TREATMENTS FOR PSYCHOLOGICAL DISORDERS

Types of Treatment

Psychotherapy Insight therapies

“talk therapy” Ex. Family and marital therapy Behavior therapies

Changing overt behavior Ex. Treatments for phobias and drug addiction

Biomedical therapies Biological functioning interventions Ex.

Schizophrenia

Group Question Minute: Out of all of the people who receive psychotherapy, how many of them have mental disorders?

15% of U.S. population in a given year, almost half of which do not have a psychological disorder (Surgeon General’s report)

Group Question Minute: What are some reasons to receive psychotherapy?

Figure 15.3 Psychological disorders and professional

treatment

Who Seeks Treatment and Why?

Common presenting problemsAnxiety, depression, unsatisfactory interpersonal

relations, troublesome habits, poor self-control, low self-esteem, marital conflicts, self-doubt, a sense of emptiness, and feelings of personal stagnation.

Most common presenting problems Anxiety and Depression

Interesting Population Facts Women seek treatment more than men Medical insurance is a large factor in whether

or not people seek treatment. The higher your level of education, the more

likely you are to seek treatment

[Packet] Therapy Clips

These clips, from a larger show called Enraged depicts two people from different families and their experiences with therapy. Answer the following questions:

1. What “insights” did Andree and Sam have because of therapy?

2. What was the role of the therapist in Andree’s and Sam’s changes?

3. What behavioral improvements can the viewer see in Andree’s and Sam’s lives?

4. What will be Andree’s and Sam’s challenges regarding their behavior in the future?

5. What do you think are some of the potential disadvantages of therapy? Pictures from

Enraged by Discovery Health

Who Provides Treatment? Psychiatrists: medical doctors who study and treat

psychological disorders, sometimes by using medications Psychiatric nurses: within the nursing specialty; apply

nursing process to assess, diagnose, and treat individuals or families with psychiatric disorders and identify risk factors for such disorders

Clinical psychologists: psychologists who have advanced degrees; study and treat psychological illnesses through using various kinds of therapies

Counseling psychologists: advanced degree in psychology; help both normally and abnormally-functioning individuals personally and interpersonally over the lifespan through applying talk and behavioral therapies

Counselors: NOT doctors and NOT counseling psychologists; degree in counseling; support people in various settings and situations in their lives such as schools, vocations, and individual practices

Clinical social workers: degree in social work; use social work theory in the diagnosis, prevention, improvement and treatment of bio-psycho-social-spiritual dysfunction, disability and impairment

[Packet] Therapies Chart

Use pgs. 611-627 to complete your “Therapies Chart.”

3 TYPES OF THERAPY BINGOINSIGHT THERAPIES (PGS. 611-618) , BEHAVIOR THERAPIES (PGS. 619-622), BIOMEDICAL THERAPIES (PGS. 622-630)

Therapy Subcategories Descriptions

Tools Descriptions

Insight •Psychoanalysis•Client-centered therapy•Cognitive Therapy•Group Therapy

•Probing unconscious•Interpretation•Resistance•Climate•Process•Change thinking•Roles

Behavioral •Systematic desensitization•Aversion Therapy•Social Skills Training

•Anxiety hierarchy•Deep muscle relaxation•Counter conditioning•Emetic drug•Modeling•Behavioral rehearsal•shaping

Biomedical •Treatment with drugs•Other treatments (give history of ECT)

•Antianxiety•Antipsychotic•Antidepressant•Mood stabilizers•ECT

Insight Therapies Client Character Intro: My name is Wanda. I start fires a

lot. If you’re a psychoanalyst, you will say that the

origin of my behavior lies where in my mind? How will you access the “hidden” part of my mind?

Tools? When you ask me questions, I might yell at you and

tell you to shut up. Why? (see tools) How might you make me feel comfortable in a

client-centered environment. Once you discover that I was the victim of a fire at

age 3 and that I’m obsessed with them, how could you try to change my thinking?

You begin a therapy group with other arsonists in it and invite me. What “roles” would group members have?

