psychological science, 3rd edition michael gazzaniga todd heatherton diane halpern

Psychological Science, 3rd EditionMichael Gazzaniga

Todd Heatherton Diane Halpern

Treating Disorders of the Mind and Body

15

Questions to Consider:

How Are Mental Disorders Treated?

What Are the Most Effective Treatments?

Can Personality Disorders Be Treated?

How Should Childhood and Adolescent Disorders Be Treated?

How Are Mental Disorders Treated?

Psychotherapy Is Based on Psychological Principles

Culture Can Affect the Therapeutic Process

Medication Is Effective for Certain Disorders

Alternative Biological Treatments Are Used in Extreme Cases

Pseudotherapies Can Be Dangerous

Learning Objectives

Recognize different styles of psychotherapy.

Describe the uses, mechanisms, and side effects of common psychotropic medications.


With over 400 psychological therapies available, the precise techniques used by individual therapists may vary widely

One factor known to affect the outcome of therapy is: The relationship between the therapist and the

client


Psychodynamic therapy focuses on insight:

Along with Josef Breuer, Sigmund Freud pioneered the method of psychoanalysis

Treatment involved uncovering unconscious feelings and drives that, Freud believed, gave rise to maladaptive thoughts and behaviors

Techniques included free association and dream analysis


The general goal of psychoanalysis is to increase clients’ awareness (insight) of these unconscious processes and how they affect daily functioning

Over the past few decades, psychodynamic therapy has become controversial due to:

Its expense, the length of time required for treatment, and the lack of evidence of effectiveness for most disorders


Humanistic therapies focus on the whole person:

Emphasizes personal experience, belief systems and the phenomenology of individuals

The goal of humanistic therapy is to treat the person as a whole


Key ingredients of client-centered therapy include:

Creating a safe and comforting setting, empathy, reflective listening, and unconditional positive regard

Many techniques advocated by Rogers are used currently to establish a good therapeutic relationship between practitioner and client


Cognitive-behavioral therapy targets thoughts and behaviors:

Many of the most successful therapies involve trying to change people’s behavior and cognition directly

Beck pioneered cognitive restructuring

Ellis promoted rational-emotive therapy


Examples of these treatments include: behavior modification, modeling, social skills training, cognitive therapy and cognitive behavior therapy (CBT)

Interpersonal therapy integrates insight therapy with cognitive therapy

CBT is one of the most effective treatments available for anxiety and mood disorders

Exposure is an effective treatment for phobias and relies on classical conditioning processes

Cognitive Restructuring

Cognitive restructuring involves replacing maladaptive thought patterns with more realistic, positive ones.


Group therapy builds social support:

Group and family therapy have become more widespread

Group therapy is less expensive than individual therapy

Offers the opportunity for practice of social skills and peer learning


Family therapy focuses on the family context:

Family therapy reflects an understanding of systems approaches—an individual is part of larger groups that can maintain or exacerbate behavior

Negative expressed emotion within families, for example, has been linked to higher relapse rates among those diagnosed with schizophrenia


Confession is good for the spirit:

Irrespective of type of therapy, evidence suggests that simply talking about (or writing about) one’s problems can have a positive effect


Culture impacts the way mental disorders are expressed, which people are likely to recover, and people’s willingness to seek help

Stigmas exacerbate the problem because people will often suffer in silence, failing to get the psychotherapy that can help them

Stigma varies from culture to culture


Culture also plays a critical role in:

Determining the availability, use, and effectiveness of different types of psychotherapy

Psychotherapy and definitions of mental health are based on the dominant cultural paradigm


Drugs that affect mental processes are called psychotropic medications

The success of medication in the treatment of mental disorders is largely responsible for the era of deinstitutionalization

Scores of patients were discharged from mental hospitals and treated with drugs as outpatients


Most psychotropic medications fall into three categories:

Anti-anxiety drugs

Antidepressants

Antipsychotics


Anti-anxiety drugs Reduce anxiety and promote relaxation, but they

also induce drowsiness and are highly addictive They should be used sparingly

Antidepressants:

There are several classes including MAO inhibitors, tricyclic antidepressants, and the SSRIs

Selective Serotonin Reuptake Inhibitors

SSRIs, such as Prozac, work by blocking reuptake into the presynaptic neuron, thereby allowing

serotonin to remain in the synapse, where its effects on postsynaptic receptors are prolonged.


