Chapter 13

Therapies

Copyright McGraw-Hill, Inc. 2013

Chapter Preview
In the previous session you learned about psychological disorders. In this chapter well focus on the methods used to treat these disorders, and the philosophies underpinning them. This study guide will highlight the concepts upon which you should focus your reading in the chapter.

Copyright McGraw-Hill, Inc. 2013

Biological Therapies
Also called biomedical therapies Treatments that reduce symptoms of psychological disorders by altering aspects of body functioning Drug therapy Electroconvulsive therapy Psychosurgery

Copyright McGraw-Hill, Inc. 2013

Drug Therapy
Revolutionized mental health care in the 20th century Today there are many psychoactive drugs on the market for various disorders However, effectiveness is often disputed, and the exact mechanisms by which some of them work are not fully understood In this guide well review the major categories of drugs used in treatment of disorders

Copyright McGraw-Hill, Inc. 2013

Antianxiety Drugs
Commonly known as tranquilizers Bind to receptor sites of neurotransmitters that become overactive during anxiety Benzodiazepines e.g. Xanax, Valium Relatively fast acting Side effects include drowsiness, loss of coordination, fatigue, and mental slowing Can become addictive, so intended for short-term use, but often abused

Copyright McGraw-Hill, Inc. 2013

Antidepressant Drugs
Regulate mood through effects on neurotransmitters Tricyclics Increase norepinephrine and serotonin levels Monoamine oxidase (MAO) inhibitors Block enzyme that breaks down serotonin and norepinephrine Selective serotonin reuptake inhibitors (SSRI) e.g. Prozac, Zoloft, Paxil Inhibit the reabsorption of serotonin in brain Lithium Solid element used to treat bipolar disorder
Copyright McGraw-Hill, Inc. 2013

Antipsychotic Drugs
Neuroleptics Block dopamines action in brain Powerful drugs, which often have serious side effects, including: Dysphoria: Lack of pleasure Tardive Dyskinesia: Movement disorder Atypical antipsychotic medications Claimed to have lower risk of side effects Block reuptake of serotonin in addition to affecting dopamine

Copyright McGraw-Hill, Inc. 2013

Overview of Drug Therapy for Psychological Disorders

Copyright McGraw-Hill, Inc. 2013

Electroconvulsive Therapy
Commonly called shock therapy Goal is to set off seizure in brain Patient receives anesthesia and muscle relaxants Used primarily to treat severe depression that has been nonresponsive to other treatments Controversial because of potential for side effects, especially in the domain of memory loss

Copyright McGraw-Hill, Inc. 2013

Psychosurgery
Irreversible removal or destruction of brain tissue to improve adjustment Historically, the most common (and notorious) form was the prefrontal lobotomy Severing of fibers connecting frontal lobe with thalamus Actual effectiveness questioned, but widely used in the US from 1930s-1950s Ethical concerns regarding long-term brain damage, pressure to consent to the surgery as a condition of release from treatment, and use of treatment as a means of social control over undesirable behavior

Copyright McGraw-Hill, Inc. 2013

Biological Approach
That summarizes the state of the biological approach to treatment. Understand, though, that this is still a very young science, with a history tied mostly to the last 60 years or so. We still have a long way to go in understanding the biological bases of behavior and psychological disorder.

Copyright McGraw-Hill, Inc. 2013

Psychotherapy
Nonbiological process that helps individuals with psychological disorders recognize and overcome their problems Approaches include: Psychodynamic Humanistic Behavioral Cognitive There are many different types of professionals who practice psychotherapy. Be sure to review these in your book ahead of your next exam

Copyright McGraw-Hill, Inc. 2013

Psychodynamic Therapies
Stress importance of: Unconscious mind Extensive interpretation by therapist Role of early childhood experiences

Copyright McGraw-Hill, Inc. 2013

Psychodynamic Therapies
Freudian psychoanalysis was the first major psychodynamic approach The goal was to bring unconscious conflicts into conscious awareness, using techniques such as free association and dream analysis, in order to trigger a release of emotional tension called catharsis

Copyright McGraw-Hill, Inc. 2013

Contemporary Psychodynamic Therapies

Contemporary (post-Freudian) approaches place more importance on the conscious mind and a persons current relationships Heinz Kohuts view says that early social relationships with attachment figures are critical. We internalize these relationships as a basis for developing our sense of our own self

Copyright McGraw-Hill, Inc. 2013

Humanistic Therapies
As you may recall from our history chapter, the humanist position emerged in part as a response to what they saw as the pessimism of the Freudian approach Humanists encourage people to understand themselves and to grow personally, with a clinical emphasis on self-healing capacities Primary approach is client-centered therapy (Carl Rogers) Warm, supportive atmosphere to improve self-concept and to encourage insight Reflective speech by therapist used to mirror feelings Therapist must enter into an authentic relationship with the client, valuing her with unconditional positive regard
Copyright McGraw-Hill, Inc. 2013

Behavior Therapies
Use principles of learning to reduce or eliminate maladaptive behavior Classical conditioning techniques include systematic desensitization, a technique used to associate deep relaxation with situations that usually trigger anxiety. These are often used to treat phobias. They also include aversive therapy, which tries to create automatic, negative associative responses Operant conditioning techniques include applied behavior analysis, which was discussed in chapter 5

