History of Mental Illness Treatment

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

Historical Perspective

• Mental illness was often attributed to supernatural forces like witchcraft or demonic possession, leading to cruel treatment
• Treatments focused on supernatural forces included exorcism, trephining, and execution/imprisonment for witchcraft

18th Century

• People exhibiting unusual behaviour began to be institutionalized in asylums
• Asylums were created to house people with psychological disorders
• Ostracizing people from society was the focus more than treatment
• Individuals were often kept in windowless dungeons, chained to beds, with little to no caregiver contact

Philippe Pinel (Late 1700s)

• French physician who advocated for more humane treatment of the mentally ill
• Suggested the mentally ill should be unchained and talked to
• His methods were implemented in Paris in 1975
• Patients benefited and many were able to be released from hospital

19th Century

• American asylums were usually filthy, offered little treatment, and often institutionalized people for decades
• Treatments included submersion into cold baths for long periods
• Electroshock treatment, now electroconvulsive therapy, utilizes a brief electrical stimulus to induce a generalized seizure

20th Century

• 1954 saw the introduction of antipsychotic medications, which proved successful in treating symptoms of psychosis

• The Mental Retardation Facilities & Community Mental Health Centers Construction Act of 1975 provided federal support for community mental health centers and started deinstitutionalization

• Despite patients being released, the new system was not effectively set up

• Centers were underfunded, staff untrained to handle severe mental illnesses

• This led to an increase in homelessness

• Mental illness is still common among the homeless population today

• Around one-quarter of homeless individuals in U.S. shelters experience severe mental illness

• Correctional institutions also report a high number of individuals living with mental illness

Psychodynamic Psychotherapy

• Talk therapy rooted in the belief that unconscious and childhood conflicts impact behavior
• Example: A patient discusses their past

Behavior Therapy

• Principles of learning are applied to change undesirable behaviors
• Example: A patient learns to overcome fear of elevators via relaxation techniques

Cognitive Behavioral Therapy

• Work to change cognitive distortions and self-defeating behaviors
• Example: A patient learns to identify self-defeating behaviors to overcome an eating disorder

Humanistic Therapy

• Increases self-awareness and acceptance through focus on conscious thoughts
• Example: A patient learns to articulate thoughts that keep them from achieving goals

Psychodynamic Therapy

• Founded by Sigmund Freud in early 20th century
• Aims to uncover repressed feelings
• Free association occurs when a patient relaxes and says whatever comes to mind
• Freud theorized that the ego would try to block unacceptable urges or painful conflicts during free association causing the patient to demonstrate resistance
• Dream analysis involves a therapist interpreting the underlying meaning of dreams
• Transference: patients transfer positive or negative emotions from other relationships to the psychoanalyst

Behavior Therapy: Classical Conditioning

• Principles of learning are applied to change undesirable behaviors
• Conditioning principles recondition clients and change their behavior
• Counterconditioning: Clients learn a new response to a stimulus that previously elicited an undesirable behaviour
• Aversive conditioning: An unpleasant stimulus is used to stop an undesirable behaviour
  • A client is repeatedly exposed to something unpleasant while engaging in a specific behaviour, such that they associate the stimulus with the unwanted behaviour
  • Antabuse, which causes negative side effects like vomiting when combined with alcohol, is used to treat alcoholism
• Exposure therapy seeks to change the response to a conditioned stimulus
  • It is used to treat fears or anxiety
  • Clients are repeatedly exposed to the object/situation that causes their problem, with the idea that they will eventually get used to it

Jones’ Study (1924)

• Aims to replace Peter’s fear of rabbits with a conditioned response of relaxation
• Repeatedly exposed Peter to a rabbit, while he was eating a snack (in a relaxed state)
• The rabbit started in a cage and moved closer to Peter while he ate over several days
• After 2 months, Peter could pet the rabbit while eating his snack

Exposure Therapy for Phobias

• Systematic desensitization teaches people with a phobia to react calmly rather than fearfully to the situation
• Involves creating a fear hierarchy, learning deep-muscle relaxation, and gradually exposing oneself to the hierarchy

