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Treatment of Mental
Disorders
What is a psychiatrist?
Psychiatrists are MDs (medical doctors)
with a specialty in treating mental
disorders, usually with a biomedical
therapy (medicine) and some talk therapy.
You would see a “shrink” if you have
schizophrenia, severe depression, suicidal
thoughts, and other severe mental
problems that need medication.
What is a clinical psychologist?
A clinical psychologist has a PhD in
psychology (no medical school).
They treat fairly serious mental
illnesses with “talk” therapies.
They might treat personality
disorders, anxiety disorders,
addictions using insight or “talk”
therapy.
What is a counselor?
A counselor uses “talk” therapy to
treat non-mental disorders like
improving communication between
family members, grief counseling,
marital counseling, life strategies.
Counselors have a Masters Degree
with specialty training.
2. In contrast to a clinical psychologist,
a psychiatrist is more likely to
a) engage in an eclectic
b) use a biomedical/somatic
treatment
c) recognize the importance of
group therapy with patients having
the same disorder
d) treat clients in community
mental health centers exclusively
Perspectives on Treatment
Psychoanalytic
Behavioral
Humanistic
Cognitive
Biophysical
What are Psychoanalytic methods?
Dream Analysis – Manifest content
(actual content) AND Latent content
(hidden)
Transference – strong emotional
outburst/connection with therapist
Hypnosis
Free association – talk about
whatever and Dr. analyzes it
All 5 rely on exposing unconscious
thoughts and interpreting them.
VII. Psychoanalysis (psychodynamic):
Unconscious thoughts & emotions are
brought into awareness to be dealt with.
Psychological problems – the result of
unconscious processes.
Bringing unpleasant unconscious thoughts
into to consciousness, produces catharsis.
A. What are Psychoanalytic methods of
therapy (4 of them on same card if possible):
1. Free Association – patient reports
anything that comes to his/her mind.
The psychoanalyst takes whatever you say
and treats it like a window into your
unconscious mind.
B. Dream analysis:
Dreams have two types of content:
Manifest content- actual events in dream.
Latent content – hidden message in dream.
(latent = hidden)
Freud thought that each dream represents a
form of wish fulfillment. The wish may be
disguised, but it is always there.
C. Transference
Feelings of love or other emotions (hatred)
are expressed toward the therapist.
These feelings are actually unconsciously felt
toward others; the patient is projecting these
feelings onto the therapist.
This provides clues about the client’s feelings
about these other people.
Hypnosis
Hypnosis is a psychoanalytic
therapeutic technique.
Some people are more susceptible to
hypnosis than others – can’t by
hypnotized against your will.
Whatever you think, patients report
benefits from hypnosis.
video
5. The goal of psychoanalytical therapy
is
a) to change maladaptive behavior
to more socially acceptable behavior
b) to change negative thinking into
more positive attributions
c) to attain self-actualization
d) to bring unconscious conflicts to
conscious awareness and gain
insight
7. Treating the therapist as though he
were a very important person from
one’s past, such as a parent, defines
a) resistance
b) transference
c) frustration
d) reaction formation
In psychoanalysis, an emotional
attachment to the therapist that
symbolically represents other
important relationships is called
a. resistance.
b. transference.
c. identification.
d. empathy
A psychoanalyst who believes in the
theories of Freud would see mental
disorders as caused by
a. birth trauma.
b. repressed sexuality and aggression.
c. bizarre dreams.
d. immature personal relationships.
Psychoanalysis summary
What causes mental disorders? –
unconscious (whatever)
Treatment? –
Probing the unconscious mind
(psychoanalysis)
Behavioral Therapy
Behavioral causes of disorders?
Behaviorists believe that mental
problems are caused by classical
conditioning (for example, phobias),
operant conditioning (addictions,
depression), and observational
learning (we watch our parents and
friends suffer so we copy them).
Treatment: they change maladaptive
behavior.
What are classical conditioning
techniques?
Systematic desensitization (gradual
exposure) to your phobia or germs
(for OCD and phobias)
Flooding – overexposure to what
bugs you
Aversive conditioning – associate bad
things with your maladaptive behavior
(shock testicles) video
Operant conditioning treatment
Token economy – (operant
conditioning) Therapists will reward
desirable behaviors with a reward
system. This is usually applied to
groups like hospital mental wards or
classrooms or workplaces.
If you don’t kill anyone this week, I’ll
give you a nickel. If everyone passes,
we’ll have a pizza party.
