Treatments for Psychological Disorders

Biological and Psychological Based Treatments

Early Attempts at Biological Intervention

Coma and convulsive therapies Insulin coma therapy Electroconvulsive shock therapy (ECT)

Bilateral ECT and Unilateral ECT Shock lasting 1.5 Seconds 3 x week (2-4 weeks) Memory Impairment for Months After

Neurosurgery Psychosurgery or Neurosurgery The prefrontal lobotomy Very, Very Seldom Today Due to Medications

Psychopharmacological Methods of Treatment

Note: Keep in mind that the role of neuro-transmitters in mental illness is not well known. The use of medication is based on theory not fact

Psychopharmacology- the science of determining which drugs alleviate which mental disorders and why they do so

Antipsychotic Medications Neuroleptics or Major Tranquilizers

Traditional Antipsychotics included side effects including Tardive Dyskinesia- a disfiguring disturbance of motor control, particularly of the facial muscles

Atypical Antipsychotics Zyprexa, Geodon, Risperdal, Clozaril, Seraquil

Side Effects Include: Dry Mouth, Motor Disturbances, Sedation,

Weight Gain, Damage to Liver (blood levels need to be taken), Risperdal (lactation in females)

Effectiveness (20-30% do not respond)

Neurotransmitter Functioning

Antidepressant Medications

Monoamine oxidase (MAO) inhibitors Inhibits breakdown of neurotransmitters Used in depression with hypersomnia Requires Dietary Supplement

Tricyclic antidepressants (TCAs) Inhibits reuptake of serotonin & norepinephrine Cause death with overdose

Selective serotonin re-uptake inhibitors (SSRI) Prozac, Zoloft, Paxil, Luvox, Lexapro, Celexa Not as selective as once thought

Should be taken for minimum of 9-12 months

Antianxiety MedicationsAnxiolytics or Minor Tranquilizers

Benzodiazepines Sedative effect Dependency Issues Used to Treat Alcohol Withdrawal High Relapse Rate After Termination of Medication Probably stimulate GABA an inhibitory

neurotransmitter

Side Effects Include: Drowsiness and Lethargy Lithium for the bipolar mood disorders

Long Term Use Side Effects Include: thyroid dysfunction, kidney damage, memory and motor speed problems

Medication and Children

Do anti-depressants increase suicidality? Natural increase in likelihood to suicide when

mood improves Medications do result in an initial adjustment for

the body that can be agitating Important to monitor the individuals mood in the

first 10 days

A client’s response to a medication in the first 10-14 days is often predictive of how effective the medication will be in alleviating antidepressant

Psychologically Based TherapiesPsychologically

Based Therapies

An Overview of Psychological Treatment

Who provides psychotherapeutic services? Psychologists, Psychiatrists, Social Workers

Educational Backgrounds Vary Theories of Change Vary (see next slide)

Commonalities in Effective Therapists Form a Therapeutic Alliance with Their Clients Focus on Client Goals Use Research Based Interventions

Psychotherapy

Psychotherapy- the treatment of mental disorders by psychological methods.

To Achieve changes a therapist may: Change maladaptive behavior patterns Minimize or eliminate influences from the environmental

condition Improve interpersonal skills or other competencies Resolve disabling conflicts among motives Modify dysfunctional beliefs Reduce or remove distressing or disabling emotional

reactions. Foster a clear cut sense of identity

An Overview of Psychological Treatment

Why do people seek therapy? Those in highly stressful situations. Referred by physician or other professional. Forced by spouse, parent, or court.

Who has the best prognosis? (YAVIS) Young, Attractive, Verbal, Intelligent, and

Successful Individuals. Why YAVIS?

Motivation, Cognitive Abilities, Malleable The client’s contribution to the success of

treatment includes his or her motivation and expectation

Successful Therapy

Qualities of the client (personality, motivation) Qualities of the therapist (relational skills) Qualities of the relationship (therapeutic alliance) Qualities of the method being used.

Stages of Change Prochaska’s Levels of Change

Pre-contemplation Contemplation Preparation Action Maintenance Termination

Customer or not a customer

Psychodynamic Therapies:Freudian psychoanalysis

Four Basic Techniques Free association Analysis of dreams

Manifest content Latent content

Analysis of resistance An unwillingness or inability to talk about certain thoughts,

motives or experiences Analysis of transference

Transference- the process whereby clients project onto the therapist attitudes and feelings they had in a past relationship with a parent or other person close to them

Countertransference- the process in which the therapist reacts in accord with the client’s transferred attributions rather than objectively

Psychodynamic Therapies:Since Freud

Interpersonal therapy Object relations Self psychology Other interpersonal variations

Psychodynamic therapies tend to be time consuming and expensive They suggest that past issues need to be

resolved for change to occur Efficacy vs Effectiveness of of Psychodynamic

Approaches

Behavior Therapy

Guided exposure Systematic desensitization

Graduated scenes Require an inconsistent bx from the client

while exposed (real or imagined) to the feared stimuli

In Vivo Exposure

Aversion therapy Use of Punishment (antabuse) Driving Movie Pornography and Children Walking In

Modeling, Imitation, and Role Playing

Behavior Therapy

Systematic Use of Reinforcement Also referred to as Contingency Management Response Shaping- a behavior therapy technique using

positive reinforcement to establish by gradual approximation a response that is actively resisted or is not initially in a person’s behavioral repertoire

Remove Reinforcements or Add Reinforcements Super-Nanny

Token Economies Behavioral Contracting (marital tx and social exchange) Biofeedback Treatment

Monitor Physical, Convert to Signal, Prompt Feedback

Cognitive & Cognitive-Behavioral Tx

Rational emotive behavior therapy (REBT) Focus on changing core irrational beliefs

See table 3.5 Stress-inoculation therapy (SIT)

Three stages include: cognitive preparation, skill acquisition & rehearsal, and application and process.

Beck’s cognitive therapies Focus on illogical thinking about self, world, and

future.

Humanistic-Experiential Therapies

Client-Centered (person-centered) therapy Nondirective Unconditional Positive Regard Self-actualization

Existential Therapy The human predicament Focus on here and now Therapist is to be authentic

Gestalt Therapy Integration of thought, feeling, and action into

one’s self-awareness

Therapy for Interpersonal Relationships

Couples Counseling (Marital Therapy) Family Systems Therapy

Systemic Recursiveness Identified Patient Homeostasis

Structural Family Therapy (Salvador Minuchin) Family Rules and Boundaries

Eclecticism and the Integration of the Psychotherapies How do they all fit together?

How Does One Measure Success in Psychotherapy?

Objectifying and quantifying change Would change occur anyway? Can therapy be harmful?

Psychotherapy and Society

Social values and psychotherapy Psychotherapy and cultural diversity

EVALUATING PSYCHOTHERAPIES

Is psychotherapy effective Client perceptions

indicates that 3 out of 4 are satisfied while 1 in 2 are very satisfied.

Reports may be inaccurate due to crisis effect, effort effect, and liking the therapist

Clinician’s Perceptions Most testify to therapy success (big surprise)

Outcome Research Indicates that the average therapy outcome for clients who

receive treatment surpasses that of the client who remains untreated.

“Those not undergoing therapy often improve, but those undergoing therapy are more likely to improve.”

On average psychotherapy is somewhat effective (it depends on the diagnosis obviously)

Psychotherapy has been shown to decrease medical costs. Contrary to Myer’s presentation, some treatment approaches

have been proven to be more effective than others.

UNRESOLVED ISSUES

Efficacy versus effectiveness