Transcript PowerPoint Slide Set Westen Psychology 2e

Psychology: Brain, Mind,
and Culture, 2e
by
Drew Westen
Paul J. Wellman
Texas A&M University
John Wiley and Sons, Inc.
PowerPoint  Presentation: Chapter 16
Treatment of Psychological Disorders
Lecture Outline

Biological Therapies
 Pharmacotherapies
 Electroconvulsive Therapy
 Psychosurgery

Psychotherapies
 Psychodynamic Therapies
 Cognitive-Behavioral
 Humanistic, Group, and Family Therapies

Evaluating Therapies
© 1999 John Wiley and Sons, Inc.
The Medical Model

The Medical Model views abnormal
behavior as reflecting a biological disorder
 Usually localized within the brain
 Involving either brain damage or a disruption
of the neurotransmitter processes of the brain
 Person is viewed as a patient, treated by
doctors in a mental hospital
 Therapies tend to be physical in nature
• Drugs (Pharmacotherapy)
• Surgical alteration of brain (Psychosurgery)
© 1999 John Wiley and Sons, Inc.
Pharmacotherapy


Psychotropic medications are drugs that
act on the brain to alter mental function
Prior to 1956, schizophrenia was virtually
untreatable with many patients confined
for life in mental hospitals
 Chlorpromazine (Thorazine) was found to
reduce severity of psychotic thought allowing
people to live outside of mental institutions
• Reduced size of institutions
 The psychotropic actions of many drugs are
accidentally discoveries
© 1999 John Wiley and Sons, Inc.
Impact of Chlorpromazine on
Institutionalization
© 1999 John Wiley and Sons, Inc.
(Figure adapted from Davis, 1985)
Psychotropic Mechanisms of
Action

Psychotropic drugs can alter behavior via:
 An interaction with neurotransmitters in brain
•
•
•
•
Some release specific transmitters
Some block the reuptake of transmitters
Some interact with postsynaptic receptors
Some may act within neuron cells
 A placebo effect
• Subjects believe in the efficacy of the drug and
show an actual change in function (analgesia or
relief from pain shows moderate placebo effects)
© 1999 John Wiley and Sons, Inc.
Neurotransmitter Interactions
© 1999 John Wiley and Sons, Inc.
Antipsychotic Medications

Schizophrenia can be viewed as composed
of:
 Positive Symptoms: Presence of hallucinations
 Negative Symptoms: Absence of affect

Antipsychotic medications refer to drugs
that alleviate schizophrenia
 Antipsychotic medications are more effective
for the positive symptoms than for negative
symptoms of schizophrenia
© 1999 John Wiley and Sons, Inc.
Dopamine and Schizophrenia

The positive symptoms of schizophrenia
reflect too much brain dopamine activity
 Antipsychotic drugs are effective antagonists
of dopamine receptors (block the action of
dopamine)
 Drugs such as amphetamine release
dopamine from terminals; too much
amphetamine exposure can induce a
psychotic state in humans

Negative schizophrenic symptoms may
reflect brain damage enlarged ventricles)
© 1999 John Wiley and Sons, Inc.
Antidepressant Medications


Depression reflects a disturbance of mood,
sleep, and appetite
Psychotropic antidepressant drugs can lift
depression (require 3-4 weeks for effect)
 Tricylic antidepressants: Act by blocking the
reuptake of norepinephrine and serotonin
 Monoamine oxidase (MAO) inhibitors: MAO
degrades transmitters; drugs that inhibit MAO
allow the transmitter to work for longer periods
 Selective serotonin reuptake inhibitors: Prozac
blocks the reuptake of serotonin
© 1999 John Wiley and Sons, Inc.
Antianxiety Medications


Anxiety reflects an intense emotional state
of dread and apprehension
Drugs such as Valium increase the activity
of the transmitter GABA to dampen the
neural activity of the brain
 Valium is useful in the short-term treatment of
anxiety

Antianxiety medications can result in drug
dependence
© 1999 John Wiley and Sons, Inc.
Electroconvulsive Therapy


Antidepressant drugs require 3-4 weeks to
take action on mood; the person may be
at risk for suicide or is not responding to
drug treatment
Electroconvulsive shock therapy (ECT)
refers to the intentional induction of a
brain seizure by shock administered to
either or both hemispheres
 ECT produces immediate improvement in
mood (explanation is unknown)
 Side effects of ECT include memory loss
© 1999 John Wiley and Sons, Inc.
Psychosurgery