Antipsychotics (neuroleptics) Block the effects of dopamine Antipsychotics are not always effective They have significant side effects that can be

irreversible Tardive dyskinesia

These drugs are not useful for treating the negative symptoms of schizophrenia Such as apathy and social withdrawal


Alternative biological methods often are used as last resorts because they are more likely to have serious side effects than will either psychotherapy or medication


Lobotomies: One of the earliest formal procedures used on

patients with severe mental illness was psychosurgery Areas of the frontal cortex were selectively damaged

These prefrontal lobotomies were used to treat severe mental disorders, including: Schizophrenia, major depression, and anxiety

disorders


Patients who received lobotomies were often listless and had flat affect

The procedure often impaired many important mental functions, such as abstract thought, planning, motivation, and social interaction

With the development of effective pharmacological treatments in the 1950s, the use of lobotomy was discontinued


Electroconvulsive therapy (ECT): Common in the 1950s and 1960s to treat mental

disorders including schizophrenia and depression

ECT now generally occurs under anesthesia with powerful muscle relaxants

ECT is particularly effective for some cases of severe depression, although there are some risks to its use


Transcranial magnetic stimulation and deep brain stimulation are newer techniques that may be promising

Especially in relation to depression and OCD

In TMS, current flows through a wire coil placed over the scalp area to be stimulated.

Deep Brain Stimulation


Some treatments widely believed to be effective are actually counterproductive:

Including encouraging people to describe their experiences following major trauma

Scaring adolescents into going straight Having police officers run drug education

programs (DARE) Using hypnosis to recover painful memories


It is important to recognize the difference between evidence-based psychotherapies and “alternative” or “fringe” pseudotherapies

The latter can prevent people from getting effective treatment and may even be dangerous


Treatments That Focus on Behavior and on Cognition Are Superior for Anxiety Disorders

Many Effective Treatments Are Available for Depression

Lithium Is Most Effective for Bipolar Disorder Pharmacological Treatments Are Superior for

Schizophrenia There Are Important Considerations in Selecting

a Psychotherapist Critical Thinking Skill: Avoiding the Sunk Costs

Fallacy

Learning Objectives

Identify the therapies most effective for treating specific disorders.


According to Barlow, three features characterize psychological treatments:

They vary according to the client and disorder The techniques used in these treatments have

been developed in the laboratory by psychological scientists

No overall grand theory guides treatment Treatment is based on evidence of its effectiveness

Behavioral and Cognitive Treatments Are Superior for Anxiety Disorders

Cognitive-behavioral therapy (CBT) works best to treat most adult anxiety disorders

Anxiety-reducing drugs are also beneficial in some cases

Although there are risks of side effects and, after drug treatment is terminated, the risk of relapse


Specific phobias:

Systematic desensitization is most effective

Brain imaging data indicate that successful treatment with CBT alters the way the brain processes the fear stimulus


Findings suggest that psychotherapy effectively “rewires” the brain

Both Prozac and CBT are effective in treating social phobia

However, those taking Prozac report more physical complaints, such as a lack of sexual interest


Panic attacks: Imipramine prevents panic attacks

But does not reduce the anticipatory anxiety that occurs when people fear they might have an attack

CBT Helps break the learned association between the

physical symptoms and the feeling of impending doom Cognitive restructuring addresses ways of reacting to

the symptoms of a panic attack


In the short term:

CBT alone and imipramine alone were effective for treating panic disorder, and they did not differ in results

However, six months after treatment had ended:

Those who received psychotherapy were less likely to relapse than those who had taken medication

Behavioral and on Cognitive Treatments Are Superior for Anxiety Disorders

OCD: SSRIs and CBT are effective treatments

Researchers imaged the brains of patients with OCD who were being treated either with Prozac or with CBT Patients in both treatment groups showed the same

changes in neural activity CBT may be a more effective way of treating OCD

than medication, especially over the long term

Treatments for OCD can include the drug clomipramine, exposure, and ritual prevention, with varying rates of success.

ZAPS: The Norton Psychology Labs

ObsessiveCompulsive Disorder


Deep brain stimulation may be an effective treatment for those with OCD who have not found relief from CBT or medications

DBS leads to a clinically significant reduction of symptoms and increased daily functioning in about two-thirds of those receiving treatment


Pharmacological treatment:

Early antidepressant medication – MAO inhibitors and tricyclics: Fairly effective in reducing depression but had serious

side effects

Prozac, an SSRI, was developed in the 1980s and lacks the serious side effects of earlier antidepressant drugs


Approximately 60 to 70 percent of patients who take antidepressants experience relief from their symptoms

Some evidence suggests that tricyclics might be beneficial for the most serious forms of depression But SSRIs are generally considered first-line

medications because they have the fewest serious side effects


Cognitive-behavioral treatment of depression:

Just as effective as biological therapies in treating depression

The goal of CBT is to help the client think more adaptively

Although CBT can be effective on its own, combining it with antidepressant medication is significantly more effective than either one of these approaches alone


As with other mental disorders, treatment of depression with psychotherapy leads to changes in brain activation similar to those observed for drug treatments

In slightly different areas of the brain


Alternative treatments: Phototherapy is the treatment of choice for those

experiencing SAD Regular aerobic exercise can reduce depression

and prevent recurrence

Incidence of SAD varies by latitude.


