Treatment of Psychological Disorders Essays, Papers, Questions and Answers

Treatment of Psychological Disorders Essays, Papers, Questions and Answers

Treatment of Psychological Disorders

Learning Objectives

What do treatments for psychological problems look like?
How did Freud influence psychotherapy?
What is cognitive-behavior therapy?
Does psychotherapy work?
What is the placebo effect? How do placebos work?
Is it important to “click” with your therapist?

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Overview

What helps?
- Different treatments work better for different disorders.
- Psychotherapy
  - The use of psychological techniques and the therapist–client relationship to produce emotional, cognitive, and behavior change
- Adherents to different paradigms offer very different treatments (Prochaska & Norcross, 2006).
Most mental health professionals describe themselves as eclectic.
- Using different treatments for different disorders
Evidence-based treatments
- The practical and scientific approach to therapy
According to Kessler et al. (2005), about two-thirds of people with a diagnosable disorder fail to receive treatment.
Four Views of Frances
- Biological therapist
  - Draws an analogy with physical illness
  - Focuses on diagnosis
  - Considers genetic predisposition or chemical imbalance
- Psychodynamic therapist
  - Likely to focus on the defensive style
  - Develop the client’s insight
  - Expect changes as a result of increased emotional awareness
- Cognitive-behavior therapist
  - Focus on cognitive-behavioral patterns
  - Therapist is directive
  - Identify cognitive distortions
  - Assign homework
  - Change behaviors
- Humanistic therapist
  - Likely to focus on lack of emotional genuineness
  - Therapist is nondirective
  - Encourage the client to “own” her feelings
- Biological Treatments
  - First, a diagnosis is developed and refined.
  - Second, clues about causes are put together.
  - Third, scientists experiment with various treatments for preventing or curing the disorder until an effective treatment is found.
  - Treatment focuses on symptom alleviation.
- Psychopharmacology
  - The use of medications to treat psychological disturbances
  - Psychotropic medications are chemical substances that affect psychological states.
  - 21% of American women, and half as many men, are taking antidepressants.
  - Antipsychotic drugs are also highly prescribed.
  - Often safe and effective
  - Alleviate symptoms, not cure causes of illness
  - Many must be taken for long periods of time.
  - All medications have side effects.
  - Psychotropic medications are prescribed by primary care physicians, not psychiatrists.
  - American population wants a quick fix (as a medication) to treat psychological disorders.
- Electroconvulsive Therapy (ECT)
  - Involves causing seizures by passing electricity through the brain
  - Developed by Ugo Cerletti and Lucio Bini in 1938
  - ECT involves 6 to 12 sessions over the course of a few weeks.
  - Electrical current is approximately 100v.
  - Bilateral ECT
    - Current passes through both hemispheres
  - Unilateral ECT
    - Current passes through one hemisphere
  - Psychosurgery
    - Surgical destruction of specific regions of the brain
    - Developed by Egas Moniz in 1935
    - Nearly 10,000–20,000 procedures were done in the United States.
    - Eventually discredited
    - Cingulotomy is used to treat very severe cases of OCD.
  - Freudian Psychoanalysis
    - Psychoanalysis
      - Free association reveals aspects of the unconscious mind.
      - Free associations, dreams, and slips of the tongue—Freudian slips—are “windows into the unconscious.”
    - Psychoanalytic Techniques
      - Insight
        
        Bringing formerly unconscious material into conscious awareness
      - Interpretation
        
        Analyst suggests hidden meanings to patients’ accounts.
      - Psychoanalytic Techniques
        
        Resistance
        
        Patient must discover the hidden meaning.
        
        Transference
        
        Patients transfer their feelings about some key figure.
        
        The Decline of Freudian Psychoanalysis
        
        Requires substantial amount of time, expense, and self-exploration
        
        Very little research has been conducted on its effectiveness
        
        Psychodynamic psychotherapy
        
        Derived from psychoanalysis
        
        Psychotherapists are more directive and engaged, and treatment may be brief.
        
