Journal Entry 4: Ch 13- Psychological Disorders
dareen haddad
PSYCh.pptxTREATMENT OF PSYCHOLOGICAL DISORDERS
chapter fourteen
PSYCHOLOGY DEBORAH M. LICHT MISTY G. HULL COCO BALLANTYNE
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The Sun Dancer
Dr. Dan Foster is the lead clinical psychologist on the Rosebud Reservation.
He frequently works with clients suffering from severe emotional trauma, but he maintains a positive outlook.
“I feel like the crucible of poverty and pain also is the crucible for transformation,” says Dr. Foster, who is a respected member of the Lakota community he serves.
An Introduction to Treatment (part 1)
A PRIMITIVE PAST: THE HISTORY OF TREATMENT
Trephination
Stone Age: Holes were drilled in the skull to create exit routes for evil spirits.
Asylums
16th century: Special places were created by religious groups to house and treat people with psychological disorders.
Late 1700s: Pinel began a reformation of the system and advocated for moral treatment, kindness, and respect.
Mid to late 1800s: Dix championed the mental hygiene movement in the United States.
Early 1900s: Psychiatrists began to view mental health as a continuum; classification of disorders began.
1952: The first DSM was created.
The Reformer
American schoolteacher Dorothea Dix led the nation’s “mental hygiene movement,” an effort to improve the treatment of people living in mental institutions.
Her advocacy work began in the mid-1800s, at a time when people in some mental hospitals were chained, beaten, and locked in cages (Parry, 2006).
An Introduction to Treatment (part 2)
A PRIMITIVE PAST: THE HISTORY OF TREATMENT
Deinstitutionalization
Mass movement of patients with psychological disorders out of mental institutions, and the attempt to reintegrate them into the community
Psychiatric hospitals and institutions
In spite of the deinstitutionalization movement, psychiatric hospitals and institutions continue to play an important role in the treatment of psychological disorders.
Deinstitutionalization
Since the 1950s, the rate of institutionalization has declined dramatically.
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The Variable Outcomes of Therapy
An Introduction to Treatment (part 3)
TREATMENT TODAY: AN OVERVIEW OF MAJOR APPROACHES
Psychotherapy
Understanding origins of problems in order to deal with them
Changing thoughts and behaviors that precede issues
Correcting disorders from a physical standpoint
An Introduction to Treatment (part 4)
TREATMENT TODAY: AN OVERVIEW OF MAJOR APPROACHES
Common features of approaches
The relationship between client and treatment provider is important.
Common goal of approaches
Reduce symptoms and improve quality of life
Definitions (part 1)
Biomedical therapy
Drugs and other physical interventions that target the biological processes underlying psychological disorders; primary goal is to reduce symptoms
Psychotherapy
“Talk therapy”; a treatment approach in which a client works with a mental health professional to reduce psychological symptoms and improve quality of life
Insight therapies
A type of psychotherapy aimed at increasing awareness of self and the environment
Definitions (part 2)
Behavior therapies
A type of therapy that focuses on behavioral change
Eclectic approach to therapy
Drawing on multiple theories and approaches to tailor treatment for a client
Evidence-based practice
Making decisions about treatment that integrate valuable research findings, clinical expertise, and knowledge of a patient’s culture, values, and preferences
An Introduction to Treatment (part 5)
TREATMENT TODAY: AN OVERVIEW OF MAJOR APPROACHES
Major dimensions of psychological therapies
Delivery (individual or group)
Treatment approach (biomedical or psychological)
Theoretical perspective (insight or behavior)
An Introduction to Treatment (part 6)
TREATMENT TODAY: AN OVERVIEW OF MAJOR APPROACHES
Broad categories
Insight therapies
Behavior therapies
Eclectic approach therapy
Insight Therapies (part 1)
PSYCHOANALYSIS
Freud and the unconscious
Freud proposed that humans are motivated by aggression and sex.
Acting on these drives is not always compatible with social norms—a conflict is created and drives are repressed.
Repressed behavior affects moods and behaviors.
Psychoanalysis attempts to increase awareness of conflicts and work through them.
Insight Therapies (part 2)
PSYCHOANALYSIS
Freud and dreams
Dreams are the pathways to unconscious awareness.
