treating psychological disorders. reducing disorder by confronting it: psychotherapy reducing...

Treating Psychological Disorders


• Reducing Disorder by Confronting It: Psychotherapy• Reducing Disorder Biologically: Drug and Brain Therapy• Reducing Disorder by Changing the Social Situation• Evaluating Treatment and Prevention: What Works?


•involves providing help to individuals or families through psychological therapy•includes psychoanalysis, humanistic-oriented therapy and cognitive-behavioral therapy (CBT)

psychological approach

•based on the use of medications to treat mental disorders•includes brain intervention techniques, such as electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and psychosurgery

biomedical approach

•focuses on changing the social environment•includes group, couples, and family therapy, and community outreach programs

social approach

Reducing Disorder by Confronting ItPsychotherapy

Reducing Disorder by Confronting It: Psychotherapy

• Learning Objectives1. Outline and differentiate the psychodynamic, humanistic, behavioral, and

cognitive approaches to psychotherapy.2. Explain the behavioral and cognitive aspects of cognitive-behavioral therapy

and how CBT is used to reduce psychological disorders.


psychological assessment• evaluation of

psychological and mental health

medical assessment• provides information

about Axis III (physical) problems

diagnosis• based on DSM

selection of course of treatment


• psychotherapy– the professional treatment for psychological disorder through techniques

designed to encourage communication of conflicts and insight

Psychodynamic Therapy

• psychodynamic therapy (psychoanalysis) – a psychological treatment based on Freudian/neo-Freudian personality theories

in which the therapist helps the patient explore the unconscious dynamics of personality

– goal is to help the patient develop insight, an understanding of the unconscious causes of the disorder

– traditional psychoanalytic treatment is lengthy and expensive.• Modern psychodynamic approaches frequently use shorter-term, more goal-

oriented approaches.

Psychodynamic Therapy

Humanistic Therapies

• humanistic therapy– a psychological treatment based on the personality theories of Carl Rogers and

other humanistic psychologists• emphasizes client’s capacity for self-realization and fulfillment• tries to promote growth and responsibility

Humanistic Therapies

• Rogers argued that therapy is most productive when the therapist creates a positive therapeutic alliance with the client.

therapeutic alliance

genuine• no barriers to

thoughts and feelings

unconditional positive regard• accepting

empathy• active listening• accurate

perceptions

Cognitive-Behavior Therapies

• cognitive-behavior therapy (CBT)– a structured approach to treatment that attempts to reduce psychological

disorders through systematic procedures based on cognitive and behavioral principles

• used for the treatment of a wide variety of problems• treats current cognitions and behaviors, but does not attempt to address underlying

issues• problem-solving and action-oriented• most appropriate for clients with specific goals

Cognitive-Behavior Therapies

• Cognitive-behavior therapy is based on the idea that our thoughts, feelings, and behavior reinforce each other and that changing our thoughts or behavior can make us feel better.

Behavioral Aspects of CBT

• behavioral therapy • psychological treatment based on

principles of learning •based on extinction•client is confronted with a feared stimulus to decrease negative emotional responses

exposure therapy

•client is exposed to the source of his fear all at once

flooding

•combines imagining or experiencing a feared with relaxation exercises

systematic desensitization

•positive punishment is used to reduce the frequency of an undesirable behavior

aversion therapy

Cognitive Aspects of CBT

• cognitive therapy– helps clients identify incorrect or distorted beliefs that are contributing to

disorder– goal is to help clients develop healthier, more accurate ways of thinking

• Beck and Ellis provided the foundations of cognitive therapy.– Beck developed a short-term treatment for depression aimed at modifying

negative thoughts.– Ellis’ rational-emotive therapy focuses on identifying flaws in clients’ thinking.

Combination (Eclectic) Approaches to Therapy

• eclectic therapy– an approach to treatment in which the therapist uses whichever techniques

seem most useful and relevant for a given patient• Example: Treatment for major depressive disorder usually combines

antidepressant drugs with cognitive-behavioral therapy.• dialectical behavioral therapy (DBT)

– a cognitive therapy with an additional emphasis on enlisting the help of the patient in his or her own treatment

– useful in the treatment of borderline personality disorder


• Key Takeaways– Psychoanalysis is based on the principles of Freudian and neo-Freudian

personality theories. The goal is to explore the unconscious dynamics of personality.

