Transcript File

Treatment of
Psychological
Disorders
Unit 13
• History of treatment has ranged from beatings to warm
baths… and everything between and beyond that.
• 2 pioneers for ethical treatment were Philippe Pinel
(France) and Dorothea Dix (USA/Canada/Scotland).
• Hospitals constructed for more humane treatment options.
History
• 2 Main categories:
• 1) Treatment of Learning-related disorders, such as phobias.
• 2) Treatment of Biological-influenced disorders, such as
Schizophrenia.
• Fall under all encompassing branch of Psychotherapy  treatment
involving psychological techniques; consists of interactions
between a trained therapist and someone seeking to overcome
psychological difficulties or achieve personal growth.
• Most psychologists today advocated for the eclectic approach  an
approach to psychotherapy that, depending on the client’s
problems, uses techniques from various forms of therapy.
• This allows each patient to be treated individually based on their
specific needs.
Current
• Psychoanalysis  Sigmund Freud’s therapeutic
technique. Freud believed the patient’s free
associations, resistances, dreams, and
transferences – and the therapist’s interpretations
of them – released previously repressed feelings,
allowing the patient to gain self-insight.
• As much as all of your roll your eyes at Freud, some
of his treatment practices are still part of treatment
today. This is most seen in the psychodynamic
theories.
Types of Therapies
• Patients work through buried feelings and take
responsibility for their own growth.
• Presumes that healthier, less anxious living becomes
possible when people release the energy they had
previously devoted to id-ego-superego conflicts.
• Childhood impulses and conflicts.
Aim of Psychoanalysis
Therapies
Freud’s Office!
• Free Association – To allow patients to focus on own thoughts and feelings, the
therapist sits outside your field of view. Whatever comes to mind is expressed
and he therapist tries to use questioning techniques to find the deeper meaning.
• This can be difficult for the patient because rarely do you say anything without
somehow editing it in your mind first. This leads to resistance  in
psychoanalysis, the blocking from consciousness of anxiety-laden
material.
• The therapist takes note of your resistance and then interprets ( in
psychoanalysis, the analyst’s noting supposed dream meanings,
resistances, and other significant behaviors and events in order to
promote insight.) the meaning providing insight into your underlying
wishes, conflicts and feelings. (ex. Not wanting to talk about your mother).
•
.
Methods of Psychoanalysis
Therapies
• Freud encouraged using the latent content of dreams –
their underlying, but censored meaning – for dream
analysis to gain insight into the true meanings.
• Over time, the patient will start to disclose more to their
therapist as they become more comfortable with them.
You start to feel strong negative or positive feelings
towards your therapist. This leads to transference  in
psychoanalysis, the patient’s transfer to the analyst
of emotions linked with other relationships (such as
love or hatred for a parent).
Methods of Psychoanalysis
Therapies
• Traditional psychoanalysis takes time up to several years
with several sessions per week and costs can add up. (3x
a week, for 2 years at $100 a session = $30,000).
• Only common in France, Germany, Quebec and NYC
because of insurance costs.
Methods of Psychoanalysis
Therapies
• Psychodynamic therapy 
therapy deriving from the
psychoanalytic tradition that
views individuals as responding
to unconscious forces and
childhood experiences, and that
seeks to enhance self-insight
Psychoanalysis
Psychodynamic Therapy
• Aims of psychodynamic therapy – help
the person explore and gain
perspective on thoughts and feels.
• Similarities with psychoanalysis – uses
unconscious or ‘unsaid’ things to help
interpret patients issues.
• Differences with psychoanalysis – face
to face with patient, one a week, only
for a few weeks or months at a time.
Psychodynamic and
Humanistic Therapy
• Insight Therapies ( a variety of therapies that aim to improve
psychological functioning by increasing the client’s awareness
of underlying motives and defenses) focus more on:
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the present rather than the past
conscious rather than the unconscious
taking immediate responsibility
promoting growth instead of curing
Clients rather than patients
Humanistic Therapies
• Client Centered Therapy  a humanistic therapy,
developed by Carl Rogers, in which the therapist uses
techniques such as active listening within a genuine,
accepting, empathic environment to facilitate client’s
growth. (Also called person-centered therapy.)
• Nondirective therapy – therapist listens, without judgement or
interpretation and seeks to refrain form directing the client
towards certain insights.
• Rogers encouraged therapists to exhibit genuineness,
acceptance and empathy.
• Clients can feel more accepted when the therapists
empathetically sense and reflect their client’s feelings. Allows
clients to deepen sense of self-understanding and selfacceptance.
