Chapter 15

Treatment of Abnormal Psych

History of Treatment

Chapter Introduction

Therapeutic drugs and community-based treatments are why many mental health hospitals have been empty since the 1950s.

Therapy

Psychotherapy an emotionally charged,

confiding interaction between a trained therapist and someone who suffers from psychological difficulties

Eclectic Approach an approach to psychotherapy

that, depending on the client’s problems, uses techniques from various forms of therapy

Therapy- Psychoanalysis

Psychoanalysis Freud believed the patient’s

free associations, resistances, dreams, and transferences – and the therapist’s interpretations of them – released previously repressed feelings, allowing the patient to gain self-insight

use has rapidly decreased in recent years

Resistance blocking from consciousness of

anxiety-laden material

Psychoanalytic theory creates less anxious individuals for their conflicted energy is now released

Free association is when you say aloud whatever is on your mind.

Therapy-Psychoanalysis

Therapy-Psychoanalysis

The latent content of a dream is the underlying, but censored meaning.

A dream analysis is a suggestion of a dream’s meaning.

Therapy- Psychoanalysis

Interpretation the analyst’s noting

supposed dream meanings, resistances, and other significant behaviors in order to promote insight

Transference the patient’s transfer to the

analyst of emotions linked with other relationships e.g. love or hatred for a

parent

Psychodynamic Therapy

Therapy deriving from the psychoanalytic tradition that views individuals as responding to unconscious forces and childhood experiences, and that seek to enhance self-insight

The goal is to interpret the patient’s conflict

Humanistic Therapy

Client-Centered Therapy humanistic therapy

developed by Carl Rogers therapist uses techniques

such as active listening within a genuine, accepting, empathic environment to facilitate clients’ growth

Active Listening-empathic listening in which the listener echoes, restates, and clarifies

Humanistic Therapy

Rogers wanted therapists to focus on GENUINENESS, ACCEPTANCE, AND EMPATHY.

Unconditional positive regard: a caring, accepting, nonjudgmental attitude, which Carl Rogers believed to be conducive to developing self-awareness & acceptance

Humanistic Therapy

Insight therapies: aim to improve the psychological functioning by increasing the client’s awareness of underlying motives and defenses.

focuses more on the present and future more than the client’s past

Behavior Therapy

Behavior Therapy therapy that applies learning

principles to the elimination of unwanted behaviors

Counterconditioning procedure that conditions new

responses to stimuli that trigger unwanted behaviors

based on classical conditioning

includes systematic desensitization and aversive conditioning

Behavior Therapy

Exposure Therapy treat anxieties by

exposing people (in imagination or reality) to the things they fear and avoid

Behavior Therapy

Systematic Desensitization type of counterconditioning associates a pleasant, relaxed

state with gradually increasing anxiety-triggering stimuli

commonly used to treat phobias

Aversive Conditioning type of counterconditioning

that associates an unpleasant state with an unwanted behavior

nausea ---> alcohol

Discrimination

Mary Cover Jones did not receive the credit she deserved in psychology because she was a woman.

Systematic Desensitization

Systematic Desensitization: a type of exposure therapy that associates a pleasant relaxed state with gradually increasing anxiety triggering stimuli.

Commonly used to treat phobias.

Progressive Relaxation

Progressive Relaxation: Relaxing one muscle group at a time to receive relaxation and comfort.

Virtual Reality Exposure Therapy

Virtual Reality Exposure Therapy: Anxiety treatment that progressively exposes people to stimulations of their greatest fears such as airplane flying to public speaking.

Virtual Reality Exposure Therapy

This is helpful because your fear is stimulated to help people get through it without a high cost.

Also, using an avatar lets you try out new behaviors in virtual environments for people suffering a social phobia.

Aversive Conditioning

Aversive Conditioning: type of counter-conditioning that associates an unpleasant state with an unwanted behavior.

