Transcript Treatment of Psychological Disorders

Treatment of Psychological
Disorders
From TOPSS
Mary L. Spilis & Dr. Maureen McCarthy
Introduction and Overview
• When a psychological disorder becomes
serious enough to cause problems in
everyday functioning, the client may seek to
have the disorder treated.
Introduction and Overview
• Types of treatment:
1. Psychotherapy—This therapy applies psychological principles
and techniques to treatment of a psychological disorder.
Psychotherapy includes discussion of the psychological problem
and specific exercises/techniques that are designed to help a
client function better in everyday life.
2. Biological Therapy—This is the term when physiological
methods are used to treat psychological illness. Examples of
medically based treatments include medication and
electroconvulsive therapy (ECT).
3. Combined treatments—The combined use of medication and
psychotherapy is a common approach to treating psychological
disorders (Sammons & Schmidt, 2001).
History of Treatment
• Historically, treatment of people with
psychological disorders ranged from lack of care
to extreme and often violent mistreatment of
individuals with serious psychological disorders.
• Early treatment approaches (circa 1300–1900)—
Early psychological treatment consisted primarily
of imprisonment, rather than specific techniques to
help people with mental illness.
History of Treatment
• Treatment facilities,
called asylums or
mental hospitals,
were built to house
people with mental
illness in the mid1500s. Patients often
were chained and
mistreated in the
early attempts to
treat psychological
illness.
History of Treatment
• Phillipe Pinel (1745–1826) was the first physician
to remove the chains from seriously mentally ill
patients, which resulted in calmer patients.
• In the 1840s, in the United States, Dorothea Dix
(1802–1887) also initiated freeing the mentally ill
from mistreatment in jails and other locations.
History of Treatment
• The precursor to modern psychotherapy
began with a physician, Josef Breuer (1845–
1925), who used hypnosis to get his patients
to talk about their problems or what became
known as cathartic therapy (Sternberg,
1995).
History of Treatment
• Contemporary treatment approaches (1900–2000)—Early
twentieth century treatments also included harsh medical
interventions which were performed in mental hospitals.
• Although these hospitals remained operational, they failed
to reach their full potential, and in the 1950s, efforts were
undertaken to close many large mental hospitals.
• Deinstitutionalization of patients resulted in release of
many patients. Treatment of psychological disorders now
includes hospital inpatient treatments and community
mental health or outpatient treatments.
Who provides treatment?
1. Psychiatrist—A psychiatrist is a medical doctor who
specializes in treating psychological disorders. A
psychiatrist can diagnose a mental illness, prescribe
medication, or administer other biomedical treatments.
2. Psychologist—A clinical or counseling psychologist has a
doctoral degree (PhD or PsyD) that includes training in
diagnosis and treatment of psychological illnesses.
3. Psychiatric social worker or psychiatric nurse—This social
worker or nurse works as part of a team of people in a
hospital setting. Services include monitoring treatments
that are prescribed by a psychiatrist or psychologist.
4. Counselor—A counselor provides limited psychotherapy
for individuals who do not have a serious mental illness.
Ethics in treatment
• Professionals should adhere to a set of ethical
standards issued by their respective organizations.
For example, psychologists should adhere to the
ethical principles of the American Psychological
Association.
• In addition to ethical standards, professionals must
adhere to legal stipulations governing the practice
of psychology.
BIOMEDICAL TREATMENT
Introduction to biomedical
treatments
• Biomedical treatments include specific
medical procedures and medications that
can help to alleviate symptoms of
psychological disorders.
• Often, biomedical treatments are used in
conjunction with talk therapies and are
described as combined approaches to
treatment.
Psychopharmacological treatment
• Medications have been developed to treat
many psychological disorders. Generally, these
medications work by altering neurochemical
systems in the brain.
• Four broad classes of drugs are used for
treatment.
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–
–
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Neuroleptics (antipsychotics)
Antidepressants
Lithium and anticonvulsants
Anxiolytics (antianxiety)
Neuroleptics
• This class of drugs, also referred to as
antipsychotics, helps to reduce serious symptoms of
schizophrenia in particular.
• These medications are moderately successful in
reducing hallucinations and similar serious
expressions of altered behavior.
• Essentially, these drugs act as dopamine blockers.
