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Treatment of
Psychological Disorders
Chapter 15
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Types of Treatment
Psychotherapy
all the diverse approaches used in the treatment of
mental disorder and psychological problems
Classifications of Psychotherapy
A. Insight therapies
B. Behavior therapies
“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?
Psychiatrists (M.D.)
Physicians who specialize in treating psychological disorders
* They can prescribe medications,
Tend to see those with the most serious problems
Clinical psychologists (Ph.D., Psy.D., or Ed.D.)
expertise in research, assessment, and therapy, supplemented by a
supervised internship
About half work in agencies and institutions, half in private practice
Counseling psychologists
Clinical social workers (Master’s degree)
two-year Master of Social Work graduate program plus postgraduate
supervision
offer psychotherapy, mostly to people with everyday personal and family
problems
Psychiatric nurses (Bachelor’s or Master’s)
Counselors (Master’s)
Marriage & family counselors
Pastoral counselors
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.
1. Psychoanalysis
Sigmund Freud and followers
Goal: discover unresolved unconscious conflicts
Therapeutic Process
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)
2. Humanist Therapies
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
Carl Rogers (1950’s)
Goal: restructure self-concept to better correspond to reality
(become more congruent)
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)
b. Gestalt Therapy
Insight therapy in which client confronts past and present
experiences in an attempt to restore a sense of
completeness ~ “whole self”
More intensive and directed than client-centered therapy
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Insight Therapies (con’t )
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)
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)
a. Cognitive therapy
Aaron Beck
Belief: disorders result from distorted thinking
about the “cognitive triad”
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)
b. Rational-Emotive therapy (RET)
Direct (confrontational) therapy in which therapist
confront client’s illogical beliefs w/ rational arguments
Developed by Albert Ellis
Goal: restructure thinking and view environment
more realistically
Updated to Rational-Emotive Behavioral Therapy
(1993)
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Insight Therapy (con’t)
c. Stress-Inoculation Therapy
Use of negative cues to initiate positive self
statements
d. Social skills training
Modeling (based on Bandura’s work)
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Insight Therapy (con’t)
4. Family & Group therapy
Family
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.
B.F. Skinner & colleagues
Goal: unlearning maladaptive behavior and learning
adaptive ones
1. Counterconditioning
A. Systematic Desensitization – client associates a pleasant,
relaxed state with gradually increasing anxiety-triggering stimuli
Developed by Joseph Wolpe
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:
build an anxiety hierarchy (a ranked list of anxietyarousing stimuli)
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
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)
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
2. Extinction Methods (aka. Exposure Therapy)
Use of massive amounts of anxiety in a non-threatening
environment to extinguish a behavior, typically a phobia
a. Flooding
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
b. Implosive Therapy
Extinction method used to treat phobias in which the feareliciting events are presented in imagined form
Uses an unrealistic verbal description presented by the
therapist
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)
an operant conditioning procedure
that rewards desired behavior
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
1. Psychopharmacotherapy (drug therapy)
A. 3 Major Categories
1. Antianxiety Compounds
Relieve tension, apprehension, nervousness
Early compounds were barbiturates
1960’s - benzodiazepines introduced (ex: Valium, Xanax)
New compound : Buspar
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Biomedical Therapies con’t
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2. Antipsychotics (a.k.a neuroleptics)
Reduce psychotic symptoms, including hyperactivity,
mental confusion, hallucinations, and delusions
Decreases activity @ the dopamine synapse
Examples: Thorazine, Mellaril, Haldol
Side effects
Tardive dyskinesia (an incurable neurological
disorder marked by tics and spasms)
Parkinson’s disease
Newer compound: Clozapine (less motor side effects)
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Biomedical Therapies con’t
3. Antidepressants:
Tricyclics
Mao inhibitors (MAOIs)
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)
Operate on the serotonin synapse
Examples: Prozac, Paxil, Zoloft
Most frequently prescribed
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Biomedical Therapies con’t
B. Mood stabilizers
Not in the 3 major categories, but important for “bipolar” treatment
Examples
Lithium (can be toxic, requires monitoring)
Valproic acid
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Biomedical Therapies con’t
2. Electroconvulsive therapy (ECT)
administration of a bilateral or unilateral electric shock to
produce a cortical seizure
Used w/ unipolar and bipolar disorders
may increase responsiveness, therefore, allowing use of
other treatments
Noted side effects:
memory loss
hippocampus and amygdala damage in animals
peaked in 40s and 50s; a recent resurgence
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Biomedical Therapies con’t
3. Psychosurgery
surgery designed to alter
the behavior of profoundly
disturbed patients by
lesioning a portion of the
brain
Example: prefrontal
lobotomy
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Historic case: Phineous Gage
1848
Psychosurgery roots
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Trephining
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Science “off track”
Transorbital or "ice pick"
lobotomy – a crude and
destructive brainscrambling operation
performed on thousands
of psychiatric patients
between the 1930s and
1960s
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)
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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