Aversive Conditioning vs. Systematic Desensitization

Aversive Conditioning is the opposite of systematic desensitization.

Aversive Conditioning

Aversive Conditioning: to get rid of nail biting, you could paint your nails with a nasty tasting nail polish.

Aversive Conditioning

Aversion is much better in the short term rather than long term.

When coyotes stopped eating sheep because there coats were treated with poison, later they began to eat the sheep again.

Aversive Conditioning

Cognition influences aversive conditioning.

After 3 years people treated with alcohol aversion, only 33% stayed away from alcohol.

Behavior Modification

Behavior Modification: reinforcing behaviors and withholding reinforcement for undesired behaviors or punishing them.

Behavior Modification

Children with disabilities have learned to care for themselves.

People suffering from Schizophrenia have learned to behave more rationally.

Token Economy

Token Economy: an operant conditioning procedure in which people earn a token of some sort for exhibiting a desired behavior and can later exchange the tokens for various privileges or treats.

Token Economy

Criticisms: Will people stop

doing the behaviors when the rewards stop.

Is it right to deprive people of something they desire and decide which behaviors to reinforce.

Cognitive Therapies

Cognitive Therapies: therapy that teaches people new, more adaptive ways of thinking and acting; based on the assumption that thoughts intervene between events and our emotional reactions.

Cognitive Therapies

Cognitive therapists try to teach new, more constructive ways of thinking.

Aaron Beck

Aaron Beck was originally trained Freudian but turned cognitive therapist.

Beck tries to reverse clients’ catastrophizing beliefs about themselves, situations, and future.

Stress Inoculation Training

Meichenbraum’s stress inoculation training teaches people to restructure their thinking in stressful situations.

After learning how to dispute negative thoughts there was a halved rate of future depression.

Cognitive Behavior Therapy

Cognitive Behavior Therapy: a popular integrated therapy that combines cognitive therapy and behavior therapy.

Group Therapy

Economically, group therapy is good because it saves time and money.

It allows people to see problems similar to their own and receive feedback as they try new ways of behaving.

Family Therapy

Family therapy: therapy that treats the family as a system views an individuals unwanted behaviors as influenced by, or directed at, other family members.

Family Therapy

Goals are beneficial because they open up communication within the family or to help family members.

Group Therapy

AIDS, anorexia, alcohol, and hearing loss have successful support groups.

Whereas hypertension, migraines, ulcers, and vision loss don’t really have support groups.

Alcoholics Anonymous

Worldwide, Alcoholics Anonymous has over 2 million members in 114,000 groups.

Their 12 step program, you need to admit powerless, seek help from a higher power, and to share message with others.

Figure 15.1

Psychotherapy

Clients testimonials affirm the use of psychotherapy.

Criticisms: People often enter

therapy in a crisis. Clients may need to

believe therapy was worth the effort.

Clients generally speak highly of their therapists.

Placebo Effect Regarding Therapy

Power or belief in the treatment, whether or not it actually is successful.

Regression Towards the Mean

Regression Towards the Mean: tendency for the extremes to fall back towards the average, or what is normal.

Lack of Psychotherapy

Eysenck said that without psychotherapy, roughly 66% of people with depression improved noticeably.

Time heals. Criticism:

Sample for testing was small.

Research of Therapy

Randomized clinical trials are the best way to study outcome research.

Researchers need to randomly assign people to either a therapy group, or no therapy.

Meta-Analysis

Meta-Analysis: a procedure for statistically combining the results of many different research studies.

Smith’s 1980 Research

Psychotherapists welcomed the first meta-analysis of some 475 psychotherapy outcome studies It showed that the average therapy client ends up better off than 80 percent of the untreated individuals on waiting lists. The claim is modest—by definition, about 50 percent of untreated people also are better off than the average untreated person. Nevertheless, Mary Lee Smith and her colleagues exulted that “psychotherapy benefits people of all ages as reliably as schooling educates them, medicine cures them, or business turns a profit.”

