chapter 15 treatment of psychological disorders. table of contents types of treatment types of...
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Chapter 15
Treatment of Psychological Disorders
Table of Contents
Types of Treatment
Types of therapies– Insight therapies
• “talk therapy”
– Behavior therapies• Changing overt behavior
– Biomedical therapies• Biological functioning interventions
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Who Seeks Treatment?
15% of U.S population in a given year Most common presenting problems
– Anxiety and Depression– Treatment seeking for various disorders – (slide)
• Mood disorders
Utilization rates – (slide) Women more than men Medical insurance Education level Psychological Disorders and professional treatment –
Figure (slide)
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Treatment seeking for various disorders
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Therapy utilization rates – Olfson et al. (2002)
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Who Provides Treatment?
Clinical psychologists Counseling psychologists Psychiatrists Clinical social workers Psychiatric nurses Counselors On-line treatment?
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Therapists and their Training
Clinical psychologists Most are psychologists with a Ph.D. and expertise in
research, assessment, and therapy, supplemented by a supervised internship
About half work in agencies and institutions, half in private practice
Clinical or Psychiatric Social Worker A two-year Master of Social Work graduate program
plus postgraduate supervision prepares some social workers to offer psychotherapy, mostly to people with everyday personal and family problems
About half have earned the National Association of Social Workers’ designation of clinical social worker
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Counselors Marriage and family counselors specialize in
problems arising from family relations Pastoral counselors provide counseling to countless
people Abuse counselors work with substance abusers and
with spouse and child abusers and their victims
Psychiatrists Physicians who specialize in the treatment of
psychological disorders Not all psychiatrists have had extensive training in
psychotherapy, but as M.D.s they can prescribe medications. Thus, they tend to see those with the most serious problems
Many have a private practice
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Insight Therapies: Psychoanalysis
Sigmund Freud and followers– Goal: discover unresolved unconscious conflicts
• Free association: clients spontaneously express their thoughts and feelings exactly as they occur, with as little censorship as possible. The analyst looks for clues about what is going on in the unconscious.
• Dream analysis: “royal road to the unconscious."
• Interpretation– Resistance and transference
Psychodynamic Therapies
Freud’s view of the roots of disorders
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Insight Therapies: Client Centered Therapy
Carl Rogers– Goal: restructure self-concept to better correspond to reality– Therapeutic Climate
• Genuineness
• Unconditional positive regard
• Empathy
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Therapies Inspiredby Positive Psychology
Martin Seligman Uses theory and research to better understand the
positive, adaptive, creative, and fulfilling aspects of human existence– well-being therapy– positive psychotherapy
• can be an effective treatment for depression
Table of ContentsPositive psychotherapy for depression
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Other issues
Groups therapy– Group size– Advantages – social dimension of change
Effectiveness of Insight therapies (Slide)– Spontaneous remission
Talk therapies or other approaches?– Common factors contribute to progress in those treated
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Recovery as a function of number of therapy sessions
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Behavior Therapies
B.F. Skinner and colleagues– Goal: unlearning maladaptive behavior and
learning adaptive ones– Systematic Desensitization – Joseph Wolpe
• Classical conditioning (slide)• Anxiety/Fear hierarchy
– Aversion therapy – (slide)• Alcoholism, sexual deviance, smoking, etc.
– Social skills training• Modeling • Behavioral rehearsal
– Biofeedback
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Cognitive-Behavioral Therapy
Aaron Beck– Cognitive therapy – Depression and negative thinking – (Slide)
Albert Ellis– Rational-emotive therapy
Goal: to change the way clients think– Detect and recognize negative thoughts– Reality testing
Effectiveness of Behavior Therapies– Efficacy of behavioral interventions for a variety of
disorders
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Biomedical Therapies Psychopharmacotherapy
– Antianxiety - Valium, Xanax, Buspar– Antipsychotic - Thorazine, Mellaril, Haldol
• Tardive dyskinesia• Atypical antipsychotic – reduce motor effects and other
neurotransmitters• Time course
– Antidepressant: - Actions• Tricyclics – Elavil, Tofranil• Mao inhibitors (MAOIs) - Nardil• Selective serotonin reuptake inhibitors (SSRIs) – Prozac, Paxil,
Zoloft – side effects – • Risk of suicide –
– Mood stabilizers• Lithium, Valproic acid
Electroconvulsive therapy (ECT) – Transcranial Magnetic Stimulation Deep brain stimulation –
Table of ContentsFigure 15.13 Antidepressant drugs’ mechanisms of action
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Electroconvulsive Therapy
Table of ContentsFigure 15.15 Deep brain stimulation
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Current Trends and Issues in Treatment
Managed care Empirically validated treatments Blending Approaches to treatment –
– Conjunctive therapy –
Multicultural sensitivity Deinstitutionalization
– Dorthea Dix -– Changes in population –
• Factors – treatments, legal, service delivery model
– Revolving door problem– Homelessness– Increase use of criminal justice system
Table of ContentsThe leading approaches to therapy among psychologists
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Relapse rates in Reynolds et al. (1999) study
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Percentage of psychiatric inpatient admissions that are readmissions
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Looking for at therapist
Factors to consider– Sources of services – (slide)– Profession– Gender– Theoretical approach
Comparison of approaches for effectiveness – (slide)
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Table 15-2, p. 626
Table of ContentsEstimates of the effectiveness of various approaches to psychotherapy.