Download Unit XIII Treatment of Psychological Disorders

Unit XIII Treatment of
Psychological Disorders
Brief Historical Perspective Plus Contemporary Practices
An introduction to the treatment of psychological disorders through an
overview of the approaches used by therapists of different treatment
orientations. The orientations include Psychoanalytical,
Psychodynamic, Humanistic, Behavioral, Cognitive, Biomedical,
Therapeutic Lifestyle Changes and Alternative strategies.
Dr. Connie Giles
3/18/2012
Page 2 of 19
Unit XIII Treatment of Psychological Disorders—
Table of Contents
A Brief History of Psychological Disorders:
Causes & Treatments
Page 3
Psychoanalysis
Page 5
Psychodynamic Therapies
Page 6
Humanistic Therapies
Page 7
Behavioral Therapies
Page 8
Cognitive Therapies
Page 10
Biomedical Therapies
Page 12
Brain Stimulation
Page 15
Psychosurgery
Page 16
Therapeutic Lifestyle Change
Page 17
Alternative Therapies
Page 17
Does Therapy Help?
Page 18
Additional Resources
`
Page 19
Page 3 of 19
AP Psychology ISC/Unit XIII—Treatment of Psychological Disorders
Topic: History of Mental Illness & Treatments through Current Treatment Trends and Practices
I. A Brief History of Psychological Disorders: Causes & Treatments
Why study history?
Mostly to learn from our past mistakes. For as long as there have been people living in groups, there also have been
some individuals who behaved in disturbing and abnormal ways. As such, people have tried to understand or explain
why some individuals are abnormal. These explanations are the theories about what causes psychological disorders. A
theory about what causes a disorder allows a treatment to be developed. For example, if we theorized that depression is
caused by low levels of norepinephrine, serotonin and dopamine, then a treatment is developed to increase the level of
these neurotransmitters in the brain.
The value of any treatment (and the theory) is best evaluated by knowing how many and how much it helps people
with psychological disorders. A treatment that helps only a few people with psychological disorders or helps only a little
bit, may be based on an inadequate theory. So the theory is changed or abandoned for a new theory, and we try again.
History helps us learn about theories and treatments that have been tried, but failed to help people with psychological
disorders. Hopefully, by knowing about what didn’t work, we can develop new treatments that are more effective and
help more people with psychological disorders.
1. 500 BC - 500 AD
Especially in ancient Greece (and later in Rome), mental illness was believed to be a medical problem - treatable by
physicians. Hippocrates, in particular, believed that mental disorders were caused by an imbalance of the body's fluids
or humors - blood, bile, phlegm, and water. Too much or too little of any humor could cause mental illness. For
example, too much bile could lead to depression.
The imbalance of humors was treatable. The treatment was usually had the sufferer consume powdered plant roots,
leaves, or other natural substances. Theoretically, these substances would restore the bodily humors to a balanced
state and a balanced body should lead to a balanced mind.
Although Hippocrates’ theory was not entirely correct, some of his ideas are the basis for today’s medical model
which assumes that psychological disorders may have natural causes and should be treated as a disease. Treatment
with herbs and natural substances has been replaced by a pharmacopoeia of psychoactive drugs, surgery, and electroconvulsive therapy.
The notion of bodily humors is similar to the contemporary idea of genetically determined psychological traits. In trait
theory, too much of some traits may be the source of psychological disorders. For example, an extremely extroverted
and emotionally unstable person may have episodes of mania.
Page 4 of 19
2. 500 - 1700
Sometime after the fall of the Roman empire, the Catholic Church became the major social and political institution
throughout Europe. Many psychological disorders were seen as disturbances of the spirit and therefore in the sphere of
the church. Abnormal behavior was the product of possession or having one's mind taken over by demons.
Initially, the church distinguished between voluntary and involuntary possession. In involuntary possession, it was
believed that the victim was seized by the devil as a punishment for sin and became mentally ill. Priests provided
treatment by attempting to coax out the evil spirits through exorcism rituals such as praying, laying on of hands, scaring
out the devil with curses, threats, and so on.
Other people were believed to have made a deliberate pact with the devil for personal gain or vengeance. These
people were branded as witches and believed to have supernatural powers to control normal people, destroy crops and
livestock, or cause natural disasters. In these people, the devil needed to be destroyed usually by fire or drowning.