Systematic desensitization is a
technique based on
a) classical conditioning
b) instrumental conditioning
c) operant conditioning
d) aversive conditioning
The owner of a chicken ranch ends a
pet dog's habit of stealing and eating
eggs by allowing the dog to "find" and
eat several eggs laced with Tabasco
sauce. The ranch owner's approach is
similar to
a. covert sensitization.
b. aversion therapy.
c. implosive therapy.
d. desensitization techniques.
Antabuse is a drug that, when paired with
alcohol in the bloodstream, bring about
extreme nausea. For many motivated
alcoholics, this has proven to be an
effective treatment. Under which umbrella
of psychotherapy would it most likely be
found?
a) insight therapy
b) aversive conditioning
c) Gestalt therapy
d) self-help therapy
Behaviorism summary
What causes mental disorders? - We
are conditioned to be sick (classical,
operant, observational learning)
Treatment? We change the behavior
through conditioning.
Humanistic Perspective of
Psychology
Humanism
What is the root word of Humanism?
After years of psychoanalysts saying
we are a bunch of id-driven animals
and years of behaviorists studying
rats in a cage, the Humanists came
along in the 60s.
What is Humanism?
Major perspective of psychology.
Focuses on maximizing human
potential, free will.
Important people: Carl Rogers,
Abraham Maslow.
Think hippies
Who is Carl Rogers?
Humanistic therapy?
Who is Carl Rogers? Carl Rogers was the
founder of person-centered therapy,
reflective listening, unconditional positive
regard, empathy.
The patient/client has all the answers and
the means to treat themselves. In personcentered therapy, the therapist acts as a
sounding board for the patient, sometimes
rephrasing what the patient says (reflective
listening). Empathy is important!
Reflective listening
Patient to Rogerian therapist: I’m really
depressed.
Therapist: I see. Yes. You are depressed.
Patient: Nothing is going well.
Therapist: Nothing well.
Patient: I feel like killing myself.
T: You’re thinking of killing yourself.
P: Yes, I’m going to do it NOW.
T: You want to do it now.
P: [Jumps out window.]
T: Woosh. Splat
REAL
IDEAL
Incongruent self: neurosis
REAL
IDEAL
Incongruent self: psychosis (shattered self)
Fully-Functioning Individual
Congruence!
Open to experiences
Freedom from society
Creativity
Person-Centered Therapy
(Client-centered or Rogerian)
Show the client unconditional positive regard:
accepting and valuing self (and people) regardless of
their behavior
Allow the client to take responsibility for his life
Mirror the clients emotions and thoughts so that he/she
can decide their path in life
Be congruent (honest, genuine, vulnerable)
Show empathy
Abraham Maslow
Maslow’s hierarchy of needs
Maslow’s hierarchy of needs
People cannot maximize their
potential unless their more basic
needs are met.
If a family’s home just got destroyed
by a tornado, can they focus on their
communication skills?
If you are hungry, can you worry
about your self esteem?
Do these people have self esteem
issues?
Which Simpsons character is
at the bottom of Maslow’s
Hierarchy of Needs?
Which character has safety
needs?
Who has love and belonging
needs?
Who has esteem needs?
Are any Simpsons characters
self actualizing?
Depends on the episode
The Simpsons aren’t real people, but
in some episodes, Homer and Lisa
are. Even Grandpa has his day in the
Hellfish episode.
Humanistic Therapy
Humanists are really touchy-feely, but
without them we are just rats in a cage.
Rogers and Maslow put the “human”
element back into psychology and therapy.
Their philosophy: We are all humans
striving to maximize our potential. A
therapist’s job is to remove obstacles to
self-actualization.
Thinking activity
Imagine your perfect life 3 years from
now. (Be realistic. No batman
fantasies.)
What would it look like?
What is keeping you from achieving that?
Humanism treatment summary
What causes mental disorders?
Barriers to self actualization.
How to treat mental disorders?
Person-centered therapy, reflective
listening, unconditional positive regard.
Vic is encouraged to take charge of
the therapy session and his therapist
uses an active listening approach to
mirror back the feelings he hears from
him. Which therapy is most likely
being described?
a) client-centered therapy
b) cognitive therapy
c) psychodynamic therapy
d) existential therapy
When a therapist attempts to see the
world through the client's eyes and to
feel some part of what he or she is
feeling, the therapist is using
a. authenticity. b. empathy.
c. reflection.
d. ego-centering.
A therapist that engages in reflective
listening, non-directive therapy, and has
unconditional positive regard for the
client is probably
a. cognitive
b. behavioral
c. humanistic. d. psychodynamic
What is cognitive therapy?
Cognitive therapy focuses on
changing how the client/patient thinks.