– Humanist therapy, derived from the personality theory of Carl Rogers, is based on the idea that people experience psychological problems when they are burdened by limits and expectations placed on them by themselves and others. Its focus is on helping people reach their life goals.


• Key Takeaways, continued– Behavior therapy applies the principles of classical and operant conditioning, as

well as observational learning, to the elimination of maladaptive behaviors and their replacement with more adaptive responses.

– Albert Ellis and Aaron Beck developed cognitive-based therapies to help clients stop negative thoughts and replace them with more objective thoughts.

– Eclectic therapy is the most common approach to treatment. In eclectic therapy, the therapist uses whatever treatment approaches seem most likely to be effective for the client.

Reducing Disorder BiologicallyDrug and Brain Therapy

Reducing Disorder Biologically

• Learning Objectives:1. Classify the different types of drugs used in the treatment of mental disorders

and explain how they each work to reduce disorder.2. Critically evaluate direct brain intervention methods that may be used by

doctors to treat patients who do not respond to drug or other therapy.


• biomedical therapies– treatments designed to reduce psychological disorder by influencing the action

of the central nervous system• mainly involve the use of medications• also include direct methods of brain intervention, such as electroconvulsive therapy

(ECT), transcranial magnetic stimulation (TMS), and psychosurgery

Drug Therapies

Direct Brain Intervention Therapies

• electroconvulsive therapy (ECT)– a medical procedure to alleviate psychological disorder in which electric currents

are passed through the brain, deliberately triggering a brief seizure • used only when all other treatments have failed• 80% of people report dramatic relief from their depression• reduces suicidal thoughts• but relief may be short-lived, and short-term memory loss or cognitive impairment

may occur

• Transcranial magnetic stimulation (TMS) is a new, noninvasive procedure that uses a pulsing magnetic coil to electrically stimulate the brain.

• TMS has been used in the treatment of depression, schizophreniaand Parkinson’s disease.

Direct Brain Intervention Therapies

• surgery that removes or destroys brain tissue in the hope of improving disorder

• most well-known type is the prefrontal lobotomy– left many patients worse off– hardly used today

• a contemporary, limited form of psychosurgery

psychosurgery cingulotomy


• Key Takeaways– Psychostimulants are commonly prescribed to reduce the symptoms of ADHD.– Antipsychotic drugs play a crucial role in the treatment of schizophrenia. They do

not cure schizophrenia, but they help reduce the positive, negative, and cognitive symptoms, making it easier to live with the disease.

– Antidepressant drugs are used in the treatment of depression, anxiety, phobias, and obsessive-compulsive disorder. They gradually elevate mood by working to balance neurotransmitters in the CNS. The most commonly prescribed antidepressants are the SSRIs.


• Key Takeaways, continued– Antianxiety drugs (tranquilizers) relieve apprehension, tension, and nervousness

and are prescribed for people with diagnoses of generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and panic disorder. The drugs are effective but have severe side effects including dependence and withdrawal symptoms.


• Key Takeaways, continued– Electroconvulsive therapy (ECT) is a controversial procedure used to treat severe

depression, in which electric currents are passed through the brain, deliberately triggering a brief seizure.

– A newer method of brain stimulation is transcranial magnetic stimulation (TMS), a noninvasive procedure that employs a pulsing magnetic coil to electrically stimulate the brain.

Reducing Disorder by Changing the Social Situation


• Learning Objectives:1. Explain the advantages of group therapy and self-help groups for treating

disorder.2. Evaluate the procedures and goals of community mental health prevention

services.

