Treatment of Treatment of Psychological DisordersPsychological Disorders

C:\Users\mburt\Desktop\AP Psych\psych disorders\video\Sheldon the Therapist - The Big Bang Theory.mp4

IntroductionIntroduction• History of treatment - Maltreatment of the

insane throughout the ages was the result of irrational views. Many patients were subjected to strange, debilitating, & downright dangerous treatments. C:\Users\mburt\Desktop\AP Psych\Therapy\239_Early_Treatment_Mental_Disorders.mp4

–Philippe Pinel: France–Dorothea Dix: US/CA–founded humane movements to care for the

mentally sick.

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TherapiesTherapiesPsychotherapyPsychotherapy involves an emotionally charged, confiding interaction between a trained therapist and a mental patient.

Biomedical therapyBiomedical therapy uses drugs or other procedures that act on the patient’s nervous system, treating his or her psychological disorders.

An Eclectic approachEclectic approach uses various forms of healing techniques depending upon the client’s unique problems.

The Psychological TherapiesThe Psychological Therapies4 Major Therapies4 Major Therapies

PsychoanalysisPsychoanalysis• Psychoanalysis Sigmund Freud’s therapeutic technique.

Freud believed the patient’s free associations, resistances, dreams, & transferences – & the therapist’s interpretations of them – released previously repressed feelings, allowing the patient to gain self-insight.

• When energy devoted to id-ego-superego conflicts is released, the patient’s anxiety lessens.

• - 4:09 C:\Users\mburt\Desktop\AP Psych\psych disorders\video\Application of Psychoanalytic Therapy.flv

• Aims of therapy– Childhood impulses & conflicts

PsychoanalysisPsychoanalysisMethods

–Free association–Resistance in psychoanalysis, the blocking from

consciousness of anxiety-laden material• Interpretation in psychoanalysis, analyst’s noting

supposed dream meanings, resistances, & other significant behaviors & events in order to promote insight of the meaning

– Dream analysis– Transference

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Psychoanalysis: Psychoanalysis: Methods at workMethods at work

During free association, the patient edits his thoughts, resisting his or her feelings to express emotions. Such resistance becomes important in the analysis of conflict-driven anxiety.

Eventually the patient opens up & reveals his or her innermost private thoughts, developing positive or negative feelings (transference) towards the therapist. C:\Users\mburt\Desktop\AP Psych\psych disorders\video\Psychoanalysis - explained.mp4

Psychoanalysis Psychoanalysis C:\Users\mburt\Desktop\AP Psych\Therapy\247_Psychodynamic_Therapies.mp4 C:\Users\mburt\Desktop\AP Psych\Therapy\247_Psychodynamic_Therapies.mp4

Psychodynamic TherapyPsychodynamic Therapy• therapy deriving from the Freud’s psychoanalytic tradition that views individuals

as responding to unconscious forces & childhood experiences, & that seeks to enhance self-insight

–Aims of psychodynamic therapy …. understand symptoms & themes across important relationships in a patient’s life.

– Similarities & Differences to psychoanalysis

Interpersonal psychotherapyInterpersonal psychotherapy, a variation of psychodynamic therapy, is effective in treating depression. It focuses on symptom relief here & now, not an overall personality change.

Humanistic TherapiesHumanistic Therapies• Insight therapies a variety of therapies that aim to

improve psychological functioning by increasing the client’s awareness of underlying motives & defenses.

focus more on:–the present rather than the past–conscious rather than the unconscious–taking immediate responsibility–promoting growth instead of curing

Humanistic TherapiesHumanistic Therapies• Client-centered therapy (AKA person-centered therapy.) Humanistic therapy, developed by Carl Rogers, the therapist uses techniques such as active listening within a genuine, accepting, empathic environment to facilitate client’s growth. – Nondirective therapy– Genuineness, acceptance, & empathy– Active listening empathic listening in which the listener echoes, restates,