The therapist focuses on
changing/fixing the maladaptive
thoughts of the patient
It can be confrontational
Cognitive therapy also “educates” the
client, teaches him/her proper
behaviors/thoughts
Cognitive perspective
We are depressed because we are
irrational. Our expectations are too
high and misplaced. We want
everyone to love us and accept us.
We want every thing to go our way.
We stay angry about stuff that
happened a looong time ago. WE
MUST CHANGE THE WAY WE
THINK TO BE HAPPY AND
SUCCESSFUL.
Who are famous cognitive
therapists?
Aaron Beck –
reality therapy
Albert Ellis –
rational emotive
therapy
Aaron Beck? Cognitive therapy
Distorted thinking has a negative
effect on our behavior no matter what
type of disorder (Aaron Beck, 1997).
Albert Ellis Rational Emotive
Behavioral Therapy
vigorously challenges people’s
illogical, self-defeating attitudes and
assumptions; a confrontational
therapy
Rational Emotive Therapy: Ellis
A-B-C theory of dysfunctional
behavior
A – Activating event
B – Belief
C – emotional Consequence based
on that belief.
Example of Rational Thinking
A= fail a midterm examination
B=It’s unfortunate that I failed-I did
not study hard enough and I must
make sure that I study harder for the
final
C=no consequences (no emotional
disturbance)
Example Irrational Thinking: leads
to Emotional Disturbance
A= Fail exam
B= I’m stupid, I’ll never be able to
pass this course and I will fail this
course
C=depression
Ellis’ List of Common Irrational
Ideas
I absolutely must have sincere love and approval
almost all the time from all the significant people in
my life
I must be thoroughly competent, adequate and
achieving in all respects, or I must at least have
real competence or talent at something important;
otherwise I am worthless.
People who harm me or who do a bad thing are
uniformly bad or wicked individuals, and I should
severely blame, damn, and punish them for their
sins and misdeeds
Ellis’ List of Common Irrational
Ideas (continued)
When things do not go the way I
would like them to go, life is awful,
terrible, horrible, or catastrophic
Unhappiness is caused by external
events over which I have almost no
control. I also have little ability to
control my feelings or rid myself of
feelings of depression and hostility.
Rational Emotive Therapy
Identify patient’s irrational beliefs
Add “D” and “E” to A-B-C theory
Teach the patient to Dispute the
beliefs and substitute logical and
rational beliefs
Evaluate the effects of disputing their
irrational beliefs
CBT: Effective for Which
Disorders?
Empirically supported treatment for
Depression
Generalized anxiety disorder
Obsessive compulsive disorder
Panic disorder
Cognitive summary
What causes mental disorders?
Irrational thoughts and beliefs
How to treat disorders?
Change the thoughts and beliefs
In rational-emotive therapy,
a.clients are encouraged to take
responsibility for their own choices.
b.clients learn to challenge irrational
beliefs.
c.the therapist seeks to have the client
discover rational insights on his or her
own.
d.irrational elements of the unconscious
are made to conform to reality.
One difference between
psychoanalytic and cognitive models
of treatment is that cognitive
therapists
A. Say little during sessions
B. Emphasize the primacy of behavior
C. Focus on the present
D. View repressed thoughts about one’s
childhood as the root of most
problems
E. Do not face their clients
Who would suggest that cognitive
distortions or errors in logic that are
blown out of proportion could lead to
psychological disorders?
A. Sigmund Freud
B. Ivan Pavlov
C. Carl Rogers
D. Aaron Beck
E. Tommy Chong
Eclectic therapy? – uses tools
from cognitive, behavioral and
humanistic perspectives
Group Therapy
Benefits of Group Therapy?
Is cheap, effective. (only 1 professional is
needed)
It allows people to gain insight into their
own behaviors and thoughts
People don’t feel like they are the only one
with their problem; they can witness the
therapist treat others with similar problems.
You can cure yourself while curing others.
All of the following are potential benefits of
group therapy EXCEPT
a) it is often more economical than 1:1
treatment
b) it does not require the services of a
mental health professional
c) clients with similar problems can
provide helpful insight and feedback to
peers
d) group members can see how their
problems might impact others
What is the biomedical
approach to treatment?
Drugs, surgery, ECT
Types of drugs?
