Unit 11: Abnormal PsychologyLesson 7: Treating Psychiatric Disorders

• Essential Question– How do therapists, psychiatrists, and psychologists

understand and treat individuals with psychological disorders?

• Key Vocabulary– Psychoanalysis

• Resistance• Interpretation• Transference

– Humanistic Therapy• Client centered therapy• Active listening

– Behavior Therapies• Counterconditioning • Aversive conditioning• Exposure therapy• Systematic desensitization• Token economies

– Cognitive Therapy• Cognitive-Behavior therapy

– Group therapy– Family therapy– Alternative Therapies:

• EMDR• light exposure• therapeutic touch

– Drug Therapies & treatments

• DAILY COMMENTARY:– How willing are you / would

you be to see a therapist?

• Upcoming Deadlines:– Assigned Readings: Daily– Present Projects: April 15-17– Vocab Quizzes:

• Lessons 1-7: April 15th

– Mock Exam: • MC Section:

– 4/17 (Unit 11 test score will be based on relevant questions from the mock exam)

• FRQ Section: Monday, April 13

Take notes from PsychSim 5

• Therapies– Mystery Client Module– Mystery Therapist

• Then move on – check out some of the disorder modules

• Then work on your Presentations – Due Monday

THERAPEUTIC TREATMENTS FOR PSYCHOLOGICAL

DISORDERS

By: Christopher K. Nixon

A Historical Perspective• Treatment options for people with

mental illness have improved tremendously over time.

• Beginning in the 1500s, asylums were created to care for the mentally ill.

• Cells were dark dungeons with no provisions for heat in the winter.

A Historical Perspective• Patients’ hands and feet were

chained and patients slept on straw rather than beds.

• As they were chained to the walls, they were forced to sit in their own urine and feces.

Asylum Reform in Europe• In 1792, Philippe Pinel was placed in charge of an

asylum in Paris – an asylum bearing the aforementioned conditions.

• Pinel’s philosophy was that the mentally ill should be treated with consideration and kindness.

• Pinel removed the shackles, allowed patients to go outside on hospital grounds, and gave them beds to sleep on.

Asylum Reform in the U.S.• In the United States, the mentally ill were

traditionally either institutionalized in the manner just described, kept in jails and poor houses, or just left alone to wonder the countryside.

• Yet, through the efforts of Dorothea Dix during the 19th century, a network of state-funded mental hospitals began to emerge.

• Many of these hospitals were extremely large facilities.

The Emergence of Psychological Therapy

• Sigmund Freud is widely credited with launching modern psychotherapy. – Freud was inspired by his colleague Josef

Breuer’s work with a young woman referred to as “Anna O.”

– Anna O. exhibited many physical maladies – headaches, coughing, loss of feeling and movement in her right arm.

– Breuer discovered that Anna’s symptoms began to clear up when he encouraged her to talk about emotionally charged experiences from her past.

The Emergence of Psychological Therapy

• Freud applied Breuer’s treatment to other patients and found similar success…

• This led to the development of a systematic treatment procedure focused on uncovering bottled up emotions, unconscious conflict and the like… He called this therapy “Psychoanalysis”

• This, in may ways, was the beginning of Psychotherapy.

The Nature and Purpose of Therapy

• “Therapy”, from the Latin term therapīa literally means “curing, healing”.

• Psychotherapies aim to provide people with an explanation for their problems, offer hope, and engage the client in a therapeutic alliance with their therapist.

• Therapies are often used to alleviate issues such as: Drug and alcohol dependence, bipolar disorder, major depression, phobic disorder, posttraumatic stress, generalized anxiety disorder, and panic disorder.

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Therapies

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

Biomedical therapy uses drugs or other procedures that act on the patient’s nervous system, curing him or her of

psychological disorders.An eclectic approach uses various forms of healing techniques depending upon

the client’s unique problems.

Therapies we will analyze

• Insight Therapies• Behavioral Therapies• Cognitive Therapies• Group Therapies• Biomedical Therapies

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Psychological Therapies

Most therapeutic methods are based in a particular approach to understanding

human Psychology

1. Psychoanalytical theory (Freud, Adler, Jung)2. Humanistic theory (Maslow, Rogers)3. Behavioral theory (Pavlov, Skinner)4. Cognitive theory (Bandura)

Insight Therapies• Insight therapies are “a variety of individual

psychotherapies designed to give people a better awareness and understanding of their feelings, motivations, and actions in the hope that this will help them adjust.”

