HSC1010 Mental Health PDF

HSC1010 Mental Health Part 1: Overview of Psychological Disorders Presented by: Dr Peter Tay, Assistant Professor in Psychology Developed by: Dr Angela Papadimitriou, Clinical Psychologist & Dr Peter Tay Learning Objectives Define mental health, psychopathology & mental illness Describe h...

HSC1010 Mental Health Part 1: Overview of Psychological Disorders Presented by: Dr Peter Tay, Assistant Professor in Psychology Developed by: Dr Angela Papadimitriou, Clinical Psychologist & Dr Peter Tay Learning Objectives Define mental health, psychopathology & mental illness Describe history of mental illness Understand criteria for abnormality Understand causes of mental disorders & biopsychosocial model Explain pros and cons of classification of mental disorders Understand features and causes of main anxiety disorders Describe types and causes of main mood disorders Understand characteristics and causes of eating disorders Understand diagnostic criteria & causes of schizophrenia Describe clusters and causes of personality disorders Understanding Mental Health Mental Health Basics History of Mental Health Defining Abnormality Causes of Mental Disorders Classification of Mental Disorders Mental Health Basics Mental Health: “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community” (WHO, 2014) Psychopathology: scientific study of mental disorders (origin, development & manifestations) psyche= mind pathos= suffering or distress -ology= study of Psychopathology synonym for mental illness Mental Illness: wide range of mental health conditions (disorders) characterised by psychological dysfunction and abnormal behaviour History of Mental Illness Craniotomy (stone age onwards) Extracting the stone of madness (cure of folly) Demonology 14th century 18th century - France 6th century BC 3th century BC  History of Mental Illness Somatogenesis: mental illness attributed to bodily causes Hippocrates (460-370): psychopathology result of imbalance of body’s 4 humors (blood, phlegm, yellow bile, black bile) First attempt to classify mental disorders Middle Ages: Return to Demonology Renaissance Illness directly linked to body (physiology & pathology) Psychopathology branch of medicine (Weyer) ridiculed & banned by church Classification of mental illness based on symptoms History of Mental Illness Mental Asylum Era: Birth of Psychiatry Bethlehem Royal Hospital– «Bedlam» (London 1547) Men’s Viewing Gallery Restraining Bed Rotating Chair History of Mental Illness Humanistic Approach: Removing the shackles, Pinel (1793) Salpetriere Hospital, France patients allowed outside wards & sleep on beds “Lunatic Ball” Moral treatment Definitions of Abnormality Abnormality (behaviour and thinking) defined as: 1. Statistical Deviance: rare/infrequent behaviour or thinking that deviates from the average or majority Are all rare behaviours abnormal? Example: genius / gifted person What about common abnormal behaviours? 2. Social Norm Deviance: deviance from social norms / cultures (e.g., dress code, personal space) Example: behaviour harmful to others Hallucinations (symptom) or Visions (faith)? Definitions of Abnormality 3. Subjective Discomfort: emotional distress (e.g., depression, anxiety) that has a significant impact on person’s functioning are all abnormal behaviours considered distressing? manic state, or lack of distress of serial killer when and at what degree is discomfort considered abnormal? 4. Inability to function normally: when a person is unable to adapt to stressors and everyday demands of life (maladaptive thinking or behaviour) Subjectivity again an issue Definition of psychological disorder based on all 4 criteria: atypical behaviour and thinking that is significantly distressing, harmful to oneself or others and disruptive to daily life functioning Causes of Mental Disorders Biological (Medical) Model: psychological disorders have biological or medical causes Psychological Perspective: psychological disorders have psychological causes (emotional, behavioural, cognitive) Psychodynamic: repressed conflicts, unconscious motivations, childhood experiences Behaviorist: abnormal behaviour learned (classical conditioning, operant conditioning, Social Leaning Theory) Cognitive: abnormal behaviour the result of irrational thinking and errors in logic Sociocultural Perspective: psychological disorders product of family, social and cultural influences Causes of Mental Disorders genetic makeup Biopsychosocial Model immune system disability Biological