5 Subsequent studies

Proved that: Those not undergoing therapy often improve, but those undergoing therapy are more likely to improve.

Psychotherapy-cost effective

Studies show that when people seek psychological treatment, their search for other medical treatment drops—by 16 percent in one digest of 91 studies.

Given the staggering annual cost of psychological disorders and substance abuse—including crime, accidents, lost work, and treatment—this is a good investment.

Both reduce long-term costs. Boosting employees’ psychological well-being, for example, can lower medical costs, improve work efficiency, and diminish absenteeism.

Clinicians experience

There is little if any connection between clinicians’ experience, training, supervision, and licensing and their clients’ outcomes.

Behavioral Benefits from therapy

Behavioral conditioning therapies, for example, have achieved especially favorable results with specific behavior problems, such as bed-wetting, phobias, compulsions, marital problems, and sexual disorders.

Cognitive Therapy

And new studies confirm cognitive therapy’s effectiveness in coping with depression and reducing suicide risk.

Behavioral Optimism

Behavioral change is most optimistic with specific problems (rather than general problems).

Non-recommended therapies

Energy therapies Recovered-memory

therapies Rebirthing therapies Facilitated

communication Crisis debriefing

Psychology’s Civil War

But this question—which therapies get prizes and which do not?—lies at the heart of a serious controversy some call psychology’s civil war.

Evidence Based Practice

Clinical decision-making that integrates the best available research with clinical expertise and patient characteristics and preferences.

EMDR

EMDR (eye movement desensitization and reprocessing) is a therapy adored by thousands and dismissed by thousands more as a sham—“an excellent vehicle for illustrating the differences between scientific and pseudoscientific therapy techniques.”

James Herbert and seven others suggested it

Created when one day while walking in a park and observing that anxious thoughts vanished as her eyes spontaneously darted about.

Francine Shapiro and EMDR

After she tried this on 22 people haunted by old traumatic memories, and all reported marked reductions in their distress after just one therapeutic session, the extraordinary result evoked an enormous response from mental health professionals.

Also noted: To date, nearly 70,000 of them, from more than 75 countries, have undergone training for EMDR.

Does it work?

The treatment need take no more than three 90-minute sessions. The Society of Clinical Psychology task force on empirically validated treatments acknowledges that the treatment is “probably efficacious” for the treatment of nonmilitary post-traumatic stress disorder

Encouraged by their seeming successes, EMDR therapists are now applying the technique to other anxiety disorders, such as panic disorder, and, with Shapiro’s encouragement, to a wide range of complaints, including pain, grief, paranoid schizophrenia, rage, and guilt.

Skeptics

It seems eye movements are not the therapeutic ingredient.

In trials in which people imagined traumatic scenes and tapped a finger, or just stared straight ahead while the therapist’s finger wagged, the therapeutic results were the same.

Seasonal Affective Disorder (SAD)

The wintertime blahs constitute a form of depression (for especially women and those living far from the equator).

Light Exposure Therapy

After four weeks of treatment, 61 percent of those exposed to morning light had greatly improved, as had 50 percent of those exposed to evening light and 32 percent of those exposed to the placebo

Other studies have found that 30 minutes of exposure to 10,000-lux white fluorescent light produced relief for more than half the people receiving morning light therapy and for one-third receiving evening light the

Elements in all forms of psychotherapy

Hope for demoralized people

A new perspective on oneself and the world

An empathic, trusting, caring relationship

Participant’s belief

This belief, apart from any therapeutic technique, may function as a placebo, improving morale, creating feelings of self-efficacy, and diminishing symptoms.

A new perspective

Every therapy also offers people a plausible explanation of their symptoms and an alternative way of looking at themselves or responding to their world. Armed with a believable fresh perspective, they may approach life with a new attitude, open to making changes in their behaviors and their views of themselves.