Humanistic Therapies
• Rogers ideas included Active Listening  empathic listening
in which the listener echoes, restates, and clarifies. A
feature of Roger’s client-centered therapy. Used in
teaching, counselling and modern therapy techniques.
Includes ideas of:
1) Paraphrase – Rather than saying ‘I
know how you feel’, checking the
understanding by summarizing the
speaker’s words in your own words.
2) Invite clarification – ‘What might this
be an example of?’ may encourage the
speaker to say more.
3) Reflect feelings – “It sounds
frustrating’ might mirror what you’re
sensing from the speaker’s body
language and intensity.
• Rogers also advocated for Unconditional Positive Regard
 a caring, accepting, nonjudgmental attitude,
which Carl Rogers believed would help clients to
develop self-awareness and self-acceptance.
• What differences do you see between Freud’s ideas
and Rogers? Why might one work better than
another in different treatment situations? DISCUSS
• Behaviour Therapy  therapy that applies learning
principles to the elimination of unwanted behaviors.
• Doubts the healing power of self-awareness. For example, you
can become aware of why you are highly anxious during tests
and still be anxious.
• Assume that problem behaviours are the problems themselves
and that applying learning principles can eliminate them.
• View maladaptive symptoms –such as phobias – as learned
behaviours that can be then replaced by constructive
behaviours.
• Based on Skinner and Pavlov’s animal research.
Behaviour Therapies
• Can maladaptive symptoms be
examples of conditioned
responses? If so, can we fix it with
reconditioning?
• Ex. Bed wetting alarm.
• Counter-Conditioning a
behavior therapy procedure
that used classical conditioning
to evoke new responses to
stimuli that are triggering
unwanted behaviors; includes
exposure therapies and
aversive conditioning.
• Ex. Associate fear of elevator with
a calming feeling to retrain the
fear.
Classical Conditioning
Techniques
• Ex. Rabbit and Snack – Page 611
• Exposure Therapies  behavioral techniques, such as
systematic desensitization, that treat anxieties by
exposing people (in imagination or actuality) to the things
they fear and avoid.
• Systematic Desensitization  a type of exposure therapy
that associates a pleasant relaxed state with gradually
increasing anxiety-triggering stimuli. Commonly used to
treat phobias.
• Cannot be simultaneously anxious and relaxed.
Therefore if you can be repeatedly relaxed while facing
anxiety provoking stimuli, anxiety can be gradually
eliminated. Trick? Must be gradual.
Exposure Therapies
Treating Phobias
• Virtual Reality Exposure
Therapy  an anxiety
treatment that
progressively exposes
people to simulations
of their greatest fears,
such as airplane flying,
spiders, or public
speaking.
• Avatars can be used to
place oneself in
situations and adjust to
different phobias. (ex.
Social phobias)
• Averse Conditioning  a type of counterconditioning
that associates an unpleasant state (such as
nausea) with an unwanted behavior (such as
drinking alcohol).
• Works in the short run. The problem is that cognition
influences conditioning. Ex. People know that
outside of the therapists office, they can drink
without nausea. Thus, averse conditioning must be
used in combination with other treatments to ensure
success.
Averse Conditioning
Behavior Therapies
Aversion Therapy
• Voluntary behaviours are strongly influenced by their
consequences.
• Can use behaviour modification, by reinforcing desired
behaviours and withholding reinforcement or enacting
punishment for undesired behaviour.
• Takes a lot of time and work initially but pays off later.
Ex. 40 hours a week for 2 years with autistic 3 year olds.
Operant Conditioning
• Rewards used to modify behaviour vary.
• Sometimes praise works, sometimes need concrete
rewards, such as food.
• In institutional settings therapists create token economy
 an operant conditioning procedure in which
people earn a token of some sort for exhibiting a
desired behavior and can later exchange the tokens
for various privileges or treats.
Concerns – How durable are behaviors? Will they stop
when enforcers stop? Is it right for one human to
control another’s behavior?
• Cognitive Therapy  therapy that teaches people new,
more adaptive ways of thinking and acting; based on the
assumption that thoughts intervene between events and
our emotional reactions.
• Thinking colours our feelings and in between the event
and our response lies the mind.
• If thinking patterns can be learned, then they must be
able to be replaced.
• Cognitive therapists try in various ways to teach people
new, more constructive ways of thinking.
• Client/Patient interaction – pg 615-616
Cognitive Therapies
• Cognitive Behavioural
Therapy  a popular
integrative therapy that
combines cognitive
therapy (changing selfdefeating thinking) with
behavior therapy
(changing behavior).