Manifest content
Free association
Interpretation
Resistance
Transference
Projection
Counter-transference
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Insight Therapies (part 3)
PSYCHOANALYSIS
Appraisal of psychoanalysis
Strengths
Psychoanalysis still in use today
Impact of work extensive; focus on importance of early childhood experiences and how these shape personality
Weaknesses
Subjective interpretations very difficult to empirically evaluate
Difficulty in knowing if unconscious is actually tapped
Insight Therapies: Psychodynamic Therapy
Ties to Freud
Updated approach to psychoanalysis
Incorporated idea that personality and behaviors can often be traced to past unconscious conflicts and experiences
Updates/changes
Shorter time in therapy, using face-to-face dialogue, direct approach, and feedback/advice
Therapy tested with scientific methodology
Insight Therapies: Humanistic Therapy
Rogers
Emphasized positive nature of humankind and concentrates on present and current problems
Recognized that humans have basic biological needs for food and sex and a desire to form close relationships, treat others with warmth, and mature as individuals
Person-centered Therapy
Natural tendency toward self-actualization, but family and society may hinder growth and can cause an incongruence between ideal self and real self
Main treatment goal is reduction of incongruence between these selves.
Therapeutic alliance based on mutual respect and caring: empathy, unconditional positive regard, genuineness and active listening
Insight Therapies: Person-Centered Therapy
Appraisal of humanistic therapy
Strengths
Significant impact on understanding of personality development and on practice of psychology
Used by therapists from variety of theoretical orientations
Weaknesses
Methodology not operationalized
Rrequires high level of verbal skills and self-awareness
Building a Therapeutic Alliance
White Terror
A classic in the history of psychology, the case study of Little Albert showed that emotional responses such as fear can be classically conditioned.
Researchers John B. Watson and Rosalie Rayner (1920) repeatedly exposed Albert to a frightening “bang!” every time he reached for a white rat, which led him to develop an intense fear of the animals.
Behavior Therapies (part 1)
BEHAVIOR THERAPY
Exposure
Technique of placing clients in feared situations without any risk
Extinction used to eliminate learned, fearful associations
Response prevention
The person is encouraged to confront the feared object or situation to prevent normal, fearful response.
The fear response eventually diminishes or disappears.
Face The Spider
A woman with arachnophobia (spider phobia) confronts the dreaded creature in a virtual environment called SpiderWorld.
So do you think virtual reality therapy works?
Behavior Therapies (part 2)
BEHAVIOR THERAPY
Systematic desensitization
Combination of anxiety hierarchies with relaxation techniques
Often uses progressive muscle relaxation
Systematic Desensitization (part 1)
Anxiety hierarchy for fear of needles
Looking at a photo of a hypodermic needle
Looking at an actual hypodermic needle
Touching a hypodermic needle in its packaging
Holding a hypodermic needle
Watching someone get a shot
Visiting a health clinic to discuss getting a shot
Allowing someone to prep your arm for a shot
Getting a flu shot
Systematic Desensitization (part 2)
During conditioning, two stimuli that produce incompatible responses (calm and anxiety) are repeatedly paired.
Because the responses are incompatible, one response will eventually be extinguished. Starting at the bottom of the hierarchy with the least anxiety-provoking situation enables the desired response (calm) to prevail.
Behavior Therapies (part 3)
BEHAVIOR THERAPY
Aversion therapy
Links problem behaviors to unpleasant physical reactions
Goal to make people have involuntary unpleasant physical reaction to undesired behavior
Aversion therapy seeks to diminish a behavior by linking it with an unpleasant reaction. To reduce alcohol consumption, alcohol is consumed with a drug that causes feelings of nausea. Eventually, alcohol becomes a conditioned stimulus, prompting the unpleasant physical reaction all on its own.
Behavior Therapies (part 4)
CONDITIONING, LEARNING, AND THERAPY
Behavior modification
Draws on principles of operant conditioning, shaping behavior through reinforcement
Uses positive and negative reinforcement and punishment or observational learning to increase adaptive behaviors and reduce those that are maladaptive
Behavior Therapies (part 5)
CONDITIONING, LEARNING, AND THERAPY
Token economy
Positive reinforcement is used to encourage good behavior.