physical health school temperament drug effects self esteem social support IQ thinking & work Mental reasoning skills family circumstances Health stress management Social family Psychological socio-economic relationships status trauma emotion regulation culture coping skills social skills Psychological Disorder Definition syndrome (collection of symptoms) characterized by clinically significant disturbance in an individual’s cognition, emotional regulation, or behaviour reflecting a dysfunction in the psychological, biological, or developmental processes underlying mental functioning usually associated with significant distress or disability in social, occupational, or other important activities an expectable or culturally approved response to common stressor or loss (e.g., death of a loved one, is NOT a mental disorder) socially deviant behaviour (e.g., political, religious, or sexual) and conflicts are NOT mental disorders unless result from dysfunction Adapted from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, (2013) Classification of Mental Disorders THE most prevalent and widely used resources Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association (2013) International Classification of Diseases, 10th Edition (ICD-10) World Health Organization (1992) DSM facts: 1st DSM (1952) 86 pages and 100 disorders DSM-IV-TR (2000): 900 pages and about 365 disorders DSM-5 (2013): 947 pages and over 400 disorders DSM-5 DSM-5 replaced multiaxial (Axis I-V) & categorical classification of mental disorders of previous DSMs with a dimensional approach disorders viewed & ranked on a continuum vs present/absent dimensions: spectrum of related psychological & behavioural characteristics that occur together Using Diagnostic Labels Pros common language to professionals facilitates diagnosis and standardises treatment Cons over-diagnosing (e.g., caffeine intoxication) prejudicial (e.g., premenstrual dysphoric disorder) “psychology student’s syndrome” (symptoms ≠ disorder) Mental and Personality Disorders Anxiety Disorders Mood Disorders Eating Disorders Schizophrenia Personality Disorders Anxiety, Trauma & Stress Disorders Anxiety Disorders: characterized by excessive or unrealistic worry and fearfulness and dysfunctional related behaviours DSM-5: 3 categories for anxiety-related disorders (previously 1): Anxiety Disorders Obsessive-Compulsive & Related Disorders Trauma- & Stressor-Related Disorders Main Anxiety Disorders Phobias: irrational, persistent fear and avoidance of an object, situation, or activity Social Anxiety Disorder (Social Phobia): fear of being in social situations that could lead to a negative evaluation of oneself Specific Phobias: fear of specific objects or situations Agoraphobia: fear of any place where escape might be difficult, including open spaces, crowds, public transportation Claustrophobia: fear of enclosed spaces Some Common Phobias Fear of Scientific Name Heights Acrophobia Enclosed spaces Claustrophobia Darkness Nyctophobia Lightning Ceraunophobia Thunder Brontophobia Fire Pyrophobia Spiders Arachnophobia Snakes Ophidiophobia Animals Zoophobia Foreigners, strangers Xenophobia Germs, contamination Mysophobia / Germophobia Blood Hematophobia Pain Algophobia Injections, needles Trypanophobia Disease Nosophobia Main Anxiety Disorders Panic Disorder: repeated and unexpected panic attacks, persistent worry about future attacks, and/or related maladaptive behaviour panic attack: sudden rush of intense and disabling anxiety and fear with multiple physical symptoms (minimum of 4 required) Going crazy? Fear of dying l Generalised Anxiety Disorder: excessive anxiety and worry occurring more days than not for ≥ 6 months about number of events / activities Obsessive-Compulsive Disorder Obsessive-Compulsive Disorder: characterized by presence of obsessions and/or compulsions obsessions: intrusive, unwanted recurrent thoughts, urges or images that create anxiety compulsions: repetitive, ritualistic, persistent behaviours (e.g., hand- washing, checking) or mental acts (e.g., counting, repeating words silently) driven by obsessions aimed at reducing anxiety Trauma & Stressor-Related Disorders Acute Stress Disorder (ASD): anxiety resulting from exposure to major and traumatic stressor, lasting 3 days to 1 month Symptoms include: recurrent distressing memories, nightmares, flashbacks, difficulty experiencing positive emotions, difficulty remembering details of event, avoidant behaviours, sleep disturbance, hypervigilance, concentration problems