• Seeks to make people
aware of their irrational
negative thinking, replace
it with new ways of
thinking and to practice a
more positive approach
to everyday settings.
• How would a cognitive
therapist treat a patient
with an eating disorder?
Cognitive Therapies
Cognitive Behavioral
Therapy
OCD
• Does not provide as much of a one on one with each
patient, but is less expensive and time consuming and has
been proven to be no less effective than individual
therapy.
• The social context of group therapy allows for people to
both discover that others have similar problems to them
and receive feedback as they try out new was of
behaving.
• What do you think is the most successful example of
group therapy on record?
Group and Family Therapy
• Family Therapy  therapy that treats the family as a
system. Views an individual’s unwanted behaviors
as influenced by, or directed at, other family
members.
• No one person is an island. We live and grow in
relation to others, especially our families.
• Sometimes we struggle to differentiate ourselves
from our families, but we also need to connect with
them emotionally. A lot of problem behaviours come
from the tension between these 2 tendencies, which
creates family stress.
Family and Group Therapy
Comparison of Psychotherapies
• The question of evaluation lies in does psychotherapies
work or not?
• Perceptions fall under client, clinicians and outcome
research.
Evaluating
Psychotherapies
• Most people (about 85%) say that their therapy has helped
them.
• People often enter therapy in crisis – However, if the crisis is
removed by natural causes, they attribute the solution to their
therapy.
• Clients may need to believe the therapy was worth the effort –
To admit that investing time and money in self-justification
and improvement is a powerful motive.
• Clients generally speak kindly of their therapists – Clients feel
therapists have lots of understanding, give new perspectives,
allow them to communicate better, etc.
Client Perceptions
• Case studies of successful treatment abound.
• However, a even the best clinician may not hear back
from successful clients or do not know what clients went
to another clinician.
• Most people start therapy when they are in a low state,
leave in a higher state. Does not mean they are ‘cured’.
May repeat clients are the ‘successes’ in different
clinicians files.
Clinitians Perspective
• Controlled observation studies used to legitimize success
rates.
• Over 5 dozen studies have been done to legitimize the
effectiveness of psychotherapy. All reflect the same
outcome – Those not undergoing therapy often improve,
but those undergoing therapy are more likely to improve.
Outcome Research
• When outcome research is
being conducted, 2 common
practices are used:
• Regression Towards the Mean
 the tendency for extreme
or unusual scores to fall
back (regress) toward their
average.
• Meta-analysis  a procedure
for statistically combining
the results of many different
research studies.
• Placebo research plays a
big role in determining the
validly to therapies. Why?
Outcome Research
• Ones to avoid according to outcome research:
• Energy Therapies – propose to manipulate people’s
invisible energy fields.
• Recovered-memory therapies – aim to unearth ‘expressed
memories’ of early childhood abuse.
• Rebirthing therapies – engage people in reenacting the
supposed trauma of their birth.
• Crisis debriefing – forces people to verbalize, rehearse
and process their traumatic experiences.
• Lets play… NAME THAT FLAW!
The Relative Effectiveness of
Different Therapies
• What works in
psychology? What does
not? It comes down to
used Evidence based
practice  clinical
decision-making that
integrates the best
available research with
clinical expertise and
patient characteristics
and preferences.
The Relative Effectiveness of
Different Therapies
• No evidence for or against.
• Eye movement desensitization and reprocessing
(EMDR) – Can make anxious thoughts disappear
when eyes spontaneously dart about. Relive
tragedy while waving objects in front of the eyes.
70,000 people trained in this to date.
• Light exposure therapy
• Seasonal affective disorder (SAD) – Sunlamps
used to boost light exposure. As effective as antidepressants in some cases.
Evaluating Alternate
Therapies
• 3 elements shared by all
psychologists:
• Hope for demoralized
people – things can and will
get better, no matter how
bad the start.
• A new perspective –
plausible explanation of
symptoms.
• An empathic, trusting,
caring relationship – seek to
understand the experience
of others.
Commonalities Among
Psychotherapies
Culture and Values in
Psychotherapy
• Similarities between cultures –
want patients to get better
overall
• Differences between cultures –
religion, values, expectations
Types of Therapists
• Biomedical Therapies (prescribed medications or
medical procedures that act directly on the patient’s
nervous system.) fall under 5 categories:
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•
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Drugs
Electroconvulsive therapy
Magnetic impulses
Psychosurgery
Psychiatrist
Biomedical Therapies
• Psychopharmacology  the study of the effects of drugs
on mind and behavior.