& clarifies. • Paraphrase• Invite clarification• Reflect feelings

– Unconditional positive regard

Behavior Therapies Behavior Therapies C:\Users\mburt\Desktop\AP Psych\Therapy\244_Cognitive_and_Behavioral_Therapies.mp4• Behavior Therapy- therapy that

applies learning principles to the elimination of unwanted behaviors. Focus: the ACTION, not the thought patterns associated with the behavior, doesn’t look for the “inner cause”

–Classical conditioning techniques• We learn various behaviors & emotions via classical conditioning

–Operant conditioning techniques• Behavior modification – reinforces desired behaviors & withholding

reinforcement for undesired behaviors or punishments

Behavior TherapiesBehavior TherapiesClassical Conditioning TherapiesClassical Conditioning Therapies

Counterconditioning behavior therapy procedure that uses classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors; Includes 242_Drug_Addiction.mp4

– Exposure therapies behavior therapy procedure that uses classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors; Includes

• Systematic desensitization• Virtual reality exposure therapy

– Aversive conditioning associates unpleasant state (e.g. nausea) with unwanted behavior (e.g. alcohol).

Behavior TherapiesBehavior TherapiesAversion Therapy

Behavior TherapiesBehavior TherapiesAversion Therapy

Behavior TherapiesBehavior TherapiesAversion Therapy

Short term success(66%)

Long term less successful (33%)

Often used in combo with other treatments

Behavior TherapiesBehavior TherapiesOperant Conditioning

• Behavior modification- reinforce desired behaviors withholding reinforcement for undesired behavior or punishment. Can work b/c a behavior strongly influenced by consequences. (effective with autism, retardation, schizophrenia). Rewards used to modify behavior vary from praise, to attention to more concrete rewards, food. – Raises ethical Questions

–Token economy operant conditioning procedure. People earn a token of some sort for exhibiting a desired behavior & can later exchange tokens for various privileges/treats. Successful in various settings, cultures, & many mental disorders.

Cognitive TherapiesCognitive Therapies• Cognitive therapy that teaches people new, more adaptive

ways of thinking & acting; based on the assumption that thoughts intervene btwn events & our emotional reactions

– Aaron Beck’s therapy for depression• Catastrophizing beliefs- recurring negative themes of loss,

rejection, abandonment, self-blaming & over generalizing that perpetuate existing feelings of depression

–Cognitive-behavioral therapy popular integrative therapy that combines cognitive therapy (changing self-defeating thinking) w/ behavior therapy (changing behavior). Seeks to restructure thinking (retrain) people to restructure negative thinking 249_OCD.mp4

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Beck’s Therapy for Beck’s Therapy for DepressionDepression

Aaron Beck (1979) suggests that depressed patients believe that they can never be happy (thinking) and thus associate minor failings (e.g. failing a test [event]) in life as major causes for their depression.

Beck believes that cognitions such as “I can never be happy” need to change in order for depressed patients to recover. This change is brought about by gently questioning patients.

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Cognitive TherapyCognitive TherapyTeaches people adaptive ways of thinking & acting based on the assumption that thoughts intervene between events & our emotional reactions.

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Stress Inoculation Stress Inoculation TrainingTraining

Meichenbaum trained people to restructure their thinking in stressful situations.

“Relax, the exam may be hard, but it will be hard for everyone else too. I studied harder than most people. Besides, I don’t need a perfect score to get a good grade.”

Group & Family TherapiesGroup & Family TherapiesUtilized by all Therapy Types accept Psychoanalysis

Group Therapy • saves therapists’ time & client’s money. • As is often no less effective than individual therapy• Occurs 1 time a week for about 90 minutes • Unique benefit: the social context allows people both to discover that

others have problems similar to their own & to receive feedback as they try out new ways of behaving

Family therapy• treats the family as a system • guides family members toward positive relationships & improved

communication.

