflicts
that induce anxiety
 Insight refers to the situation in a person
comes to understand their unconscious
conflicts
 Therapeutic change requires an alliance
(relationship) between the patient and therapist
© 2004 John Wiley & Sons, Inc.
Psychodynamic Techniques
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The goal of psychodynamic therapy is to
achieve insight into unconscious conflicts
 Free Association refers to a technique in
which the patient is encouraged to say
whatever comes to mind to reveal the
unconscious processes of the patient
 Interpretation: Therapist interprets the
thoughts, and feelings of the patient in order
to reveal the hidden conflicts and motivations
 Analysis of transference: Patients bring into
therapy their past troubled relationships;
these are transferred to the therapist
© 2004 John Wiley & Sons, Inc.
Cognitive-Behavioral Therapies
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Cognitive-behavioral therapies focus on
the current behaviors of a person
 Emphasis is on the present rather than the
past
 Cognitive-Behavioral therapists are very
directive
 Therapy duration is short-term rather than
years long
 Initial focus is on a detailed behavioral
analysis: focus is on the problem behavior
and the stimuli associated with it
© 2004 John Wiley & Sons, Inc.
Behavior Therapies
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Classical conditioning techniques can alter
emotional responses
 Systematic desensitization: Patient is encouraged to
confront a feared stimulus (snake) while in a relaxed
state
• Therapist trains relaxation
• Patient constructs an image hierarchy
• While relaxing, patient imagines the least fearful of the
images in their hierarchy (e.g. being on the planet as a
snake)
 Exposure: Patient is exposed to the stimulus that
they fear (locked in a room full of snakes)
© 2004 John Wiley & Sons, Inc.
Cognitive Therapies
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Focus of cognitive therapies is on
changing dysfunctional thought patterns
Rational Emotive Therapy focuses on the
hurtful thought patterns of the patient
 Ellis’s theory suggests that pathology results
when persons adopt illogic in response to life
situations
 Therapist notes illogical and self-defeating
thoughts and teaches alternative thinking that
promotes rational thought
© 2004 John Wiley & Sons, Inc.
Gestalt Therapies
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Gestalt therapists emphasize that losing
touch with ones feelings in order to meet
social obligations is the root of mental
disorder
 Focus of gestalt therapy is to have people
focus on their current feelings
 Empty-chair technique: Therapist places an
empty chair next to the client and asks them
to imagine that the object of their emotion is
actually sitting in the chair. The client then is
asked to direct their conversation to the chair
© 2004 John Wiley & Sons, Inc.
Eclectic Therapy and Schizophrenia
(Figure adapted from Herz et al., 2000, p 280.)
© 2004 John Wiley & Sons, Inc.
Evaluation of Therapies
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Pharmacotherapy
 Drug therapies for depression, anxiety, and
schizophrenia can be effective in a number of
patients; focus is on long-term treatment
(years)
 Issues are related to side effects of the drugs
and to the high relapse rate when the drugs
are stopped
 Continued use of certain drugs can minimize
relapse of mental disorder
© 2004 John Wiley & Sons, Inc.
Copyright
Copyright 2004 by John Wiley & Sons, Inc., New
York, NY. All rights reserved. No part of the
material protected by this copyright may be
reproduced or utilized in any form or by any means,
electronic or mechanical, including photocopying,
recording, or by any information storage and
retrieval system, without written permission of the
copyright owner.
© 2004 John Wiley & Sons, Inc.