The distinction between voluntary and involuntary possession became blurred, so that by the 1600s, nearly anyone
accused of being a witch (or mentally ill) was tortured then murdered. Some history texts on psychopathology point out
that a disproportionate number of mentally ill women, rather than men, were killed in Europe during these centuries.
3. 1700 - 1900
By the 17th century in Europe, people with psychological disorders or "madmen" were seen as dangerous animals that
should be caged in order to protect society. Anyone undesirable - criminals, lepers, old people, and the mentally ill - was
confined in asylums. Such institutions were usually dungeons where food and fresh hay were dumped in once a week or
so by the keepers. Many institutions charged a small admission fee for the public to view the caged madmen. Needless
to say, there was a very high mortality rate among inmates of these asylums.
Physicians were challenging church doctrine about demonic possession by the 1500 and 1600's, advocating a newer
version of Hippocrates’ medical model of psychological disorders. By 1793, a French physician, Philippe Pinel,
introduced a new idea that "humane treatment" in institutions could cure or help people get better so that they could
eventually return to the community. Instead of being dangerous animals in a prison, mentally ill people should be seen
as sick patients to be treated in a hospital. Some of Pinel’s ideas are the basis of contemporary humanistic theory.
By 1897, medical researchers discovered that untreated syphilis infections were the cause of some psychological
disorders. Other physicians also were experimenting with medical treatments for psychological disorders in the 1700s
and 1800s. For example, Benjamin Rush (an American physician) experimented with rapidly spinning patients in special
chairs; Franz Mesmer (an Austrian physician) experimented with various concoctions of herbs and natural substances,
which he boiled in large vats so patients could breath in the fumes; and Jean Charcot (a French physician) experimented
with hypnosis. Sigmund Freud studied with Charcot, and later developed psychoanalytic treatment methods.
4. 1900 -2000 - See descriptions in Part II and also Myers (page 618) table 13.1 Comparison of a Sample of Major
Psychotherapies
Page 5 of 19
II. Psychological Therapies & Biomedical Therapies
Psychoanalysis
* repressed anxieties about unresolved childhood conflicts
* "schizophrenic mother" or schizophrenic family system
* help client to get in touch with repressed feelings & conflicts in order to gain insight; once the client
understands then s/he can resolve the conflict.
* techniques include:
1) free association to overcome resistance
2) interpretation of dreams
3) analyzing transference
Psychoanalysis assumes that the past experiences cause current psychological problems. Psychoanalysis, like
Humanistic therapies, are often called insight therapies. Because these post experiences were emotionally upsetting,
negative and hurtful, the person represses memory of these experiences into the unconscious. Therefore, the therapist
talks with the client to reconstruct or uncover these past experiences. However, since the memories are unconscious,
the therapist must use indirect methods to discover these repressed memories. Furthermore, since these unconscious
memories are painful, the client is likely to use defense mechanisms to resist discovering these painful past experiences.
The indirect methods that a psychoanalyst uses include:
* free association - the therapist says several words and the client says the first thing that comes to mind in
response to each stimulus word.
* dream interpretation - unconscious conflicts are believed to be symbolically represented in dream content.
Recurring dreams or emotionally charged dreams are especially important for uncovering unconscious memories.
* transference - the therapist tries to be a stand-in or substitute for other persons in the client's life who caused
the past emotional stress. For example, if a person has an unresolved anger toward his/her father, the therapist
encourages the client to see the therapist as a father-like substitute - and transfer the angry feelings into the clienttherapist relationship. Now, the therapist can help the client with expressing, managing and resolving conflicts
associated with these feelings.
Page 6 of 19
Psychodynamic Therapies
Influenced by Freud, Psychodynamic therapists try to understand a patient’s current symptoms by focusing on themes
across important relationships, including childhood experiences and the therapist’s relationship. Psychodynamic
therapists also help the person to explore and gain perspective on defended-against thoughts and feelings. Unlike
Psychoanalysts, the Psychodynamic therapist will:
*Talk face to face with patients (and not out of a patient’s line of vision)
*Meet with clients once per week (as opposed to several times per week)
*Meet with clients for a period of a few months (rather than several years)
Psychodynamic therapy is another form of insight therapy. One version, Interpersonal psychotherapy (see Myers page
608), has proven effective in treating depression.
