Chapter 16

TREATMENT OF PSYCHOLOGICAL

DISORDERS

Analyze This and Analyze That - misconceptionsTypes of therapies

Insight therapies “talk therapy”

Behavior therapies Changing overt behavior

Biomedical therapies Biological functioning interventions

TYPES OF TREATMENT

15% of U.S population in a given yearMost common presenting problems

Anxiety and Depression Treatment seeking for various disorders – Figure 15.1

Mood disorders Utilization rates – Figure 15.2Women more than menMedical insuranceEducation levelPsychological Disorders and professional treatment – Figure

15.3

WHO SEEKS TREATMENT?

Figure 15-1 – Treatment seeking for various disorders

Figure 15-2 – Therapy utilization rates – Olfson et al. (2002)

XX 15.3

Clinical psychologistsCounseling psychologistsPsychiatristsClinical social workersPsychiatric nursesCounselorsOn-line treatment?

WHO PROVIDES TREATMENT?

INSIGHT THERAPIES: PSYCHOANALYSIS

Sigmund Freud and followers Goal: discover unresolved unconscious conflicts - Figure 15.4

Free association Dream analysis Interpretation

Resistance and transferencePsychodynamic Therapies

INSIGHT THERAPIES: CLIENT CENTERED THERAPY

Carl Rogers Cause: Figure 15.5 Goal: restructure self-concept to better correspond to reality Therapeutic Climate

Genuineness Unconditional positive regard Empathy

THERAPIES INSPIREDBY POSITIVE PSYCHOLOGY

Martin SeligmanUses 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 – F 15.6

Figure 15.6 Positive psychotherapy for depression

OTHER ISSUES

Groups therapy Group size Advantages – social dimension of change

Effectiveness of Insight therapies – Figure 15.7 Spontaneous remission

Talk therapies or other approaches? Common factors contribute to progress in those treated

Figure 15.7 – Recovery as a function of number of therapy sessions

BEHAVIOR THERAPIES

B.F. Skinner and colleagues Goal: unlearning maladaptive behavior and learning adaptive

ones Systematic Desensitization – Joseph Wolpe

Classical conditioning – Figure 15.8 Anxiety/Fear hierarchy – Figure 15.9

Aversion therapy – Figure 15.10 Alcoholism, sexual deviance, smoking, etc.

Social skills training Modeling Behavioral rehearsal

Biofeedback Operant conditioning flooding Classical conditioning

XXX 15.8

XXX 15.10

COGNITIVE-BEHAVIORAL THERAPY

Aaron Beck Cognitive therapy Depression and negative thinking – Figure 15.11

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

XXX 15.11

BIOMEDICAL THERAPIES

Psychopharmacotherapy Antianxiety - Valium, Xanax, Buspar Antipsychotic - Thorazine, Mellaril, Haldol

Tardive dyskinesia Atypical antipsychotic – reduce motor effects and other

neurotransmitters Time course – Figure 15.12

Antidepressant: - Actions - Figure 15.13 Tricyclics – Elavil, Tofranil Mao inhibitors (MAOIs) - Nardil Selective serotonin reuptake inhibitors (SSRIs) – Prozac, Paxil, Zoloft –

side effects – Table 15.1 Risk of suicide – Figure 15.14

Mood stabilizers Lithium, Valproic acid

Electroconvulsive therapy (ECT) Transcranial Magnetic Stimulation Deep brain stimulation

Figure 15.13 Antidepressant drugs’ mechanisms of action

Figure 15.15 Deep brain stimulation

CURRENT TRENDS AND ISSUES IN TREATMENT

Managed careEmpirically validated treatmentsBlending Approaches to treatment – Figure 15.17

Conjunctive therapy – Figure 15.16Multicultural sensitivityDeinstitutionalization

Dorthea Dix - Figure 15.18 Changes in population – Figure 15.19

Factors – treatments, legal, service delivery model Revolving door problem – Slide 26 Homelessness Increase use of criminal justice system

Figure 15.17 The leading approaches to therapy among psychologists

Figure 15-16 – Relapse rates in Reynolds et al. (1999) study

XX 15.19

Slide 26 – Percentage of psychiatric inpatient admissions that are readmissions

Psychopharmacology

Antipsychotics (thorazine, haldol)

Anti-anxiety (valium, barbiturates, Xanax)

Mood Disorders (serotonin reuptake inhibitors)

Bipolar (lithium)

SOMATIC THERAPIES

•Electroconvulsive Therapy (ECT)- for depression

•Psychosurgury - Prefontal lobotomy

SOMATIC THERAPY

LOOKING FOR AT THERAPIST

Factors to consider Sources of services – Table 15.2 Profession Gender Theoretical approach

Comparison of approaches for effectiveness - Figure 15.20

Table 15-2, p. 626

Figure 15.20 Estimates of the effectiveness of various approaches to psychotherapy.