Tokens are exchanged for candy, outings, privileges, and other perks.
Some believe that this technique manipulates and humiliates.
Behavior Therapies (part 6)
COVETED COINS
In a token economy, positive behaviors are reinforced with tokens, which can be used to purchase food, obtain privileges, and secure other desirable things.
Token economies are typically used in institutions such as schools or mental health facilities.
Behavior Therapies (part 7)
BEHAVIOR THERAPIES
Strengths
Work fast; produce quick resolutions to stressful situations; easily operationalized
Lower costs
Weaknesses
Not all behaviors are learned.
Newly learned behaviors may disappear when reinforcement stops.
Focusing on observable behavior may not address social, biological, and cognitive sources of psychological disorders.
Cognitive Therapies (part 1)
COGNITIVE THERAPY
Type of therapy aimed at addressing the maladaptive thinking that leads to maladaptive behaviors and feelings
Beck’s cognitive therapy
The father of cognitive therapy, Aaron Beck, believes that distorted thought processes lie at the heart of psychological problems.
Cognitive Therapies (part 2)
BECK’S COGNITIVE THERAPY
Scientific methods
Beck developed his own approach after unsuccessful attempts to produce scientific evidence showing that Freud’s methods worked.
Cognitive schema underlie pattern of automatic thoughts.
In therapy, mental frameworks (paradigms) containing cognitive errors are replaced with more positive beliefs.
Automatic thoughts
Proposed as roots of psychological disturbances
Cognitive distortions or errors in thinking cause misinterpretation of life events.
Cognitive Therapies (part 3)
Cognitive Therapies (part 4)
COGNITIVE THERAPY
Ellis’ rational emotive behavior therapy
People tend to have unrealistic beliefs, often perfectionist in nature, about how they and others should think and act.
This leads to disappointment.
The goal is to change irrational thoughts to realistic ones and arrive at self-acceptance.
Therapy focuses on change of behavior and cognitions.
Cognitive Therapies (part 5)
COGNITIVE THERAPY
Appraisal of cognitive therapy
Overlap in Ellis and Beck approaches
Both are short-term, action-oriented, and homework-intensive.
Not successful with all clients
Biomedical Therapies (part 1)
Three basic biological approaches underlying psychological disorders
Use of drugs or psychotropic medications
Use of electroconvulsive therapy
Use of surgery
Medications for Psychological Disorders
Biomedical Therapies: Medicines That Help
Psychopharmacology
Scientific study of how these medications alter perceptions, moods, behaviors, and other aspects of psychological functioning
Drugs can be divided into four categories: antidepressant, mood-stabilizing, antipsychotic, and antianxiety.
Biomedical Therapies (part 2)
PSYCHOPHARMACOLOGY
Antidepressant drugs
Psychotropic medications used for the treatment of depression; often major depressive disorder
Three classes: monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants, and selective serotonin reuptake inhibitors (SSRIs)
Do you know the difference between these three classes of medication?
Biomedical Therapies (part 3)
PSYCHOPHARMACOLOGY
Mood-stabilizing drugs
Psychotropic medications that minimize the lows of depression and the highs of mania
Often used to treat bipolar disorder; some side effects
Anticonvulsants may also be used to reduce symptoms of mania; some may increase risk of suicide.
Biomedical Therapies (part 4)
PSYCHOPHARMACOLOGY
Antipsychotic drugs
Psychotropic medication used in the treatment of psychotic symptoms, such as hallucinations and delusions
Designed to block neurotransmitter receptors
Biomedical Therapies (part 5)
PSYCHOPHARMACOLOGY
Antipsychotic drugs
Psychotropic medication used in the treatment of psychotic symptoms, such as hallucinations and delusions
Designed to block neurotransmitter receptors; often used to reduce dopamine activity in brain (antagonist)
Two kinds of medications: traditional antipsychotic medications and atypical antipsychotics (each with about a half-dozen generic drug offshoots)
Biomedical Therapies (part 6)
PSYCHOPHARMACOLOGY
Antianxiety drugs
Psychotropic medications used for treating the symptoms of anxiety disorders, including panic disorders, social phobias, and generalized anxiety disorders
Most are benzodiazepines which are fast-acting, but dangerously addictive; enhances effect of neurotransmitter (GABA).