Page 7 of 19
Humanistic Therapies
* environmental stressors
* lack of social support or friends
* person-centered therapy
1) unconditional positive regard
2) active listening
* Gestalt therapy
Humanistic therapies, like Psychoanalysis therapies, are often called insight therapies. Humanistic therapy differs
from Psychoanalytical, though, in that it focuses on the present and the future more than the past; the conscious
thoughts of clients more than the unconscious; a client’s need to take immediate responsibility for his or her own
feelings rather than uncovering hidden determinants; and, a promoting growth rather than curing an illness. Note the
reference to “clients” versus “patients” under the humanistic perspective.
Carl Rogers developed the therapeutic technique he called Client-centered therapy - the therapist focuses on the client's
conscious self, listens to the client without judging or interpreting comments, and expresses unconditional positive
regard for the client. The therapy is referred to as non-directive. Rogers believes that most people already possess the
resources for growth, so he encouraged therapists to exhibit genuineness, acceptance, and empathy. Rogers
encouraged a grace filled, non-judgmental environment for therapy.
* active listening—echo, restate, and seek clarification of what the person says to the therapist both verbally
and non-verbally
* paraphrase—Check for understanding by summarizing the speaker’s feelings in your own words rather than
saying, “I know how you feel.”
* invite clarification—Ask questions like, “What might be an example of that?” By doing so, the therapist
encourages the speaker to say more.
* reflect feelings—Try to mirror (in words) what the therapist senses the client is sharing based on body
language and intensity of words
Page 8 of 19
Behavioral Therapies
* peculiar reinforcement history
* overgeneralization
* classical conditioning
systematic desensitization & aversive conditioning
* operant conditioning
token economies
Behavioral therapies assume that the behavior is the problem and that there are no unconscious conflicts or
underlying problems of self-esteem. Instead, psychological disorders are behaviors that have been learned - sometimes
under extreme or unusual circumstances. If disordered behavior is learned, then it can be unlearned or extinguished.
Classical conditioning and Operant conditioning theories each offer variations of behavioral therapies.
Classical Conditioning Therapies:
(1) The classical conditioning technique involves the use of Counterconditioning (pairing the trigger stimulus with a
new response, which is incompatible with fear)
(2) Exposure therapies “expose” people to what they would normally avoid
i. Systematic Desensitization - This therapy has been especially effective for treating phobias. It is based on the
idea that an individual cannot be relaxed and anxious at the same time. First, the situations that trigger anxiety
are identified and rank ordered based on how much anxiety each situation triggers. Second, the client is taught
relaxation techniques. Next, the client imagines the least anxiety provoking situation and practices the
relaxation techniques. Several trials of relaxing while imagining the anxiety situation may be needed until the
situation triggers a relaxation response instead of an anxiety response. This process is repeated with the next
situation on the hierarchy, then the next, then the next. Eventually, the client will practice relaxation techniques
in the real situations until there are no more anxiety responses in those situations.
Flooding—flooding is an extreme and controversial form of systematic desensitization in which patients
are immersed in the object or situation that they fear. For example, being thrown in a pool of water or having
bugs that you fear crawling all over you. The idea of “flooding” is to show the person that they have no reason
to fear and that experiencing the feared situation or object in this way will lead to less fear later.
ii. The exposure therapy technique was originally developed in 1924 by Mary Cover Jones (a student of John
Watson who was concerned with Watson’s Little Albert experiments). Jones’ ideas did not get attention until the
1950’s when Joseph Wolpe, a psychiatrist, refined her technique and began using it.
iii. When an anxiety-arousing situation is too expensive, difficult or embarrassing to recreate, Virtual Reality
Exposure Therapy is used as a middle ground.
Page 9 of 19
(3) Aversive Conditioning - This therapy has been used most with undesirable compulsive behaviors, such as
alcoholism or child molesting. It is also based on the idea that a fear response cannot occur at the same time as a
pleasurable or arousal response. This stimulus that has provoked a positive response is paired with an aversive stimulus.
For example, alcoholic drinks are laced with another drug that induces vomiting. Several trials of drinking and vomiting
should extinguish the undesirable behavior. Unfortunately, aversive conditioning has the same problems associated
with using punishment as a learning tool. A client may learn not to drink in the presence of the therapist, but drinking in
the neighborhood bar is still O.K.