• The most common trade names of these drugs are
Thorazine and Haldol.
• Most drugs in this class have serious potential side
effects.
Antidepressants
• This group of medications is used to treat people
who are severely depressed.
• Antidepressants increase the presence of serotonin
and norepinephrine.
• It usually takes several weeks before these drugs
have a positive effect on the patient.
• There are three main classes of antidepressants:
– Monoamine oxidase inhibitors (MAOIs)
– Tricyclic antidepressants (TCAs)
– Selective serotonin reuptake inhibitors (SSRIs)
Lithium and anticonvulsants
• Lithium helps to reduce the severity of the
highs and lows that someone with bipolar
disorder typically experiences.
• Lithium does not act immediately on the
symptoms and must be carefully monitored so
that the patient does not experience side
effects.
• Immediate treatment of a manic episode might
include an anticonvulsant, known by the trade
name of Depakote
Anxiolytics
• Tranquilizers or anxiolytics are used to treat
anxiety disorders.
• Common drugs used today are usually
benzodiazepines (e.g., Librium and Valium).
These drugs produce an immediate calming
effect for a person who may be experiencing
anxiety. Xanax has become popular for
treating panic disorders.
• Patients can become dependent on these drugs.
Electroconvulsive therapy (ECT)
• When ECT was originally introduced, the approach
was somewhat barbaric. An electrical current was
passed through the brain, resulting in convulsions.
• Today, anesthetic is administered prior to delivering
the shock to make the client more relaxed and to
reduce the severity of the convulsions.
• One of the side effects of this treatment is temporary
memory loss of the time period immediately
preceding the treatment.
• This treatment is used only as a last resort for
patients who are severely depressed.
PSYCHOTHERAPY
Psychological Treatment Approaches
• Psychoanalytic, humanistic, and cognitive
approaches to therapy are often called
insight therapies. Insight therapy helps
patients develop an understanding of their
inner conflicts. It is through understanding
himself or herself that a patient can begin to
solve the problems of daily living.
PSYCHOANALYSIS
Psychoanalytic approaches
• Psychoanalysis emphasizes the importance
of the unconscious mind. Freud attempted
to help people understand, or develop
insight, into their unconscious conflicts as a
way to relieve neurotic anxiety (Dryden &
Mytton, 1999).
Techniques of psychoanalysis
• Psychoanalysis is an intensive and long-term
therapy that may include several sessions per
week over a period of several years.
• A psychoanalyst helps the patient to discover
unconscious conflicts, yet the therapist remains
neutral, does not reveal personal information,
and does not give advice.
Techniques of psychoanalysis
• Free association—During a therapy session,
psychoanalysts encourage patients to
verbalize any thoughts or feelings that come
into their consciousness.
• Free association practice
Dream Analysis
• According to Freud, dreams reflect symbolic or
unconscious desires.
• A psychoanalyst asks a patient to describe a dream
in as much detail as possible. Then, the
psychoanalyst interprets the underlying meaning
of the dream.
• Freud believed that unfulfilled desires that are not
expressed consciously during waking hours may
be represented in latent content of dreams.
Other elements of psychoanalysis
• Resistance occurs when patients
unconsciously try to censor their
thoughts/feelings or sabotage therapy by
missing appointments or holding back their
thoughts.
• Transference occurs when patients treat the
psychoanalyst like someone from their past
(e.g., a parent).
HUMANISTIC THERAPY
Humanist Approaches
• Humanistic therapies emphasize free will of
the client and encourage growth or selfactualization.
• In other words, if the client can understand
or develop insight into his or her problems
of living, then the client can choose to
change his or her behavior.
Client-centered or nondirective therapy
• Carl Rogers developed client-centered
therapy that allowed clients to direct the
therapeutic process.
• Rogerian-oriented therapists want to help
clients to develop insight into themselves as
valuable human beings and to worry less
about what others think of them.
• Psych Sim of ELIZA program
Conditions for client-centered therapy
1. Genuineness—The therapist has to be completely
honest and genuine.
2. Unconditional positive regard—The therapist
emphasizes the value of the client by fully
accepting the worth of the client.
3. Empathy—The therapist has an emotional
understanding of the client.