• Psychoanalysis• Client-Centered Therapy• Therapies Inspired by Positive Psychology• Gestalt Therapy

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Psychoanalysis

The first formal psychotherapy to emerge was psychoanalysis, developed by

Sigmund Freud.

Sigmund Freud's famous couch

Edmund Englem

an

The Emergence of Psychological Therapy

• Sigmund Freud is widely credited with launching modern psychotherapy. – Freud was inspired by his colleague Josef

Breuer’s work with a young woman referred to as “Anna O.”

– Anna O. exhibited many physical maladies – headaches, coughing, loss of feeling and movement in her right arm.

– Breuer discovered that Anna’s symptoms began to clear up when he encouraged her to talk about emotionally charged experiences from her past.

Psychoanalytic Techniques

• Free association – clients spontaneously express their thoughts and feelings exactly as they occur, with as little censorship as possible. Gradually, all of the repressed material begins to flow out into the open.

• Dream analysis – the therapist interprets the symbolic meaning of the client’s dreams. Freud saw dreams as the “royal road to the unconscious”.

Psychoanalytic Techniques

• Interpretation – the therapist’s attempts to explain the inner significance of the client’s thoughts, feelings, memories, and behaviors.

• Transference – when clients unconsciously start relating to their therapist in ways that mimic critical relationships in their lives… Arguing with the therapist as you would with an abusive parent, for example.

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Psychoanalysis: Criticisms

1. Psychoanalysis is hard to refute because it cannot be proven or disproven.

2. Psychoanalysis takes a long time and is very expensive.

Client/Person-Centered Therapy• Using a Humanistic Perspective, Carl Rogers

devised client-centered therapy in the 1940s and 1950s.

• CCT is “an insight therapy that emphasizes providing a supportive emotional climate for clients, who play a major role in determining the pace and direction of their therapy.

Client/Person-Centered Therapy

• This therapy is usually for those who seek to “find themselves” or “get in touch with their real feelings.”

• The therapeutic climate tends to be one of:

• Genuineness – honest and spontaneous communication between therapist and client

• Unconditional positive regard – nonjudgmental acceptance of the client as a person

• Empathy – the therapist seeks to understand the world from the client’s point of view

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Humanistic Therapy

The therapist engages in active listening and echoes, restates, and clarifies the

patient’s thinking, acknowledging expressed feelings.

Michael Rougier/ Life M

agazine © Tim

e Warner, Inc.

Therapies Inspired by Positive Psychology

• Positive Psychology was founded by Martin Seligman.– Positive Psychology “uses theory and research to

better understand the positive, adaptive, creative, and fulfilling aspects of human existence.”

– The emphasis isn’t on weakness and pathology as with most other psychotherapies, rather; the focus is on contentment, well-being, human strengths, and positive emotions.

Gestalt Therapy• Gestalt therapy is largely an outgrowth of the work of

Frederick Perls • The therapy is designed to help people become more

genuine or “real” in their day-to-day interactions.• The term Gestalt means “whole”, as such, the

therapist’s role is to “fill in the holes in the personality to make the person whole and complete again.”

• For example, the therapist might tell a person to “own their feelings” through talking in an active, rather than passive way.

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Behavior Therapy

Therapy that applies learning principles to the elimination of unwanted behaviors.

To treat phobias or sexual disorders, behavior therapists do not delve deeply below the surface looking for inner causes.

Behavioral Therapies• Behavior therapies differ from the insight therapies

– They make no attempt to help clients achieve insights about themselves, but seek simply to change the behavior.

– Maladaptive behaviors such as compulsive gambling, alcohol and drug abuse, fear responses to external stimuli (phobias), and personal care maintenance are often the focus here.

• Classical Conditioning• Operant Conditioning

Classical vs. Operant Conditioning Therapies

• Classical Conditioning therapies seek to remove the undesirable behavior by reconditioning the client to produce desired behaviors.