Operant Conditioning Therapies
(1) Therapists employ the basic concepts of operant conditioning known as behavior modification (reinforcing
desired behaviors or enacting punishment for undesired behaviors)
(2) Token Economies - A system of rewards or points is created to reward positive or desirable behaviors. Rewards
or points are lost when the client performs undesirable behaviors. Token economies work best when they are used in
institutional settings or group-homes where there can be frequent monitoring of behavior and frequent rewards. As the
client gets used to the token economy, time intervals between rewards can be increased. Eventually, points or rewards
also need to be replaced with naturally occurring positive or negative consequences.
(3) Critics question
i. Ethical nature of this therapeutic approach (“Is it right for one human to control another?”)
ii. Durability of the behaviors demonstrated (“How durable are the behaviors?” and “Will people become so
dependent on extrinsic rewards that the appropriate behaviors will stop when the reinforcers stop? What are the
implications for institutionalized persons who are discharged and no longer subject to behavior modification strategies?)
Page 10 of 19
Cognitive Therapies
* irrational belief systems
* learned helplessness & attributions of self-blame
* rational-emotive therapy (Ellis)
* cognitive-behavioral therapy for depression (Beck)
Cognitive therapies recognize the importance of disordered behavior patterns, but also that one’s thoughts and feelings
about oneself, relationships, and so forth, affect psychological disorders. In particular, a symptom of many disorders is
negative thoughts about the self such as self-blame. Another negative thought process common in many psychological
disorders is overgeneralization. Often self-blame and overgeneralization are accompanied by an external locus of control
- or the belief that the self cannot influence his or her own experiences.
Self-blame is the belief that everything that goes wrong is one’s own fault. For example, many women who are
physically beaten by relationship partners blame themselves for the partners’ violent behavior. The woman thinks that
she is not loving enough or that she is a bad cook or that she nags too much and provokes the beating. Similarly, she
may believe that she does not deserve a better relationship partner or that she could not live independently, so she
stays in the abusive relationship.
Overgeneralization is extending beliefs about one situation to many other unrelated situations. For example, a student
who fails a calculus class will also believe that she is bad at all math - statistics, algebra, geometry, etc. Furthermore, the
student may believe that she is just a bad student regardless of the subject and that she will probably flunk out of
college, will have problems finding or keeping a job, and that no one would want to have a relationship with a failure like
her.
External locus of control is the belief or perception that fate, destiny, or other environmental factors determine what
happens to an individual and the individual's "free-will" or "self-determination" have little or no impact on what
happens to the individual. If this belief is exaggerated, a person may fall into a pattern of learned helplessness, where a
person feels helpless, hopeless and no expectation of being able to do anything to improve his situation. Learned
helplessness (or lack of personal control) is common among people with mood disorders, anxiety disorders, and
substance abuse problems. (See chapter 14 in the textbook for more information.)
Page 11 of 19
(1) Rational-Emotive Therapy (RET) - This therapy directly challenges the logic of an individual’s self-blaming, over
generalizing, learned helplessness, and other irrational beliefs. It assumes that there is a thought or belief system for
every behavior; for maladaptive behaviors these beliefs are irrational or illogical (Albert Ellis, 1974). An example of an
irrational belief system would suggest that:
"Because I want something it is not only desirable or preferable that it exist, but it absolutely should exist and it is
awful when it really doesn't. It is so awful, that I just can't stand it!"
The therapist often restates the clients illogical believes in extreme, absurd terms....so absurd that the client is likely
to disagree with the therapist. The therapist contradicts irrational beliefs or statements by the client. Clients are often
given "homework" to take risks or do things that they are afraid of and take notes about all the bad things that did not
happen. The therapist often uses strong, confrontational language with the client.
(2) Cognitive Therapy (cognitive-behavioral therapy) - This therapy is commonly used with depressive disorders and
generally is effective. The focus of therapy is to identify, then dismantled negative self-thinking and replace these
negative thoughts with more positive thinking. Some cognitive therapies use humanistic techniques (e.g. unconditional
positive regard) to accomplish goals similar to those of RET
Page 12 of 19
Biomedical Therapies
Generally, biomedical therapies (also called somatic therapies) essentially accept Hippocrates theory - that
psychological disorders are physical disorders. Something must be 'wrong' with normal biological or physiological
processes and this causes the psychological problems. Therapy for the psychological problem must include some kind of
medical intervention or treatment for the body.
