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Psychology

Twelfth Edition

Chapter 16

Approaches to Treatment and Therapy

Biological Treatments for Mental Disorders

LO 16.1.A Describe the four main categories of drugs commonly prescribed for the treatment of mental disorders, and discuss five major cautions associated with drug treatment.

LO 16.1.B Identify four forms of direct brain intervention used in treating mental disorders, and discuss the limitations of each.

The Question of Drugs (1 of 5)

Biological treatments for mental disorders are in the ascendance.

There are two reasons:

research findings on the genetic and biological causes of some disorders

economic and social factors

The most common treatment is medication that alters the production of or response to neurotransmitters in the brain.

The Question of Drugs (2 of 5)

The medications most commonly prescribed for mental disorders include:

antipsychotic drugs

antidepressants

anti-anxiety drugs (tranquilizers), and

lithium carbonate

The Question of Drugs (3 of 5)

Drawbacks of drug treatment include:

the placebo effect

high dropout and relapse rates among people who take medications without also learning how to cope with their problems

the difficulty of finding the correct dose for each individual

the long-term risks of medication and of possible drug interactions when several are being taken

The Question of Drugs (4 of 5)

Medication should not be prescribed uncritically and routinely.

This is especially true when psychological therapies can work as well for many mood and behavioral problems.

The Question of Drugs (5 of 5) Figure 16.1 Drugs and Publication Bias

(Based on Turner et al., 2008.)

To get FDA approval for a new medication, a pharmaceutical company must present evidence of the drug’s effectiveness. On the bars in this figure, each box represents one study. On the left side, you can see that most of the published studies supported the effectiveness of 12 antidepressants. But when independent researchers got hold of all of the data submitted to the FDA, they found that many unpublished studies had questionable or negative results (right). (Based on Turner et al., 2008.)

Direct Brain Intervention (1 of 3)

Drugs and psychotherapy have failed to help seriously disturbed people.

In those cases, some psychiatrists have intervened directly in the brain (psychosurgery).

Prefrontal lobotomy never had any scientific validation, yet was performed on many thousands of people.

Direct Brain Intervention (2 of 3)

Electroconvulsive therapy (ECT) has been used successfully to treat acute episodes of suicidal depression.

“shock therapy”

However, its benefits rarely last.

A newer method, transcranial magnetic stimulation (TMS), is being studied as a way of treating severe depression.

Direct Brain Intervention (3 of 3)

Deep brain stimulation (DBS) requires the surgical implantation of electrodes and a stimulation device.

DBS was originally approved for patients with Parkinson’s disease and epilepsy.

Now it is being used for a variety of mental disorders.

obsessive–compulsive disorder

No one knows how or why it might be helpful.

Major Schools of Psychotherapy

LO 16.2.A Summarize the main elements of psychodynamic therapy.

LO 16.2.B Describe four methods of behavior therapy, and discuss the main techniques used in cognitive therapy.

LO 16.2.C Summarize the similarities and differences between client-centered therapy and existential therapy.

LO 16.2.D List the hallmarks of the family-systems perspective, and describe how they apply to family and couples therapy.

Psychodynamic Therapy (1 of 2)

Psychodynamic (“depth”) therapies include Freudian psychoanalysis and its modern variations.

One approach is object-relations theory, which emphasizes:

the unconscious influence of people’s earliest mental representations of their parents, and

how these affect reactions to separations and losses throughout life

Psychodynamic Therapy (2 of 2)

These therapies explore unconscious dynamics.

defenses and conflicts

They focus on the process of transference to break through the patient’s defenses.

the client’s transfer (displacement) of emotional elements of their inner life outward onto the analyst

They also examine:

childhood issues

past experiences

Behavior and Cognitive Therapy (1 of 3)

Behavior therapists draw on classical and operant principles of learning.

They use such methods as:

graduated exposure

flooding

systematic desensitization

behavioral self-monitoring

skills training

Behavior and Cognitive Therapy (2 of 3)

Cognitive therapists aim to change the irrational thoughts involved in:

negative emotions and

self-defeating actions

Two leading approaches are:

Aaron Beck’s cognitive therapy

Albert Ellis’s rational emotive behavior therapy (REBT)

Behavior and Cognitive Therapy (3 of 3)

Cognitive-behavioral therapy (CBT) is now the most common approach.

A new wave of CBT practitioners propose a form of CBT based on “mindfulness” and “acceptance.”

nonjudgmental approach

focus on coping techniques

“attentional breathing”

Humanist and Existential Therapy (1 of 3)

Humanist therapy holds that human nature is essentially good.

People behave badly or develop problems when they have been warped by self-imposed limits.

It attempts to help people feel better about themselves by focusing on:

here-and-now issues

their capacity for change

Humanist and Existential Therapy (2 of 3)

Carl Rogers developed client-centered (nondirective) therapy.

The therapist’s role is to listen to the client’s needs in an accepting, nonjudgmental way.