• Therapies based on operant conditioning attempt to alter the consequences of the client’s behavior.– The therapist uses positive reinforcement, negative

reinforcement, punishment, and extinction to modify client behavior… Reward the desired, punish the undesired, for example…

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Classical Conditioning Techniques

Counterconditioning is a procedure that conditions new responses to stimuli that

trigger unwanted behaviors.

It is based on classical conditioning and includes exposure therapy and aversive conditioning.

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Exposure Therapy

Expose patients to things they fear and avoid.

Through repeated

exposures, anxiety lessens because they

habituate to the things feared.

The Far Side © 1986 FARW

ORKS. Reprinted w

ith Permission. All Rights Reserved.

Systematic Desensitization• A classical conditioning exposure

therapy that associates a pleasant, relaxed state with gradually increasing anxiety-triggering stimuli commonly used to treat phobias.

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Aversive Conditioning

A type of counterconditioning that associates an

unpleasant state with an unwanted behavior. With this

technique, temporary

conditioned aversion to alcohol has been reported.

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Operant Conditioning

Operant conditioning procedures enable therapists to use behavior modification,

in which desired behaviors are rewarded and undesired behaviors are either

unrewarded or punished.

A number of withdrawn, uncommunicative 3-year-old autistic children have been successfully trained by giving and withdrawing reinforcements for desired and undesired behaviors.

Token Economy

• Based on Operant Conditioning, a system wherein subjects are given tokens for desirable behaviors and are taken away for various undesirable behaviors.

• These tokens can later be exchanged by the client for a wide variety of rewards and priveledges.

• Token economies have been especially useful in mental hospitals where desirable behaviors might include aiding in self-care, making one’s own bed, and interacting well with others.

Behavioral Contract

• A written agree that explicitly states the consequences of certain acts…

• Such contracts are useful in resolving interpersonal conflict

• Consider a marriage wherein the wife is fed up with the husband always leaving his socks everywhere)

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Cognitive Therapy

Teaches people adaptive ways of thinking and acting based on the assumption that thoughts intervene between events and

our emotional reactions.

Cognition• Cognitions are mental processes (memory,

interpretation of experience, beliefs, ideas, thoughts, perception.)

• Cognitive Psychotherapy focuses mostly on interpretations, beliefs and perception.

• Consider the cognitive characteristics of a depression-prone person…

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Cognitive Therapy for Depression

• 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. Enter Becks’s COGNITIVE BEHAIVORAL

THERAPY

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 Therapy for Depression

Rabin et al., (1986) trained depressed patients to record positive events each day, and relate how they contributed to these events. Compared to other depressed patients, trained patients showed lower depression scores.

Stress-Inoculation Therapy• “A type of cognitive therapy that trains clients to cope with

stressful situations by learning a more useful pattern of self-talk.”

• The client is taught to replace negative, anxiety-provoking inner dialogue with positive, affirmative, “coping” dialogue.

• The Positive self talks becomes a kind of vaccine against stress-induced anxiety.

• Instead of, saying “This class is too difficult, I will fail…”, say “I studied hard, I am ready to give my best.”

Rational-Emotive Therapy• Developed by Albert Ellis, RET is “a directive cognitive

therapy based on the idea that clients’ psychological distress is caused by irrational and self-defeating beliefs, and that the therapist’s job is to challenge such dysfunctional beliefs.”

• The desired outcome is that the client will see these beliefs for what they are and change them.

• Irrational beliefs are often extremegeneralizations.

Beck’s Cognitive Therapy• Developed by Aaron Beck, this therapy “depends on

identifying and changing inappropriately negative and self-critical patterns of thought.”

• It differs from Rational-Emotive Therapy in that the client is encouraged to come up with challenges to their own irrational beliefs, rather than the therapist doing so…

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Cognitive-Behavior Therapy

Cognitive therapists often combine the reversal of self-defeated thinking with

efforts to modify behavior.

Cognitive-behavior therapy aims to alter the way people act (behavior therapy) and alter the way they think (cognitive therapy).

Group Therapy

• Family Therapy

• Couples Therapy

• Self-Help Groups

Group Therapy• Group therapy is “a type of psychotherapy in

which clients meet regularly to interact and help one another achieve insight into their feelings and behavior.”