1. Drug Therapy (psychopharmacology) - In the 1950s, biochemists developed Thorazine, a psychoactive drug that
helps control symptoms of schizophrenia. This allowed many individuals to leave psychiatric hospitals and live with
family, friends, in supportive care facilities, or on their own. Since the 1950s, dozens of new drugs have be developed to
treat a range of psychological symptoms.
*Antipsychotic Drugs
(1) Thorazine dampens responsiveness to irrelevant stimuli; therefore, effective in patients with symptoms of
schizophrenia such as auditory hallucinations or paranoia
(2) The molecules of antipsychotic drugs such as Thorazine are similar enough to the molecules of Dopamine
such that the idea of an overactive dopamine system contributing to schizophrenia is reinforced
(3) Some antipsychotic drugs can cause sluggishness, tremors, etc. characteristic of Parkinson’s disease (which is
thought to be caused by the absence of enough Dopamine; so, a balance in the use of the drugs has to be maintained so
that remediating one disorder does not produce another disorder)
(4) Long term use of the antipsychotic drugs can produce Tardive Dykenesia or the involuntary movements of
the facial muscles (e.g., grimacing), tongue, and limbs
(5) Patients exhibiting the “negative” symptoms of schizophrenia (catatonia, loss of affect, etc.) do not respond
well to Thorazine. However, newer atypical antipsychotic drugs such as Clozaril that target both dopamine and
serotonin receptors have proved to be effective. Patients with “negative” symptoms are observed to have an
“awakening” when using the atypical antipsychotic medications.
(6) General additional side effects to monitor for the antipsychotic drugs are obesity and diabetes
(7) Antipsychotic drugs combined with life-skill programs and family support have been effective forms of
treatment
*Antianxiety Drugs
(1) Antianxiety drugs such as Xanax or Ativan depress central nervous system activity (and so should not be used
with alcohol)
(2) Antianxiety drugs are often used in combination with psychotherapy
Page 13 of 19
(3) A new antianxiety drug, the antibiotic D-Cycloserine, acts upon a receptor that facilitate the extinction of
learned fears. Experiments indicate that the drug enhances the benefits exposure therapy and helps relieve the
symptoms of PTSD and obsessive compulsive disorder,
(4) Antianxiety drugs are criticized (similar to behavior therapies) for reducing the symptoms of the anxiety
disorder without resolving the underlying problem
(5) Antianxiety drugs are also criticized for contributing to an individual’s over reliance (over time) on them
resulting in psychological and physiological dependence. After heavy use, people who stop taking them may experience
increased anxiety, insomnia, and other withdrawal symptoms
(6) See Myers rates of use info page 630 (steadily increasing and the latest treatment for anxiety disorders is the
use of Antidepressants)
*Antidepressant Drugs
(1) Increasingly being used to treat such disorders as OCD
(2) For depression, the antidepressants work by increasing the availability of norepinephrine or serotonin, the
neurotransmitters that elevate arousal and mood and which are both scarce during depression
(3) Prozac (Fluoxetine) partially blocks the removal and/or reabsorption of serotonin.
(4) Because Prozac and similar drugs (Zoloft, Paxil, etc.) slow down the synaptic vacuuming up of serotonin,
these drugs are called selective-serotonin-reuptake-inhibitors or SSRIs.
(5) Other antidepressants work by blocking the reabsorption or breakdown of both norepinephrine and
serotonin. (Monamine Oxidase Inhibitors or MAOIs). These older drugs have more potential side effects such as dry
mouth, weight gain, hypertension, or dizzy spells. They are often administered using a patch so that the medication
bypasses the intestines and liver, which helps to reduce the side effects.
(6) After the introduction of SSRI’s, the percentage of patients receiving medication for depression jumped
dramatically. Women, more than men, take antidepressants.
(7) Antidepressants take about 4 weeks to get into the system and show effect. Anti depressants also contribute
to neurogenesis (the birth of new brain cells).
(8) Documented side effects, which are rare, include suicide for some patients taking Prozac. But there is no firm
evidence that groups of individuals taking Prozac have elevated rates of suicide.
Page 14 of 19
*Mood Stabilizing Medications
(1) The simple salt, Lithium, can be an effective mood stabilizer for people suffering the emotional highs and
lows of bipolar disorder
(2) Australian, John Cade, accidently discovered the effective use of Lithium with a bipolar patient (he thought
use of the drug had earlier calmed excitable guinea pigs, but the drug actually made the guinea pigs sick!). Nonetheless,
his patient was responsive to the use of Lithium.
