Modern Approaches to Treatment and Therapy in Mental Health

1. Treatment of Disorders

2. History of Treatment

3. Ethical Issues in Treatment • Deinstitutionalization occurred during the mental health movement of the 1960s • Don’t exclude mentally ill from society, but help them function within society • Shorten in-patient treatment (only keep in hospital if necessary) • More out-patient care • APA guidelines 

4. Who Provides Treatment? • Psychiatrists – Medical doctors, MD • Psychologists – PhD, PsyD, some MA • Clinical Social Workers, MA • Marriage/Family Therapists, MA • Licensed Professional Counselors, MA • Psychiatric Nurses, RN • Substance Abuse Counselors, CADC • Pastoral Counselors

5. Psychotherapy – trained therapist uses psychological techniques to help someone to overcome problems or difficulties • Biomedical therapy – prescribed medication that acts on nervous system • Eclectic approach – use a blend of therapies and approaches

6. Psychoanalysis • Free association • Say whatever comes to mind, no censoring of thoughts • Overcome resistance (blocking of anxiety-laden material) • Transference • Patient transfers unconscious feelings towards someone else onto the therapist • i.e. patient w/Electra complex has attraction to Freud (transfers attraction to father onto therapist)

8. Psychodynamic • Childhood experiences • Enhance self-insight • Interpersonal therapy – brief (12-16 session) treatment, effective for depression

9. Psychoanalysis v. Humanistic • Humanistic therapies differ from psychoanalysts in focusing on… 1) Present & future (not past) 2) Conscious rather than unconscious 3) Immediate responsibility 4) Promoting growth instead of curing illness

10. Client-Centered Therapy (Carl Rogers) • Nondirective  Active listening • Clarification or “reflect” what has been said back to patient • Genuineness, acceptance, empathy • Unconditional positive regard  no judgment

11. Behavior Therapies – Classical Conditioning • Counterconditioning • Pair feared stimulus w/good outcome • Exposure therapy • Learn relaxation techniques • Systematic desensitization hierarchy • Aversive conditioning • Pair the undesirable behavior with bad outcome

12. Behavior Therapy • Systematic Desensitization

13. Behavior Therapy • Aversion therapy for alcoholics

14. Behavior Therapies – Operant Behavior Modification – use reinforcement to increase desired behaviors Token Economy – provide “tokens” each time desired behavior is performed that can be redeemed later for a bigger reward

15. Cognitive Therapies • Cause = irrational thinking patterns • Aim = correct habitual thinking errors • Aaron Beck’s Cognitive(-Behavioral) Therapy  Cognitive Triad 1) Negative feelings about self “I am a failure” 2) Negative feelings about world “The world is unfair” 3) Negative feelings about future “The future is hopeless, it will never get better”

16. Beck’s Cognitive Therapy for Depression • Over-generalization  drawing general conclusions from a single (usually negative) event. E.g. thinking that failing to be promoted at work means a promotion will never come. • Minimalization and Maximization  Getting things out of perspective: e.g. either grossly underestimating own performance or overestimating the importance of a negative event. • Dichotomous thinking  Thinking that everything is either very good or very bad so that there are no gray areas. In reality, of course, life is one big gray area.

17. Cognitive-Behavioral Therapies Albert Ellis’s Rational Emotive Behavior Therapy (REBT) The A-B-C model A= Adversity (anticipating event) B = Belief about “A” C = Consequences (behavioral, emotional)

18. Evaluating Psychotherapies • To whom do people turn for help for psychological difficulties?

19. Is Psychotherapy Effective? • Overestimation • Clients enter in crisis (temporary) • Want to believe it was worth the effort • Placebo effect (expect to get better) • Regression toward the mean (the usual state is better than rock bottom, which is where most patients start)

20. Is Psychotherapy Effective? • Those not treated often improve, but those undergoing therapy are more likely to improve • No one therapy is best in all cases • Evidence-based practice – clinical decision making that integrates best available research w/clinical expertise and patient characteristics

21. Three Benefits of Psychotherapies • Offer expectation that things can and will get better • Offers plausible explanation for symptoms and alternative way of thinking • Effective therapists are empathetic and seek to understand  builds trust

22. Number of persons Average untreated person Average psychotherapy client Poor outcome Good outcome 80% of untreated people have poorer outcomes than average treated person Evaluating Psychotherapies

23. Biomedical Therapies • Psychopharmacology

24. Antipsychotic Drugs • Treats schizophrenia • Decrease receptiveness to irrelevant stimuli • Block dopamine • Thorazine, Haldol, neuroleptics • Atypical antipsychotics (Clozapine) • Tardivedyskinesia – involuntary movements of face, tongue, limbs

25. Antianxiety Drugs • Depress CNS activity (tranquilizers – benzodiazepines) • Boost GABA • Xanax, Ativan, D-cycloserine • Can lead to psychological and physiological dependence • Treats anxiety disorders (PTSD, OCD)

26. Antidepressant Drugs • Increase serotonin & norepinephrine • Selective Serotonin Reuptake Inhibitors (SSRIs) • Prozac, Zoloft, Paxil • Block reabsorption of serotonin from synapse • Treat depression, some anxiety disorders (OCD) • Tricyclics are more effective (serotonin & norepinephrine)

27. Lithium • Mood stabilizer • Treats bipolar disorder • Lowers risk of suicide

28. Brain Stimulation Techniques • Electroconvulsive Therapy (ECT) • Repetitive transcranial magnetic stimulation (rTMS)

29. Psychosurgery • Removes or destroys brain tissue to change behavior • Lobotomy • ONLY USED IN EXTREME CASES