Chapter 15

Treatment of Psychological Disorders

Table of Contents

Types of Treatment

Types of therapies– Insight therapies

• “talk therapy”

– Behavior therapies• Changing overt behavior

– Biomedical therapies• Biological functioning interventions

Table of Contents

Who Seeks Treatment?

15% of U.S population in a given year Most common presenting problems

– Anxiety and Depression– Treatment seeking for various disorders – (slide)

• Mood disorders

Utilization rates – (slide) Women more than men Medical insurance Education level Psychological Disorders and professional treatment –

Figure (slide)

Table of Contents

Treatment seeking for various disorders

Table of Contents

Therapy utilization rates – Olfson et al. (2002)

Table of Contents

Table of Contents

Who Provides Treatment?

Clinical psychologists Counseling psychologists Psychiatrists Clinical social workers Psychiatric nurses Counselors On-line treatment?

Table of Contents

Therapists and their Training

Clinical psychologists Most are psychologists with a Ph.D. and expertise in

research, assessment, and therapy, supplemented by a supervised internship

About half work in agencies and institutions, half in private practice

Clinical or Psychiatric Social Worker A two-year Master of Social Work graduate program

plus postgraduate supervision prepares some social workers to offer psychotherapy, mostly to people with everyday personal and family problems

About half have earned the National Association of Social Workers’ designation of clinical social worker

Table of Contents

Counselors Marriage and family counselors specialize in

problems arising from family relations Pastoral counselors provide counseling to countless

people Abuse counselors work with substance abusers and

with spouse and child abusers and their victims

Psychiatrists Physicians who specialize in the treatment of

psychological disorders Not all psychiatrists have had extensive training in

psychotherapy, but as M.D.s they can prescribe medications. Thus, they tend to see those with the most serious problems

Many have a private practice

Table of Contents

Insight Therapies: Psychoanalysis

Sigmund Freud and followers– Goal: discover unresolved unconscious conflicts

• Free association: clients spontaneously express their thoughts and feelings exactly as they occur, with as little censorship as possible. The analyst looks for clues about what is going on in the unconscious.

• Dream analysis: “royal road to the unconscious."

• Interpretation– Resistance and transference

Psychodynamic Therapies

Freud’s view of the roots of disorders

Table of Contents

Insight Therapies: Client Centered Therapy

Carl Rogers– Goal: restructure self-concept to better correspond to reality– Therapeutic Climate

• Genuineness

• Unconditional positive regard

• Empathy

Table of Contents

Therapies Inspiredby Positive Psychology

Martin Seligman Uses theory and research to better understand the

positive, adaptive, creative, and fulfilling aspects of human existence– well-being therapy– positive psychotherapy

• can be an effective treatment for depression

Table of ContentsPositive psychotherapy for depression

Table of Contents

Other issues

Groups therapy– Group size– Advantages – social dimension of change

Effectiveness of Insight therapies (Slide)– Spontaneous remission

Talk therapies or other approaches?– Common factors contribute to progress in those treated

Table of Contents

Recovery as a function of number of therapy sessions

Table of Contents

Behavior Therapies

B.F. Skinner and colleagues– Goal: unlearning maladaptive behavior and

learning adaptive ones– Systematic Desensitization – Joseph Wolpe

• Classical conditioning (slide)• Anxiety/Fear hierarchy

– Aversion therapy – (slide)• Alcoholism, sexual deviance, smoking, etc.

– Social skills training• Modeling • Behavioral rehearsal

– Biofeedback

Table of Contents

Table of Contents

Table of Contents

Cognitive-Behavioral Therapy

Aaron Beck– Cognitive therapy – Depression and negative thinking – (Slide)

Albert Ellis– Rational-emotive therapy

Goal: to change the way clients think– Detect and recognize negative thoughts– Reality testing

Effectiveness of Behavior Therapies– Efficacy of behavioral interventions for a variety of

disorders

Table of Contents

Table of Contents

Biomedical Therapies Psychopharmacotherapy

– Antianxiety - Valium, Xanax, Buspar– Antipsychotic - Thorazine, Mellaril, Haldol

• Tardive dyskinesia• Atypical antipsychotic – reduce motor effects and other

neurotransmitters• Time course

– Antidepressant: - Actions• Tricyclics – Elavil, Tofranil• Mao inhibitors (MAOIs) - Nardil• Selective serotonin reuptake inhibitors (SSRIs) – Prozac, Paxil,

Zoloft – side effects – • Risk of suicide –

– Mood stabilizers• Lithium, Valproic acid

Electroconvulsive therapy (ECT) – Transcranial Magnetic Stimulation Deep brain stimulation –

Table of ContentsFigure 15.13 Antidepressant drugs’ mechanisms of action

Table of Contents

Electroconvulsive Therapy

Table of ContentsFigure 15.15 Deep brain stimulation

Table of Contents

Current Trends and Issues in Treatment

Managed care Empirically validated treatments Blending Approaches to treatment –

– Conjunctive therapy –

Multicultural sensitivity Deinstitutionalization

– Dorthea Dix -– Changes in population –

• Factors – treatments, legal, service delivery model

– Revolving door problem– Homelessness– Increase use of criminal justice system

Table of ContentsThe leading approaches to therapy among psychologists

Table of Contents

Relapse rates in Reynolds et al. (1999) study

Table of Contents

Table of Contents

Percentage of psychiatric inpatient admissions that are readmissions

Table of Contents

Looking for at therapist

Factors to consider– Sources of services – (slide)– Profession– Gender– Theoretical approach

Comparison of approaches for effectiveness – (slide)

Table of Contents

Table 15-2, p. 626

Table of ContentsEstimates of the effectiveness of various approaches to psychotherapy.