Electroconvulsive therapy has been effective for some people with major depression

Although ECT frequently results in an amelioration of depressed mood, the mechanism by which this occurs is unknown

ECT does have some serious limitations, including a high relapse rate (often necessitating repeated treatments), and memory impairments


Transcranial magnetic stimulation can reduce depressive symptoms

A series of studies has demonstrated that TMS over the left frontal regions results in a significant reduction in depression

In October 2008, TMS was approved by the U.S. Food and Drug Administration for the treatment of major depression in patients who are not helped by traditional therapies


Deep brain stimulation:

As with OCD, recent case studies indicate that DBS might be valuable for treating severe depression when all other treatments have failed


Gender issues in treating depression: Female-specific stressors:

The way work and family interact to place additional burdens on women

The biological realities of reproduction and of menopause

Men are reluctant to admit to depression and even more reluctant to seek appropriate therapy Efforts are being made to help men stop masking their

depression with alcohol, isolation, and irritability

Lithium Is Most Effective for Bipolar Disorder

Only about 20% of patients maintained on lithium will experience relapses

Lithium seems to modulate neurotransmitter levels Balancing excitatory and inhibitory activities

Although lithium is effective in stabilizing mood, it has unpleasant side effects including thirst, hand tremors, excessive urination, and memory problems

Lithium Is Most Effective for Bipolar Disorder

Because lithium works better on mania than on depression, patients often are treated with both lithium and an antidepressant SSRIs are preferable to other antidepressants

because they are less likely to trigger episodes of mania

CBT can help increase compliance with medication regimens

ZAPS: The Norton Psychology Labs

Bipolar Disorder

Pharmacological Treatments Are Superior for Schizophrenia

Pharmacological treatments:

Early antipsychotic drugs such as haloperidol and chlorpromazine allowed those suffering from psychotic disorders to be released from hospitals

These drugs, however, created major side effects and only addressed the positive symptoms of the patients


Clozapine is different from previous antipsychotic medications in a number of ways:

Acts not only on dopamine receptors but also on those for serotonin, norepinephrine, acetylcholine, and histamine

Beneficial in treating the negative as well as the positive symptoms of schizophrenia

No signs of Parkinson’s symptoms or of tardive dyskinesia appeared in any of the patients taking the drug


Clozapine’s side effects are serious:

Seizures, heart arrhythmias, substantial weight gain, a fatal reduction in white blood cells

More recently, second-generation antipsychotics have been introduced that do not reduce white blood cell counts


Psychosocial treatments:

Medication does not substantially affect patients’ social functioning

Social skills training is an effective way to address some deficits in schizophrenics

Initial studies using CBT indicate that it is more effective than other psychological treatments in reducing symptoms


Prognosis in schizophrenia:

One long-term study followed participants for an average of 32 years: Between half and two-thirds were recovered or had

considerable improvement in functioning on follow-up

The prognosis for schizophrenic patients depends on factors including age of onset, gender, and culture

There Are Important Considerations in Selecting a Psychotherapist

The major types of specialized mental health practitioners include the following:

Clinical psychologists Psychiatrists Counseling psychologists Psychiatric social workers Psychiatric nurses Paraprofessionals

There Are Important Considerations in Selecting a Psychotherapist

The right therapist must have the appropriate training and experience for the specific mental disorder, and the person seeking help must believe the therapist is trustworthy and caring

Critical Thinking Skill

Avoiding the sunk cost fallacy

People often stick with something because they have already invested so much in it, even if it’s not working

The investment is gone, you cannot get it back Instead, you should focus on deciding what is the

best option for the future

Can Personality Disorders Be Treated?

Dialectical Behavior Therapy Is Most Successful for Borderline Personality Disorder

Antisocial Personality Disorder Is Difficult to Treat

Learning Objectives

Explain why personality disorders are difficult to treat.