• Group therapy can also help to identify problems that a person has when interacting with other people (hostility, aggressiveness, hyper-anxious…)

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Group Therapy

Group therapy normally consists of 6-9 people attending a 90-minute session that can help more people and costs less. Clients benefit from knowing others have similar problems.

© M

ary Kate Denny/ PhotoEdit, Inc.

Family Therapy• Family therapy is “a form of group therapy that sees

the family as at least partly responsible for the individual’s problems and that seeks to challenge all family members’ behaviors to the benefit of the family unit as well as the troubled individuals.”

• The primary goals are improving family communication, encouraging increased empathy between family members, getting each other to share responsibility, and reducing conflict.

Couple Therapy• Couple therapy is a form of therapy is intended

to help troubled partners improve their problems of communication and interaction.

• One technique is called empathy training, wherein each member is taught to listen to and understand their partner’s feelings before responding to them.

Self-Help Groups• Because an estimated 40 million Americans suffer

some kind of psychological problem (Narrow et al., 2001), and because the cost of individual treatment can be so high, more people who are faced with crises are turning to low cost self-help groups.

• Most group members express strong support for their groups.

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The Relative Effectiveness of Different Therapies

Which psychotherapy would be most effective for treating a particular

problem?Disorder Therapy

Depression Behavior, Cognition, Interpersonal

Anxiety Cognition, Exposure, Stress Inoculation

Bulimia Cognitive-behavior

Phobia Behavior

Bed Wetting

Behavior Modification

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Evaluating Alternative Therapies

Lilienfeld (1998) suggests comparing scientific therapies against popular

therapies through electronic means. The results of such a search are below:

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Eye Movement Desensitization and Reprocessing (EMDR)

In EMDR therapy, the therapist attempts to unlock and 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.

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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.

Courtesy of Christine Brune

Biomedical Therapy• Biomedical Therapies are “physiological

interventions intended to reduce symptoms associated with psychological disorders.”

• Drug Therapy• Electroconvulsive Therapy• Psychosurgery

Drug Therapy• Psychopharmacology is “the treatment of mental

disorders with medication.” • This form of treatment is commonly referred to as

drug therapy.

• The four main categories of theraputic drugs for psychological problems are:

• Anti-anxiety drugs• Antipsychotic drugs• Antidepressant drugs• Mood-Stabilizing drugs

Drug Therapy• Antianxiety drugs are used to relieve tension, apprehension, and

nervousness.• Valium, Xanax and other drugs in the benzodiazepine family are often

called tranquilizers. • GABA

• Antipsychotic Drugs are used to gradually reduce psychotic symptoms, including hyperactivity, mental confusion, hallucinations, and delusions.

• Such drugs appear to decrease activity at certain subtypes of dopamine synapses.

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Antianxiety Drugs

Antianxiety drugs (Xanax and Ativan) depress the central nervous system and reduce anxiety

and tension by elevating the levels of the Gamma-aminobutyric acid (GABA)

neurotransmitter.

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Atypical Antipsychotic

Clozapine (Clozaril) blocks receptors for dopamine and serotonin to remove the negative symptoms of schizophrenia.

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Mood-Stabilizing Medications

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

of norepinephrine and glutamate neurotransmitters.

Drug Therapy• Antidepressant Drugs gradually elevate mood and help

bring people out of a depression.• The newest class of antidepressant drugs are known as

selective serotonin reuptake inhibitors.

• Mood Stabilizers are drugs used to control mood swings in patients with bipolar mood disorder.

• Lithium is common mood stabilizer.• The neurotransmitter that these drugs affect is

presently unknown.

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Antidepressant Drugs

Antidepressant drugs like Prozac, Zoloft, and Paxil are Selective Serotonin Reuptake

Inhibitors (SSRIs) that improve the mood by elevating levels of serotonin by inhibiting

reuptake.

Electroconvulsive Therapy• Electroconvulsive Therapy is a biomedical

treatment in which electric shock is used to produce a cortical seizure accompanied by convulsions.

• In recent decades, this treatment has primarily been recommended for the treatment of depression.

Psychosurgery

• Psychosurgery is a form of brain surgery performed to change a person’s behavior and emotional state.

• This form of biomedical therapy is rarely used today.