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!   Treating Psychological Disorders
!   The psychological therapies
!   Evaluating psychotherapies
!   The biomedical therapies
!   Preventing psychological disorders
The Granger Collec.on, NYC — All rights reserved.
THE HISTORY OF TREATMENT
Visitors to eighteenth-century mental hospitals paid to gawk at patients,
as though they were viewing zoo animals. William Hogarth’s (1697–1764)
painting captured one of these visits to London’s St. Mary of Bethlehem hospital
(commonly called Bedlam).
Approach Differences
!   Psychotherapy
!   Therapy in which a trained therapist uses
psychological techniques to assist someone seeking
to overcome difficulties or achieve personal growth
!   Biomedical therapy
!   Therapy in which a trained therapist, most often a
medical doctor, offers medications and other
biological treatments
!   Eclectic approach
!   Uses blend of therapies
The Psychological Therapies
!   Psychoanalysis and psychodynamic therapy
!   Humanistic therapies
!   Behavior therapies
!   Cognitive therapies
!   Group and family therapies
The Psychological Therapies
!   Psychoanalysis
!   Goals: To bring patients’ repressed feelings into
conscious awareness; to help patients release energy
devoted to id-ego-superego conflicts
!   Techniques: Historical reconstruction, initially through
hypnosis and later through free association;
Interpretation of resistance, transference
In psychoanalysis, patients may experience strong
feelings for their analyst, which is called ________.
Patients are said to demonstrate anxiety when
they put up mental blocks around sensitive
memories—showing ________.
The analyst will attempt to offer insight into the
underlying anxiety by offering a(n) ________ of the
mental blocks.
Tetra Images / Ge=y Images
Psychodynamic
Therapy
FACE-TO-FACE THERAPY In this
type of therapy session, the couch has
disappeared. But the influence
of psychoanalytic theory may not
have, especially if the therapist seeks
information from the patient’s
childhood and helps the patient
reclaim unconscious feelings.
!   Goals: To help people
understand current
symptoms; to explore
and gain perspective
on defended-against
thoughts and feelings
!   Techniques: Clientcentered face-to-face
meetings; Exploration
of past relationship
troubles to understand
the origins of current
difficulties
Humanistic Therapies
!   Theme: Emphasis on people’s potential for self-
fulfillment; to give people new insights
!   Goals: To reduce inner conflicts that interfere
with natural development and growth
!   Techniques: Client-centered therapy; focus on
taking responsibility for feelings and actions and
on present and future rather than past
Humanistic
Therapies
!   Rogers
Time & Life Pictures/Ge=y Images !   Person-centered therapy
focuses on a person’s
conscious selfperceptions; nondirective; active listening;
unconditional positive
regard
ACTIVE LISTENING Carl Rogers (right)
empathized with a client during this
group therapy session.
!   Most people possess
resources for growth
!   Therapists foster growth
by exhibiting
genuineness, acceptance,
and empathy
Humanistic Therapies
!   Strengthening communication: Rogers
!   Summarize
!   Invite clarification
!   Reflect feelings
Behavior Therapies
!   Classical conditioning techniques
!   Counterconditioning: Uses classical conditioning to
evoke new responses to stimuli that are triggering
unwanted behaviors
!   Exposure therapies: Treat anxieties by exposing
people (in imagination or actual situations) to the
things they fear and avoid
!   Systematic desensitization: Associates a pleasant,
relaxed state with gradually increasing, anxietytriggering stimuli
Virtual Reality
Exposure Therapy
creative electronic
simulations in which
people can safely face
their greatest fears,
such as airplane
flying, spiders, or
public speaking
Jack Kearse/ Emory University
!   Treats anxiety by
Within the confines of a room,
virtual reality technology exposes
people to vivid simulations of feared
stimuli, such as walking across a
rickety bridge high off the ground.
Aversion Therapy for Alcohol Abuse
Therapists gave people with a history of alcohol abuse a mixed drink containing alcohol
and a drug that produces severe nausea. After repeated treatments, some people
developed at least a temporary conditioned aversion to alcohol. (Classical conditioning
terms: US is unconditioned stimulus, UR is unconditioned response, NS is neutral
stimulus, CS is conditioned stimulus, and CR is conditioned response.)
