Chapter 15

Treatment of Psychological Disorders – 8th Edition

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Types of Treatment

Analyze This and Analyze That - misconceptions

Types of therapies

– Insight therapies

• “talk therapy”

– Behavior therapies

• Changing overt behavior

– Biomedical therapies

• Biological functioning interventions

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Who Seeks Treatment?

15% of U.S population in a given year

Most common presenting problems

– Anxiety and Depression

– Treatment seeking for various disorders – Figure 15.1

• Mood disorders

Utilization rates – Figure 15.2

Women more than men

Medical insurance

Education level

Psychological Disorders and professional treatment –

Figure 15.3

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Figure 15-1 – Treatment seeking for various disorders

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Figure 15-2 – Therapy utilization rates – Olfson et al. (2002)

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XX 15.3

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Who Provides Treatment?

Slide 8

Clinical psychologists

Counseling psychologists

Psychiatrists

Clinical social workers

Psychiatric nurses

Counselors

On-line treatment?

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XXXXX Slide 8

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Insight Therapies: Psychoanalysis

Sigmund Freud and followers

– Goal: discover unresolved unconscious conflicts - Figure 15.4

• Free association

• Dream analysis

• Interpretation

– Resistance and transference

Psychodynamic Therapies

Figure 15.4 Freud’s view of the roots of disorders

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Insight Therapies: Client Centered Therapy

Carl Rogers

– Cause: Figure 15.5

– Goal: restructure self-concept to better correspond to reality

– Therapeutic Climate

• Genuineness

• Unconditional positive regard

• Empathy

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Therapies Inspired by Positive Psychology

Martin Seligman

Uses theory and research to better understand the

positive, adaptive, creative, and fulfilling aspects of

human existence

– well-being therapy

– positive psychotherapy

• can be an effective treatment for depression – F 15.6

Table of Contents Figure 15.6 Positive psychotherapy for depression

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Other issues

Groups therapy

– Group size

– Advantages – social dimension of change

Effectiveness of Insight therapies – Figure 15.7

– Spontaneous remission

Talk therapies or other approaches?

– Common factors contribute to progress in those treated

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Figure 15.7 – Recovery as a function of number of

therapy sessions

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Behavior Therapies

B.F. Skinner and colleagues

– Goal: unlearning maladaptive behavior and learning adaptive ones

– Systematic Desensitization – Joseph Wolpe

• Classical conditioning – Figure 15.8

• Anxiety/Fear hierarchy – Figure 15.9

– Aversion therapy – Figure 15.10

• Alcoholism, sexual deviance, smoking, etc.

– Social skills training

• Modeling

• Behavioral rehearsal

– Biofeedback

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XXX 15.8

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XXX 15.10

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Cognitive-Behavioral Therapy

Aaron Beck – Cognitive therapy

– Depression and negative thinking – Figure 15.11

Albert Ellis – Rational-emotive therapy

Goal: to change the way clients think – Detect and recognize negative thoughts

– Reality testing

Effectiveness of Behavior Therapies – Efficacy of behavioral interventions for a variety of

disorders

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XXX 15.11

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Biomedical Therapies

Psychopharmacotherapy – Antianxiety - Valium, Xanax, Buspar

– Antipsychotic - Thorazine, Mellaril, Haldol

• Tardive dyskinesia

• Atypical antipsychotic – reduce motor effects and other neurotransmitters

• Time course – Figure 15.12

– Antidepressant: - Actions - Figure 15.13

• Tricyclics – Elavil, Tofranil

• Mao inhibitors (MAOIs) - Nardil

• Selective serotonin reuptake inhibitors (SSRIs) – Prozac, Paxil, Zoloft – side effects – Table 15.1

• Risk of suicide – Figure 15.14

– Mood stabilizers

• Lithium, Valproic acid

Electroconvulsive therapy (ECT) – pages 642-643

Transcranial Magnetic Stimulation

Deep brain stimulation – Figure 15.15

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Figure 15.13 Antidepressant drugs’ mechanisms of action

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Figure 15.15 Deep brain stimulation

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Current Trends and Issues in Treatment

Managed care

Empirically validated treatments

Blending Approaches to treatment – Figure 15.17

– Conjunctive therapy – Figure 15.16

Multicultural sensitivity

Deinstitutionalization

– Dorthea Dix - Figure 15.18

– Changes in population – Figure 15.19

• Factors – treatments, legal, service delivery model

– Revolving door problem – Slide 26

– Homelessness

– Increase use of criminal justice system

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Figure 15.17 The leading approaches to therapy among psychologists

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Figure 15-16 – Relapse rates in Reynolds et al. (1999) study

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XX 15.19

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Slide 26 – Percentage of psychiatric inpatient admissions that

are readmissions

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Looking for at therapist

Factors to consider

– Sources of services – Table 15.2

– Profession

– Gender

– Theoretical approach

Comparison of approaches for effectiveness - Figure

15.20

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Table 15-2, p. 626

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Figure 15.20 Estimates of the effectiveness of various approaches to psychotherapy.