History of Mental Health Treatment

• 19% of U.S. adults and 13% of adolescents (ages 8-15) experience mental illness annually.
• One-third to one-half of U.S. adolescents with mental disorders receive treatment; behaviour-related disorders are more likely to be treated.

Historical Context of Mental Health Treatment

• Historically, mental illness was attributed to supernatural causes like witchcraft or demonic possession, leading to cruel treatment.

• Treatments focused on addressing supernatural forces

  • Exorcism involved prayers and incantations over the afflicted.
  • Trephining involved drilling holes in the skull.
  • Mentally ill individuals were sometimes executed or imprisoned for witchcraft.

• 18th-century saw the institutionalization of people with unusual behaviour

  • Asylums were created to house individuals with psychological disorders.
  • The focus was more on ostracizing individuals than providing treatment
  • Individuals were often confined to dungeons with little to no contact with caregivers.

• Philippe Pinel, a French physician in the late 1700s, advocated for humane treatment.

  • He argued for unchaining patients and engaging with them.
  • His reforms were implemented in Paris in 1975.

• 19th-century American asylums were often filthy and offered minimal treatment.

  • Individuals were often institutionalized for years

• 20th Century advances

  • In 1954, antipsychotic medications were introduced and found to be effective for psychosis.
  • In 1975, the Mental Retardation Facilities & Community Mental Health Centers Construction Act supported community mental health centers.
  • Deinstitutionalization began, but the new community system was ineffective, leading to underfunded centers and untrained staff.
  • Homelessness increased, and correctional institutions now report a high number of individuals living with mental illness.

Modern Treatment Types

• Psychodynamic psychotherapy: Talk therapy addressing unconscious and childhood conflicts, impacts behaviour
  • Example: patient talks about his past.
• Behaviour therapy: Uses learning principles to change undesirable behaviours.
  • Example: overcoming fear of elevators through relaxation.
• Cognitive-behavioural therapy: Targets cognitive distortions and self-defeating behaviours.
  • Example: identifying negative thoughts to overcome an eating disorder.
• Humanistic therapy: Increases self-awareness and acceptance by focusing on conscious thoughts.
  • Example: articulating thoughts that hinder goal achievement.

Psychodynamic Therapy

• First psychotherapy form developed by Sigmund Freud in the early 20th century, focused on repressed feelings.
• Free association: Patients relax, verbalizing whatever comes to mind.
  • Freud suggested that the ego might resist unacceptable urges or painful conflicts, which can cause the patient to demonstrate resistance.
• Dream analysis: Therapists interpret the underlying meaning of dreams.
• Transference: Patients transfer emotions from other relationships onto the psychoanalyst.
• Psychodynamic psychotherapy: Talk therapy that addresses unconscious and childhood conflicts

Behaviour Therapy: Classical Conditioning

• Principles of learning are applied to change undesirable behaviours through conditioning.
• Counterconditioning: Learning a new response to a previously problematic stimulus.
• Aversive conditioning: Uses unpleasant stimuli to stop undesirable behaviours.
  • Example: Antabuse treats alcoholism by causing negative side effects when combined with alcohol.
• Exposure therapy: Changes the response to a conditioned stimulus.
  • Treats fears and anxiety by repeated exposure to the feared object/situation.

Exposure Therapy Details

• Involves presenting an unconditioned stimulus just after a conditioned stimulus.
• Jones’ Study (1924): aimed to replace Peter’s fear of rabbits with relaxation.
  • Peter was exposed to a rabbit while eating a snack in a relaxed state.
  • The rabbit started in a cage, which was moved closer while Peter snacked.
  • After 2 months, Peter petted the rabbit while eating.
• Systematic desensitization: Teaches people with phobias to react calmly.
  • Involves creating a fear hierarchy, learning relaxation techniques, and gradual exposure.

