Intro-treatment
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Transcript Intro-treatment
Disorders
Who Gets What?
Prevalence of Neurotic Disorders by Age
Prevalence of Neurosis by Age & Social Class
Prevalence of Psychosis by Age & Gender
Heritability of Psychosis: Schizophrenia
Scz incidence & poverty/residential area
Some Interim Conclusions
Psychoses (focus on SCZ) is a disorder of
heredity and/or prenatal environment
But it’s also a disorder of poverty (and that may
be bidirectional)!
Another view of prevalence and recent dramatic
changes in prevalence
Incidence & Prevalence
Schizophrenia: approx. 1%
Bipolar Disorder: approx. 1%
Depression:
approx. M 13% F 21%
Treatment
Overview
Brief History
Psychological Treatments
Biomedical Treatments
Client-Therapist Relationship
Is Treatment Effective?
History
Earliest history
Mental illness believed to be caused by evil
spirits
Treatments were harsh, ineffective
Drill holes in skulls to create exits for spirits
Make the body horribly uncomfortable for the spirits
Purge demons through inducing vomiting
History
Middle Ages
Mental illness viewed more like a disease
Mental institutions were created
Purpose: confine madmen
Included other social “undesirables”
Inhumane treatment (shackles and chains)
Beginning of Reform
Early to Mid 1800s
Philippe Pinel put in charge of Paris’ hospital
system
Removed shackles and chains
Patients allowed to exercise, venture outside
Beginning of Reform
Dorthea Dix
Fought for humane
treatment of patients in
U.S.
19th century
Freud’s “talking cure”
Psychological Treatment
Overview
Treatment involves addressing three
major components of the illness:
Biological
Psychological
Social
Something to keep in mind:
These three major components are not
necessarily black-and-white
Who provides treatment?
Clinical psychologists
Psychologists
Neurologists
Psychiatric Nurses
Marriage and Family Counselors
Social workers
School counselors
Who seeks treatment?
People with mental illness, hoping to relieve
pain and dysfunction
People with subsyndromal disorders
People looking for assistance in recovering
from grief, anxiety, confusion, relationship
issues…
Women
European Americans
Financially well off
Psychological Treatments
Focused on changing the way the patient thinks
and behaves
Involves discussion, instruction, or training
Over 500 different forms of such treatment
Psychodynamic
Humanistic
Behavioral
Cognitive
Psychodynamic Approaches
Illness result of unconscious conflicts developed early in
childhood
Defense mechanisms shield from the inner conflict
This can lead to symptoms of mental illness
Treatment: Uncovering unconscious desires and
conflicts, and resolving them
Integrate thoughts and memories coherently
Psychodynamic Approaches
“Working through” the conflict
Transference
Used as a therapeutic tool
In order to be effective, therapist must remain
neutral
Humanistic Approaches
Based off of Freud’s “talking cure”
However, less focused on basic drives
Instead, focus on creating meaning
Clients need to take responsibility for their lives
and actions, and live in the “here and now”
Humanistic Approaches
Client-Centered Therapy (Carl Rogers)
Focuses on achieving self-acceptance
Does not pass judgment, or provide instruction
Aim is to create an environment in which the client feels
understood and valued
Humanistic Approach
Creating the therapeutic environment
Genuineness- sharing authentic reactions
Unconditional positive regard
Non-judgmental, accepting
Empathic Understanding- putting oneself in the
patients’ shoes
Humanistic Approaches
Gestalt Therapy (Fritz Perls)
Mental illness is result of inconsistencies in one’s
understanding of the self