It emphasizes the importance of the therapist’s empathy and ability to provide unconditional positive regard.

Humanist and Existential Therapy (3 of 3)

Existential therapy helps people cope with the great questions of existence, such as:

death

freedom

loneliness

meaninglessness

All therapies help people determine:

what matters to them

what values guide them, and

what changes they will have the courage to make

Family and Couples Therapy (1 of 2)

Family therapies are based on the view that individual problems:

develop in the context of the whole family

are sustained by the dynamics of the family, and that

any changes made will affect the family

The family-systems perspective recognizes that people’s behavior in a family is interconnected.

Family and Couples Therapy (2 of 2)

In couples therapy, the therapist usually sees both partners in a relationship.

By seeing both partners, the therapist cuts through blaming and attacking.

(“She never listens to me!” “He never does anything!”)

They instead focus on helping the couple:

resolve their differences

get over hurt and blame, and

make specific behavioral changes to reduce anger and conflict

Evaluating Psychotherapy

LO 16.3.A Define the scientist–practitioner gap, and identify some of the problems associated with assessing the effectiveness of therapy.

LO 16.3.B Provide examples of areas in which cognitive and behavior therapies have shown themselves to be particularly effective.

LO 16.3.C Discuss four ways in which therapy has the potential to harm clients, and give an example of each.

The Scientist–Practitioner Gap (1 of 5)

Successful therapy depends, in part, on the bond between the therapist and client.

This is called the therapeutic alliance.

The client is more likely to improve when both parties:

respect each other

understand each other

agree on the goals of treatment

The Scientist–Practitioner Gap (2 of 5)

Over the years, the breach between scientists and therapists has widened.

This has created what is commonly called the scientist–practitioner gap.

Researchers and clinicians tend to hold different assumptions about the value of empirical research, particularly for:

doing psychotherapy and

assessing its effectiveness

The Scientist–Practitioner Gap (3 of 5)

In assessing the effectiveness of psychotherapy, researchers need to control for:

the placebo effect and

the justification of effort effect

They rely on randomized controlled trials to determine which therapies are empirically supported.

The Scientist–Practitioner Gap (4 of 5)

Sometimes the results of randomized controlled trials have been startling.

critical incident stress debriefing (CISD) interventions

The Scientist–Practitioner Gap (5 of 5) Figure 16.2 Do Posttraumatic Interventions Help—or Harm?

(Mayou et al., 2000)

Victims of serious car accidents were assessed at the time of the event, 4 months later, and 3 years later. Half received a form of posttraumatic intervention called critical incident stress debriefing (CISD); half received no treatment. As you can see, almost everyone had recovered within 4 months, but one group had higher stress symptoms than everyone else, even after 3 years: the people who were the most emotionally distressed right after the accident and who received CISD. The therapy actually impeded their recovery (Mayou et al., 2000).

When Therapy Helps (1 of 3)

Some psychotherapies are better than others for specific problems.

Behavior therapy and cognitive-behavioral therapy are often the most effective for:

depression

anxiety disorders

anger problems

certain health problems

pain, insomnia, eating disorders

childhood and adolescent behavior problems

When Therapy Helps (2 of 3)

Family-systems therapies are especially helpful for:

children

young adults with schizophrenia, and

aggressive adolescents

These therapies are particularly effective when combined with behavioral techniques.

as in multisystemic therapy

When Therapy Helps (3 of 3)

The length of time needed for successful therapy depends on the problem and the individual.

Some methods, such as motivational interviewing, produce benefits in only a session or two.

Long-term psychodynamic therapy can be helpful for people with:

severe disorders and

personality problems

When Therapy Harms (1 of 2)

In some cases, therapy is harmful.

The therapist may:

use empirically unsupported and potentially harmful techniques, such as “rebirthing”

inadvertently create new disorders in the client through undue influence or suggestion

hold a prejudice about the client’s gender, ethnicity, religion, or sexual orientation

behave unethically

for example, by permitting a sexual relationship with the client

When Therapy Harms (2 of 2) Table 16.1 Potentially Harmful Therapies

Based on Lilienfeld (2007).

Intervention	Potential Harm
Critical incident stress debriefing (CISD)	Heightened risk of emotional symptoms
Scared Straight interventions	Worsening of conduct problems
Facilitated communication	False allegations of sexual and child abuse
Attachment therapies	Death and serious injury to children
Recovered-memory techniques (e.g., dream analysis)	Induction of false memories of trauma, family breakups
“Multiple personality disorder”–oriented therapy	Induction of “multiple” personalities
Grief counseling for people with normal bereavement reactions	Increased depressive symptoms
Expressive-experiential therapies	Worsening and prolonging painful emotions
Boot-camp interventions for conduct disorder	Worsening of aggression and conduct problems
DARE (Drug Abuse and Resistance Education)	Increased use of alcohol and other drugs