Posttraumatic stress disorder (PTSD): similar symptoms as ASD, lasting ≥ 1 month may occur acutely (immediately after trauma) or late onset, develop ≥ 6 months after trauma Causes of Anxiety Disorders Psychodynamic: anxiety created by repressed urges & desires trying to surface from the unconscious fear of knives = fear of own aggressive tendencies Behavioural: anxious behavioural reactions are learned through conditioning or reinforcement phobia= classically conditioned feared response (“Little Albert”) Cognitive: anxiety stems from illogical, irrational thinking process heart palpitations = I am having a heart attack… I am dying Biological: chemical imbalance in NS (e.g., serotonin, GABA dysfunction) genetic basis (e.g., GAD, OCD, Panic Disorder) ↑ activity in amygdala & limbic system (neuroimaging: phobias, PTSD) Cultural variations of anxiety disorders: Latin America: ataque de nervios, breakdown after significant stressor Japan: taijin kyofusho (TKS), fear of doing something inappropriate or embarrassing in public (e.g., blushing, staring) Mood Disorders Mood Disorders: characterized by significant disturbance (elevation or lowering) in mood or emotion DSM-5: 2 categories for mood disorders (previously 1): Depressive Disorders Bipolar & Related Disorders 2 most prevalent mood disorders are Major Depressive Disorder Bipolar Disorder I and II Main Mood Disorders Major Depressive Disorder (MDD): pervasive and significantly low mood involving one or more major depressive episodes major depressive episode: severely depressed mood, lasting ≥ 2 weeks MDD most prevalent mood disorder, associated with ↑ mortality Bipolar I Disorder: presence of one or more manic episodes, with or without episodes of depression manic episode: pervasive & significant elation or irritability ≥ 1 week Bipolar II Disorder: presence of at least one hypomanic episode and at least one depressive episode hypomanic episode: pervasive & significant elation or irritability ≥ 4 consecutive days Causes of Mood Disorders Psychodynamic: depression is repressed anger turned against self Behavioural: depression associated with learned helplessness learning to be unable to influence outcomes and feel helpless Cognitive: depression stems from distorted & illogical thoughts mental filter: focus on negative points and filter out any positive aspects personalization: seeing self as responsible for negative events Biological: chemical imbalance in brain (serotonin, norepinephrine, dopamine) genes and heritability (e.g., MDD, Bipolar) Eating Disorders Eating Disorders: characterized by persistent disturbances of eating behaviours that significantly impair physical health & social functioning (Feeding & Eating Disorders, DSM-5) Most prevalent DSM-5 Feeding & Eating Disorders: Anorexia Nervosa Bulimia Nervosa Binge-Eating Disorder Eating Disorders Anorexia Nervosa: severe diet restriction resulting in significantly low body weight based on age, gender, developmental course and physical health Significantly low weight based on body mass index (BMI) BMI = weight (kg) / height (m)2 adults BMI < 17 kg/m (DSM-5), US 18.5 Bulimia Nervosa: recurrent episodes of binge eating and unhealthy behaviours to avoid weight gain (e.g., vomiting, laxatives) binge eating episode: uncontrolled overeating of excessive amount of food within 2-hour period Binge-Eating Disorder: recurrent episodes of binge eating (≥ 1 per week for 3 months) without attempts to avoid weight gain Causes for Eating Disorders Psychodynamic: disturbances in parent-child relationships resulting in ego deficiencies food = symbol of mother-daughter conflict; binging represents hate and love of mother Behavioural: maladaptive eating behaviours learned through conditioning and reinforcement Cognitive: disordered eating stems from significant cognitive disturbance (e.g., overvalued ideas of weight & body image, self-identity issues) Biological: evidence of genetic factors, though specific genes not yet identified Causes of Anorexia and Bulimia Nervosa not yet fully understood Greatest risk factor: adolescent or young female Cultural variations: less common in non-Western cultures Schizophrenia Schizophrenia most prevalent psychotic disorder from the DSM 5 category of Schizophrenia Spectrum & Psychotic Disorders Psychotic disorders: mental disorders in which a person loses touch with reality and their personality is severely confused Schizophrenia: severe brain disorder characterized by abnormal interpretation of reality, involving disordered thinking (delusions), perceptual disturbance (hallucinations), bizarre behaviours and emotional dysfunction Schizophrenia Symptoms Diagnosis warranted if ≥ 2 of the following for ≥ 1 month Delusions: false and fixed beliefs, despite conflicting evidence persecutory: belief that one is going to be attacked or harassed by others (conspiracy against oneself) grandiose: belief that one has exceptional abilities, wealth, fame Hallucinations: internal sensory perception that isn’t actually present, involving any of the 5 senses auditory (hearing voices or sounds) and visual most common Disorganised Thinking (Speech): disordered thinking evidenced by one’s speech derailment (loose associations): switching from one topic to another incoherence (word salad): confused or unintelligible mixture of words Disorganised Behaviour: ranging from immobility to excessive movement and odd gesturing Negative Symptoms: diminished emotional expression (flat affect) Schizophrenia Symptoms A Beautiful Mind - https://www.youtube.com/watch?v=O3qyC6Z3t5g Causes of Schizophrenia Two most prevalent explanations of schizophrenia Biological: chemical imbalances (dopamine, GABA, glutamate etc) structural defects in the brain (frontal lobe, ↓ white matter) genetic and hereditary factors supported twin & adoption studies prenatal factors (viral infections) Environmental: Stress-Vulnerability Model: genetic predisposition (vulnerability) interacts with environmental stressors (e.g., living circumstances, social stressors, trauma) to produce the disorder Personality Disorders Personality Disorders: maladaptive thinking & behaviours defined by 3 Ps: Persistent: longstanding, relatively stable over time (from mid-adolescence onwards) Pervasive: affect entire life adjustment (e.g., emotional functioning, social interactions, employment etc.) Problematic: disturbed thinking and behaviour that deviates markedly from social norms; causing significant distress to self and/or others DSM-5 lists 10 personality disorders, classified into 3 clusters: Cluster A: odd or eccentric (Paranoid, Schizoid, Schizotypal) Cluster B: dramatic, emotional, or erratic (Antisocial, Borderline, Histrionic, Narcissistic) Cluster C: anxious or fearful (Avoidant, Dependent, Obsessive-Compulsive) Personality Disorders Antisocial Personality Disorder: pervasive pattern of disregard and violation of rights of others lack conscience and remorse manipulative and deceptive aggressive (repeated physical fights / assaults) often referred to “psychopaths” or sociopaths” Borderline personality disorder: pervasive pattern of instability in moods, interpersonal relationships, self-image and marked impulsivity self-destructive (including self-mutilation, suicide attempts) impulsive behaviours (substance abuse, binge-eating, spending) unstable & intense relationships difficulty controlling anger (including outbursts) Causes of Personality Disorders Most prevalent explanations: Cognitive-Behavioural: personality disorders stem from learned behaviours and associated beliefs through reinforcement, shaping and modelling Biological: evidence of genetic factors (e.g., antisocial, borderline) Environmental: disturbances in family relationships, childhood abuse, extreme parenting styles (overprotectiveness, rejection, neglect) End Mental Health – Part 1 of 2 HSC1010 Mental Health Part 2: Treatments of Psychological Disorders Presented by: Dr Peter Tay, Assistant Professor in Psychology Developed by: Dr Angela Papadimitriou, Clinical Psychologist & Dr Peter Tay Learning Objectives Distinguish between insight and action therapies Describe difference between psychoanalysis and psychodynamic therapy Understand person-centered therapy, motivational interviewing and gestalt therapy Explain behaviour therapy, its key techniques and applications, as well as pros and cons Understand cognitive therapy, its contributions and criticisms Identify different types of group therapy Discuss effectiveness of psychotherapy Describe different types and applications of biomedical and emerging therapies Understanding Therapy Insight vs. Action Therapy Psychoanalysis vs. Psychodynamic Therapy Person-Centred Therapy Behavioural Therapy Cognitive Therapy Group Therapy Early Treatments in Asylums Asylum: sanctuary (Latin); refuge (Greek) Mid-1500s: first asylum (institution) where people with mental disorders were confined & allegedly treated “Treatments” were inhumane and harmful 1793: Pinel’s moral treatment in France mentally ill be treated with kindness no shackles, beds