Download Treatment of Disorders

Treatment of Disorders
History of Treatment
Ethical Issues in Treatment
• Deinstitutionalization occurred during the mental
health movement of the 1960s
Don’t exclude mentally ill from society, but help them
function within society
Shorten in-patient treatment (only keep in hospital if
necessary)
 More out-patient care
• APA guidelines 
Who Provides Treatment?
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Psychiatrists – Medical doctors, MD
Psychologists – PhD, PsyD, some MA
Clinical Social Workers, MA
Marriage/Family Therapists, MA
Licensed Professional
Counselors, MA
• Psychiatric Nurses, RN
• Substance Abuse Counselors,
CADC
• Pastoral Counselors
• Psychotherapy – trained therapist uses psychological
techniques to help someone to overcome problems
or difficulties
• Biomedical therapy – prescribed medication that
acts on nervous system
• Eclectic approach – use a
blend of therapies and
approaches
Psychoanalysis
• Free association
– Say whatever comes to mind,
no censoring of thoughts
– Overcome resistance (blocking
of anxiety-laden material)
• Transference
– Patient transfers unconscious
feelings towards someone else
onto the therapist
– i.e. patient w/Electra complex
has attraction to Freud
(transfers attraction to father
onto therapist)
Type of Therapy
Cause/Problem
Aim of Treatment
Psychodynamic
Unconscious forces &
childhood experiences
Reduce anxiety through selfinsight; analysis &
interpretation
Client-centered
(Humanistic)
Barriers to selfunderstanding & selfacceptance
Personal growth through
self-insight
Behavior
Maladaptive behaviors
(learned or observed)
Extinguish maladaptive
behaviors
Cognitive
Negative, self-defeating
thoughts
Healthier thinking, positive
self-talk
Group (Family)
Stressful relationships
Relationship healing, better
communication
Biomedical
Chemical imbalances or
nervous system
dysfunction
Prescribed medications of
medical surgery
Psychodynamic
• Childhood experiences
• Enhance self-insight
• Interpersonal therapy – brief
(12-16 session) treatment, effective for
depression
Psychoanalysis v. Humanistic
• Humanistic therapies differ from psychoanalysts in
focusing on…
1) Present & future (not past)
2) Conscious rather than
unconscious
3) Immediate responsibility
4) Promoting growth instead of
curing illness
Client-Centered Therapy (Carl Rogers)
• Nondirective  Active listening
– Clarification or “reflect” what has been said back to
patient
• Genuineness, acceptance, empathy
• Unconditional positive regard  no judgment
Behavior Therapies – Classical
Conditioning
• Counterconditioning
– Pair feared stimulus w/good
outcome
• Exposure therapy
– Learn relaxation techniques
– Systematic desensitization
hierarchy
• Aversive conditioning
– Pair the undesirable
behavior with bad outcome
Behavior Therapy
 Systematic Desensitization
Behavior Therapy
 Aversion
therapy for
alcoholics
Behavior Therapies – Operant
Behavior Modification – use
reinforcement to increase
desired behaviors
Token Economy – provide “tokens”
each time desired behavior is
performed that can be redeemed
later for a bigger reward
Cognitive Therapies
• Cause = irrational thinking patterns
• Aim = correct habitual thinking errors
• Aaron Beck’s Cognitive(-Behavioral) Therapy
 Cognitive Triad
1) Negative feelings about self
“I am a failure”
2) Negative feelings about world
“The world is unfair”
3) Negative feelings about future
“The future is hopeless, it
will never get better”
Beck’s Cognitive Therapy for Depression
• Over-generalization  drawing general
conclusions from a single (usually negative)
event. E.g. thinking that failing to be promoted
at work means a promotion will never come.
• Minimalization and Maximization  Getting
things out of perspective: e.g. either grossly
underestimating own performance or
overestimating the importance of a negative
event.
• Dichotomous thinking  Thinking that
everything is either very good or very bad so that
there are no gray areas. In reality, of course, life is
one big gray area.
Cognitive-Behavioral Therapies
Albert Ellis’s Rational Emotive Behavior Therapy (REBT)
The A-B-C model
A= Adversity (anticipating event)
B = Belief about “A”
C = Consequences
(behavioral, emotional)
Evaluating Psychotherapies
 To whom do
people turn for
help for
psychological
difficulties?
Is Psychotherapy Effective?
• Overestimation
– Clients enter in crisis (temporary)
– Want to believe it was worth the effort
– Placebo effect (expect to get better)
– Regression toward the mean (the usual state is
better than rock bottom, which is where most
patients start)
Is Psychotherapy Effective?
• Those not treated often improve, but those
undergoing therapy are more likely to improve
• No one therapy is best in all cases
• Evidence-based practice – clinical decision making
that integrates best
available research w/clinical
expertise and patient
characteristics
Three Benefits of Psychotherapies
1) Offer expectation that things can and will get
better
2) Offers plausible explanation for symptoms and
alternative way of thinking
3) Effective therapists are
empathetic and seek to
understand  builds trust
Evaluating Psychotherapies
Number of
persons
Average
untreated
person
Poor outcome
80% of untreated people have poorer
outcomes than average treated person
Average
psychotherapy
client
Good outcome
Biomedical Therapies
• Psychopharmacology
Antipsychotic Drugs
• Treats schizophrenia
• Decrease receptiveness to
irrelevant stimuli
• Block dopamine
• Thorazine, Haldol, neuroleptics
• Atypical antipsychotics
(Clozapine)
• Tardive dyskinesia – involuntary
movements of face, tongue, limbs
Antianxiety Drugs
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•
•
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Depress CNS activity (tranquilizers – benzodiazepines)
Boost GABA
Xanax, Ativan, D-cycloserine
Can lead to psychological and physiological
dependence
• Treats anxiety disorders
(PTSD, OCD)
Antidepressant Drugs
• Increase serotonin & norepinephrine
• Selective Serotonin Reuptake Inhibitors (SSRIs)
– Prozac, Zoloft, Paxil
– Block reabsorption of
serotonin from synapse
• Treat depression, some
anxiety disorders (OCD)
• Tricyclics are more
effective (serotonin &
norepinephrine)
Lithium
• Mood stabilizer
• Treats bipolar disorder
• Lowers risk of suicide
Brain Stimulation Techniques
• Electroconvulsive Therapy (ECT)
• Repetitive transcranial magnetic
stimulation (rTMS)
Psychosurgery
• Removes or destroys brain tissue to change
behavior
• Lobotomy
• ONLY USED IN
EXTREME CASES