Insight Therapies: Psychoanalysis Sigmund Freud and followers Goal: discover unresolved unconscious conflicts

Probing unconscious: bringing unconscious thoughts to the surface Free association- clients spontaneously express

thoughts and feelings without censorship Interpretation: attempt to explain the inner

significance of the client’s thoughts, feeling, memories, and behaviors. Resistance- unconscious defensive maneuvers that

help people save face and hinder progress in therapy. Transference- clients unconsciously start relating to

their therapist in ways that mimic critical relationships in their lives

Figure 15.4 Freud’s view of the roots of

disorders

Insight Therapies: Client-Centered Therapy Carl Rogers

Goal: restructure self-concept to better correspond to reality

Therapeutic Climate Genuineness Unconditional positive regard Empathy

Does insight therapy work?- Homework assignments mimic behavioral therapieso -Depends on goals- Some have doubts, but research shows it’s superior toplacebo treatments or no treatments.

Figure 15.5 Rogers’s view of the roots of disorders

Behavioral Therapy ClientCharacter Intro: My Name is Martha. I have a phobia of Neapolitan ice cream. How might you desensitize me to my fear of

Neapolitan ice cream? What would my anxiety hierarchy look like? How could you counter condition me to

Neapolitan ice cream? How could you serve as a model for me in

conquering my phobia? How could you shape me to not be afraid of

Neapolitan ice cream?

Behavior Therapies

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

adaptive ones Systematic Desensitization – Joseph Wolpe

Classical conditioning Step #1: Anxiety hierarchy: Step #2: the client is trained in deep muscle

relaxation Step #3: the client tries to work through the

hierarchy, learning to remain relaxed while imagining each stimulus.

The basic idea: You cannot be anxious and relaxed at the same time.

Aversion therapy Operant conditioning Pair an aversive stimulus with the problem behavior. Alcoholism, sexual deviance, smoking, etc.

Behavior Therapy

B.F. Skinner and colleagues Social skills training

Modeling Behavioral rehearsal

Biofeedback A bodily function is monitored, and

information about the function is fed back to the person so that they can develop more control over the physiological process.

Example: Anxiety attacks

Biomedical Therapies Patient Character Intro: My name is Judith. I

suffer from extreme, psychotic mania and deep depressions.

What kinds of medications would you prescribe me? Why?

Based upon the fact that you treat me with medications, what is the origin (etiology) of my problem?

Why might you also prescribe me antipsychotics?

What is ETC and during which phase of my cycle might you use it?

Biomedical therapies Assumption: Certain disorders are caused, at least in part,

by biological malfunctions. Psychopharmacotherapy=drug therapy 3 Categories:

Antianxiety - relieve tension, apprehension, and nervousness.

Examples: Valium, Xanax, Buspar Antipsychotic - gradually reduce psychotic symptoms,

including hyperactivity, mental confusion, hallucinations, and delusions.

decrease activity at dopamine synapses Side-effects: symptoms of Parkinson’s disease and

tardive dyskinesia, an incurable neurological disorder marked by involuntary writhing and ticklike movements of the mouth, tongue, face, hands, or feet.

Newer drugs, which have a different mechanism of action, such as clozapine, have fewer motor side effects but are not risk free.

Examples: Thorazine, Mellaril, Haldol Antidepressant:

Selective serotonin reuptake inhibitors (SSRIs) – Prozac, Paxil, Zoloft

Examples: Tricyclics – Elavil, Tofranil

Biomedical therapies

Psychopharmacotherapy Mood stabilizers

Lithium: chemical used to control mood swings in patients with bipolar mood disorders

Very successful at preventing future episodes of mania and depression, but it can be toxic and requires careful monitoring.

Valproic acid: same result as lithium, but has fewer averse side effects.

Electroconvulsive therapy (ECT) Electroconvulsive therapy (ECT) is a biomedical

treatment in which electric shock is used to produce a cortical seizure accompanied by convulsions. While the use of ECT peaked in the 40s and 50s, there has been a recent resurgence in this therapy.

Example: In A Beautiful Mind a version of ECT is used on a schizophrenic patient.

[Packet] Therapy Analysis Activity Do Concept Check 15.3 on pg. 622 to solidify your

knowledge of behavior therapies. Do Concept Check 15.4 on pg. 627 to solidify your

knowledge of biomedical therapies.

Which of the three kinds of therapy (insight, behavior, biomedical) would be best for the following conditions? Answer by making this chart in your spiral.