(3) How Lithium works is not fully understood.
(4) Another drug, Depakote (which was originally intended to control seizures) is also used to effectively control
the manic episodes associated with bipolar disorder.
Summary Observations on Drug Therapy-- Psychoactive drugs may mimic the normal effects of neurotransmitters, or
increase the amount of the neurotransmitter being released (agonist), or block receptors sites (antagonist), etc.
However, no psychoactive drug is a perfect replacement for normal brain functioning. For example, we suspect that
multiple neurotransmitters interact and influence the effects of one another. Many of the neuro-chemical processes are
not well understood, so we cannot replicate these processes with drugs. Also, there are side effects - these are the extra
effects of the drug that are not needed or wanted. For example, many drugs like Thorazine cause Tardive Dykenesia, a
condition that causes Parkinson like tremors and sluggishness.
Page 15 of 19
2. Brain Stimulation
* Electro-convulsive Shock Therapy (ECT) - This is used only with depressed clients who are dangerously suicidal
and who have not responded to other forms of treatment. Famous patient, Kitty Dukakis. (See full description
Myers page 632)
(1) Patients are electrically shocked into convulsions (30 to 60 seconds of electrical current; patients now receive
anesthesia and muscle relaxants to prevent injury from convulsions)
(2) After 3 sessions a week for two to four weeks, patients show improvement. There is some memory loss for
the treatment period but no discernible brain damage.
(3) How the method works is not clearly known—it is like rebooting a computer!
*Alternative Neuro stimulation therapies
(1) Vagus nerve stimulation-- Some patients have found relief for chronic depression through a chest implant
that intermittently stimulates the vagus nerve, which sends signals to the brain’s mood-related limbic system
Vagus nerve stimulation is a procedure that sends electrical impulses into your brain in an effort to improve
depression symptoms. Sometimes called vagal nerve stimulation, vagus nerve stimulation is one of a few newer
brain-stimulation methods designed to treat chronic depression when other treatments haven't worked.
There's one vagus nerve on each side of your body. Each nerve runs from your brainstem through your neck and
down to your chest and abdomen.
With vagus nerve stimulation, a device called a pulse generator is surgically implanted in your chest. A wire
threaded under your skin connects the pulse generator to the left vagus nerve in your neck. The pulse generator
sends out electrical signals along the vagus nerve to your brain. These signals affect mood centers of your brain,
which may improve depression symptoms
(2) Magnetic stimulation—more gentle than vagus nerve stimulation—Patients seem to improve when repeated
pulses surge through a magnetic coil held close to the person’s skill.
i. The magnetic energy penetrates to the brain’s surface
ii. The procedure is painless and is called repetitive Transcranial magnetic stimulation (rTMS)
iii. One possible explanation is that stimulation energizes depressed patient’s relatively inactive left
frontal lobe. When repeatedly stimulated, nerve cells can form functioning circuits through long-term
potentiation (LTP). See Myers Unit 7A for a discussion on long-term potentiation.
Page 16 of 19
(3) Deep brain stimulation—patients who have resisted both drugs that flood the body and ECT that jolts at least
half the brain have benefited from an experimental treatment that involves implanting electrodes and a
pacemaker stimulator in areas of the brain known to be associated with depression
i. Neurologist Helen Mayberg identified a area of the brain she calls the “brain depression center” (a
cortex area that bridges the thinking frontal lobes to the limbic system; this area is overactive in depressed or
sad people, but is calmed when ECT or antidepressants are administered)
ii. Mayberg sought to implant electrodes and a pacemaker in the “brain depression center” to excite
those neurons that inhibit the negative emotion-feeding activity
iii. Mayberg modeled her work after the deep-brain technology sometimes used for Parkinson’s
patients. More research needs to be done in this area.
3. Psychosurgery - Brain tissue is removed or destroyed. More common in the past, today this is a rarely used
treatment for psychological disorders.
i. Lobotomy—a now rare psychosurgical procedure once used to calm uncontrollably emotional or
violent patients. The procedure cut the nerves connecting the frontal lobes to the emotion-controlling centers
of the inner brain.
ii. The lobotomy procedure is not used today; other psychosurgeries are used rarely
iii. For instance, an MRI guided precision surgery is done occasionally to cut the circuits involved in
severe obsessive-compulsive disorder.
iv. The psychosurgery procedures are irreversible. Therefore, neurosurgeons perform them as a last
resort
Page 17 of 19
Therapeutic Lifestyle Change
*Aerobic exercise (30 minutes per day)
*Adequate sleep (7 hours sleep)
*Light exposure (30 minutes each morning with a light box)
*Social connections (two meaningful social engagements weekly)
III. Alternative Therapies
Observations and Critical Questions
The tendency of many abnormal states of mind to return to normal, combined with the placebo effect, creates a fertile
ground for pseudo therapies. Some methods include: herbal medicine, massage, and spiritual healing, etc.