for patients, access to hospital grounds Therapy Therapy: treatment methods aimed at improving psychosocial functioning and overall quality of life of people with mental disorders Modern therapies classified into: Psychotherapy, applying psychological theory & techniques Biomedical therapy, involving medications or procedures Psychotherapy Psychotherapy: therapy of mental disorders based on the collaboration between a trained mental health professional (therapist) and an individual (client, patient) or a group (couple, family) seeking to overcome psychological difficulties Insight therapy: psychotherapy aimed at helping an individual discover the reasons and motivation for their behaviour, thoughts and feelings Action therapy: psychotherapy aimed at helping an individual change dysfunctional thinking and behaviours Psychotherapy Approaches Insight Therapies Action Therapies Psychoanalysis Behavioural Therapies Humanistic Therapies Classical Conditioning Techniques Person-Centered Therapy Operant Conditioning Techniques Gestalt Therapy Cognitive Therapies Cognitive Behavioural Therapy (CBT) Rational Emotive Behavioural Therapy (REBT) Group Therapies Couples Therapy Family Therapy Self-Help Groups Psychoanalysis Psychoanalysis: founded by Freud, based on making conscious unconscious thoughts, conflicts and motivations (gaining insight) “the talking cure” Psychoanalytic techniques: dream interpretation: tapping into repressed material by understanding the hidden or symbolic meaning of dreams (latent content) free association: facilitate unconscious concerns to come to the surface by encouraging patient to talk about whatever comes to mind transference: patient transfers unconscious emotions or reactions on to the therapist (e.g., love or hatred for a parent) resistance: reluctance (changing topic, staying silent) to discuss certain topics suggesting presence of a repressed idea Modern Psychoanalysis Psychodynamic Therapy shorter in duration than traditional psychoanalysis client instead of patient – replacing the “sick” image therapist no longer sitting behind the couch (may be face to face) more directive therapists actively interpret client's statements recommend behaviours or actions the client can apply suitable for fairly intelligent individuals with non-psychotic disorders Humanistic Therapies Person-Centered Therapy: developed by Rogers, client takes center stage and does all the talking, therapist is an accepting, non-judgmental listener Successful person-therapist relationship based on: authenticity: therapist reacts in a genuine and open manner unconditional positive regard: therapist accepts the client as they are, maintaining a positive attitude to client, even when unapproving of client's actions empathy: therapist shows they understand sensitively and accurately (but not sympathetically) client's experience and feelings reflection: a technique that mirrors clients’ statements used by therapist seeking clarification into the experience of the client without attempting to interpret it Motivational Interviewing Motivational Interviewing (MI): person-centered, goal-oriented method of communication for increasing a person’s motivation to change by exploring and resolving ambivalence and resistance MI unlike person-centered therapy, is directive and guided MI is not a therapy or a technique, but a communication method Key aspects of MI: express empathy with reflective listening non-confrontational: avoid arguments roll with resistance rather than confronting or opposing it support self-efficacy and optimism for change Gestalt Therapy Gestalt Therapy: developed by Perls, therapist directs client on how to become more aware of their true feelings & own up to current or past behaviour Gestalt therapy: focuses on whole picture (actual and ideal self) is directive (unlike person-centered therapy) focuses on conscious experiences and denied past (unlike psychoanalysis) Gestalt techniques: internal dialogue – arguing both sides of an emotion “empty chair” addressing unresolved conflict through virtual role-play Behavioural Therapies Behavioural Therapy: action therapies that apply learning principles to eliminate maladaptive behaviour behavioural therapies use classical conditioning and / or operant conditioning techniques behavioural therapists do not look for inner causes but view symptoms as learned behaviours that can be replaced by new and adaptive behaviours (learning caused it, learning can fix it) Behavioural Modification (Applied Behavioural