Gestalt Therapy
• Fritz Perls and his wife, Laura, developed Gestalt therapy
from the perspective that people create their own
understanding of the world and continue to grow as long as
they have insight into their feelings.
• Gestalt therapy is more directive and confrontational than
client-centered therapy.
• A Gestalt approach may include helping clients to identify
inconsistencies between the statements they make about
how they see themselves and how they really interact with
the world.
• I need 6 volunteers for a demonstration.
Other humanistic therapies
1.
Group therapy—A group of clients who may be experiencing similar
problems (e.g., alcoholism, domestic abuse, violence) meet under the
direction of one or more therapists who help them work through their
problems.
•
2.
Advantages of group therapy include helping clients to understand that
they are not alone and identifying possible mechanisms for dealing with
difficult situations.
Family therapy—Rather than treating an individual for a specific
problem, a family therapist considers the person within the context of
a system (family) and treats the entire system.
•
The goal of family therapy is to improve the functioning of the family
system as a whole through a better understanding of interactions that
occur within the system.
BEHAVIORAL THERAPY
Behavior Therapy
• Behavior therapy emphasizes changing learned
behaviors rather than understanding feelings.
• This relatively new approach (1970) evolved out
of general principles of classical and operant
conditioning that were studied by Watson, Pavlov,
and Skinner.
• Common applications of behavior therapy include
the treatment of phobias and anxiety disorders.
Systematic Desensitization
1. Systematic desensitization—
Systematic desensitization used the
principles of classical conditioning by
creating new associations for the
original phobic stimulus.
Systematic Desensitization
Process
• Establish a hierarchy of the anxietytriggering stimuli
• Learning relaxation methods
(progressive relaxation)
• Slowly think through the hierarchy,
working to relax whenever anxiety
is felt
Systematic Desensitization
Systematic Desensitization Variations
• Virtual realitysystematic
desensitization by way
of computerized,
anxiety-triggering 3-D
stimuli
• Combined with models
by having the subjects
watch someone perform
the anxiety-causing
behavior
Behavior Therapy Techniques
2. Aversion therapy—This therapy is the
opposite of systematic desensitization.
(With systematic desensitization, the
client learns to become less fearful of a
situation or stimulus.) In aversion therapy,
an unpleasant stimulus is introduced at the
same time as an undesirable response.
Aversion therapy seeks to increase the
unpleasant reaction to a stimulus.
Behavior Therapy Techniques
3. Extinction techniques—Principles of operant conditioning
are applied to reduce or eliminate a behavior.
a) Extinction can occur if reinforcements are removed after an
undesirable behavior is exhibited. For example, a student may
receive attention from a teacher for being disruptive in class. In
this case, the reinforcement was the attention received for acting
out in class. If, instead of receiving attention, the person is asked to
leave, the reinforcement is removed, and this may result in
extinction of behavior.
b) Flooding is a second method of effecting extinction. If someone
who is fearful of needles is inundated with repeated mild finger
pricks, after a period of time, the person will be able to receive
injections without the debilitating fear associated with the phobia.
Behavior Therapy Techniques
4. Punishment— Operant conditioning
principles can be used to reduce unwanted
behavior. An unpleasant stimulus is
introduced after an undesirable response
occurs.
Behavior Therapy Techniques
5.
Token economies—Positive reinforcement, or operant
conditioning, can be used to encourage people to engage
in appropriate behaviors. Token economies involve
giving people a “token,” such as play money, for
performing a desired behavior. The tokens can be
exchanged for a desired reward at a later point in time. A
pleasant stimulus is introduced after a desirable response
occurs.
COGNITIVE THERAPY
Cognitive Therapy Techniques
• Cognitive therapy techniques are designed
to help people change the way that they
think about their problems. People can deal
with problems by learning to change their
thoughts or cognitions.
Cognitive Therapy
• Almost half of all
therapist at a
university setting
use cognitive
therapies
Cognitive Therapy
Irrational Belief
• I must make “A’s.” I
simply can’t stand the
thought of making
anything less.
Rational Alternative
• Food, oxygen, and
water are things you
must have; “A’s” are
not. And though it is
frustrating and
disappointing not to
achieve the grade to
which you aspire, your
life will continue.
Irrational Belief
• I never understand what
my instructor says; my
stupidity will lead to
certain failure.
