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Psychology

CHAPTER16 Approaches to

Treatment and

Therapy

Biological treatments for mental

disorders

• Biological explanations and treatments are

dominant today:

– Evidence that some disorders have a genetic

component or involve chemical or

neurological abnormality

– Physicians and pharmaceutical companies

have been aggressively promoting biomedical

solutions

Biological Treatments for Mental Disorders LO16.1 Describe the four main categories of drugs commonly prescribed for the

treatment of mental disorders, and note the side effects of each.

• Antipsychotic drugs

– Many block or reduce sensitivity of dopamine

receptors.

– Some increase levels of serotonin, a

neurotransmitter that inhibits dopamine

activity.

– Can relieve positive symptoms of

schizophrenia, but can be ineffective for—or

even worsen—negative symptoms.

Biological Treatments for Mental Disorders LO16.1 Describe the four main categories of drugs commonly prescribed for the

treatment of mental disorders, and note the side effects of each.

• Antidepressant drugs

– Monoamine oxidase inhibitors (MAOIs):

Elevate norepinephrine and serotonin in brain by

blocking an enzyme that deactivates these

neurotransmitters

– Tricyclic antidepressants: Boost

norepinephrine and serotonin by preventing

reuptake

– Selective serotonin reuptake inhibitors

(SSRIs): Boost serotonin by preventing reuptake

Biological Treatments for Mental Disorders LO16.1 Describe the four main categories of drugs commonly prescribed for the

treatment of mental disorders, and note the side effects of each.

• Anti-anxiety drugs (tranquilizers)

– Increase the activity of GABA

– Developed for treatment of mild anxiety

– Often prescribed inappropriately by general

practitioners for any patient mood complaints

Biological Treatments for Mental Disorders LO16.1 Describe the four main categories of drugs commonly prescribed for the

treatment of mental disorders, and note the side effects of each.

• Lithium carbonate

– Used to treat bipolar disorder.

– Must be given in right dose, bloodstream

levels monitored

– Newer treatments include Tegetrol and

Depakote.

Biological Treatments, cont’ LO16.2 List six major cautions associated with drug treatments, and give a brief example

of each.

• Placebo effect

– The apparent success of a treatment due to

patient’s expectation rather than the treatment

itself

– Meta-analysis indicates that clinicians

consider medication helpful, yet patient

ratings in treatment groups were no greater

than those in placebo groups.

Biological Treatments, cont’ LO16.2 List six major cautions associated with drug treatments, and give a brief example

of each.

• High relapse and dropout rate

– There may be short-term success, but

50–66% of patients stop taking medication due to

side effects.

– Individuals who take antidepressants without

learning to cope with problems are more likely to

relapse.

– Appropriate dosage is also affected by metabolic

rates, amount of body fat, number and type of

drug receptors in the brain, smoking, and eating

habits.

Biological Treatments, cont’ LO16.2 List six major cautions associated with drug treatments, and give a brief example

of each.

• Disregard for nonmedical treatments

– The popularity of drugs has been fueled by

pressure from managed-care organizations

and by drug companies’ marketing and

advertising efforts.

– Research shows that nonmedical treatments

may work as well or even better.

Biological Treatments, cont’ LO16.2 List six major cautions associated with drug treatments, and give a brief example

of each.

• Unknown risks over time

and drug interations

– Antidepressants are assumed to be safe, but

no long-term studies have been conducted.

– Medication “cocktails” are sometimes

prescribed, but the risks and benefits of this

approach have not been investigated.

Biological Treatments, cont’ LO16.2 List six major cautions associated with drug treatments, and give a brief example

of each.

• Untested off-label uses

– The use of antipsychotics for nonpsychotic

disorders

– Antidepressants being used to treat “social

phobias”

Biological Treatments, cont’ LO16.3 Identify four forms of direct brain intervention used in treating mental disorders,

and discuss the limitations of each.