Analysis): using principles of behaviour & learning techniques to change unhelpful behaviours and increase healthy ones (operant conditioning) Classical Conditioning Techniques Systematic Desensitization: behavioural technique for treating phobias, associating a pleasant relaxed state with gradually increasing anxiety-provoking stimuli. Consists of 3 steps: 1. learn to use relaxation techniques effectively 2. develop a hierarchy (list) of anxiety-provoking stimuli 3. learn to manage anxiety in a step-by-step manner using relaxation techniques (from least threatening → most threatening stimulus) Behaviour Fear Rating Think about spider 10 Look at photo of spider 25 Look at real spider in closed box 50 Hold box with spider 60 Let spider crawl on your desk 70 Let spider crawl on your shoe 80 Let spider crawl on your pants leg 90 Let spider crawl on your shirt sleeve 95 Let spider crawl on your arm 100 Classical Conditioning Techniques Aversion therapy: associating an unpleasant state (e.g., nausea) with an unwanted behaviour (e.g., smoking, drinking) Exposure therapy: exposed to a feared situation, under carefully controlled conditions, to confront it until panic and anxiety subsides useful for Phobias, Panic Disorder, SAD, OCD, PTSD, GAD methods include: In vivo: Directly facing a feared object, situation, or activity in real life Imaginal: Vividly imagining feared object, situation, or activity Virtual reality: used when in vivo exposure not practical (e.g., virtual flight to address fear of flying) Operant Conditioning Techniques Modeling: learning through observation and imitation of others used for dental fears, social withdrawal & OCD in children Reinforcement: strengthening or weakening a behaviour by following it with a pleasurable consequence (+ve reinforcement) or removal of an unpleasant stimulus (-ve reinforcement) token economy: rewarding correct behaviour with tokens that can be accumulated & exchanged for desired items or privileges contingency contract: formal agreement between therapist & client (or teacher & student) that clearly specifies goals for behavioural change, reinforcements and penalties Extinction: removal of reinforcer to reduce frequency of behaviour time-out technique for children Evaluation of Behavioral Therapy Pros: solution focused & time limited effective in treating specific behavioural problems (e.g., bed wetting, drug addictions, phobias) used to address specific symptoms of serious mental disorders (rather than treatment of the disorder) Cons long-term effects of conditioning techniques ethical issue of using rewards & punishment to control one’s behaviours token economy system in hospitals & prisons Cognitive Therapies Cognitive Therapy: developed by Beck (1967, 1979) from his research on depression: negative thinking → depression Cognitive therapy: helping clients recognise distortions in thinking and replace irrational, unrealistic beliefs with more rational, realistic and helpful thoughts Some cognitive distortions that create negative emotions arbitrary inference: jumping to conclusions without evidence overgeneralization: seeing a single negative even as a never ending pattern of defeat magnification and minimization: unreasonably magnifying the negative and / or minimising the positive the events Cognitive Behavioural Therapies Cognitive-Behaviour Therapy (CBT) was the outcome of: Ellis’s Rational Emotive Therapy (1957, 1962) & Rational Emotive Behaviour Therapy (1955) Beck’s expansion on CT, known as CBT(1967) CBT: evidence-based, action and goal-oriented therapy aimed at changing both maladaptive cognitions and behaviours CBT focuses on interrelationship between thoughts, behaviours and emotions 3 main goals of CBT relieve symptoms and solve the problems develop strategies for solving future problems change irrational, distorted thinking Cognitive Behavioural Therapies Rational Emotive Behaviour Therapy (REBT): highly directive, persuasive, time-effective therapy aimed at evaluating and modifying irrational core beliefs and developing more attainable goals REBT is selectively-eclectic approach to therapy, using interchangeably: Cognitive techniques: change irrational beliefs and self-talk (e.g., rational analysis, disputation) Emotive techniques: teach unconditional acceptance of self & others (e.g., imagery, role-playing) Behavioural techniques: test and modify beliefs through actions (e.g., exposure, risk-taking) Evaluation of CBT Pros: more time efficient than psychoanalysis Evidence-based and goal-oriented