Therapy for Mental Illness: Techniques and Perceptions

1. Treating mental illness - Outline • History and careers • Psychological treatment = therapy • Does therapy work? • Psychological testing • Bio-medical treatment

2. History • Grim • Bedlam • Rosenhan • 1973 • Pseudopatients in mental wards • Less than 7 min/day with trained staff • Dehumanizing contact with staff

3. Careers in psychology as atreatment provider • Psychiatrist - MD • Nurse - BS, MS • Clinical / counseling psychologist - PhD • Counselors - MS in Psychology • Social workers - MS in Social Work

4. Treatment: Two general kinds Psychological Structured interaction between a trained professional and a patient Bio-medical Drugs, allopathic intervention, directly acting on the nervous system

5. Different approaches to therapy and assessment • Cognitive - habitual patterns of expression and thinking • Behavioral - behaviors and settings • Humanistic - conscious perceptions and beliefs • Psychoanalytic - repressed thoughts as important as expressed thoughts

6. Cognitive therapy Focus on habitual patterns of expression and thinking

7. Cognitive Therapy • Central assumption: • Neurosis derived from cognitive failure, e.g. irrational thinking, overgeneralization of pessimism etc. • The patient is not acting rationally • Therapy • Teaching instructive ways of thinking • Many different styles of therapist-patient interaction

8. Cognitive Therapy Example • You are depressed. • The therapist asks you to: • Take an issue that you’re depressed about • Think about other explanations for why the event is happening • E.g., Not your fault

9. Behavioral therapy Focus on behaviors and the settings that elicit them

10. Behavior Therapy • Central assumption: • Condition is learned • The product of Classical or Operant Conditioning • Therapy • Systematic desensitization • Undoing the link between the conditioned stimulus and the conditioned response • Aversive conditioning • Transform a positive conditioned response into a negative conditioned response • Positive reinforcement • Token economies

11. Behavioral Therapy Example • You are depressed. • The therapist • Isolates what making you depressed • Exposes you to it incrementally • More customarily used for anxiety • Phobias

12. Humanistic = person-centered therapy Focus on the patient’s conscious perceptions and beliefs

13. Person-Centered Therapy • Central assumption: • The person is a client, not a patient, with potential for self-actualization • Client’s self-perceptions are accurate • Conversation is fruitful • Therapy • Active Listening = echoing, restating, seeking clarification.

14. Person-Centered Example • You are depressed. • The therapist listens what you have to say: • Conversation without judgment, interpretation, or direction. • Therapist looks for an opportunity for the client’s growth • Most group therapy is person-centered • AA is person-centered

15. Psychoanalytic therapy Repressed thoughts as important as expressed thoughts

16. Psychoanalysis • Central assumption: • Possible and desirable to discovering what hidden feelings/memories underlie the problem • There is tension between the ID and SUPEREGO that therapy can resolve • Therapy • Free association • Say whatever comes to mind • Dream interpretation • A window to the subconscious

17. Psychoanalysis Example • You are depressed. • The therapist asks you to: • Freely associate about e.g. your family • Would not ask about a specific event because you (by assumption) don’t know what you are depressed about

18. Does therapy work?Client’s Perceptions • 89% of therapy consumers were at least “fairly well satisfied” with the results (Consumer Reports) • 9 of 10 who recalled feeling “fair” or “very poor” at beginning reported feeling “very good” “good” or at least “so-so” at end.

19. Skepticism about therapy • Placebo effect • Regression to the mean • People often enter therapy in crisis. • Clients may need to believe that therapy was worth it. • Clients generally like their therapists.

20. Clinician’s Perceptions • Resounding “yes” • case studies, feedback from clients, etc. • However, they know of “failures” by other clinicians. • Not particularly reliable.

21. Outcome Research • Controlled research has looked at how well therapy works • People who are NOT in therapy get better • People in therapy get more better

22. Commonalities • Hope for demoralized people • A new perspective • An empathic, trusting, caring relationship

23. Psychological testing MMPI-2 Projective tests Behavioral monitoring Neuroimaging

24. MMPI-2 • Minnesota Multiphasic Personality Inventory • 567 true / false questions • Scored on 27 different scales • Clinical • Content • Validity: lying and faking

25. MMPI examples • Q: The world seems hopeless to me • A: True • Score a point to the scale for Depression • Q: I never get angry • A: True • Score a point to the scale for Lying

26. Other • Projective tests • Rorschach inkblots • Thematic apperception (TAT) • Behavioral monitoring • Ward staff counts positive and negative interactions with other patients and staff • Self-monitoring

27. Bio-medical treatment == Drugs • Used to treat Neurosis AND Psychosis • Drugs • Anti-psychotic • Anti-anxiety • Anti-depressant • Other • Electroconvulsive Therapy • Psychosurgery

28. Anti-psychotic drugs • Their effects: • Dampen responsiveness to irrelevant stimuli • Help decrease the positive symptoms of schizophrenia (e.g., hallucinations, paranoia) • These work by: • blocking dopamine receptors • Examples: Thorazine, Clozaril

29. ± Anti-psychotics drugs • + Reduce positive symptoms • Fewer hallucinations and delusions • Able to live at home • - Fail to touch negative symptoms • Patients still lack motivation • A zest-less life • Yucky side-effects • Parkinson’s disease • Tardive dyskinesia

30. Anti-anxiety drugs • Tranquilizers: • Reduce tension and anxiety • These work by • Depressing central nervous system activity (by augmenting the action of the neurotransmitter GABA) • Examples: Valium, Librium

31. ± Anti- tranquilizers • Habit forming! • Serious addiction problems • Interact with alcohol to make a lethal tonic

32. Anti-Depressant Drugs • Their effects: • Help to elevate arousal and mood • These work by • Increasing the availability of serotonin and norepinephrine

33. Tricyclic anti-depressants • Examples: Tofranil, Elavil • Block the reuptake of serotonin and norepinephrine into the presynaptic neuron • Prolong the effects of the neurotransmitters • Side-effects • Dry mouth, fatigue

34. SSRI anti-depressants • Selective serotonin reuptake inhibitors • Example: Prozac • Alter personality, mood becomes more elevated • Few side-effects but not as effective as tricyclics for severe depression

35. Electroconvulsive Therapy (ECT) • Its effects: • Decreases disabling depression • Used only: • in rare cases for severe depression • in patients not responding to drug treatments • It works by: • Sending a brief electric current through the brain of the anesthetized patient

36. ECT Continued • How does it work? • We don’t know for sure; • Maybe it releases neurotransmitters, • Maybe causes seizures that calm neural centers • Are there any problems? • Causes memory loss for the duration of the treatment • Otherwise, there appears to be no resulting brain trauma