Behavior Therapy: Operant Conditioning

• Based on the principle that behaviours become extinguished when not reinforced
• Applied behaviour analysis: operant conditioning technique to reinforce positive behaviors and punish unwanted behaviors
• Effective in helping children with autism
  • Child-specific reinforcers (e.g., stickers, praise, candy) are used to reward and motivate autistic children when they demonstrate certain behaviors
  • Punishment (e.g., timeout) might be used to discourage unwanted behaviors
• Token economy: Individuals are reinforced for desired behaviours with tokens (e.g., a poker chip), that can be exchanged for items or privileges
  • It is often used in psychiatric hospitals or prisons to increase cooperation

Cognitive Behaviour Therapy

• CBT focuses on present issues rather than a patient’s past
• CBT is used to change cognitive distortions and self-defeating behaviours
• Helps clients examine how their thoughts affect their behaviour
• Involves the combination of cognitive therapy to help individuals become aware of irrational, negative thoughts and replacing them with positive thinking with behaviour therapies that teach people to practice and engage in more positive approaches
• Uses the ABC model to reveal cognitive distortions (e.g., overgeneralizing, black and white thinking, jumping to conclusions)
• Action: activating event
• Belief about the event
• Consequences of the belief

Cognitive Distortions

• All or nothing thinking: If a situation falls short of perfect, you see it as a total failure
• Overgeneralization: Seeing a negative event as a never-ending pattern of defeat
• Mental filter: Picking out a single negative detail and dwelling on it exclusively
• Discounting the positives: Rejecting positive experiences by insisting they "don't count”
• Jumping to conclusions: Interpreting things negatively when there are no facts to support the conclusion, such as mind reading or fortune-telling
• Magnification or Minimization: You exaggerate the importance of your problems and shortcomings or minimize the importance of your desirable qualities
• Emotional reasoning: Assuming your negative emotions necessarily reflect the way things really are
• "Should" statements: Telling yourself that things should be the way you hoped or expected them to be
• Labeling: Attaching a negative label to yourself or others
• Personalization: Holding yourself personally accountable for an event that is not entirely under your control

Rogerian/Client-Centered Therapy

• Focuses on helping people achieve their potential
• The goal is to increase self-awareness and acceptance through focus on conscious thoughts
• Emphasizes the importance of the person taking control of his own life
• Non-directive therapy: a therapist does not give advice or provide interpretations to help clients identify conflicts and understand feelings
• Techniques include:
  • Active listening: Therapist acknowledges, restates, and clarifies what the client expresses
  • Unconditional positive regard: a therapist does not judge clients and simply accepts them for who they are
  • Genuineness, empathy, and acceptance towards clients should be demonstrated to help the client become more accepting of themselves to result in personal growth

Biomedical Treatment

• Psychotropic medications are used to treat psychological disorders and do not cure the disorder, but treat the symptoms
• Antipsychotics treat positive psychotic symptoms by blocking dopamine
• Anti-depressants alter levels of serotonin and norepinephrine
• Anti-anxiety agents depress central nervous system activation
  • They are used to treat anxiety, OCD, PTSD, panic disorder and social phobia
• Mood stabilizers treat episodes of mania and depression (Bipolar disorder)
• Stimulants improve ability to focus on a task and maintain attention (ADHD)
• Electroconvulsive therapy induces seizures to alleviate severe depression
• Transcranial magnetic stimulation uses magnetic fields to stimulate nerve cells to improve depression symptom

Sociocultural Model

• Looks at a person’s behaviours, and symptoms in the context of their culture and background
• Factors to consider include cultural and religious beliefs and their impact on mental health treatment
• Cultural competence requires mental health professionals to understand and address issues of race, culture, and ethnicity and use strategies to effectively address needs of various populations
• Multicultural counseling and therapy involves:
  • Integrating the impact of cultural and social norms
  • 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 to mental health services include:
  • Lack of insurance, transportation, and time
• Despite comparable access among racial and ethnic groups, minorities utilize mental health services less than white, middle-class Americans

Ethnic Disparities stem from

• Lack of bilingual treatment
• Stigma
• Fear of not being understood
• Family privacy
• Lack of education on mental illness

Perceptions and Attitudes

• Self-sufficiency and not seeing the need for help
• Not seeing therapy as effective
• Concerns about confidentiality
• Fear of psychiatric hospitalization or treatment itself