highly effective for mood disorders, anxiety disorders, eating disorders, personality disorders and some types of schizophrenia Cons: unclear if faulty cognitions are cause of psychopathology or a consequence criticized for focusing on the symptoms rather than causes (though cognitions perceived as the cause by cognitive therapists) ineffective and damaging if used by untrained non-specialists Psychotherapy Overview Psychology, 4th ed. 2015 Ciccarelli & White Group Therapies Group Therapy: therapy conducted with groups rather than individuals, with therapeutic benefits from group interaction Couples Therapy: helping couples understand and resolve conflicts that occur in relationships Family Therapy: therapy based on family-system perspective, understanding that one person’s behaviour affects the whole family Self-help Group: group of people with related issues aimed at helping each other through discussion, problem-solving, social and emotional support without the presence of a therapist Evaluation of Group Therapies Pros low-cost (individuals who can’t afford individual therapy) enables people to see that others have similar problems emotional and social support by other members practical setting for exploring social behaviours, developing and testing social skills Cons less individual time with therapist privacy, anonymity and social anxieties may interfere with therapy not suitable for people with severe mental disorders or in crisis personality clashes within group Effectiveness and Biomedical Approaches Effectiveness of Psychotherapies Biomedical Therapies Emerging Therapies Effectiveness of Psychotherapy Approx. 75% of people who enter psychotherapy show some benefit (APA, 2012) Psychotherapy has been found to be effective with or without medication No single psychotherapy approach is effective for all mental disorders therapy needs to be tailored to the client and the problem Eclectic therapies combine elements of several different therapy techniques (e.g., REBT) should be used by experienced clinicians who are well versed in all treatment modalities In spite of numerous therapy approaches the recommendation is to use only evidence-based treatments (well-researched interventions with demonstrated effectiveness) Psychotherapy may be hindered by differences in culture, ethnicity Modern psychotherapy may be provided online (cybertherapy) more accessible but not recommended for severe disorders or acute crisis Biomedical Therapies Biomedical Therapies: act directly on the person’s physiology: changing brain’s functioning by altering its chemistry with drugs affecting brain’s circuitry with electroconvulsive shock, magnetic impulses Psychosurgery Psychopharmacology: use of drugs to treat mental disorders antipsychotic drugs: used to treat psychotic symptoms (delusions, hallucinations, bizarre behaviour) antianxiety drugs: used to control anxiety and agitation antidepressant drugs: used to treat depression, anxiety, OCD & PTSD mood-stabilizers: used to treat bipolar disorders  Psychopharmacology Psychology, 4th ed. 2015 Ciccarelli & White  Biomedical Therapies Electroconvulsive Therapy (ECT): procedure in which a brief brain seizure (convulsion) is induced by an electric current sent via electrodes placed on one or both sides of patient’s head still used for treatment-resistant depression Psychology, 11th ed. 2015 Myers & Dewall Biomedical Therapies Psychosurgery: surgery that removes or destroys brain tissue to treat severe mental disorders prefrontal lobotomy: severing connections in brain's prefrontal lobe widely used in the 1900s until development of antipsychotics bilateral anterior cingulotomy: an electrode is inserted to the anterior cingulated gyrus using MRI machine to create a small lesion to disrupt the circuits in the brain (limbic system & frontal lobes) used as last resort for OCD, depression and bipolar disorder Emerging Therapies Repetitive Transcranial Magnetic Stimulation (rTMS): magnetic pulses applied to cortex Transcranial Direct Current Stimulation (tDCS): uses scalp electrodes to pass very low amplitude direct currents to the brain rTMS & tDCS evaluated as treatments for PTSD, depression Deep Brain Stimulation (DBS): impulse-generator surgically implanted under collarbone sending impulses to electrodes placed into specific deep- brain areas DBSs being evaluated as treatment for depression & OCD Virtual Reality Therapy: software-generated 3D simulated environments considered as treatment for PTSD End Mental Health – Part 2 of 2