Transcript Treatment of psychological disorders

TREATMENT OF
PSYCHOLOGICAL
DISORDERS
Chapter 16
T YPES OF TREATMENT
 Analyze This and Analyze That - misconceptions
 Types of therapies
 Insight therapies
 “talk therapy”
 Behavior therapies
 Changing overt behavior
 Biomedical therapies
 Biological functioning interventions
WHO SEEKS TREATMENT?
 15% of U.S population in a given year
 Most common presenting problems
 Anxiety and Depression
 Treatment seeking for various disorders – Figure 15.1
 Mood disorders
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Utilization rates – Figure 15.2
Women more than men
Medical insurance
Education level
Psychological Disorders and professional treatment – Figure
15.3
Figure 15-1 – Treatment seeking for various disorders
Figure 15-2 – Therapy utilization rates – Olfson et al. (2002)
XX 15.3
WHO PROVIDES TREATMENT?
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Clinical psychologists
Counseling psychologists
Psychiatrists
Clinical social workers
Psychiatric nurses
Counselors
On-line treatment?
INSIGHT THERAPIES: PSYCHOANALYSIS
 Sigmund Freud and followers
 Goal: discover unresolved unconscious conflicts - Figure 15.4
 Free association
 Dream analysis
 Interpretation
 Resistance and transference
 Psychodynamic Therapies
INSIGHT THERAPIES: CLIENT CENTERED THERAPY
 Carl Rogers
 Cause: Figure 15.5
 Goal: restructure self-concept to better correspond to reality
 Therapeutic Climate
 Genuineness
 Unconditional positive regard
 Empathy
THERAPIES INSPIRED
BY POSITIVE PSYCHOLOGY
 Martin Seligman
 Uses theory and research to better understand the
positive, adaptive, creative, and fulfilling aspects of
human existence
 well-being therapy
 positive psychotherapy
 can be an effective treatment for depression – F 15.6
Figure 15.6 Positive psychotherapy for depression
OTHER ISSUES
 Groups therapy
 Group size
 Advantages – social dimension of change
 Ef fectiveness of Insight therapies – Figure 15.7
 Spontaneous remission
 Talk therapies or other approaches?
 Common factors contribute to progress in those treated
Figure 15.7 – Recovery as a function of number of
therapy sessions
BEHAVIOR THERAPIES
 B.F. Skinner and colleagues
 Goal: unlearning maladaptive behavior and learning adaptive
ones
 Systematic Desensitization – Joseph Wolpe
 Classical conditioning – Figure 15.8
 Anxiety/Fear hierarchy – Figure 15.9
 Aversion therapy – Figure 15.10
 Alcoholism, sexual deviance, smoking, etc.
 Social skills training
 Modeling
 Behavioral rehearsal
 Biofeedback
 Operant conditioning flooding
 Classical conditioning
XXX 15.8
XXX 15.10
COGNITIVE-BEHAVIORAL THERAPY
 Aaron Beck
 Cognitive therapy
 Depression and negative thinking – Figure 15.11
 Albert Ellis
 Rational-emotive therapy
 Goal: to change the way clients think
 Detect and recognize negative thoughts
 Reality testing
 Ef fectiveness of Behavior Therapies
 Efficacy of behavioral interventions for a variety of disorders
XXX 15.11
BIOMEDICAL THERAPIES
 Psychopharmacotherapy
 Antianxiety - Valium, Xanax, Buspar
 Antipsychotic - Thorazine, Mellaril, Haldol
 Tardive dyskinesia
 Atypical antipsychotic – reduce motor effects and other
neurotransmitters
 Time course – Figure 15.12
 Antidepressant: - Actions - Figure 15.13
 Tricyclics – Elavil, Tofranil
 Mao inhibitors (MAOIs) - Nardil
 Selective serotonin reuptake inhibitors (SSRIs) – Prozac, Paxil, Zoloft –
side effects – Table 15.1
 Risk of suicide – Figure 15.14
 Mood stabilizers
 Lithium, Valproic acid
 Electroconvulsive therapy (ECT)
 Transcranial Magnetic Stimulation
 Deep brain stimulation
Figure 15.13 Antidepressant drugs’ mechanisms of action
Figure 15.15 Deep brain stimulation
CURRENT TRENDS AND ISSUES IN TREATMENT
 Managed care
 Empirically validated treatments
 Blending Approaches to treatment – Figure 15.17
 Conjunctive therapy – Figure 15.16
 Multicultural sensitivity
 Deinstitutionalization
 Dorthea Dix - Figure 15.18
 Changes in population – Figure 15.19
 Factors – treatments, legal, service delivery model
 Revolving door problem – Slide 26
 Homelessness
 Increase use of criminal justice system
Figure 15.17 The leading approaches to therapy among psychologists
Figure 15-16 – Relapse rates in Reynolds et al. (1999) study
XX 15.19
Slide 26 – Percentage of psychiatric inpatient admissions that
are readmissions
SOMATIC THERAPIES
Psychopharmacology
Antipsychotics ( thorazine,
haldol)
Anti-anxiety (valium,
barbiturates, Xanax)
Mood Disorders (serotonin
reuptake inhibitors)
Bipolar (lithium)
SOMATIC THERAPY
•Electroconvulsive
Therapy (ECT)- f or
depression
•Psychosurgur y
- Pref ontal lobotomy
LOOKING FOR AT THERAPIST
 Factors to consider
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Sources of services – Table 15.2
Profession
Gender
Theoretical approach
 Comparison of approaches for ef fectiveness - Figure 15.20
Table 15-2, p. 626
Figure 15.20 Estimates of the effectiveness of various approaches to psychotherapy.