Copyright McGraw-Hill, Inc. 2013

Cognitive Therapies
Emphasize thoughts as main source of psychological problems Attempt to change feelings and behaviors by changing cognitions Cognitive restructuring Changing pattern of thought presumed to be causing maladaptive behavior or emotion Widely used in treatment of anxiety disorders, mood disorders, schizophrenia and personality disorders

Copyright McGraw-Hill, Inc. 2013

Examples of Cognitive Therapy

Rational-Emotive Behavior Therapy (Albert Ellis) Emotional reactions to life events are a product of irrational beliefs and expectations Central false belief that feelings cannot be controlled Demands create dysfunctional, exaggerated beliefs Goal is to eliminate self-defeating beliefs by rationally examining them Approach is directive, persuasive, and sometimes confrontational

Copyright McGraw-Hill, Inc. 2013

Examples of Cognitive Therapy

Aaron Becks Cognitive Therapy Problems, such as depression, are a result of illogical thoughts about self, world, future Emotions are a product of these maladaptive cognitions Goal is to identify negative automatic thoughts so they can be changed Role of therapist includes challenging accuracy of automatic thoughts Approach includes more open-ended dialogue with therapist

Copyright McGraw-Hill, Inc. 2013

Examples of Cognitive Therapy

Cognitive-Behavioral Therapy Combination of: Cognitive therapy to reduce self-defeating thoughts Behavior therapy to changer maladaptive behavior Bandura places emphasis on developing self-efficacy in order to better handle situations and produce positive outcomes Self-instructional methods Teach person to modify own behavior Using reinforcing self-statements to take positive steps

Copyright McGraw-Hill, Inc. 2013

Therapy Integrations
Many therapists do not subscribe strictly to one particular approach Integrative therapy: a combination of techniques from different therapies based on therapists judgment Integration often involves combining psychotherapy and drug therapy Conceptually compatible with biopsychosocial model which, as we saw in the previous chapter, is a framework for understanding many disorders

Copyright McGraw-Hill, Inc. 2013

Sociocultural Approaches & Issues

The sociocultural approach says we should regard and treat individuals as part of social system of relationships, influenced by social and cultural factors Thus, cultural norms must be understood, and sometimes therapy may include not just the person with the disorder, but others in the immediate social group (e.g. family) or others who also have the disorder

Copyright McGraw-Hill, Inc. 2013

Cultural Perspectives
Understanding cultural issues is necessary in order to best understand the disorder from the perspective of an individual who belongs to that culture For instance. collectivistic cultures place more importance on social groups, rather than on the individual. So, individual psychotherapy may not be as effective within such cultures Ethnicity An ethnic match between therapist and client also may be helpful in forging both trust and understanding of experiences related to ethnicity in society Changing gender roles in society may also be relevant within therapy
Copyright McGraw-Hill, Inc. 2013

Group Therapy
Individuals sharing psychological disorder brought together in sessions typically led by a professional Features (see book for more details) Information Universality Altruism Experiencing a positive family group Development of social skills Interpersonal learning

Copyright McGraw-Hill, Inc. 2013

Family and Couples Therapy

Family therapy Group therapy among family members Uses techniques such as validation, reframing, detriangulation, and structural change to address role of family in both disorder and treatment (detailed in book) Couples therapy Group therapy with married or unmarried couples with relationship problems Views symptoms as function of relationship, and thus treatment needs to involve relationship change, not just individual change Focus on roles and communication between partners
Copyright McGraw-Hill, Inc. 2013

Self-Help Support Groups

Voluntary organizations of individuals who get together to discuss relevant topics (e.g. Alcoholics Anonymous) May rarely be conducted by professionals, but more often by paraprofessionals, or by those who have the disorder Provide a sympathetic audience for confession, sharing, and emotional release, as well as social support, role modeling, and sharing of concrete problem-solving strategies Increase accessibility of care, because they are often free or very low-cost However, they need to be managed well, otherwise they may have risk of giving poor advice or developing groupthink

Copyright McGraw-Hill, Inc. 2013

Community Mental Health

Movement born in 1960s, which argued that individuals with disorders ought to remain in society, rather than being treated in mental health institutions The deinstitutionalization movement aimed to release people from such hospitals and re-integrate them into the community Success depends on resources and commitment of community; some communities offer more mental-health outpatient support than do others

Copyright McGraw-Hill, Inc. 2013

Effectiveness of Psychotherapy
Research indicates that psychotherapy works A meta-analysis is a statistical combination of results of different studies; meta-analyses of research on different therapies finds them to be more effective than no treatment No specific therapy is significantly better than the others in general, though some specific techniques may work better for specific disorders Increasing move to evidence-based practice, which aims to integrate best available research in treatment of disorders Research indicates therapy effective at least for 6 months, if not longer.
Copyright McGraw-Hill, Inc. 2013

Common Themes
The similarity of effectiveness of different psychotherapies may be because most have common elements: Expectations of improvement Mastery of difficulties The idea that you are not alone, but dealing with your problems in a therapeutic alliance with your therapist Client factors The quality of participation by the client is the best predictor of success. So, motivated clients will do better, but those who are not motivated (e.g. ordered into therapy by the court system) are less likely to succeed.
Copyright McGraw-Hill, Inc. 2013