• Direct brain intervention

– Prefrontal lobotomy

• Never assessed or validated scientifically

– Electroconvulsive therapy (ECT)

• Procedure used in cases of prolonged and severe

major depression.

• Brief brain seizure is induced.

• The mood-improving effect of ECT is usually short-

lived, and the depression almost always returns

within a few weeks or months.

Biological Treatments, cont’ LO16.3 Identify four forms of direct brain intervention used in treating mental disorders,

and discuss the limitations of each.

– Transcranial magnetic stimulation (TMS)

• Involves use of pulsing magnetic coil held to a

person’s skull over the left prefrontal cortex

– Deep brain simulation – Has been approved for patients with Parkinson’s disease

and epilepsy; it requires surgery to implant electrodes

into the brain and to embed a small box, like a

pacemaker, under the collarbone.

Major Schools of Psychotherapy LO16.4 Summarize the main elements of psychodynamic therapy.

• Major schools of psychotherapy

– Psychoanalysis

• A method of psychotherapy developed by Sigmund

Freud, that emphasizes the exploration of

unconscious motives and conflicts.

– Transference

• In psychodynamic therapies, a critical process in

which the client transfers unconscious emotions or

reactions, such as emotional feelings about his or

her parents, onto the therapist.

Schools of Psychotherapy, cont’ LO16.5 Describe four methods of behavioral therapy, and provide an example of each.

• Behavior and cognitive therapy Behavior therapy: A form of therapy that applies principles

of classical and operant conditioning to help people change

self-defeating or problematic behaviors.

– Graduated exposure: In behavior therapy, a method

in which a person suffering from a phobia or panic

attacks is gradually taken into the feared situation or

exposed to a traumatic memory until the anxiety

subsides.

• Flooding: In behavior therapy, a form of exposure treatment

in which the client is taken directly into a feared situation until

his or her panic subsides.

Schools of Psychotherapy, cont’ LO16.5 Describe four methods of behavioral therapy, and provide an example of each.

(behavior and cognitive therapy, cont’)

– Systematic desensitization: In behavior therapy, a

step-by-step process of desensitizing a client to a feared

object or experience; it is based on the classical-

conditioning procedure of counter conditioning.

– Behavioral self-monitoring: In behavior therapy, a

method of keeping careful data on the frequency and

consequences of the behavior to be changed.

– Skills training: In behavior therapy, an effort to teach

the client skills that he or she may lack, as well as new

constructive behaviors to replace self-defeating ones.

Schools of Psychotherapy, cont’ LO16.6 Discuss the main techniques used in cognitive therapy.

• Cognitive techniques

– Cognitive therapy: A form of therapy

designed to identify and change irrational,

unproductive ways of thinking and, hence, to

reduce negative emotions.

– Rational emotive behavior therapy (REBT):

A form of cognitive therapy devised by Albert

Ellis, designed to challenge the client’s

unrealistic thoughts.

Schools of Psychotherapy, cont’ LO16.6 Discuss the main techniques used in cognitive therapy.

• Cognitive-behavior therapy (CBT)

– Clients learn to explicitly identify and accept

whatever negative thoughts and feelings

arise, without trying to eradicate them or

letting them derail healthy behavior.

– More common than behavior or cognitive

therapy alone

Schools of Psychotherapy, cont’ LO16.7 Summarize the similarities and differences between client-centered therapy and

existential therapy.

• Humanist and existential therapy

– Humanist therapy

• Based on the philosophy of humanism

• Emphasizes people’s free will to change, not past

conflicts

– Client-centered (nondirective) therapy

• Developed by Carl Rogers, which emphasizes the

therapist’s empathy with the client and the use of

unconditional positive regard.

Schools of Psychotherapy, cont’ LO16.7 Summarize the similarities and differences between client-centered therapy and

existential therapy.

• Existential therapy

– Helps clients explore the meaning of

existence and face with courage the great

issues of life such as death, freedom, free will,

alienation, and loneliness.