Condition Therapy Type

Reason

Schizophrenia or Disassociation

Homesickness

Panic Attacks

Bipolar

Alcoholism

A BEAUTIFUL MIND

• The semi-true story of John Nash. For a more accurate portrayal, visit the PBS website and look under A Brilliant Madness.• This assignment consists of watching the film, A

Beautiful Mind, and completing the viewing guide.• The film is PG_13. I will skip the few inappropriate

parts that are in the film and some other clips that aren’t particularly relevant to the

topic of psychological treatments and disorders.• The viewing guide is due the class period after we finish the film.

[PACKET] THERAPY ANALYSIS CTD.

• Reflection Paragraph: What is the origin of the increase for the need for mental health professionals in the late 20th Century? In other words, why do so many people need therapy in our day? According to your personal view and your knowledge of the world, write a RACE paragraph naming one or a few reasons for this increase. Please explain your reasons and cite evidence.

Personality Disorder Profile

Review the chart on pg. 590. Choose a type of personality disorder. On a piece of paper, make a profile of an

imaginary patient who has that disorder. Set up your profile in this manner:

Patient Name: Disorder Name: Profile: Under “Profile,”

describe in 10 sentences how the symptoms of that disorder impact the patient’s family, friends, job, pastimes, social life, and/or health.

describe in a few sentences what the patient’s doctors, family, and friends could do to help the patient manage his/her disease.

Make a dignified visual.

Example: Joe Jensen is currently a happy husband and a flight attendant. He loves his family and his work, and has now been married and flying for 25 years. However, earlier on in his adult life, he almost lost his wings and his new family. Joe was diagnosed with histrionic personality disorder at the age of 23. He found himself overreacting to small events in order to get attention. No matter how juvenile he knew this behavior to be, he couldn’t stop himself from laughing hysterically, throwing tantrums, and staging accidents to draw the attention of his wife and the plane passengers. Finally, passengers began complaining to the company about Joe’s behavior on flights. A pilot with whom Joe worked pulled him aside and gave him the card of a competent psychiatrist. Joe saw this doctor for several years, and he was finally able to master his impulsiveness through a combination of behavioral and cognitive treatments. His wife came near to leaving him, but decided to hang in there when she saw Joe’s determination to control his problem. Joe still visits the psychiatrist, but much less frequently than at the beginning. With the help of caring coworkers and an understanding wife, and with his determination to control his behavior, Joe was able to keep his family and job.

Cornell Notes: What are the current trends and issues in psychological treatment? Key Points Notes

Summary:

Current Trends and Issues in Treatment

Managed care through Health Insurance:

• Are HMOs negatively impacting psychological care? Many say “yes.”

• + Consumers pay lower prices (copays)

• - Consumers give up freedom to choose providers and obtain whatever treatments they believe necessary.

• - In the mental health domain, the question of what is “medically necessary” is more ambiguous.

Current Trends and Issues in Treatment

Empirically validated treatments• Psychologists have increased research efforts to

validate the efficacy of specific treatments for specific problems.

• + Insurance companies will pay for “research based” treatments.

• - Concerns about the inability of empirical studies to capture the complexity of the real world or the flexibility with which therapists must practice their craft.

• - Some argue that the movement toward empirically supported treatment runs counter to the eclectic blending of therapeutic approaches, which current studies suggest has merit.

Current Trends and Issues in Treatment

Blending approaches to treatment• Most mental health professionals use a mixture of

treatments

Multicultural sensitivity• Western cultures view “the self” as independent,

reflective, rational, and capable of self-improvements. Not all cultures hold these beliefs.

• Ethnic minorities are undertreated.

Current Trends and Issues in Treatment

Deinstitutionalization Definition: the movement away from inpatient

treatment in mental hospitals to more community based treatment.

The negative effects of mental hospitals have fueled this movement, as has the ability to treat serious mental problems with effective drug therapy. Long-term hospitalization for mental disorders is almost non-existent.

+ Fewer people are being hospitalized long-term, because other treatments are available.

- Revolving door problem: people who really do need long-term treatment spend their lives coming and going from the psych. ward.

- Homelessness: 1/3 of homeless people are mentally ill.