treatment of disorders
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Treatment of Disorders
History of Treatment
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 societyShorten in-patient treatment (only keep in
hospital if necessary) More out-patient care
• APA guidelines
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
• 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
Psychoanalysis• Aim of treatment is to
make client aware of their unconscious & resolve unconscious childhood conflicts
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
Type of Therapy Cause/Problem Aim of TreatmentPsychodynamic Unconscious forces &
childhood experiencesReduce anxiety through self-insight; analysis & interpretation
Client-centered (Humanistic)
Barriers to self-understanding & self-acceptance
Personal growth through self-insight
Behavior Maladaptive behaviors (learned or observed)
Extinguish maladaptive behaviors
Cognitive Negative, self-defeating thoughts
Healthier thinking, positive self-talk
Group (Family) Stressful relationships Relationship healing, better communication
Biomedical Chemical imbalances or nervous system dysfunction
Prescribed medications of medical surgery
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
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
Psychoanalysis v. Humanistic
• Humanistic therapies differ from psychoanalysts in focusing on…1) Present & future (not past)2) Conscious rather than
unconscious3) Immediate responsibility 4) Promoting growth instead of
curing illness
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
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
Behavior Therapy Systematic Desensitization
Behavior Therapy Aversion
therapy for alcoholics
Behavior Therapies – OperantBehavior Modification – reinforcement & punishment
Token Economy
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, itwill never get better”
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
Cognitive-Behavioral Therapies
Albert Ellis’s Rational Emotive Behavior Therapy (REBT)
- It is not the events but our beliefs about the events that cause harmThe A-B-C modelA= Adversity (anticipating event)B = Belief about “A”C = Consequences (behavioral, emotional)
Group & Family Therapies
Evaluating Psychotherapies
To whom do people turn for help for psychological difficulties?
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)
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
Three Benefits of Psychotherapies
1) Offer expectation that things can and will get better
2) Offers plausible explanation for symptoms and alternative way of thinking
3) Effective therapists are empathetic and seek to understand builds trust
Evaluating Psychotherapies
Poor outcome Good outcome
Averageuntreated
person
Averagepsychotherapy
client
Number ofpersons
80% of untreated people have pooreroutcomes than average treated person
Biomedical Therapies• Psychopharmacology = study of drug
effects on mind and behavior
Antipsychotic Drugs• Work by decreasing receptiveness to
irrelevant stimuli, block dopamine• Treats schizoprhenia, sometimes
bipolar• Thorazine, Haldol, neuroleptics• Atypical antipsychotics
(Clozapine)• Tardive dyskinesia – involuntary
movements of face, tongue, limbs
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)
Antidepressant Drugs• Work by increasing serotonin &/or
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)
Lithium• Mood stabilizer used to treat bipolar
disorder• Lowers risk of suicide
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
Psychosurgery• Removes or destroys brain tissue to
change behavior• Lobotomy • ONLY USED IN
EXTREME CASES
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