Operant Conditioning
!   Operant conditioning therapy: Consequences
drive behavior
!   Behavior modification: The desired behavior is
reinforced; undesired behavior is not reinforced
and is sometimes ignored or punished
!   Token economy: People earn a token for
exhibiting a desired behavior and can later
exchange the tokens for privileges or treats
Quick Comparisons
Insight
therapists
•  Assume selfawareness and
psychological
well-being are
complementary
Psychodynamic
therapists
Humanistic
therapists
•  Expect people’s
problems lessen
insight into
unresolved and
unconscious
tensions gained
•  Expect people’s
problems to
lessen as they
get in touch with
their feelings
Behavior
therapists
•  Assume
problem
behaviors are
the problems
How do the insight therapies differ from behavior
therapies?
Some maladaptive behaviors are learned. What
hope does this fact provide?
Exposure therapies and aversive conditioning are
applications of ________ conditioning. Token
economies are an application of ________
conditioning.
Cognitive Therapies
Cognitive Therapies
!   Cognitive therapies
!   Teach people new, more adaptive ways of thinking; Based
on the assumption that thoughts intervene between events
and our emotional reactions
!   Beck’s therapy for depression
!   Gentle questioning seeks to reveal irrational thinking and
then to persuade people to change their perceptions of
their own and others’ actions as dark, negative, and
pessimistic
!   People are trained to recognize and modify negative selftalk
Selected Cognitive Therapy Techniques
Cognitive Therapies
!   Cognitive-behavioral therapy
!   An integrative therapy that combines cognitive
therapy (changing self-defeating thinking) with
behavior therapy (changing behavior)
!   Aims to alter the way they act AND they way they
think
!   Helps people learn to make more realistic appraisals
How do the humanistic and cognitive therapies
differ?
What is cognitive-behavioral therapy, and what
sorts of problems does this therapy address?
Group and Family Therapies
!   Group therapy
!   Conducted with groups rather than individuals,
providing benefits from group interaction
!   Often used when client problems involve interactions
with others
!   Family therapy
!   Treats the family as a system
!   Views an individual’s unwanted behaviors as
influenced by, or directed at, other family members
John Moore/Ge=y Images News/Ge=y Images
FAMILY THERAPY This type of
therapy often acts as a preventive
mental health strategy.
•  The therapist helps family
members understand how
their ways of relating to one
another create problems
•  The treatment’s emphasis
is not on changing the
individuals, but on changing
their relationships and
interactions
Which therapeutic technique has focused more on the
present and future than the past, and has promoted
unconditional positive regard and active listening?
Which of the following is NOT a benefit of group
therapy?
a. more focused attention from the therapist
b. less expensive
c. social feedback
d. reassurance that others share troubles
Evaluating Psychotherapies
!   Is psychotherapy effective?
!   Which psychotherapies work best?
!   How do psychotherapies help people?
!   How do culture and values influence
psychotherapy?
!   CLOSE-UP: A consumer’s guide to
psychotherapists
Evaluating Psychotherapies
!   Clients’ perceptions
!   Client self-reports indicate that psychotherapy is
effective
!   Critics of client self-reports
!   Clients may need to justify their investment of effort
and money
!   Clients generally speak in positive terms of their
therapists
!   Clients often enter therapy in crisis
Evaluating Psychotherapies
!   Clinicians’ perceptions
!   Therapists are most aware of the failure of other
therapists
!   Outcome research
!   With or without psychotherapy: People improved
noticeably over time (Eyenck)
!   After extensive research review: Those not
undergoing therapy often improve, but those
undergoing therapy are more likely to improve
Evaluating Psychotherapies
Which Psychotherapies Work Best?
!   Some forms of psychotherapy work best for
particular problems
!   Behavior therapies: Bed-wetting, phobias,
compulsions, marital problems, and sexual
dysfunctions
!   Psychodynamic therapy: Depression and anxiety
!   Cognitive therapies: Anxiety, depression, and
posttraumatic stress disorder
Which Psychotherapies Work Best?
!   Unsupported approaches
!   Energy therapies
!   Recovered memories therapies
!   Rebirthing therapies
Which Psychotherapies Work Best?
Therapy is more likely to be helpful in those with
the ________ (most/least) clearly defined
problems.
What is evidence-based practice?
STEVE SZYDLOWSKI KRT/Newscom
How Do
Psychotherapies Help
People?
!   Three basic
benefits for all
psychotherapies
A CARING RELATIONSHIP
Effective counselor aboard a ship,
form a bond of trust with the
people they are serving.
!  Hope for
demoralized people
!  A new perspective
for oneself and the
world
!  An empathic,
trusting, caring
relationship
Those who undergo psychotherapy are ________
(more/less) likely to show improvement than those
who do not undergo psychotherapy.