• Methods & Goals & ParticipationMethods & Goals & Participation– Family therapists work with family groups to heal

relationships and to mobilize family resources– to help family members discover the role they play

within their family’s social system – To open up communication within the family or the help

family members discover new ways of preventing or resolving conflicts

– Self-help support groups are widely used & require a high live of involvement for success

• Great for stigmatized illnesses (AIDS, Alcoholism, Anorexia, etc)

Group & Family TherapiesGroup & Family Therapies

Comparison of Psychotherapies

Comparison of Psychotherapies

Comparison of Psychotherapies

Comparison of Psychotherapies

Comparison of Psychotherapies

Comparison of Psychotherapies

Evaluating PsychotherapiesEvaluating Psychotherapies

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Who do people turn to for help with psychological difficulties?

Evaluating TherapiesEvaluating Therapies

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Is Psychotherapy Is Psychotherapy Effective?Effective?

It is difficult to gauge the effectiveness of psychotherapy because there are different levels upon which its effectiveness can be measured.

1. Does the patient sense improvement?2. Does the therapist feel the patient has improved?3. How do friends and family feel about the patient’s

improvement?

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Client’s PerceptionsClient’s PerceptionsIf you ask clients about their experiences of getting into therapy, they often overestimate

its effectiveness. Critics however remain skeptical.

1. Clients enter therapy in crisis, but crisis may subside over the natural course of time (regression to normalcy).

2. Clients may need to believe the therapy was worth the effort.3. Clients generally speak kindly of their therapists.

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Clinician’s PerceptionsClinician’s PerceptionsLike clients, clinicians believe in therapy’s success. They believe the client is better off after therapy than if the client had not taken part in therapy.

1. Clinicians are aware of failures, but they believe failures are the problem of other therapists.

2. If a client seeks another clinician, the former therapist is more likely to argue that the client has developed another psychological problem.

3. Clinicians are likely to testify to the efficacy of their therapy regardless of the outcome of treatment.

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Outcome ResearchOutcome Research

How can we objectively measure the effectiveness of psychotherapy?

Is Psychotherapy Effective?Is Psychotherapy Effective?Client & Clinician perceptions of therapy’s effectiveness

are vulnerably to inflation from 2 Phenomena• Placebo effect & Regression toward the Mean

the tendency for extreme or unusual scores to fall back (regress) toward their average. Pg 702

Client’s perceptions- justify & overly positive (placebo effect or belief in a treatment = Placebo Treatment or expectation of relief analogous with a reward)

Clinician’s perceptions- seem to mainly recognize only other clinician’s failures 251_Therapeutic_Effectiveness.mp4

• Outcome research–Meta-analysis a procedure for statistically combining

the results of many different research studies.

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Outcome ResearchOutcome ResearchResearch shows that treated patients were 80% better than untreated ones.Meta-analysis of a # of studies suggests that

1000s of patients benefit more from therapy than those who did not go to therapy.

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The Relative Effectiveness of The Relative Effectiveness of Different TherapiesDifferent Therapies

Which psychotherapy would be most effective for treating a particular & specific problem?

Disorder Therapy

Depression, reducing suicide risk

Behavior, Cognition, Interpersonal

Anxiety Cognition, Exposure, Stress Inoculation

Bulimia Cognitive-behavior

Phobia, compulsions, marital problems

Behavior

Bed Wetting Behavior Modification

Evaluating Alternative TherapiesEvaluating Alternative TherapiesEye movement desensitization & reprocessing (EMDR) therapist attempts to unlock & reprocess previous frozen traumatic memories by waving a finger in front of the eyes of the client.

–EMDR has not held up under scientific testing.

•Light exposure therapy–Seasonal affective disorder (SAD) a form of depression, has been effectively treated by light exposure therapy.– This form of therapy has been scientifically validated.

Commonalities Among PsychotherapiesCommonalities Among Psychotherapies

• Hope for demoralized people

• A fresh perspective• An empathic,

trusting, caring relationship

Three commonalities shared by all forms of psychotherapies are the following:

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Culture & Values in Culture & Values in PsychotherapyPsychotherapy

Psychotherapists may differ from each other & from clients in their personal beliefs, values, & cultural backgrounds.

