Chapter 15Treatment of Psychological Disorders - Home Link

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					                           Chapter 15: Treatment of Psychological Disorders

- different treatments depending on different perspectives
        - share common purpose: altering client’s behavior, thoughts, and/or feelings

History of Treatment
       - early societies = trephining - drilling holes in the skull to “release the harmful spirits”
       - Middle Ages = persecution (mental illnesses were interpreted as demonic possession)
       - 19th century = circus sideshow
       - 20th century = Dorothea Dix (US) & Philippe Pinel (France) led mental health reform to create
       - 1950s = deinstitutionalization occurred with the development of drugs
               - didn’t work
       - present = preventative efforts

Types of Therapy
      - psychotherapy - talking to a psychologist
               - psychoanalytic, humanistic, cognitive approach
      - behavioral therapy - changing contingencies of reinforcement for certain behaviors
               - behavioral approach
      - somatic treatments - taking a drug
               - biomedical approach
      - most therapists are eclectic
Psychoanalytic Therapy
      - designed by Freud
      - patient lies on couch while therapist sits out of patient’s line of vision
      - attempt to find underlying cause for unconscious conflicts
      - believe other kinds of therapy can help get rid of a symptom, but don’t address true problem
               - symptom substitution can result
                      - will begin to suffer new psychological problem
      - 3 ways to get into someone’s unconscious:
               1. Hypnosis - less likely to repress thoughts (unreliable)
               2. Free Association - less likely to censor what we say
               3. Dream Analysis - manifest content holds key to latent content
      - all rely heavily on the interpretation of the psychologist
               - patient may totally disagree with it (resistance)
                      - fierce resistance is considered an indication that the psychologist is close to the
                      source of the problem
      - transference may also occur
               - patients redirect emotions from troubling relationships (usually with parents) onto

Humanistic Therapies
     - main goal = self-actualization
     - operate on the ideas that people are generally good and have free will (control their own
            - if people are supported and helped to reach their goals, they will reach their highest
     - Carl Rogers
               - client-centered therapy (aka person-centered)
                       - therapist provides client with unconditional positive regard (total acceptance of
                       - non-directive - psychologist does not tell client what to do
                       - requires active listening:
                               1. paraphrase
                               2. ask for clarification
                               3. reflect feelings
       - Gestalt Therapy
               - Fritz Perls
               - importance of “the whole”
               - encourage clients to get in touch with their whole selves
                       - body language, actions, feelings should be integrated into a harmonious whole
       - Existential Therapies
               - help clients achieve a subjectively meaningful perception of their lives
               - help them see their lives as worthwhile
Behavioral Therapies
       - based on classical conditioning, operant conditioning, and modeling
       - Examples of Classical Conditioning:
       - counterconditioning – unpleasant conditioned response replaced with a pleasant one
               - ex: Charlie is afraid of going to the doctor; cries hysterically as soon as he enters.
               Charlie’s mom brings his favorite snack every time they go.
                       - conditioned response of crying replaced by contentment for snacks
               - exposure therapies – people face what they would normally avoid
                       - systematic desensitization
                               - most successful with phobias
                               - uses counterconditioning to replace fear with relaxation
                       - implosive therapy
                               - like systematic desensitization, except client imagines most frightening
                               scenario first
                       - produces a lot of anxiety, but if client can realize fears are irrational, then the
                       anxiety would be extinguished
                               - flooding = client actually experiences (not imagines) peak fear
       - aversive conditioning
               - pairs a habit the client wants to break with an unpleasant stimulus
                       - ex: habit = smoking; stimulus = electric shock
       - Examples of Operant Conditioning:
       - instrumental conditioning
               - using rewards and/or punishments to modify behavior
               - ex: token economy – desired behaviors are rewarded with tokens, which can be
               exchanged for privileges
       - modeling
               - combo of cognitive and behavioral ideas
Cognitive Therapies
       - focus on changing unhealthy thoughts
       - can be combative since therapist challenges irrational beliefs of client
               - ex: unhealthy attributional style = all failures are internal, global, and permanent
               aspects of self (see depression from Ch. 14)
       - Rational Emotive Therapy (RET)
            - Albert Ellis
            - therapist tries to expose/confront dysfunctional thoughts of clients
                    - ex: How likely is it that you will be embarrassed giving a class presentation?
                    How bad could it be?
      - Cognitive Therapy
            - Aaron Beck (cognitive triad – your self, your world, your future)
            - usually used in treating depression
            - therapist tries to get client to engage in pursuing success
                    - alleviates depression, and also challenges irrational ideas that caused their

Group Therapy
      - family therapy – reveals patterns of family interaction that may be causing problems to the
      - self-help groups (ex: AA)
              - less expensive for client
              - does not involve therapist… relies on insight of peers

Evaluating Psychotherapies
      - hard… how do you measure the effectiveness of therapy?
      - clients’ reports = usually supportive of therapy… BUT control groups show similar recovery
              - placebo effect; self-fulfilling prophesy
      - therapists’ reports = generally good… BUT patients who don’t succeed may try another
      therapist, and the first would never know
      - outcome research = people undergoing therapy are more likely to improve than those
      - specific problems may be helped by certain therapies
              - ex: phobias with behavioral conditioning; depression with cognitive therapy
              - the more specific the problem, the greater the chance for recovery
      - alternative therapies
              - not a lot of research, but TONS of testimonials
              - light exposure therapy for treating SAD seems effective

Somatic Therapies
     - psychopharmacology (drug therapy) aka chemotherapy
            - most common type of somatic therapy
            - the more severe a disorder (ex: schizophrenia), the more likely drugs will be used to
            treat it
                     - psychotherapy is useless for patients unable to express themselves coherently
            - schizophrenia
                     - antipsychotic drugs – block receptor sites for dopamine
                             - Thorazine & Haldol = most common
                                    - tardive dyskenesia can result (muscle tremors, like Parkinson’s)
                             - can increase risk for obesity and diabetes
                     - atypical antipsychotics – target dopamine and serotonin
                             - helps reduce negative symptoms
                             - may have less negative side effects
            - mood disorders
                     - antidepressants
                        - increase activity of serotonin or norepinephrine
                        - tricyclic antidepressants
                        - monoamine oxidase (MAO) inhibitors
                        - selective-serotonin-reuptake-inhibitor (SSRI)
                                - ex: Prozac, Zoloft, Paxil
                        - negative side effects (dry mouth, weight gain)
                        … do they really work? (spontaneous recovery, placebo effect, etc.)
                - mood-stablizers
                        - lithium used to treat manic phase of bipolar
        - anxiety disorders
                - drugs like barbiturates and benzodiazepines (ex: Xanax & Valium) suppress
                activity of CNS, making people feel more relaxed… but can lead to dependency
- Electroconvulsive Therapy (ECT)
        - patients are given a muscle relaxant and then experience a brief seizure and lose
        - less common than chemotherapy
        - bilateral – electric current passes through both hemispheres
                - generally more effective
                - side effects: memory loss
        - unilateral – current passes through one hemisphere
- Psychosurgery
        - rarest form of somatic therapy
        - most intrusive
        - purposeful destruction of part of brain to alter behavior
        - prefrontal lobotomy – cutting main neurons leading to the frontal lobe
                - calmed behavior, but reduce patient to vegetative state
- Alternative Therapies
        - repetitive transcranial magnetic stimulation (rTMS)
                - like ECT without the seizures or memory loss
        - deep-brain stimulation
                - very new so results are unclear

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