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Treatment of Disorders
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History of Treatment
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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
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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
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• 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
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Psychoanalysis• Aim of treatment is to
make client aware of their unconscious & resolve unconscious childhood conflicts
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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
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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
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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
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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
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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
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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
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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
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Behavior Therapy Systematic Desensitization
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Behavior Therapy
Aversion therapy for alcoholics
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Behavior Therapies – OperantBehavior Modification – reinforcement & punishment
Token Economy
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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”
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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
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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)
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Group & Family Therapies
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Evaluating Psychotherapies
To whom do people turn for help for psychological difficulties?
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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)
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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
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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
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Evaluating Psychotherapies
Poor outcome Good outcome
Averageuntreated
person
Averagepsychotherapy
client
Number ofpersons
80% of untreated people have pooreroutcomes than average treated person
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Biomedical Therapies
• Psychopharmacology = study of drug effects on mind and behavior
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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
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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)
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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)
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Lithium
• Mood stabilizer used to treat bipolar disorder
• Lowers risk of suicide
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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
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Psychosurgery• Removes or destroys brain tissue to
change behavior• Lobotomy • ONLY USED IN
EXTREME CASES
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