A therapist search should include visiting two or more therapists to judge which one makes the client feel more comfortable.

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Therapists & Their Therapists & Their TrainingTraining

Clinical psychologists: They have PhDs mostly. They are experts in research, assessment, and therapy, all of which is verified through a supervised internship.

Clinical or Psychiatric Social Worker (LCSW): They have a Masters of Social Work. Postgraduate supervision prepares some social workers to offer psychotherapy, mostly to people with everyday personal and family problems.

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Therapists & Their Training

Counselors: Pastoral counselors or abuse counselors work with problems arising from family relations, spouse and child abusers & their victims, & substance abusers.

Psychiatrists: They are physicians who specialize in the treatment of psychological disorders. Not all psychiatrists have extensive training in psychotherapy, but as MDs they can prescribe medications.

The Biomedical TherapiesThe Biomedical Therapies

IntroductionIntroduction

• Biomedical therapy - prescribed medications or medical procedures that act directly on the patient’s nervous system.–Drug therapy–Brain Stimulation (Electroconvulsive

therapy), Magnetic impulses–Psychosurgery–Psychiatrist

Drug TherapiesDrug Therapies• Psychopharmacology the study of the

effects of drugs on mind & behavior

Factors to consider with drug therapy– Normal recovery rate of untreated patients– Recovery due to Placebo effect

• Double blind procedure To test the effectiveness of a drug, patients are tested with the drug & a placebo. 2 groups of patients & medical health professionals are unaware of who is taking the drug & who is taking the placebo.In such studies several drugs have proven useful in treating Psych Disorders`

Drug TherapiesDrug TherapiesPsychopharmacology is the study of drug effects

on mind & behavior.

Drug Therapies

Drug Therapies

Drug Therapies

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Drug TherapiesDrug TherapiesHowever, many patients are left homeless on

the streets due to their ill-preparedness to cope independently outside in society.

Les Snider/ The Im

age Works

Drug TherapiesDrug Therapies• Antipsychotic drugs drugs used to treat schizophrenia &

other forms of severe thought disorder– Psychoses– Chlorpromazine (Thorazine) classical antipsychotic : remove

a number of positive symptoms associated with schizophrenia, such as agitation, delusions, & hallucinations (dampens the responsiveness to irrelevant stimuli)

– Patients with negative symptoms, (withdrawal or apathy) often do not respond well to these drugs

Drug TherapiesDrug TherapiesAntipsychotic drugs Antipsychotic drugs

• Dopamine –Block this neurotransmitter. Molecules are small enough to occupy the dopamine receptor sites, blocking its activity. This reinforces the belief that overactive dopamine system contributes to schizophrenia.

• Side Effects : tremors, sluggishness, twitches, & Tardive dyskinesia involuntary movements of the facial muscles/tongue/limbs; possible neurotoxic side effect of long-term use of drugs that target certain dopamine receptors. (D2 receptors)

NEW GENERATION of Anti psychotic drugs- target D1 receptors & have fewer side effect. BUT these drugs (clorazipine, Risperdal, Zyprxa) not more effective & increase risk of obesity & diabetes & require extreme monitoring to manage the proper dosage

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Atypical AntipsychoticAtypical AntipsychoticClozapine (Clozaril) blocks receptors for dopamine & serotonin to remove the negative symptoms of schizophrenia. Eg. apathy, jumbled thoughts, concentration difficulties, & difficulties in interacting with others

Also helps those with positive symptoms that did not respond to other drugs.Side Effect: May cause toxic effect on white blood cells

Drug TherapiesDrug TherapiesAntianxiety Drugs

• Antianxiety drugs drugs used to control anxiety & agitation–Xanax, Ativan, D-

cycloserine –Physiological dependence

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Antianxiety DrugsAntianxiety DrugsAntianxiety drugs (Xanax & Ativan) depress the

central nervous system & reduce anxiety & tension by elevating the levels of the Gamma-aminobutyric

acid (GABA) neurotransmitter.