Group, Couples, and Family Therapy

group therapy

• at least as effective as individual therapy• particularly effective for people with life-altering illness

couples therapy

• is sometimes mainly educational• may focus on such topics as sexual enjoyment, communication, or the symptoms of one of the partners

family therapy

• assumes that the problem, even if it is primarily affecting one person, reflects the interaction among family members

Self-Help Groups

• self-help group– a voluntary association of people who share a common desire to overcome

psychological disorder or improve their well-being• goals are similar to those of group therapy, but self-help groups are open to a

broader spectrum of people• benefits include social support, education, and observational learning• religion and spirituality are often emphasized; self-blame is discouraged

Community Mental Health: Service and Prevention

• community mental health services– psychological treatments and interventions that are distributed at the

community level• provided by nurses, psychologists, social workers, and other professionals in sites

such as schools, hospitals, police stations, drug treatment clinics, and residential homes

• goal is to help people get needed mental health services• primary goal is prevention

• Community prevention can be focused on one more of three levels: primary, secondary, and tertiary.

primary

• focuses on all members of the community

secondary

• focuses on people displaying risk factors

tertiary

focuses on people already diagnosed with disorder

Some Risk Factors for Psychological Disorders

• Academic difficulties• ADHD• Child abuse and neglect• Developmental disorders• Drug and alcohol abuse• Dysfunctional family • Early pregnancy• Emotional immaturity• Homelessness• Learning disorder• Low birth weight• Parental mental illness• Poor nutrition• Poverty


• Key Takeaways– Group therapy is psychotherapy in which clients receive psychological treatment

together with others. A professionally trained therapist guides the group. Types of group therapy include couples therapy and family therapy.

– Self-help groups have been used to help individuals cope with many types of disorder.

– The goal of community health service programs is to act during childhood or early adolescence with the hope that interventions might prevent disorder from appearing or keep existing disorders from expanding. The prevention provided can be primary, secondary, or tertiary.

Evaluating Treatment and PreventionWhat Works?

Evaluating Treatment and Prevention

• Learning Objectives:1. Summarize the ways that scientists evaluate the effectiveness of psychological,

behavioral, and community service approaches to preventing and reducing disorder.

2. Summarize which types of therapy are most effective for which disorders.


• Outcome research– Assesses the effectiveness of

medical treatments• independent variable -- the

type of treatment• dependent measure --

assessment of the benefit received by the client

Threats to the validity of outcome research • natural improvement –improvement might occur even without treatment• nonspecific treatment effects – improvement occurs simply by attending therapy• placebo effects –improvement may occur just because one expects it to occur

Meta-Analyzing Clinical Outcomes

• meta-analysis– a statistical technique that uses the results of existing studies to integrate and

draw conclusions about those studies • effect size

– measure of the effectiveness of treatment• empirically supported therapies

– therapies that research has shown to be effective; these include:• cognitive therapy and behavioral therapy for depression• cognitive therapy, exposure therapy, and stress inoculation training for

anxiety• CBT for bulimia• behavior modification for bed-wetting

Effectiveness of Psychological Therapy

• Research supports the benefits of psychotherapy.• However, the specific type of therapy doesn’t seem to matter that much.• Good therapies share several general features:

– They give people hope.– They help them think more carefully about themselves and about their

relationships with others.– They provide a therapeutic alliance.

Effectiveness of Biomedical Therapies

Meta-analyses support the effectiveness of biomedical

therapies.

But drug therapies don’t treat underlying causes.Drugs have negative side

effects.Caution must be used with pregnant women and the

elderly.

Effectiveness of Social-Community Approaches

• Community-based services seem to be effective, but the benefits are modest.• Still, many psychologists continue to promote policies that support community

prevention.


• Key Takeaways– Outcome research is designed to differentiate the effects of a treatment from

natural improvement, nonspecific treatment effects, and placebo effects.– Meta-analysis is used to integrate and draw conclusions about studies.– Research shows that getting psychological therapy is better at reducing disorder

than not getting it, but much of the effect is due to nonspecific effects. All good therapies give people hope and help them think more carefully about themselves and about their relationships with others.


• Key Takeaways, continued– Biomedical treatments are effective, at least in the short term, but overall they

are less effective than psychotherapy.– One problem with drug therapies is that although they provide temporary relief,

they do not treat the underlying cause of the disorder.– Federally funded community mental health prevention programs are effective,

but their effects may in many cases be minor.

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