Effective therapists

Normally have the qualities of: Empathetic Caring Trusting Willing to gain insight Communicate well

Similarities between psychologists

Similar characteristics of cognitive, psychodynamic, and interpersonal psychologists: At key moments, the

empathic therapists of both persuasions would help clients evaluate themselves, link one aspect of their life with another, and gain insight into their interactions with others.

Therapeutic Alliance

The emotional bond between therapist and client (is a key aspect of effective therapy).

Paraprofessional

That all therapies offer hope through a fresh perspective offered by a caring person is what also enables paraprofessionals (briefly trained caregivers) to assist so many troubled people so effectively.

People who don’t need therapy

They empathize, reassure, advise, console, interpret, or explain. Such qualities may explain why people who feel supported by close relationships—who enjoy the fellowship and friendship of caring people—are less likely to need or seek therapy.

What therapy wants to enhance

Sensitivity Openness Personal Responsibility

Culture

Clients who are immigrants from Asian countries, where people are mindful of others’ expectations, may have trouble relating to therapies that require them to think only of their own well-being.

Such differences help explain the reluctance of some minority populations to use mental health services.

Asian-American view points

Asian-American clients matched with counselors who shared their cultural values (rather than mismatched with those who did not) perceived more counselor empathy and felt a stronger alliance with the counselor.

Albert Ellis

Rational-Emotive Therapy Assumed that “no one and

nothing is supreme,” that “self-gratification” should be encouraged, and that “unequivocal love, commitment, service, and… fidelity to any interpersonal commitment, especially marriage, leads to harmful consequences.”

Bergin and Ellis

Bergin and Ellis disagreed more radically than most therapists on what values are healthiest. In so doing, however, they agreed on a more general point: Psychotherapists’ personal beliefs influence their practice.

Assumed that “no one and nothing is supreme,” that “self-gratification” should be encouraged, and that “unequivocal love, commitment, service, and… fidelity to any interpersonal commitment, especially marriage, leads to harmful consequences.”

Bio Medical Therapy

Bio Medical Therapy: Prescribed medications or medical procedures that act directly on the patient’s nervous system

Psychotherapy is to psychological disorders and biomedical therapy is to serious disorders

Only psychiatrists (as medical doctors) offer biomedical therapies.

The study of the effects of drugs on mind and behavior.

Psychopharmacology

Diminishing Enthusiasm

Almost any new treatment, including drug therapy, is greeted by an initial wave of enthusiasm as many people apparently improve.

Decline in enthusiasm is due to: (1) normal recovery among

untreated persons (2) recovery due to the placebo

effect, which arises from the positive expectations of patients and mental health workers alike.

Testing the drug

To test the legitimacy of a drug, scientists use the double blind procedure.

Double Blind: Half the patients get the drug, and the other half get a similar-appearing placebo. Neither the staff nor the patients know who gets which.

Psychoses

Disorders in which hallucinations or delusions indicate some loss of contact with reality

When drugs were found for this it was accidental

Antipsychotic Drugs Drugs used to treat

schizophrenia and other forms of severe thought disorder

Examples: Chlorpromazine which dampened responsiveness to irrelevant stimuli

Mimics dopamine; goal of molecule is to occupy its receptor sites and block its activity

This finding reinforces the idea that an overactive dopamine system contributes to schizophrenia. Antipsychotics are powerful drugs

Tardive Dyskinesia

Involuntary movements of the facial muscles, tongue, and limbs; a possible neurotoxic side effect of long-term use of antipsychotic drugs that target certain dopamine receptors.

Treating Positive vs. Negative symptoms

Positive: antipsychotic drugs such as Thorazine are used to dampen responsiveness to irrelevant stimuli and aiding is the prevention of hallucinations and delusions

Negative: atypical antipsychotics are used such as Clozaril. These drugs target both dopamine and serotonin receptors this helps alleviate negative symptoms and “ awakens” patients.