        Ego Analysis
        
        Emphasized the role of the ego (e.g., the mediator between the id and the superego)
        
        More concerned with unconscious motivations and dealings with the external world
        
        Emphasized the role of the ego (e.g., the mediator between the id and the superego)
        
        Ego analysts
        
        Sullivan
        
        Horney
        
        Erikson
        
        Therapists more actively involved with patients than psychoanalysts
        
        Short-term psychodynamic psychotherapy
        
        Uses many techniques
        
        Is shorter and less expensive
        
        Amenable to research
        
        Interpersonal therapy (IPT)
        
        Focuses on changing emotions and styles of interacting in close relationships
        
        Cognitive-Behavior Therapy (CBT)
        
        Encourages
        
        Collaborative therapist–client relationships
        
        Focuses on the present
        
        Direct efforts to change problems
        
        Use of research-based techniques
        
        Beginnings can be traced to John B. Watson’s behaviorism.
        
        Early behavior therapists relied heavily on classical conditioning (Pavlov) and operant conditioning (Skinner).
        
        Today, CBT incorporates many learning principles based on cognitive psychology. Treatment of Psychological Disorders Essays, Papers, Questions and Answers
        
        A practical approach oriented to changing behavior than focusing on personality.
        
        Embraces empirical evaluation
        
        Asks, “What works?”
        
        Systematic Desensitization
        
        John Wolpe (1915–1997)
        
        Research focused on eliminating phobias.
        
        Assumed that some phobias were learned through classical conditioning
        
        Developed systematic desensitization for eliminating fears by:
        
        Progressive muscle relaxation
        
        Hierarchy of fears
        
        Learning process
        
        Other Exposure Therapies
        
        In order to conquer your fears, you must confront them (Barlow et al, 2002)
        
        In vivo desensitization
        
        Gradually confronting fears
        
        Flooding
        
        Confronting fears at full intensity
        
        Aversion Therapy
        
        The use of classical conditioning to create, not eliminate, an unpleasant response
        
        Used primarily in treating substance abusers
        
        Effectiveness is not clear.
        
        Contingency Management
        
        Contingency
        
        Relationship between a behavior and its consequences
        
        Social Skills Training
        
        Teaches clients new ways of behaving that are both desirable and likely to be rewarded in everyday life
        
        Assertiveness training
        
        Teaches clients to be direct about their feelings and wishes
        
        Teaches clients new ways of behaving that are both desirable and likely to be rewarded in everyday life
        
        Role playing
        
        Rehearses new social skills
        
        Social problem-solving
        
        Teaches clients through solving a variety of life’s problems
        
        Cognitive Techniques
        
        Attribution retraining: people are “intuitive scientists”
        
        Constantly draw conclusions about the causes of events
        
        Self-instruction training: adults model an appropriate behavior
        
        Child asked to repeat the action
        
        Develop internalization
        
        Beck’s Cognitive Therapy
        
        Developed by Aaron Beck specifically as a treatment for depression
        
        Depression is caused by errors in thinking.
        
        Challenges cognitive errors by having clients analyze their thoughts more carefully (Beck et al., 1979)
        
        Rational–Emotive Therapy
        
        According to Albert Ellis, emotional disorders are caused by irrational beliefs.
        
        Absolute, unrealistic views of the world
        
        Major difference from CBT: challenge client’s beliefs during the therapy (Ellis, 1962)
        
        “Third-Wave” CBT
        
        Dialectical behavior therapy
        
        Acceptance and commitment therapy
        
        Focuses on broad, abstract principles such as mindfulness, acceptance, values, relationships
        
        Dialectical behavior therapy, used for borderline personality disorder
        
        Acceptance and commitment therapy encourages accepting oneself.

