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Treating mental illness - Outline

History and careers Psychological treatment = therapy Does therapy work? Psychological testing Bio-medical treatment

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History

Grim Bedlam

Rosenhan 1973 Pseudopatients in mental wards Less than 7 min/day with trained staff Dehumanizing contact with staff

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Careers in psychology as atreatment provider

Psychiatrist - MD Nurse - BS, MS

Clinical / counseling psychologist - PhD Counselors - MS in Psychology Social workers - MS in Social Work

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Treatment: Two general kinds

PsychologicalStructured interaction between a trained professional and a patient

Bio-medicalDrugs, allopathic intervention, directly

acting on the nervous system

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Different approaches to therapy and assessment

Cognitive - habitual patterns of expression and thinking

Behavioral - behaviors and settings

Humanistic - conscious perceptions and beliefs

Psychoanalytic - repressed thoughts as important as expressed thoughts

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Cognitive therapy

Focus on habitual patterns of expression and thinking

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Cognitive Therapy

Central assumption: Neurosis derived from cognitive failure, e.g.

irrational thinking, overgeneralization of pessimism etc.

The patient is not acting rationally Therapy

Teaching instructive ways of thinking Many different styles of therapist-patient

interaction

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Cognitive Therapy Example

You are depressed. The therapist asks you to:

Take an issue that you’re depressed about Think about other explanations for why the

event is happening E.g., Not your fault

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Behavioral therapy

Focus on behaviors and the settings that elicit them

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Behavior Therapy

Central assumption: Condition is learned

The product of Classical or Operant Conditioning Therapy

Systematic desensitization Undoing the link between the conditioned stimulus

and the conditioned response Aversive conditioning

Transform a positive conditioned response into a negative conditioned response

Positive reinforcement Token economies

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Behavioral Therapy Example

You are depressed. The therapist

Isolates what making you depressed Exposes you to it incrementally

More customarily used for anxiety Phobias

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Humanistic = person-centered therapy

Focus on the patient’s conscious perceptions and beliefs

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Person-Centered Therapy

Central assumption: The person is a client, not a patient, with

potential for self-actualization Client’s self-perceptions are accurate Conversation is fruitful

Therapy Active Listening = echoing, restating, seeking

clarification.

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Person-Centered Example

You are depressed. The therapist listens what you have to

say: Conversation without judgment, interpretation,

or direction. Therapist looks for an opportunity for the

client’s growth

Most group therapy is person-centered AA is person-centered

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Psychoanalytic therapy

Repressed thoughts as important as expressed thoughts

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Psychoanalysis

Central assumption: Possible and desirable to discovering what

hidden feelings/memories underlie the problem There is tension between the ID and SUPEREGO

that therapy can resolve

Therapy Free association

Say whatever comes to mind Dream interpretation

A window to the subconscious

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Psychoanalysis Example

You are depressed. The therapist asks you to:

Freely associate about e.g. your family

Would not ask about a specific event because you (by assumption) don’t know what you are depressed about

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Does therapy work?Client’s Perceptions

89% of therapy consumers were at least “fairly well satisfied” with the results (Consumer Reports)

9 of 10 who recalled feeling “fair” or “very poor” at beginning reported feeling “very good” “good” or at least “so-so” at end.

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Skepticism about therapy

Placebo effect Regression to the mean

People often enter therapy in crisis. Clients may need to believe that therapy

was worth it. Clients generally like their therapists.

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Clinician’s Perceptions

Resounding “yes” case studies, feedback from clients, etc.

However, they know of “failures” by other clinicians.

Not particularly reliable.

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Outcome Research

Controlled research has looked at how well therapy works

People who are NOT in therapy get better People in therapy get more better

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Commonalities

Hope for demoralized people

A new perspective

An empathic, trusting, caring relationship

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Psychological testing

MMPI-2Projective testsBehavioral monitoringNeuroimaging

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MMPI-2

Minnesota Multiphasic Personality Inventory

567 true / false questions Scored on 27 different scales

Clinical Content Validity: lying and faking

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MMPI examples

Q: The world seems hopeless to me A: True

Score a point to the scale for Depression

Q: I never get angry A: True

Score a point to the scale for Lying

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Other

Projective tests Rorschach inkblots Thematic apperception (TAT)

Behavioral monitoring Ward staff counts positive and negative

interactions with other patients and staff

Self-monitoring

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Bio-medical treatment == Drugs

Used to treat Neurosis AND Psychosis Drugs

Anti-psychotic Anti-anxiety Anti-depressant

Other Electroconvulsive Therapy Psychosurgery

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Anti-psychotic drugs

Their effects: Dampen responsiveness to irrelevant stimuli Help decrease the positive symptoms of

schizophrenia (e.g., hallucinations, paranoia)

These work by: blocking dopamine receptors

Examples: Thorazine, Clozaril

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± Anti-psychotics drugs

+ Reduce positive symptoms Fewer hallucinations and delusions Able to live at home

- Fail to touch negative symptoms Patients still lack motivation A zest-less life

Yucky side-effects Parkinson’s disease Tardive dyskinesia

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Anti-anxiety drugs

Tranquilizers: Reduce tension and anxiety

These work by Depressing central nervous system activity (by

augmenting the action of the neurotransmitter GABA)

Examples: Valium, Librium

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± Anti- tranquilizers

Habit forming! Serious addiction problems

Interact with alcohol to make a lethal tonic

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Anti-Depressant Drugs

Their effects: Help to elevate arousal and mood

These work by Increasing the availability of serotonin and

norepinephrine

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Tricyclic anti-depressants

Examples: Tofranil, Elavil

Block the reuptake of serotonin and norepinephrine into the presynaptic neuron

Prolong the effects of the neurotransmitters

Side-effects Dry mouth, fatigue

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SSRI anti-depressants

Selective serotonin reuptake inhibitors Example: Prozac

Alter personality, mood becomes more elevated

Few side-effects but not as effective as tricyclics for severe depression

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Electroconvulsive Therapy (ECT)

Its effects: Decreases disabling depression

Used only: in rare cases for severe depression in patients not responding to drug treatments

It works by: Sending a brief electric current through the

brain of the anesthetized patient

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ECT Continued

How does it work? We don’t know for sure; Maybe it releases neurotransmitters, Maybe causes seizures that calm neural

centers Are there any problems?

Causes memory loss for the duration of the treatment

Otherwise, there appears to be no resulting brain trauma