Schools of Psychotherapy, cont’ LO16.8 List the hallmarks of the family-systems perspective, and describe how they

apply to family and couples therapy.

• Family and couples therapy

– Assumes that problems develop in the context

of family, that they are sustained by family

dynamics, and that any changes will affect

whole family

– Can look for patterns of behavior across

generations and create a family tree of

psychologically significant events

Schools of Psychotherapy, cont’ LO16.8 List the hallmarks of the family-systems perspective, and describe how they

apply to family and couples therapy.

• Family-systems perspective

– Therapy with individuals or families by

identifying how each family member forms

part of a larger interacting system.

Schools of Psychotherapy, cont’ LO16.8 List the hallmarks of the family-systems perspective, and describe how they

apply to family and couples therapy.

• Family-systems perspective

– Therapy with individuals or families by

identifying how each family member forms

part of a larger interacting system.

Schools of Psychotherapy, cont’ LO16.8 List the hallmarks of the family-systems perspective, and describe how they

apply to family and couples therapy.

• Evaluating psychotherapy

– Therapeutic alliance

• The bond of confidence and mutual understanding

established between therapist and client, which

allows them to work together to solve the client’s

problems

Schools of Psychotherapy, cont’ LO16.8 List the hallmarks of the family-systems perspective, and describe how they

apply to family and couples therapy.

• Therapist-client “match”

– When there is a cultural match, clients and

psychotherapists are more likely to share

perceptions of what the client’s problem is,

agree on the best way of coping, and have

the same expectations about what therapy

can accomplish.

Schools of Psychotherapy, cont’ LO16.8 List the hallmarks of the family-systems perspective, and describe how they

apply to family and couples therapy.

Compare schools of therapy

Evaluating Psychotherapy LO16.9 Define the scientist-practitioner gap, and explain how it contributes to dilemmas

in the practice of psychotherapy.

• The scientist-practitioner gap

– Some psychotherapists believe that

evaluating therapy using research methods is

futile.

– Scientists find that therapists who do not keep

up with empirical findings are less effective

and can even harm clients.

– Economic pressures require empirical

assessment of therapies.

Evaluating Psychotherapy LO16.9 Define the scientist-practitioner gap, and explain how it contributes to dilemmas

in the practice of psychotherapy.

• Problems assessing therapy

– Justification of effort

• This is just one example of the difficulties in

assessing therapeutic results.

– Randomized controlled trials

• E.g. Some trials suggest that Critical Incident

Stress Debriefing (CISD) may delay recovery in

survivors of a traumatic event.

Evaluating Psychotherapy, cont’ LO16.10 Identify some of the problems associated with assessing the effectiveness of

therapy.

• Posttraumatic interventions

Evaluating Psychotherapy, cont’ LO16.11 Provide three examples of areas in which cognitive and behavioral therapies

have shown themselves to be particularly effective.

• When therapy helps – Depression

• Cognitive therapy

– Anxiety disorders

• Exposure techniques

– Anger and impulsive violence

• Cognitive therapy

– Health problems

• Cognitive and behavior therapies

– Childhood and adolescent behavior problems

• Behavior therapy

Evaluating Psychotherapy, cont’ LO16.12 Discuss four ways in which therapy has the potential to harm clients, and give

an example of each.

• When therapy harms

– Use of empirically unsupported, potentially

dangerous therapeutic techniques

– Inappropriate or coercive influence, which can

create new problems for the client

– Prejudice or cultural ignorance on the part of

the therapist

– Unethical behavior, especially sexual

intimacy, on the part of the therapist

The Value and Values of Psychotherapy LO16.13 List some benefits that effective psychotherapy can have for a client, and some

limitations to what psychotherapy can do for a client.

• The value and values of psychotherapy

– Psychotherapy can:

• Help you make decisions and clarify your values

and goals

• Teach you new skill and new ways of thinking

• Help you get along better with your family

• Get you through bad times

• Teach you how to manage depression, anxiety,

and anger