Psychological Disorder Treatments

Treatment of Psychological Disorders

• Historical treatments included drug-induced comas, extensive electroconvulsive therapy (ECT), sensory deprivation, LSD, and lobotomies.

Types of Treatment

• Psychotherapy encompasses diverse approaches for treating mental disorders and psychological problems.
• Three main classifications of psychotherapy are insight therapies, behavior therapies, and biomedical therapies.
• Insight therapies involve "talk therapy."
• Behavior therapies focus on changing overt behavior.
• Biomedical therapies involve biological functioning interventions.

Who Seeks Treatment?

• Anxiety and depression are the most common presenting problems.
• There are often long delays before treatment is sought.
• Half of the people who seek mental health services do not have a diagnosable problem.
• Significant barriers to treatment include finances and stigma.

Who Provides Treatment?

• Clinical psychologists' training emphasizes the treatment of full-fledged disorders.
• Counseling psychologists' training focuses on the treatment of everyday adjustment problems.
• Psychiatrists have a Doctor of Medicine (MD) degree.
• Clinical social workers have a Master's degree and link clients to community services, navigating government funding and programs.
• Psychiatric nurses have a Bachelor's or Master's degree and play a large role in inpatient psychiatric care.
• Counsellors possess a Master's degree with specific training in a particular area.

Insight Therapies

• Insight therapies enhance self-knowledge and promote healthful changes in personality and behavior.
• Sigmund Freud and his followers had a goal to discover unresolved unconscious conflicts among the id, ego, and superego.

Psychoanalysis: Techniques

• Free association involves spontaneously expressing thoughts and feelings exactly as they occur.
• Dream analysis involves therapist interpretation of the symbolic meaning of a client's dreams.
• Interpretation involves a therapist's attempts to explain the inner significance of the client's thoughts, feelings, and behaviors.
• Resistance involves largely unconscious defensive maneuvers intended to hinder the progress of therapy.
• Transference involves unconsciously relating to a therapist in ways that mimic critical relationships in one's life.

Psychoanalysis Today

• There are a number of psychodynamic approaches.
• Interpretation, resistance, and transference continue to play key roles in therapy.
• Resistance predicts therapeutic outcomes.
• Useful in treating panic disorder, borderline personality disorder, and substance use.

Client-Centered Therapy

• This emphasizes providing a supportive emotional climate for clients.
• Carl Rogers believed distress is due to incongruence, and the goal is to restructure the self-concept to better correspond to reality.

Client-Centered Therapy: Techniques

• Therapeutic climate includes genuineness, unconditional positive regard, and empathy.
• Therapists and clients work together as equals.
• The therapist's key task is the clarification of feelings.

Evaluating Insight Therapies

• Challenges to evaluations of therapies include spontaneous remission, differing goals, and subjective appraisals.
• Insight therapies are more effective than no treatment or placebos.

Behavior Therapies

• Behavior therapies involve the application of learning principles to direct efforts to change a client’s maladaptive behaviors, without particular emphasis on the underlying cause of difficulties.
• B.F. Skinner (founder) and his colleagues assumed all behavior is a product of learning.
• The goal is unlearning maladaptive behavior and learning adaptive behavior.

Behavior Therapies: Techniques

• Flooding involves intense exposure to feared stimuli.
• Systematic desensitization (Wolpe, 1958) involves creating an anxiety hierarchy, relaxation skills, and working through the hierarchy.

Other Behavior Therapy Techniques

• Aversion therapy uses classical conditioning to pair an aversive stimulus with a stimulus that elicits an undesirable response, though it is rarely used.
• Social skills training is a behavioral therapy designed to improve interpersonal skills by emphasizing modeling, behavioral rehearsal, and shaping.

Evaluating Behavior Therapies

• Lots of evidence supports the effectiveness of behavior therapies, particularly for anxiety disorders.
• Behaviour therapies may not be appropriate for all types of problems like vague feelings of discontent.
• It is difficult to make generalizations about behavior therapies.

Cognitive Therapy (CT)

• Cognitive therapy is a type of insight therapy.
• Difficulties are caused by errors in thinking.
• The goal is to correct patterns of maladaptive thoughts that underlie various types of disorders.

CT Example: Depression

• Cognitive components include blaming setbacks on personal inadequacies, focusing on negative events and ignoring the positive, pessimistic projections about the future, and negative conclusions about self-worth.

CT Techniques

• The goal is to change the way the client thinks.
• Techniques include detecting and recognizing negative thoughts, identifying emotions, and reality testing to find evidence for and against thoughts.

Cognitive Behavior Therapy (CBT)

• Cognitive behavioral therapy is a combination of insight and behavior therapy.
• The goal is to target maladaptive thought patterns AND use behavioral modification techniques.

CBT Techniques

• The goal is to change the way the client thinks AND responds.
• Techniques include:
  • Detecting and recognizing negative thoughts and emotions.
  • Reality testing (finding evidence for and against thoughts.)
  • Behavioral "homework assignments" focused on changing overt behaviors.

Mindfulness

• The focus is to identify and ACCEPT thoughts or emotions without judgment or elaboration.
• Goal to regulate attention and be present.
• Goal to Normalize negative thoughts and feelings.
• Prevent relapse.

Acceptance and Commitment Therapy (ACT)

• Core problems include fusion with thoughts, evaluation of experience, avoidance of experience, and reason-giving for behavior.
• Healthy alternatives include accepting your reactions and being present, choosing a valued direction, and taking action.
• Key goals include normalizing emotions and thoughts, clarifying personal values, and taking action.

ACT Techniques

• ACT involves discussion to discover a valued direction.
• ACT can identify and accept thoughts and feelings, like pushing vs. holding a piece of paper or considering highway billboards.
• ACT promotes taking action with behavior modification ("feel the fear and do it anyway").

Biomedical Therapies

• Biomedical therapies tackle psychological disorders through intervention in biological functioning.

Psychopharmacotherapy

• Antianxiety medications relieve tension, apprehension, and nervousness; one family is Benzodiazepines (Valium, Xanax, etc); effects include drowsiness, depression, nausea, and confusion and can cause addiction and withdrawal.
• Antipsychotic medications gradually reduce psychotic symptoms such as Thorazine, Mellaril, and Haldol; side effects include tardive dyskinesia, but newer generations such as Clozapine help.
• Antidepressants gradually elevate mood like Tricyclics, MAO inhibitors (MAOIs), Selective serotonin reuptake inhibitors (SSRIs), and Serotonin Norepinephrine Reuptake Inhibitors (SNRIs).
• Mood stabilizers manage Bipolar with medications like Lithium and Valproic acid.

Evaluating Drug Therapies

• Pros include their effectiveness with the most severe disorders.
• Cons include potential ineffectiveness, over-prescription, side effects, and financial arrangements with pharmaceutical companies that may affect the truth.

ECT and Brain Stimulation

• Electroconvulsive therapy (ECT) uses electric shock to produce a cortical seizure accompanied by convulsions.
• ECT is a controversial but effective treatment for depression.
• Risks include short term memory loss and impaired attention.
• New brain stimulation techniques include transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS).

Readiness for Change

• Pre-contemplation: no intention of change.
• Contemplation: Intention of change within 6 months.
• Preparation: intention of action in immediate future.
• Action: Specific behavioural changes made within last 6 months.
• Maintenance: prevent relapse.
• Termination: zero temptation.