Behaviour Therapy: Operant Conditioning

• Principle: Behaviours extinguish when not reinforced.
• Applied behaviour analysis: Reinforces positive and punishes unwanted behaviours.
• Is an effective technique for helping children with autism.
  • Child-specific reinforcers are used to reward and motivate autistic children when they demonstrate désired behaviours.
  • Punishment might be used to discourage undesirable behaviours.
• Token economy: Reinforces desired behaviours with tokens for privileges.
  • Often utilized in psychiatric hospitals and prisons to increase cooperation.

Cognitive Behaviour Therapy

• Addresses present issues rather than a patient’s past.
• Changes cognitive distortions and self-defeating behaviours.
• Helps clients examine the effects of their thoughts on their behaviour.
• Combines cognitive therapy in order to replace negative thoughts with positive ones and with behaviour therapies to promote healthy practices.
• ABC model reveals cognitive distortions for overgeneralizing, black-and-white thinking, and jumping to conclusions.
  • Action - activating event
  • Belief about the event
  • Consequences of the belief

Cognitive Distortions

• All or nothing thinking: Seeing a situation as a total failure if it is less than perfect.
• Overgeneralization: Viewing a negative event as a never-ending pattern of defeat.
• Mental filter: Focusing on a single negative detail.
• Discounting positives: Rejecting positive experiences.
• Jumping to conclusions: Interpreting things negatively without supporting facts.
• Magnification or Minimization: Exaggerating problems or minimizing desirable qualities.
• Emotional reasoning: Assuming negative emotions reflect reality.
• "Should" statements: Expecting things to be a certain way.
• Labeling: Attaching negative labels to oneself or others.
• Personalization: Holding oneself accountable for events that are not entirely under your control.

Rogerian/Client-Centered Therapy

• Therapy focuses on helping people achieve their potential.
• Goal: increases self-awareness and acceptance through focus on conscious thoughts.
• Emphasized the importance of the person taking control of his own life.
• Non-directive therapy: Helping but not directing the client to identify conflicts and understand feelings.
• Techniques:
  • Active listening: Therapist acknowledges, restates, and clarifies the client expresses.
  • Unconditional positive regard: Simply accepts them without judgment.
  • Genuineness, empathy, and acceptance towards clients helps the client become more accepting of themselves in turn.

Biomedical Treatments

• Psychotropic medications: are used to treat psychological disorders that.
  • Treat the symptoms but do not cure the disorder.
• Antipsychotics: Treat positive psychotic symptoms like hallucinations and delusions by targeting dopamine.
• Anti-depressants alter levels of serotonin and norepinephrine.
• Anti-anxiety agents depress the central nervous system for conditions like anxiety and OCD.
• Mood stabilizers treat mania and depression in bipolar disorder.
• Stimulants improve focus and attention, particularly in ADHD.
• Electroconvulsive therapy: Induces seizures to treat severe depression.
• Transcranial magnetic stimulation: Improves depression by stimulating nerve cells.

Sociocultural Model

• Examines behaviours and symptoms within a cultural context.
• Considers the influence of cultural and religious beliefs on mental health treatment.
• Emphasizes cultural competence to address the needs of diverse populations.
• Multicultural counseling and therapy: Integrates cultural norms and values.
  • Aims to work with clients and define goals consistent with their life experiences and cultural values.
  • Strives to recognize client identities to include individual, group, and universal dimensions.
  • Advocates the use of universal and culture-specific strategies and roles in the healing process.
  • Balances the importance of individualism and collectivism in the assessment, diagnosis, and treatment of clients.

Treatment Barriers

• Access and availability difficulties include lack of insurance, transportation, and time.
• Minorities utilize mental health services less than white, middle-class Americans despite comparable access.
• Ethnic disparities encompass lack of bilingual treatment, stigma, fear of being misunderstood, family privacy concerns, and limited education on mental illness.
• Negative perceptions and attitudes encompass a belief of self-sufficiency, ineffectiveness of therapy, confidentiality issues, and fear of psychiatric hospitalization or treatment.