Treatment of Disorders

1. Treatment of Disorders

3. History of Treatment

4. 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 

5. 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

6. 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

7. Psychoanalysis • Aim of treatment is to make client aware of their unconscious & resolve unconscious childhood conflicts

8. Psychoanalysis • Free association • Say whatever comes to mind, no censoring of thoughts • Overcome resistance (blocking of anxiety-laden material) • Transference • Patient transfers unconscious hostilities or attraction to therapist

10. Psychodynamic • Causes: childhood experiences and unconscious forces • Does not emphasize sexual development • Aim = enhance insight by exploring feelings & thoughts • Psychodynamic therapist interprets and analyzes the patient • Interpersonal therapy – brief (12-16 session) treatment, effective for depression

11. Client-Centered Therapy (Carl Rogers) • Causes = barriers to self-understanding, lack of self-acceptance • Focuses on patient’s conscious self-perceptions without judgment • Genuineness, acceptance, empathy • Nondirective therapy  Active listening • Echo, clarify, and reflect what patient has said • Unconditional positive regard  total acceptance of client

12. 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

13. Behavior Therapies – Classical Conditioning • Disorders caused by learning or observing maladaptive behaviors/responses • Aim of treatment is to replace maladaptive behaviors/responses with desirable ones

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

15. Behavior Therapy • Systematic Desensitization

16. Behavior Therapy • Aversion therapy for alcoholics

17. Behavior Therapies – Operant Behavior Modification – reinforcement & punishment Token Economy

18. Cognitive Therapies • Cause = irrational thinking patterns or incorrect perceptions of the world • 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”

20. 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. http://www.spring.org.uk/2007/02/revolutionary-treatment-of-depression.php

21. Cognitive-Behavioral Therapies Albert Ellis’s Rational Emotive Behavior Therapy (REBT) - It is not the events but our beliefs about the events that cause harm The A-B-C model A= Adversity (anticipating event) B = Belief about “A” C = Consequences (behavioral, emotional)

22. Group & Family Therapies

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

27. Is Psychotherapy Effective? • Overestimation • Clients enter in crisis (temporary) • Want to believe it was worth the effort • Placebo effect • Regression toward the mean (the usual state is better than rock bottom)

28. 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

29. 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

30. 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

31. Biomedical Therapies • Psychopharmacology = study of drug effects on mind and behavior

32. Antipsychotic Drugs • Work by decreasing receptiveness to irrelevant stimuli, block dopamine • Treats schizoprhenia, sometimes bipolar • Thorazine, Haldol, neuroleptics • Atypical antipsychotics (Clozapine) • Tardivedyskinesia – involuntary movements of face, tongue, limbs

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

34. Antidepressant Drugs • Work by increasing serotonin &/or norepinephrine • Selective Serotonin Reuptake Inhibitors (SSRIs) • Prozac, Zoloft, Paxil • Block reabsorptionof serotonin from synapse • Treat depression, some anxiety disorders (OCD) • Tricyclics are more effective (serotonin & norepinephrine)

35. Lithium • Mood stabilizer used to treat bipolar disorder • Lowers risk of suicide

36. Brain Stimulation Techniques • Electroconvulsive Therapy (ECT) • Severely depressed patients • Electric current sent through brain to produce seizure • Repetitive transcranial magnetic stimulation (rTMS) • Patient is awake • Painless magnetic field through skull to brain • Less side effects

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