Humanistic Therapies

Developed as a “third force” in psychotherapy
A counterpoint to psychodynamic and cognitive behavior therapy
Values humans’ ability to make choices and ability to be responsible for one’s own life
Encourages people to recognize and experience their true feelings
Views the therapist–client relationship as the method of change
Client-Centered Therapy
- Carl Rogers (1902–1987)
  - Viewed three qualities as essential in a therapist:
    - Warmth
    - Genuineness
    - Empathy—emotional understanding
  - Encourages therapist self-disclosure
  - Therapists do not act as experts.
    - Unconditional positive regard
      - Valuing clients for who they are
    - Therapeutic alliance
      - A bond between therapist and client

Research on Psychotherapy

Does Psychotherapy Work?
- Psychotherapy outcome research
  - Examines the outcome, or result, of psychotherapy
- Meta-analysis
  - A statistical procedure that allows researchers to combine the results from different studies in a standardized way
  - The average benefit of psychotherapy is .85 standard deviation units (Smith & Glass, 1977).
- Many benefits of psychotherapy diminish in the year or two after treatments ends (Westen & Bradley, 2005).
- Some treatments may harm.
- Improvement without Treatment?
  - Two-thirds of clients improve as a result of psychotherapy
    - Spontaneous remission (e.g., improvement without treatment)
  - Hans Eysenck (1916–1997)
  - Informal counseling vs. psychotherapy
- The Placebo Effect
  - Any type of treatment that contains no known active ingredient for the condition at hand
  - The recipient’s belief in a treatment, and expectation of improvement, are responsible for much of what works in psychological as well as physical treatments.
- Efficacy and Effectiveness
  - Efficacy
    - Whether a treatment can work under prescribed circumstances
  - Effectiveness
    - Whether therapy does work in the real world
  - Consumer Reports (1995, November): psychotherapy helps many people in the real world, not just in the laboratory
- When Does Psychotherapy Work?
  - Depends on:
    - Nature of client’s problem
    - Duration of therapy
    - Client’s background
    - YAVIS
      - Young
      - Attractive
      - Verbal
      - Intelligent
      - Successful
    - Psychotherapy Process Research
      - Common Factors
        
        Do different psychotherapies share common factors that help make them effective?
        
        Motivational interviewing: an evidence-based treatment developed to treat alcohol abuse
      - Therapy as Social Influence
        
        Client’s relationship with his or her therapist
      - Pain Relief? Treatment of Psychological Disorders Essays, Papers, Questions and Answers
        
        Psychological pain motivates seeking psychological help.

Couple, Family, and Group Therapy

Couple Therapy
- Involves seeing intimate partners together in therapy
- The goal is to improve the relationship, not to treat the individual, by improving:
  - Communication and negotiation skills
  - Conflict resolution
- Can be used for treatment of depression, anxiety, substance abuse, and child behavior problems
- Supplement to individual therapy
Family Therapy
- Might include two or more family members
- Goals are to improve communication, resolving conflicts, and perhaps change family relationships and roles.
- Family Systems Therapy
  - Emphasize interdependence among family members and the importance of viewing the individual within the family system
  - Parent management training: teaches parents new parenting skills
  - Family therapist may call attention to pattern of alliances.
- Family therapists attempt to improve mental health by altering family relationships.
Group Therapy
- Involves treating several people facing similar emotional problems or life issues
Group Therapy
- Groups may be small; three to four people; or large, 20 or more.
  - Psychoeducational groups
    - Teach specific psychological information or life skills
  - Experiential group therapy
    - Relationships are the primary mode of treatment
  - Groups may be small; three to four people; or large, 20 or more.
    - Self-help groups
      - Bringing people together who face a common problem
    - Prevention. Treatment of Psychological Disorders Essays, Papers, Questions and Answers
      - Social institutions, school, and work environments contribute to mental health.
        
        Community psychology
        
        Improve individual well-being by promoting social change
        
        Primary prevention
        
        Improve the environment in order to prevent new cases
        
        Social institutions, school, and work environments contribute to mental health.
        
        Secondary prevention
        
        Early detection of emotional problems
        
        Tertiary prevention
        
        Any of the treatments.
        
        Specific Treatments for Specific Disorders
        
        The ultimate goal of treatment research is to identify therapies that have specific active ingredients for treating specific disorders (Nathan & German, 2007).
        
        The mental health professional must inform client(s) about evidence on alternate treatments for their problem(s).
        
        Therapists unskilled in a particular approach must refer the client to someone with specialized training (McHugh & Barlow, 2010).

Treatment of Psychological Disorders Essays, Papers, Questions and Answers