Antipsychotics – (schizophrenia) can lead
to tardive dyskinesia
Antidepressants – (Prozac, Zoloft,
Wellibutruin)
Antianxiety – can lead to drowsiness
(Xanax, Paxil)
Somatic therapy (Drug Therapy)
Antipsychotic drugs
alleviate the symptoms of severe disorders
such as schizophrenia; Examples:Thorazine,
many work by blocking dopamine receptor
sites
Can lead to tardive dyskinesia, (tremors)
Tardive dyskinesia
Drug Therapy
Psychopharmacology –
The prescribed use of drugs to help
treat symptoms of mental illness
ostensibly to ensure that individuals
are more receptive to talk therapies
Drug Therapy
Antidepressants and mood stabilizers
Include Prozac, monoamine oxidase
(MOA) inhibitors,
lithium carbonate is a mood stabilizer
(effective against bipolar disorder)
Treat depression and bipolar disorder
Usually affect serotonin and/or
norepinephrine
SSRIs block the reuptake of
serotonin between 2 neurons
Drug Therapy
Antianxiety drugs
work by depressing central nervous system
activity
Most common side effect - drowsiness
highly addictive, can be fatal when mixed with
alcohol
sudden cessation after long-term use can result in
severe withdrawal symptoms, including seizures,
increased anxiety,
and in rare cases, death
Xanax, Paxil
Drug Therapy in ADHD
Stimulants suppress activity level in
persons with attentiondeficit/hyperactivity disorder (ADHD)
There is controversy from concern
that the causes and boundaries of
ADHD are vague and the potential
exists for overdiagnosis
_______ is any technique involving
surgical alteration of the brain.
a. Ablation lesioning
b. Psychosurgery
c. Deep ECT
d. Psychic surgery
4. The MOST commonly cited side
effect associated with anti-anxiety
drugs is
a) insomnia
b) blurred vision
c) drowsiness
d) tachycardia
9. Prozac and other modern
antidepressant medications work to
a) block dopamine receptors
b) decrease the level of
acetylcholine
c) break down the MAO enzymes
d) block the reuptake of seratonin
11. Valium is
a) an antidepressant drug
b) an MAO inhibitor
c) an antipsychotic drug
d) an antianxiety drug
13. Andre suffers from mood swings,
alternating from wild episodes of euphoria
and spending sprees to motionless staring
and hopelessness. If someone from the
biomedical approach were to treat his
condition, the prescription most likely would
be
a) Lithium carbonate
b) Haldol
c) Xanax
d) Thorazine
Psychosurgery
Psychosurgery –
The general term for surgical
intervention in the brain to treat
psychological disorders
The infamous prefrontal lobotomy is no
longer performed
Severing the corpus callosum, however,
can reduce life-threatening seizures
Brain-Stimulation Therapies
Electroconvulsive therapy ECT is
used for the treatment of severe
depression
Transcranial magnetic stimulation, a
possible alternative to ECT, can also
be used for the treatment of
depression, schizophrenia, and
bipolar disorder
Transcranial magnetic
stimulation
Video
1930’s-1950’s
Frontal lobotomy
Became Prefrontal lobotomy
Muniz won Nobel prize for
procedure
Procedure eventually banned
Destruction of personality
Replaced in 1954 by first antipsychotic: Thorazine
A.
B.
C.
D.
Matt enters therapy to talk about
some issues that have been causing
him distress. The therapist has
earned a PhD and uses a variety of
techniques to alleviate some of
Matt’s distressing symptoms. Matt
is most likely seeing a _____
Psychiatrist
Clinical psychologist
Psychiatric social worker
Clinical counselor
Treating disorders with drugs or surgery
is known as
a. cognitive therapy
b. humanistic therapy
c. biomedical therapy
d. psychoanalysis
Carl Rogers is responsible for
a. client-centered therapy.
b. psychoanalysis.
c. directive therapy.
d. existential therapy.
A.
B.
C.
D.
The aim of cognitive-behavioral
therapy is to _____
Discover unconscious motives for
behavior
Change the way people behave
Change the way people think and
behave
Change people’s negative thinking
patterns
A.
B.
C.
D.
Ann is suffering from depression
and no psychological or drug
therapies are working to alleviate
her symptoms. The biomedical
technique of ____ may be used as a
last resort.
Flooding
Systematic desensitization
Electroconvulsive therapy
psychosurgery
Modern antidepressants, such as
Prozac, work to block the reuptake
of which neurotransmitter?
A. Dopamine
B. Serotonin
C. Acetylcholine
D. GABA
A.
B.
C.
D.
E.
________ therapy does NOT use
the services of a trained therapist.
Biomedical
Cognitive-behavioral
Behavioral
Humanistic
Self-help
A.
B.
C.
D.
E.
John is a 12-year-old who is having
trouble dealing with his family’s relocation
to a new city. He most likely first sees a
______
Psychiatrist
Counselor
Clinical psychologist
Registered nurse
Psychoanalyst
In aversion therapy a person
__________ to associate a strong
aversion with an undesirable habit.
a. knows
b. learns
c. wants
d. hopes