Rational Alternative
• There are many reasons
why students don’t
understand instructors.
Sometimes it is due to
deficiencies in the
educational background of
the student; sometimes
instructional
ineffectiveness is the
cause. However, there are
many ways to learn
something; your instructor
is but one resource.
Irrational Belief
• If I can’t remember the
answer to test questions
I’ve studied, I must be a
real dummy.
Rational Alternative
• Forgetting is as big a part
of being human as is
remembering. You are not
dumb or despicable
because you’ve forgotten
something; you’re simply
human. Avoid thinking in
extreme terms. There is no
truth to the notion that if
you aren’t perfect or
brilliant, then you must be
a failure or a moron.
Irrational Belief
• I’ll die of embarrassment if I
fail this course. I’ll never be
able to face my family again.
Rational Alternative
• No one has ever died of
embarrassment. Blush you may,
but your heart will continue to
beat, and your brain will
continue to function. Failure is
neither a crime nor a sin; you’re
human, therefore, you are
fallible. Furthermore, poor
college grades seldom cause
spouses to stop loving each
other or children to run away
from home.
Irrational Belief
• I’ve always been deathly afraid
of exams before. This will
never change.
Rational Alternative
• To learn means to change. You
change as you acquire new
knowledge in your classes; you
can similarly learn to take tests
effectively. Your past
difficulties need not condemn
you to a lifetime of test-taking
miseries. Avoid
overgeneralizing from bad
experiences in your past; your
present and future are not
controlled by the past.
Irrational Belief
• What if I don’t have all the time
I need to study? Going to
school, then, is a total waste of
time.
Rational Alternative
• Schoolwork takes time and
energy as do other personal,
family, occupational, and
recreational needs. Often there
won’t be enough hours in the
day to complete all things
perfectly. It is false to conclude,
however, that going to school in
such instances is a total waste
of time. Much will still be
learned, even if not perfectly or
totally. Furthermore, this
exemplifies catastrophizing
about a problem before it even
occurs.
Self-Serving Bias
• Tendency to judge oneself favorably
• Severely depressed patients tend to
not have a self-serving bias and tend
to blame themselves for problems and
credit the environment for successes
Cognitive Therapy Techniques
1.
Rational emotive behavior
therapy (REBT)—Albert Ellis
is credited with introducing
REBT. The premise of REBT
or rational emotive therapy
(RET) is that people engage
in self-talk that is false. If
people can change their
beliefs, then, according to
Ellis, this will produce a
change in emotion. The
therapist confronts irrational
beliefs of the client.
Cognitive Therapy Techniques
2.
Cognitive therapy—
Aaron Beck is credited
with developing
cognitive therapy, and
his approach is widely
used in the treatment of
depression. Cognitive
schemas, methods for
organizing the way that
we view the world, have
evolved into a distorted
perception.
How effective is psychotherapy?
• What the research says:
• Clients believe in the effectiveness of psychotherapy.
(Lebow, 1982 & Consumer Reports, 1995)
• Clinicians believe in the effectiveness of psychotherapy.
• Researchers have debated the effectiveness of therapy.
– Hans Eysenck found that 2/3 of people got better, whether they
received treatment or not! (1952)
– Those who received help were better off than 80% of those who
did not get treatment. (Smith, et al., 1980)
• The more clear-cut the psychological problem, the more
effective the therapy is likely to be. (Singer, 1981)
• No one kind of therapy or therapist is absolutely more
effective than all others. (Bickman, 1999)
ALTERNATIVE THERAPIES
Are alternative therapies effective?
• Therapeutic touch therapy
– Therapists move their hands above the person’s body to “push
energy fields into balance.” (They don’t actually touch
people.)
• Touch therapists believe that it works to cure burns,
cancer, headaches, and other ailments.
• Researchers have found no evidence to support these
claims. (Scheiber & Selby, 1997; Journal of the
American Medical Association.)
• James Randi offered $700,000 dollars to any
therapeutic touch therapist who could “detect a human
energy field” under experimental conditions. Nobody
has collected the money.
Are alternative therapies effective?
• Light exposure therapy
– Bright lights used to treat Seasonal Affective
Disorder, a form of depression.
• It actually seems to improve people’s
mental health. (61% got better with lights,
32% with a placebo.)