Increase self-awareness and self-acceptance
Ask how clients felt, and point out discrepancies in the
way they appeared
Empty chair technique
Behavioral Approaches
Reaction to Freud’s psychoanalysis
Viewed Freud’s approach as too unscientific
Treatment directed at reducing or eliminating
problematic behaviors
Approach involves replacing old habits with more
effective or adaptive behaviors
Classical conditioning, operant conditioning, modeling
Behavioral Approaches
Classical Conditioning Techniques
Treatment of Phobias
Extinguish the association between the neutral
stimulus and the fearful stimulus
Exposure Therapy
Train clients in deep muscle relaxation, pair
relaxation with the fearful stimulus
Create a hierarchy of progressively more frightening
stimuli
Systematic desensitization: gradual exposure to the
real phobic stimulus
Systematic Desensitization
Behavioral Approaches
Operant Conditioning Techniques
Token economies
Earn tokens for positive behaviors, which can be exchanged
for prizes
Shaping
Contingency Management
Strict consequences for certain behaviors
Successful for shaping communicative behavior in children
with autism
Modeling Techniques
Therapist perceived as role model
Cognitive-Behavioral Approaches
Rational Emotive Behavioral Therapy
(Albert Ellis)
People typically think that an event
causes them to behave a certain way
But…beliefs matter
A (acting event) B (belief) C
(consequence)
Focused therapy on changing beliefs
Teacher-like
Cognitive Therapy
Aaron Beck
Focused on changing dysfunctional
thought
Cognitive Restructuring
Challenge a person’s unhealthy
beliefs or interpretations
Used persuasion and confrontation
Brief, problem-focused
Initially treated depression
Cognitive-Behavioral Therapy
Followers of Ellis and Beck blended the
two therapies to form CBT
Focus on addressing problems the patient
wishes to solve
Often clients are assigned homework
Practice new ways skills or thought techniques
Eclecticism
Modern therapy tends
to blend aspects from
many of these
perspectives
Makes sense, since
there are often many
causes of mental
illness
Client-Therapist Relationship
Therapeutic Alliance
Support
Trust
Hope
Understanding
Group Therapies
Often groups are chosen
because they share similar
problems (e.g., Alcoholics
Anonymous)
Focus on the shared
problems, less on the
individuals’ emotions
Advantages
Social support
Share advice, information
Observe other peoples’
successes
Realize that not alone, others
share similar problems
Couple and Family Therapy
Views the family or relationship as a
complex system
One person’s negative behavior or cognitions
may reflect a larger issue for the entire family
or relationship
Biomedical Treatments
The Early Gruesome Years
Trephination
Allowed “evil spirits” to escape the skull
Hot or Cold Baths
Spinning
Biomedical Treatments
Psychosurgery
Prefrontal Lobotomy
Sever connections between
thalamus and frontal lobes
Disrupted higher cognitive
functions
Modern techniques are more
precise and used as a last
resort treatment
Electroconvulsive Therapy (ECT)
Brief electrical current
passed through the brain
causing a convulsive seizure
Originally developed to treat
schizophrenia
Very effective for treating
severe depression (70-90%
effective)
Memory impairment
Mechanisms are not known
Different Therapies for Different
Conditions
Medical: Brain targeted drug interventions
examples:
--SCZ: Dopamine receptor blockers (the
better the block the more effective it is)
--Other neurotransmitters involved as well
--Depression: ex. Norepinephrine uptake or
release+, Serotonin release+, & a host of
other neurotransmitter controls involved
-- Electro-convulsive shock therapy!