Drug TherapiesDrug TherapiesAntidepressant Drugs

• Antidepressant drugs drugs used to treat depression; also increasingly prescribed for anxiety. Different types work by altering the availability of various neurotransmitters.–Use with mood & anxiety disorders–Fluoxetine (Prozac), Paxil

• Selective-serotonin-reuptake inhibitors (SSRI)

• Neurogenesis– Side effects of anti- depressants

Drug TherapiesAntidepressant Drugs

Antidepressant drugs like Prozac, Zoloft, & Paxil are Selective Serotonin Reuptake Inhibitors (SSRIs) that improve the mood by elevating levels of serotonin by inhibiting reuptake.

Drug TherapiesDrug TherapiesMood-Stabilizing Medications

• Mood-stabilizing medications–Lithium–Depakote

Lithium Carbonate, a common salt, has been used to stabilize manic episodes in bipolar disorders.It moderates the levels of norepinephrine & glutamate neurotransmitters.

Brain StimulationBrain StimulationElectroconvulsive Therapy

• Electroconvulsive therapy (ECT) used for severely depressed patients who do not respond to drugs. –Procedure- The patient is

anesthetized &given a muscle relaxant. Patients usually get a 100 volt shock that relieves them of depression.

–Severe depression–Problems/side effects

Brain StimulationElectroconvulsive Therapy

Brain StimulationBrain StimulationAlternative Neurostimulation Therapies• Magnetic Stimulation

–Repetitive transcranial magnetic stimulations (rTMS) - the application of repeated pulses of magnetic energy to the prefrontal regions brain; used to stimulate or suppress brain activity

• Deep-Brain Stimulation

Brain StimulationBrain StimulationAlternative Neurostimulation Therapies

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PsychosurgeryPsychosurgery

Psychosurgery was popular even in Neolithic times.

Although used sparingly today, about 200 suchoperations do take place in the US alone.

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w.epub.org.br

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PsychosurgeryPsychosurgeryPsychosurgery is used as a last resort in alleviating psychological disturbances. Psychosurgery is irreversible. Removal of brain tissue changes the mind.

PsychosurgeryPsychosurgery• Psychosurgery surgery that removes or

destroys brain tissue in an effort to change behavior–Lobotomy a now-rare psychosurgical procedure

once used to calm uncontrollably emotional or violent patients. The procedure cut the nerves connecting the frontal lobes to the emotion-controlling centers of the inner brain• History• Procedure• Side effects• Use today

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Preventing Psychological Preventing Psychological DisordersDisorders

“It is better to prevent than cure.”Peruvian Folk Wisdom

Preventing psychological disorders means removing the factors that affect society.

Those factors may be poverty, meaningless work, constant criticism, unemployment, racism, & sexism.

Preventing Psychological Preventing Psychological DisordersDisorders

Therapeutic Life-Style ChangeTherapeutic Life-Style Change

• Integrated biopsychosocial system• Therapeutic life-style change

– Aerobic exercise– Adequate sleep– Light exposure– Social connection– Anti-rumination– Nutritional supplements

Preventing Psychological DisordersPreventing Psychological Disorders

• Resilience the personal strength that helps most people cope with stress and recover from adversity and even trauma.

• Preventing psychological disorders

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Psychological Disorders Psychological Disorders are Biopsychosocial in are Biopsychosocial in

NatureNature

The End

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Eclectic Approach

= an approach to psychotherapy that, depending on the client’s problems, uses techniques from various forms of therapy.

Psychotherapy

= treatment involving psychological techniques; consists of interactions between a trained therapist and someone seeking to overcome psychological difficulties or achieve personal growth.

Psychoanalysis

= Sigmund Freud’s therapeutic technique. Freud believed the patient’s free associations, resistances, dreams, and transferences – and the therapist’s interpretations of them – released previously repressed feelings, allowing the patient to gain self-insight.

Resistance

= in psychoanalysis, the blocking from consciousness of anxiety-laden material.