Dialectical Behavior Therapy and Borderline Personality Disorder

The most successful treatment approach to date for borderline personality disorder was developed by Marsha Linehan in the 1980s

Dialectical behavior therapy (DBT) combines elements of the behavioral, cognitive, and psychodynamic approaches


Therapy proceeds in three stages: In the first stage, the therapist targets the patient’s

most extreme and dysfunctional behaviors Replacing these behaviors with more appropriate ones

In the second stage, the therapist helps the patient explore past traumatic experiences that may be at the root of emotional problems

In the third stage, the therapist helps the patient develop self-respect and independent problem-solving skills


Those undergoing DBT are more likely to remain in treatment and less likely to be suicidal than are patients in other types of therapy

SSRIs are often prescribed along with DBT to treat feelings of depression


Therapeutic approaches for antisocial personality disorder

Stimulants prescribed to normalize arousal levels

Evidence indicates that these drugs are beneficial in the short term but not the long term


Anti-anxiety drugs may lower hostility levels somewhat, and lithium has shown promise in treating the aggressive, impulsive behavior of violent criminals who are psychopathic

Overall, however, psychotropic medications have not been effective in treating this disorder


Behavioral approaches

Seems to work best when the therapist controls reinforcement, the client cannot leave treatment, and the client is part of a group

Cognitive approaches have also been tried for antisocial personality disorder with some promising results


The prognosis for antisocial personality disorder: The prognosis that patients will change their

behaviors as a result of therapy is poor Fortunately for society, antisocial individuals

without psychopathy typically improve after age 40 But many continue to commit crimes and exhibit the

callousness and manipulativeness characteristic of this disorder

For this longitudinal study, the percentage of participants in prison during each five-year period is shown.

How Should Childhood and Adolescent Disorders Be Treated?

The Use of Medication to Treat Adolescent Depression Is Controversial

Children with ADHD Can Benefit from Various Approaches

Critical Thinking Skill: Evaluating Alternatives in Decision Making

Autistic Children Benefit from a Structured Treatment Approach

Learning Objectives

Explain key arguments in the debate about prescribing medication to children with depression and ADHD.

Understand that sometimes behavioral treatments are best for biological disorders such as autism.


Fewer than 30 percent of children who have mental health problems receive any type of treatment

Twice as many of those taking SSRIs reported having suicidal thoughts (4 percent) as those taking a placebo (2 percent) None of the children or adolescents committed

suicide


The FDA voted in 2004 to require manufacturers to add to their product labels a warning that antidepressants increase the risk of suicidal thinking and behavior in depressed children and adolescents


The Treatment of Adolescents with Depression Study provides clear evidence that the SSRI Prozac is effective in treating adolescent depression

Although the combined group had the best outcomes (86% improvement), improvement with CBT alone (81%) was similar to that with Prozac alone (81%)


All treatment groups experienced a reduction in thoughts of suicide compared with the baseline

Participants in the Prozac group were twice as likely to have serious suicidal thoughts or intentions compared with those undergoing other treatments Although prescribing drugs without CBT might be cost

effective, it may not be in the best interests of depressed children


Pharmacological treatment of ADHD The most common treatment is a central-nervous-

system stimulant, Ritalin

Children on Ritalin experience an increase in positive behaviors and a decrease in negative behaviors

Side effects include sleep problems, reduced appetite, body twitches, and temporary growth suppression


Evidence indicates that although stimulants are beneficial in the short term, their benefits may not be maintained over the long term

In addition, there is a very real risk of abuse

Numerous cases of children and adolescents buying and selling these stimulants


Behavioral treatment of ADHD:

Aims to reinforce positive behaviors and ignore or punish problem behaviors

Medication plus behavioral therapy is more effective than either approach alone. Medications may be important in the short term;

psychological treatments may produce superior outcomes that last

Critical Thinking Skill

Evaluating alternatives in decision making:

The first step to good decision making is to frame the question that needs deciding

Then evaluate each alternative along many dimensions

Putting the process on paper allows you to consider multiple alternatives without being limited by working memory


Behavioral treatment for autism:

Applied behavioral analysis (ABA)

Developed by Ivar Lovaas and his colleagues One of the best-known and perhaps most effective

treatments for autistic children Based on principles of operant conditioning This very intensive approach requires a minimum of

40 hours of treatment per week


Although the ABA program has been demonstrated to be effective, it has some drawbacks:

Time commitment Financial and emotional drains on the family Other children may feel neglected or jealous because

of the amount of time and energy expended on the disabled child


Biological treatment for autism:

SSRIs have been tried as a treatment for autism because:

SSRIs such as Prozac reduce compulsions in patients diagnosed with obsessive-compulsive disorder

Autism involves compulsive and repetitive behavior Some evidence indicates abnormal serotonin

metabolism in autistic children


Indeed, in some autistic children Prozac reduces repetitive motor behavior and self-injury and improves social interactions

More recent research has focused on oxytocin


Prognosis for children with autism:

Long-term prognosis is poor

Studies indicate that nearly three-quarters of adults with autism had severe social difficulties and were unable to live and work independently

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psychological science, 3rd edition michael gazzaniga todd heatherton diane halpern

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