Pharmacological Treatments
Psychotropic drugs
Not only helped treat patients, but also further
understanding of the illness
Pharmacological Treatments
Antipsychotics
Treat positive symptoms of schizophrenia
Not effective for treating the negative symptoms
Most common are Thorazine, Haldol and Stelazine
Block dopamine receptors in particular brain pathways
Atypical Antipsychotics
Treat negative symptoms of schizophrenia, too
Risperdal, Clozaril, Seroquel
Antipsychotics and
Deinstitutionalization
Movement in the 1950s shortly after
development of the first antipsychotics
Pros
Aimed to provide less expensive mental health care at
local community centers instead of institutions
Fewer people spending their lives in institutions
Shorter stays
Downside
Lack of appropriate care in community settings
Lack of integration into the community (support
services, employment)
Many mentally ill are now homeless, or in jail
Deinstitutionalization
Antidepressants
Monoamine Oxidase Inhibitors (MAOIs)
Nardil
Tricyclic antidepressants
Tofranil
Increase serotonin and norephinephrine for
synaptic transmission
Both very effective (significant improvement in
65% of patients)
Many negative side effects
Antidepressants
Selective Serotonin Reuptake Inhibitors (SSRIs)
Prozac, Zoloft, Paxil, Celexa, Lexapro
Minimally effect dopamine and norepinephrine, and
maximally effect serotonin
Reduced side effects
Most commonly prescribed
Atypical Antidepressants
Effect serotonin, norepinephrine and dopamine in
various ways
Wellbutrin (fewer side effects)
Antidepressants
Downside
Takes a while before effective (a month)
Trial-and-error
Side effects
Weight gain, nausea, diarrhea, insomnia, reduced
sexual desire or response
Mood Stabilizers
Treat symptoms of bipolar disorder
Lithium carbonate
Treats manic episodes as well as depressive episodes
Side Effects
Weight gain, sedation, dry mouth, tremors
Adherence to medication
Often patients do not wish to treat mania, only depression
Lethal at high doses
Effective for 60 – 70% of patients
Anxiolytic Medications
Treat anxiety disorders
Increase neurotransmission of GABA
Beta Blockers
Benzodiazepines
Tricyclic Antidepressants and SSRIs
Anxiolytic Medications
Beta Blockers
Controls autonomic arousal
Benzodiazepines
Valium, Xanax, Klonopin
Short term treatments
Highly addictive
Interact dangerously with alcohol
New drugs are being developed to reduce these negative side
effects
Rebound effect
Medication: Costs and Benefits
Can be highly effective
Only treats and controls the
symptoms
Relapse
Requires trial-and-error for
correct drug and correct dosage
Side effects
Reduce adherence to medication
Overprescription
Emerging Biomedical Treatments
Repetitive TMS
Areas of the brain stimulated
with magnetic coil for 20-30
minutes over several weeks
Effective for medicationresistant depression
No cognitive side effects
Deep Brain Stimulation
Electrodes implanted in brain
Combined Treatments
Most therapists use a combination of
treatments
Drug treatments for short-term effects
Therapy for long-term effects
Evaluating the Efficacy of Treatments
Randomized Clinical Trial (RCT)
Treatment group
Placebo group
Random assignment
Symptoms and severity similar across
participants
Follow participants over several months
Efficacy vs. Utility
Difficult to run RCT for psychotherapy
Waitlist
Manualized Therapy
Controlled studies allow researchers to come to
conclusions about the efficacy of particular
treatments
In many circumstances, patients have more than
one illness
Also, therapists typically use more than one
approach
Is therapy effective?
A meta-analysis found that 80% of
patients who received treatment fared
better than those without
Are all Therapies Equally Effective?
Who provides the most effective psychological
treatment?
Number of years of practice?
Professional credentials?
Not necessarily
No
The rapport between therapist and client
seems to be strongest predictor
Respect, trust, comfort
Who is most likely to benefit from
treatment?
Strong alliance with therapist
Shop around!
Motivated
Optimistic
More effective with more therapy
Are All Treatments Equally Effective?
A depression meta-analysis shows…
Drug treatment alone 55% effective
Therapy alone 52% effective
Drug AND therapy 85% effective!
(New England Journal of Medicine, 2000)
Are all Treatments Equally Effective?
Treatment more effective than no
treatment
Combining treatments appears most
beneficial
Some therapies seem particularly effective
for specific disorders
Exposure therapy phobias
Moral of the Story
Treatment is effective!
Modern treatments are much more
effective and humane than past
treatments
The relationship between therapist and
client really matters!
Recent Reconceptualization
Some people are able to cognitively
overcome even serious levels of disorders
Available to psychotherapy
Find meaning in some symptoms
Able to live normally or quasi-normally
Example in Nash film
If you feel you need help…
Seek it! Ask for advice, or set up an appointment
with a counselor. It’s not a weakness.
Make sure the therapist is a good match for you!
Remember it can take time and you may face
some setbacks, but also…
Remember treatment is effective! Most people
improve!