Psychosurgery refers to the intentional
damage of the brain to alter behavior
 In contrast to neurosurgery, which refers to
alteration of the brain to alter a known medical
issue (remove a tumor)


Trephining: Ancient skulls show evidence
of holes drilled as if to release evil spirits
Lobotomy: Surgical procedure used by
Egas Moniz to “calm” agitated patients
 Side effects include loss of frontal lobe function
© 1999 John Wiley and Sons, Inc.
Psychological Therapies

Whereas the biological therapies view
mental disorders through the medical
model, psychological therapies view the
roots of abnormal behavior in mental
states
 Each therapy has its own view as to the
cause of mental disorder
 Each therapy has its own approach to the
treatment of mental disorder
© 1999 John Wiley and Sons, Inc.
Varieties of Psychological
Treatment

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Psychodynamic
Cognitive-behavioral
Humanistic
Family and marital
Biological
© 1999 John Wiley and Sons, Inc.
Psychodynamic Approach

The psychodynamic approach was created
by S. Freud
 Mental symptoms reflect unconscious conflicts
that induce anxiety
 Insight refers to the situation when a person
comes to understand their unconscious
conflicts
 Therapeutic change requires an alliance
(relationship) between the patient and therapist
© 1999 John Wiley and Sons, Inc.
Psychodynamic Techniques

The goal of psychodynamic therapy is to
achieve insight into unconscious conflicts
 Free Association refers to a technique in
which the patient is encouraged to say
whatever comes to mind to reveal the
unconscious processes of the patient
 Interpretation: Therapist interprets the
thoughts, and feelings of the patient in order
to reveal the hidden conflicts and motivations
 Analysis of transference: Patients bring into
therapy their past troubled relationships;
these are transferred to the therapist
© 1999 John Wiley and Sons, Inc.
Cognitive-Behavioral Therapies

Cognitive-behavioral therapies focus on
the current behaviors of a person
 Emphasis is on the present rather than the
past
 Cognitive-Behavioral therapists are very
directive
 Therapy duration is short-term rather than
years long
 Initial focus is on a detailed behavioral
analysis: focus is on the problem behavior
and the stimuli associated with it
© 1999 John Wiley and Sons, Inc.
Behavior Therapies

Classical conditioning techniques can
alter emotional responses
 Systematic desensitization: Patient is
encouraged to confront a feared stimulus
(snake) while in a relaxed state
• Therapist trains relaxation
• Patient constructs an image hierarchy
• While relaxing, patient imagines the least fearful of
the images in their hierarchy (e.g. being on the
planet as a snake)
 Exposure: Patient is exposed to the stimulus
that they fear (locked in a room full of snakes)
© 1999 John Wiley and Sons, Inc.
Cognitive Therapies


Focus of cognitive therapies is on
changing dysfunctional thought patterns
Rational Emotive Therapy focuses on the
hurtful thought patterns of the patient
 Ellis’s theory suggests that pathology results
when persons adopt illogic in response to life
situations
 Therapist notes illogical and self-defeating
thoughts and teaches alternative thinking that
promotes rational thought
© 1999 John Wiley and Sons, Inc.
Gestalt Therapies

Gestalt therapists emphasize that losing
touch with ones feelings in order to meet
social obligations is the root of mental
disorder
 Focus of gestalt therapy is to have people
focus on their current feelings
 Empty-chair technique: Therapist places an
empty chair next to the client and asks them
to imagine that the object of their emotion is
actually sitting in the chair. The client then is
asked to direct their conversation to the chair
© 1999 John Wiley and Sons, Inc.
Evaluation of Therapies

Pharmacotherapy
 Drug therapies for depression, anxiety, and
schizophrenia can be effective in a number of
patients; focus is on long-term treatment
(years)
 Issues are related to side effects of the drugs
and to the high relapse rate when the drugs
are stopped
 Continued use of certain drugs can minimize
relapse of mental disorder
© 1999 John Wiley and Sons, Inc.
Evaluation of Psychotherapy

Meta-analyses show that
psychotherapy produces
measurable benefit to patients (on
the order of a 25% benefit or gain)
© 1999 John Wiley and Sons, Inc.
Copyright
Copyright 1999 by John Wiley and Sons, New
York, NY. All rights reserved. No part of the
material protected by this copyright may be
reproduced or utilized in any form or by any means,
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© 1999 John Wiley and Sons, Inc.