Transcript Treatment_and_Therapy_web_notes_2

Treatment of
Psychological Disorders
Chapter 15
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Types of Treatment
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Psychotherapy
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all the diverse approaches used in the treatment of
mental disorder and psychological problems
Classifications of Psychotherapy
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A. Insight therapies
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B. Behavior therapies
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“talk therapy”
Use of conditioning/behavior modification techniques to
change overt behavior
C. Biomedical therapies

Biological functioning interventions
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Who Provides Treatment?
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Psychiatrists (M.D.)
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Physicians who specialize in treating psychological disorders
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* They can prescribe medications,
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Tend to see those with the most serious problems
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Clinical psychologists (Ph.D., Psy.D., or Ed.D.)
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expertise in research, assessment, and therapy, supplemented by a
supervised internship
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About half work in agencies and institutions, half in private practice
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Counseling psychologists
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Clinical social workers (Master’s degree)
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two-year Master of Social Work graduate program plus postgraduate
supervision
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offer psychotherapy, mostly to people with everyday personal and family
problems
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Psychiatric nurses (Bachelor’s or Master’s)
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Counselors (Master’s)
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Marriage & family counselors
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Pastoral counselors
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Abuse counselors
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(Ph.D., Psy.D., or Ed.D.)
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Who’s Providing Therapy?
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A. Insight Therapies: verbal interactions intended
to enhance clients’ self-knowledge, thus promote healthful changes in
personality and behavior.
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1. Psychoanalysis
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Sigmund Freud and followers
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Goal: discover unresolved unconscious conflicts
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Therapeutic Process
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Free association
Dream analysis
Interpretation
 Resistance
 Transference
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A Freudian View: The Roots of a Disorder
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Insight Therapies (con’t)
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2. Humanist Therapies
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a. Client Centered Therapy
insight therapy that emphasizes providing a supportive
emotional climate for clients, who play a major role in the
pace and direction of their therapy
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Carl Rogers (1950’s)
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Goal: restructure self-concept to better correspond to reality
(become more congruent)
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Therapeutic Climate
Genuineness
Unconditional positive regard (warmth)
Empathy
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Encounter groups
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A Rogerian View: The Roots of a Disorder
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Insight Therapies (con’t)
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b. Gestalt Therapy
Insight therapy in which client confronts past and present
experiences in an attempt to restore a sense of
completeness ~ “whole self”
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More intensive and directed than client-centered therapy
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Insight Therapies (con’t )
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3. Cognitive Therapy
Insight therapy that emphasizes recognizing and
changing negative thoughts and maladaptive beliefs
(Note: sometimes called cognitive –behavioral therapy ~ use of
behavioral techniques along w/ individual’s perception to
change behavior/cognitions)
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Goal: restructure inappropriate/ “defeatist” thinking
Detect and recognize negative thoughts
 Reality testing
 Use of behavioral techniques to change behavior
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Insight Therapies (con’t )
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“The Cognitive Revolution”
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Insight Therapy (con’t)
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a. Cognitive therapy
Aaron Beck
 Belief: disorders result from distorted thinking
about the “cognitive triad”
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self
world/experiences
future
Goal: Restructure thinking
 Early view dealt w/ depression, later expanded
to additional disorders
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Did you know…
people with higher education
levels & medical insurance also
seek treatment more often?
Another correlation!
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Beck’s View: The Roots of a Disorder
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Insight Therapy (con’t)
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b. Rational-Emotive therapy (RET)
Direct (confrontational) therapy in which therapist
confront client’s illogical beliefs w/ rational arguments
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Developed by Albert Ellis
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Goal: restructure thinking and view environment
more realistically
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Updated to Rational-Emotive Behavioral Therapy
(1993)
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Insight Therapy (con’t)
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c. Stress-Inoculation Therapy
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Use of negative cues to initiate positive self
statements
d. Social skills training
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Modeling (based on Bandura’s work)
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Insight Therapy (con’t)
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4. Family & Group therapy
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Family
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Therapy designed to investigate and treat the
social network of the family unit along with the
individual
Group
Therapy within a “safe setting” for a group
 Basic format: self-revelation
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Note: a self-help group, though therapeutic, is NOT
psychotherapy
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B. Behavior Therapies: the application of
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learning principles to change/eliminate maladaptive
behaviors.