To what extent should science guide both clinical practice and the willingness of health care providers and insurers to
pay for psychotherapy? (That is, should therapeutic practice be based on evidence and making mental health professionals
accountable for effectiveness?)
Are people too complex and therapy too intuitive to describe in a manual or test in an experiment? (That is, Should
people be protected from pseudo-therapies or should non-evidenced based therapies be allowed on “trust that they work?”)
Alternative Therapies suggested to avoid
*Energy therapies—the purpose is to regulate a person’s invisible energy fields
*Recovered memory therapies—aims to unearth repressed memories of early childhoods abuse (see also Unit 7A)
*Rebirthing therapies—engaged people in reacting the supposed trauma of their birth
*Facilitated communication—has an assistant touch the typing hand of a child with autism
*Crisis debriefing—forces people to verbalize, rehearse, and “process” their traumatic experience
Page 18 of 19
Alternative Therapies that have been evaluated in research studies
*Eye Movement Desensitization and Reprocessing (EMDR)—Francine Shapiro developed EMDR one day while walking in
a park and observing that her anxious thoughts vanished as her eyes spontaneously darted about. Offering her novel anxiety
treatment to others, she had people imagine traumatic scenes while she triggered eye movements by waving her finger in
front of their eyes, supposedly enabling them to unlock and reprocess previously frozen memories.
Critique—individuals who participated in Shapiro’s technique (with trained EMDR therapists) showed reductions in anxiety,
but critics believe that what is therapeutic in her strategy is “the combination of exposure therapy or behavioral
desensitization—repeatedly associating with traumatic memories a safe and reassuring context that provides some
emotional distance from the experience—and a robust placebo effect.
*Light Exposure Therapy—a therapeutic treatment associated with the “blahs,” weight gain, and general lethargic
feelings attributed to Seasonal Affective Disorder (SAD). To counteract the dark spirits that result from long, wintry and dark
days people are given a timed, daily dose of intense light.
Critique—Based on 20 carefully controlled studies, morning light does indeed dim SAD symptoms for many people.
Moreover, it does so as effectively as taking antidepressant drugs or undergoing cognitive-behavioral therapy. The effects
are clear in brain scans; this therapy sparks activity in a brain region that influences the body’s arousal and hormones.
IV. Does Therapy Help? (See also Myers The Relative Effectiveness of Different Types of Therapies page 622)
Research Findings. The short answer is "yes, therapy helps people with psychological disorders." But, not everyone
is helped to the same extent.
* Therapy is most effective when the problem is clear-cut and the client is motivated to get better.
* Improvement may not be permanent; people do have relapses and these are most likely to occur when they
face new traumatic, stressful life circumstances.
* No one type of therapy (e.g., psychoanalysis, behavioral, cognitive, or humanistic) is substantially better than
the others; all psychological therapies seem to have positive effects.
Common Features that seem to help.
* a therapist offers a new perspective to the client - by looking at problems in a new way, people can have new
ideas for solutions.
* the therapist offers an empathic, caring, trusting relationship to the client.
* the new perspective and caring relationship helps the client develop hope and optimism about his or her
situation.
Page 19 of 19
Additional Resources (Haiku)
Untold Story of Psychotropic Drugs (Documentary)
Discovery Inside Out Series: Therapy (http://player.discoveryeducation.com/index.cfm?guidAssetId=4986B3EE-51F644F2-A602-1EF9197954E6&blnFromSearch=1&productcode=US)
Annenberg Learner Series on Psychological Disorders
(www.learner.org/resources/series60.html?pop=yes&pid=786#
Depression: Serotonin Not the Whole Story http://www.npr.org/blogs/health/2012/01/31/146096540/i-wantedto-live-new-depression-drugs-offer-hope-for-toughest-cases
CBS News 60 Minute Report on Depression and Its Treatment