• Factors to consider with drug
therapy
• Normal recovery rate of untreated
patients
• Placebo effect
• Double blind procedure
Drug Therapies
Placebo Effect
Drug Therapies
Drug Therapies
• Antipsychotic drugs
Antipsychotic
• PsychosesDrugs
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Chlorpromazine
Dopamine
Tardive dyskinesia
Atypical antipsychotics
(Thorazine)
(Clozaril)
• Positive and negative symptoms
• xxx
• xxx
• Antipsychotic Drugs  drugs used to treat schizophrenia and other forms
of severe thought disorder.
•
Used with patients with psychoses – patients with loss of reality.
• Chlorpromazine aka (Thorazine) dampens
responsiveness to irrelevant stimuli.
• Common side effect is Tardive dyskinesia 
involuntary movements of the facial muscles, tongue, and
limbs; a possible neurotoxic side effect of long-term use of
antipsychotic drugs that target certain dopamine receptors.
• Atypical antipsychotic aka (Clozaril) for
schizophrenia. Targets both dopamine and
serotonin receptors.
Antipsychotic Drugs
• Antianxiety Drugs drugs used
to control anxiety and agitation.
Xanax, Ativan, Dcycloserine – depress
central nervous
system activity.
Cannot e used in
combination with
alcohol.
• Physiological
dependence – after
heavy use, stop
taking them, nay
experience increased
anxiety, insomnia and
withdrawal symptoms.
•
Antianxiety Drugs
• Antidepressants  drugs used to treat depression; also
increasingly prescribed for anxiety. Different types work by
altering the availability of various neurotransmitters.
• Use with mood and anxiety disorders as
they increase the availability of
norepinephrine or serotonin.
• Fluoxetine (Prozac), Paxil - SSRIs
• Selective-serotonin-reuptake inhibitors
• Side effects of antidepressants – dry
mouth, weight gain, hypertension,
dizziness, etc.
Antidepressant Drugs
Drug Therapies
Antidepressant Drugs
• Lithium – emotion highs and lows
of bipolar.
• Depakote – originally for
seizures, works well for bio-polar
as well.
Mood Stabilizing Medications
• Electroconvulsive Therapy a biomedical therapy for severely
depressed patients in which a brief electric current is sent through
the brain of an anesthetized patient.
Procedure – general anesthetic, muscle
relaxant, 30-60 seconds of electrical
impulse to the brain. Wakens within 30
minutes, with no memory. May work like
‘restarting a computer’.
• Severe depression – extremely effective in
those who do not respond to drugs.
•
Electroconvulsive Therapy
Brain Stimulation
Electroconvulsive Therapy
• Repetitive transcranial magnetic stimulation (rTMS)
the application of repeated pulses of magnetic
energy to the brain; used to stimulate or suppress
brain activity.
• Deep brain stimulation
• Major depression treatment.
Alternative Neurostimulation
Therapies
Brain Stimulation
Alternative Neurostimulation Therapies
•
•
Psychosurgery  surgery that removes or destroys brain tissue in an effort to change
behavior.
Lobotomy  a now-rare psychosurgical procedure once used to calm
uncontrollably emotional or violent patients. The procedure cut the nerves
connecting the frontal lobes to the emotion-controlling centers of the inner brain.
• History – crude, inexpensive, goal to disconnect emotion
from thought.
• Procedure – shock patient into coma, hammer icepick like
instrument through each eye socket, then wiggle to sever
connections.
• Side effects – decreased misery or tension, but produced
lethargic, immature, uncreative people.
• Use today – No lobotomies. Surgery only for seizure
disorders and very precise.
Psychosurgery
• Integrated biopsychosocial system
– everything that is psychological
is also biological.
• Therapeutic life-style change
•
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•
•
Aerobic exercise – 30 mins per day, 3
times a week.
Adequate sleep – 7-8 hours per night
Light exposure – 30 mins each morning
(light box)
Social connection – less alone time and
at least 2 meaningful social
engagements weekly.
Anti-rumination – identify and redirect
negative thoughts.
Nutritional supplements – fish oil –
omega 3 fatty acids healthy brain!
Therapeutic Lifestyle Changes
• Resilience the personal strength that helps most
people cope with stress and recover from adversity
and even trauma.
• Understand that there are connections – ex stress.
• River analogy – Page 638.
• Preventative is not as in place as it should be. May lead to
better treatment quicker.
Preventing Psychological
Disoders
Early Treatment
Drug Addiction