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B.F. Skinner & colleagues
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Goal: unlearning maladaptive behavior and learning
adaptive ones
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1. Counterconditioning
A. Systematic Desensitization – client associates a pleasant,
relaxed state with gradually increasing anxiety-triggering stimuli
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Developed by Joseph Wolpe
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Based on Classical conditioning
Uses Mary Cover-Jones’ earlier “reconditioning” experiments,
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but replaces food w/ relaxation
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Behavior Therapy con’t
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steps:
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build an anxiety hierarchy (a ranked list of anxietyarousing stimuli)
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client is trained in deep muscle relaxation
work through the hierarchy, while remaining
relaxed
“in vivo” desensitization – use of real rather than
imagined fear- eliciting stimulus
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Effective phobia treatment
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Conditioned Phobias & Systematic
Desensitization
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Behavior Therapy con’t
B. Aversive Conditioning
(aka Aversion Therapy)
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Type of type of
counterconditioning that
tries to associate an
unpleasant state with an
already acquired
negative/unwanted
behavior
Ex: antabuse (alcohol
nausea)
Used for Alcoholism,
sexual deviance, smoking,
etc.
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Behavior Therapy con’t
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2. Extinction Methods (aka. Exposure Therapy)
Use of massive amounts of anxiety in a non-threatening
environment to extinguish a behavior, typically a phobia
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a. Flooding
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extinction method, used to treat phobias, that exposes the
individual to real-life anxiety eliciting stimuli and escape is
prevented
Based on classical conditioning
Explanation: the CS loses it’s ability to elicit the CR (fear)
when no longer paired with the US
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Behavior Therapy con’t
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b. Implosive Therapy
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Extinction method used to treat phobias in which the feareliciting events are presented in imagined form
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Uses an unrealistic verbal description presented by the
therapist
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Based on classical conditioning (CC)
* Extinction methods (Flooding & implosive therapy) differ
from desensitization in that the individual works through
the anxiety as opposed to avoiding it!
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Behavior Therapy con’t
 3.
Token Economy (B.F. Skinner)
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an operant conditioning procedure
that rewards desired behavior
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patient exchanges a secondary
reinforcer, earned for exhibiting the
desired behavior, for various
privileges or treats
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C. Biomedical Therapies: physiological
interventions intended to reduce symptoms associated with
psychological disorders
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1. Psychopharmacotherapy (drug therapy)
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A. 3 Major Categories
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1. Antianxiety Compounds
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Relieve tension, apprehension, nervousness
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Early compounds were barbiturates
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1960’s - benzodiazepines introduced (ex: Valium, Xanax)
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New compound : Buspar
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Biomedical Therapies con’t
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2. Antipsychotics (a.k.a neuroleptics)
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Reduce psychotic symptoms, including hyperactivity,
mental confusion, hallucinations, and delusions
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Decreases activity @ the dopamine synapse
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Examples: Thorazine, Mellaril, Haldol
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Side effects
 Tardive dyskinesia (an incurable neurological
disorder marked by tics and spasms)
 Parkinson’s disease
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Newer compound: Clozapine (less motor side effects)
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Biomedical Therapies con’t
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3. Antidepressants:
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Tricyclics
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Mao inhibitors (MAOIs)
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Purpose: block neurotransmitter reuptake
Examples: Elavil, Tofranil
MAO: enzymes that breaks down monoamine
neurotransmitters (i.e.norepinephrine, dopamine, serotonin) in
the synaptic cleft
MAOIs reduce MAO, therefore, transmitters stay in cleft
longer
Example: Nardil
Selective serotonin reuptake inhibitors (SSRIs)
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Operate on the serotonin synapse
Examples: Prozac, Paxil, Zoloft
Most frequently prescribed
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Biomedical Therapies con’t
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B. Mood stabilizers
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Not in the 3 major categories, but important for “bipolar” treatment
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Examples
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Lithium (can be toxic, requires monitoring)
Valproic acid
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Biomedical Therapies con’t
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2. Electroconvulsive therapy (ECT)
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administration of a bilateral or unilateral electric shock to
produce a cortical seizure
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Used w/ unipolar and bipolar disorders
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may increase responsiveness, therefore, allowing use of
other treatments
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Noted side effects:
 memory loss
 hippocampus and amygdala damage in animals
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peaked in 40s and 50s; a recent resurgence
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Biomedical Therapies con’t
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3. Psychosurgery
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surgery designed to alter
the behavior of profoundly
disturbed patients by
lesioning a portion of the
brain
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Example: prefrontal
lobotomy
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•
Historic case: Phineous Gage
1848
Psychosurgery roots
•
Trephining
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Science “off track”
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Transorbital or "ice pick"
lobotomy – a crude and
destructive brainscrambling operation
performed on thousands
of psychiatric patients
between the 1930s and
1960s
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Touted as a cure for
mental illness.
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By Sandra G. Boodman
Washington Post Staff Writer
January 15, 2008
Walter J. Freeman performs a
lobotomy in 1949. (Bettmann/corbis)
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II. Current Trends & Issues in
Treatment
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Managed care
 Empirically validated treatments
 Blending Approaches to treatment
 Multicultural sensitivity
 Deinstitutionalization (1963)
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Revolving door problem
 Homelessness
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THE END!
Finish your cards & study
for the test!
100 multiple choice questions
& a free response
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