How Do Culture and Values Influence
Psychotherapy?
!   Psychotherapists’ personal beliefs and values
influence their practice
!   Differences in cultural and moral diversity and
religious values can create a mismatch
The Biomedical Therapies
!   Drug therapies
!   Brain stimulation
!   Psychosurgery
!   Therapeutic lifestyle change
The Biomedical Therapies
!   Drug therapies
!  Are the most widely used biomedical
treatments
!  Include prescribed antidepressants for 27
million Americans
!  Involve placebo and double-blind techniques
to evaluate drug effectiveness
The Biomedical Therapies
!   Most common drug treatments for
psychological disorders
!   Antipsychotic drugs
!   Antianxiety drugs
!   Antidepressant drugs
!   Mood-stabilizing medications
Let’s take a closer look at each of these.
Drug Therapies
!   Antipsychotic drugs
!   Mimic certain neurotransmitters (e.g., block or increase activity
of dopamine); reduce overreaction to irrelevant stimuli
!   May produce sluggishness, tremors, twitches, and tardive
dyskinesia; Thorazine
!   Successfully used with life-skills programs and family support to
treat schizophrenia
!   Antianxiety drugs
!   Depress CNS activity; Xanax or Ativan
!   Used in combination with psychological therapy
!   May reduce symptoms without resolving underlying problems;
withdrawal linked to increased anxiety and insomnia
Drug Therapies
!   Antidepressant drugs
!   Increase availability of norepinephrine or serotonin;
promote birth of new brain cells
!   Slow synaptic vacuuming up of serotonin (SSRIs)
!   Effectiveness sometimes questioned due to spontaneous
recovery and placebo effect
!   Mood-stabilizing medications
!   Depakote: Controlling manic episodes
!   Lithium: Levels emotional highs and lows of bipolar
disorder
How do researchers evaluate the effectiveness of
particular drug therapies?
The drugs given most often to treat depression are
called ________. The drugs that are now often
given to treat anxiety disorders are called
________. Schizophrenia is often treated with
________ drugs.
Brain Stimulation
!   Electroconvulsive therapy
!   Manipulates the brain by shocking it
!   Involves the administration of a general anesthetic
and muscle relaxation to prevent convulsions
!   Causes less memory disruption than earlier versions
!   AMA concluded that ECT methods among most
positive treatment effects; reduces suicidal thoughts
!   Involves several theories about the reason for
effectiveness
Brain Stimulation
Brain Stimulation
!   Alternative neurostimulation therapies
! Vagus nerve stimulation: Stimulates neck nerve that
sends signals to limbic system; increases available
serotonin by increasing firing rate of some neurons
!   Deep brain stimulation: Manipulates depressed brain
via pacemaker; stimulates inhibition activity related to
negative emotions and thoughts
!   Repetitive transcranial magnetic stimulation (rTMS):
Sends magnetic energy to brain surface through
coiled wire held close to brain; fewer side effects;
modest effectiveness
Severe depression that has not responded to other
therapy may be treated with ________, which can
cause memory loss. More moderate neural
stimulation techniques designed to help alleviate
depression include ________ stimulation,
________ stimulation, and ________ magnetic
stimulation.
Brain Stimulation
!   Psychosurgery
!   Involves surgery that removes or destroys brain tissue in
an effort to change behavior
!   Is irreversible; is the least used biomedical therapy
!   Lobotomy
!   Psychosurgical procedure once used to calm
uncontrollably emotional or violent patients
!   Procedure cut the nerves connecting the frontal lobes to
the emotion-controlling centers of the inner brain (Moniz)
!   Today less invasive techniques are used; MRI-guided
surgery in severe disorders
Therapeutic Lifestyle Change
!   Training seminars
!   Human brains and bodies were designed for physical
activity and social engagement
!   Our ancestors hunted, gathered, and built in groups
with little evidence of disabling depression
!   12-week training with the following goals
!   Aerobic exercise, adequate sleep, light exposure,
social connection, antirumination, nutritional
supplements
Comparing Therapies
What are some examples of lifestyle changes we
can make to enhance our mental health?
Preventing Psychological Disorders
!   Resilience
!   Involves personal strength that helps most people cope
with stress and recover from adversity and trauma
!   Can be seen in New Yorkers after 9/11, spinal cord injury
patients, Holocaust survivors, and others
!   Prevention
!   Through identification and elimination of conditions that
cause psychological casualties
!   Through support of programs and providers that control or
eliminate stress
What is the difference between preventive mental
health and psychological or biomedical therapy?