Side effects of Antipsychotic drugs

Antipsychotic drugs can increase one’s risk of obesity and diabetes

Benefits

Combined with life skill programs and family support, the most positive gain form antipsychotic drugs ate that thousands of schizophrenics have returned to near normal life

Anti-anxiety drugs

Anti anxiety drugs: drugs that are used to control anxiety and agitation

Example: Xanax or Ativan

These drugs depress central nervous system activity

Negative side effects

“popping” Xanax can lead to… Psychological dependence Reinforce repeated behavior Physiological dependence Anxiety Insomnia Other withdrawal symptoms

Antidepressants

Antidepressant drugs: drugs used to treat depression; also increasingly prescribed for anxiety. Different types alter different neurotransmitters.

Antidepressants can workon obsessive compulsive disorder

Antidepressants

Work on increasing the availability of nor epinephrine and serotonin, neurotransmitters that elevate arousal and mood and appear scarce during depression

Prozac

Prozac blocks the reabsorbsion and removal of serotonin from synapses

SSRI’s

SSRI: selective serotonin reuptake inhibitors Zoloft Paxil Prozac

Administering drugs

Most successful method: administering by a patch or bypassing the intestines and liver; helps to reduce side effects.

Prevalence

After SSRI’s were introduced in 1987, 70% of depressed patients received them

In 2001, this jumped to 89% 11% of women and 5% of men take an SSRI

Other ways to relieve depression

Aerobic exercise can often lift our spirits and gradually cure us of depression due to the release of endorphins

Cognitive therapy can also help depressed patients sort through their thoughts in order to beat depression

Effects of SSRI’s

Full effects do not take place for a few weeks; you do not wake up the next morning saying “it’s a beautiful day!” This is because increase

of serotonin promotes neurogenesis

Side effects may include diminished sexual desire

Relieving depression

Attacking depression from above and below Use antidepressants

along (bottom up) with cognitive therapy (top down)

Antidepressant Facts

Only the most severe patients should be treated using antidepressants

Adolescent SSRI use has no effect on suicide rates

There is no link between antidepressants and suicide rates

Mood stabilizing drugs

Lithium A simple salt that is an

effective mood stabilizer for those with emotional highs and lows of bipolar disorder

7 in 10 people benefit from the long term use of lithium

The suicide rate of those with bipolar disorder taking lithium is about 1/6 the rate of those who are not

Electroconvulsive Therapy

ECT: a biomedical therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized person

Introduced in 1938 Patient remembers nothing

of the treatment after 80% of patients reported

improved moods

Repetitive Transcranial Magnetic Stimulation

rTMS: the application of repeated pulses of magnetic energy to the brain; used to stimulate of suppress brain activity

No memory loss or other detrimental side effects

Half of depressed Israelis that received rTMS showed improvement

ECT Study

Mayberg found that a brain region overactive in a depressed patient becomes calm after the administration of ECT or antidepressants

This area became known as the “depression switch”

Psychosurgery

Psychosurgery: surgery that removes or destroys brain tissue in an effort to change behavior

Not used frequently Used in the most

extreme cases as a last resort

Lobotomies

Lobotomy: a now-rare psychosurgical procedure once used to calm uncontrollably emotional or violent patients. The procedure cuts the nerves connecting the frontal lobes to the emotion-controlling centers of the inner brain

Rosemary Kennedy : Famous recipiant of a lobotomy

Characteristics of a lobotomy

Decreased a person’s misery and tension

Produced lethargic, immature, uncreative people

Became more obsolete 1950’s when new drugs were developed and perfected

Therapeutic lifestyle change

Includes one with strenuous physical activity, strong community ties, sunlight exposure, and plenty of sleep

The Amish are a good example of people who live a therapeutic lifestyle

Reducing depression

The Llardi team believes that depression can be reduced by Aerobic exercise Adequate sleep Light exposure Social connections Anti-rumination Nutritional supplements

“It is better to prevent than cure”

What do you think?