treatment of disorders. history of treatment ethical issues in treatment deinstitutionalization...

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 Treatment

Psychodynamic Unconscious forces & childhood experiences

Reduce 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