Biomedical Therapies (part 7)
PSYCHOPHARMACOLOGY
Psychotropic medication plus psychotherapy
Research suggests that psychotropic drugs are most effective when used with psychotherapy.
Combining medication with an integrative approach to psychotherapy, including cognitive, behavioral, and psychodynamic perspectives, reduces major depressive symptoms faster than does either approach alone.
Biomedical Therapies (part 8)
THE OTHER BIOMEDICAL THERAPIES
Repetitive transcranial magnetic stimulation (rTMS)
Electromagnetic coils are put on (or above) a person’s head, directing brief electrical current into a particular area of the brain.
Appears to be effective in treating symptoms of depression and some types of hallucinations
Deep brain stimulation
Involves implanting a device that supplies weak electrical stimulation to specific areas of the brain thought to be linked to depression
Biomedical Therapies (part 9)
THE OTHER BIOMEDICAL THERAPIES
Electroconvulsive therapy (ECT)
Biomedical treatment of severe depression that induces seizures in the brain through electrical currents
Neurosurgery
Biomedical therapy that involves the destruction of some portion of the brain or connections between different areas of the brain
Prefrontal lobotomies
Split-brain operations
Biomedical Therapies (part 10)
STIMULATE THE BRAIN
An X-ray image of a person undergoing deep brain stimulation reveals two electrodes implanted in the brain—one in each hemisphere.
These electrodes send electrical impulses through certain neural networks, inducing changes that may lead to reduced symptoms.
This treatment has produced promising results in patients with depression, but further research is needed to identify its long-term effects (Kennedy et al., 2011).
Biomedical Therapies (part 11)
Appraisal of biomedical therapy
Medications and other biomedical treatments can reduce the symptoms of major psychological disorders.
Psychotropic drugs work so well that their introduction led to the deinstitutionalization of thousands of people.
Research on long-term effects of many treatments is needed.
Culture Conscious
A psychologist meets with two young Muslim women at the Centre for Needy Orphans and Poor Children in Thailand. Psychologists must always be mindful of cultural factors that may come into play during therapy.
Across the World
KNOW THY CLIENT
Should therapists and clients be matched according to ethnicity?
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Group Therapies
SELF HELP GROUPS
Provide support, not therapy
Often led by mental health advisor, rather than psychiatrist
AA, Weight Watchers, Parents without Partners
BENEFITS
Adapted well to changing demands of clinical field
As effective as individual therapy for many situations; preferred approach for interpersonal issues
CHALLENGES
Dependent on therapist’s skill
Possible resistance or transference from clients
Group Therapies: Family Therapy
Focus
Focuses on family as integrated system
Explores relationship problems rather than symptoms of particular disorders
Views family as dynamic, holistic
Group Therapies: Couples Therapy
Couples therapy
Uses many different therapeutic approaches
Tends to focus on conflict management and communication
More successful when commitment to save marriage exists
Benefits and Drawbacks of Group Therapy
Psychotherapy Today: Does Psychotherapy Work?
Effectiveness: Overall outcome
Solid evidence exists suggesting that therapy usually “works,” especially if it is long-term.
All therapeutic approaches performed equally well across all disorders but are limited by their insurance companies in terms of therapist choice and therapy duration.
Psychotherapy Today
I THINK I NEED HELP. WHAT SHOULD I DO?
Seek help.
Figure out what kind of therapy will work.
Find the right therapist.
Online Therapy
A clinical psychologist conducts an online consultation with a client. With digital communication technologies such as Skype and Google Hangouts, therapists can conduct sessions with clients on the opposite side of the globe. But problems may arise when therapy occurs online; for example, certain types of “nonverbal communication” may be difficult to detect (de Bitencourt Machada et al., 2016).
Social Media and Psychology
THERAPIST OR FRIEND?
Does Facebook have a place in therapy?
The relationship between therapist and client should remain a professional one, both online and offline.
Emergence of social media presents new challenges and new opportunities for therapists.
Psychologists who use social media must be adept at distinguishing between acceptable and unacceptable online activity.
e-therapy
A category of treatment that utilizes the Internet to provide support and therapy