Interpretation

= in psychoanalysis, the analyst’s noting supposed dream meanings, resistances, and other significant behaviors and events in order to promote insight.

Transference

= in psychoanalysis, the patient’s transfer to the analyst of emotions linked with other relationships (such as love or hatred for a parent).

Psychodynamic Therapy

= therapy deriving from the psychoanalytic tradition that views individuals as responding to unconscious forces and childhood experiences, and that seeks to enhance self-insight.

Insight Therapies

= a variety of therapies that aim to improve psychological functioning by increasing the client’s awareness of underlying motives and defenses.

Client-centered Therapy

= a humanistic therapy, developed by Carl Rogers, in which the therapist uses techniques such as active listening within a genuine, accepting, empathic environment to facilitate client’s growth. (Also called person-centered therapy.)

Active Listening

= empathic listening in which the listener echoes, restates, and clarifies. A feature of Roger’s client-centered therapy.

Unconditional Positive Regard

= a caring, accepting, nonjudgmental attitude, which Carl Rogers believed would help clients to develop self-awareness and self-acceptance.

Behavior Therapy

= therapy that applies learning principles to the elimination of unwanted behaviors.

Counterconditioning

= a behavior therapy procedure that used classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors; includes exposure therapies and aversive conditioning.

Exposure Therapies

= behavioral techniques, such as systematic desensitization, that treat anxieties by exposing people (in imagination or actuality) to the things they fear and avoid.

Systematic Desensitization

= a type of exposure therapy that associates a pleasant relaxed state with gradually increasing anxiety-triggering stimuli. Commonly used to treat phobias.

Virtual Reality Exposure Therapy

= an anxiety treatment that progressively exposes people to simulations of their greatest fears, such as airplane flying, spiders, or public speaking.

Aversive Conditioning

= a type of counterconditioning that associates an unpleasant state (such as nausea) with an unwanted behavior (such as drinking alcohol).

Token Economy

= an operant conditioning procedure in which people earn a token of some sort for exhibiting a desired behavior and can later exchange the tokens for various privileges or treats.

Cognitive Therapy

= therapy that teaches people new, more adaptive ways of thinking and acting; based on the assumption that thoughts intervene between events and our emotional reactions.

Cognitive-behavioral Therapy

= a popular integrative therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior).

Family Therapy

= therapy that treats the family as a system. Views an individual’s unwanted behaviors as influenced by, or directed at, other family members.

Regression Toward the Mean

= the tendency for extreme or unusual scores to fall back (regress) toward their average.

Meta-analysis

= a procedure for statistically combining the results of many different research studies.

Evidence-based Practice

= clinical decision-making that integrates the best available research with clinical expertise and patient characteristics and preferences.

Biomedical Therapy

= prescribed medications or medical procedures that act directly on the patient’s nervous system.

Psychopharmacology

= the study of the effects of drugs on mind and behavior.

Antipsychotic Drugs

= drugs used to treat schizophrenia and other forms of severe thought disorder.

Tardive Dyskinesia

= involuntary movements of the facial muscles, tongue, and limbs; a possible neurotoxic side effect of long-term use of antipsychotic drugs that target certain dopamine receptors.

Antianxiety Drugs

= drugs used to control anxiety and agitation.

Antidepressant Drugs

= drugs used to treat depression; also increasingly prescribed for anxiety. Different types work by altering the availability of various neurotransmitters.

Electroconvulsive Therapy (ECT)

= a biomedical therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized patient.

Repetitive Transcranial Magnetic Stimulation (rTMS)

= the application of repeated pulses of magnetic energy to the brain; used to stimulate or suppress brain activity.

Psychosurgery

= surgery that removes or destroys brain tissue in an effort to change behavior.

Lobotomy

= a now-rare psychosurgical procedure once used to calm uncontrollably emotional or violent patients. The procedure cut the nerves connecting the frontal lobes to the emotion-controlling centers of the inner brain.

Resilience

= the personal strength that helps most people cope with stress and recover from adversity and even trauma.