THERAPIESLast time we ended with a discussion of Bipolar Disorder. The following video picks up from this discussion and leads us into tonight’s topic of therapies for the treatment of psychological disorders.
I. BIOLOGICAL THERAPIES
- Biological therapies are treatments that reduce or eliminate a psychological disorder by altering bodily functions.
- Drug therapy is the most common form of biological therapy. An individual can also go through electroconvulsive therapy and psychosurgery.
A. Drug Therapy
1. Anti-anxiety Drugs
a. Antianxiety drugs are also known as tranquilizers. They make an individual calmer and less excitable.
b. Benzodiazepines - Xanax, Valium, and Librium.
fast working, taking effect within hours after taking them.
c. Some of the side effects are addiction, loss of coordination, drowsiness, fatigue, and mental slowing.
d. Many individuals experience stress and/or anxiety and anti-anxiety drugs are prescribed to help an individual cope with their problems effectively.
2. Antidepressant Drugs
a. Antidepressant drugs help to regulate mood.
b. The three main classes of antidepressant drugs are: tricyclics, MAO inhibitors, and selective serotonin reuptake inhibitors (SSRIs).
c. Tricyclics are believed to work by increasing the level of certain neurotransmitters, especially serotonin and norepinephrine. They relieve up to 60-70% of patients with depression. Some of the side effects can be restlessness, faintness, trembling, sleepiness, and difficulty remembering.
d. The MAO inhibitors are not used as often as tricyclics because they are much stronger. They are risky because of their interactions with certain foods and drugs, such as cheese and other fermented foods, along with red wine.
a. SSRIs work mainly by interfering with the reabsorption of serotonin in the brain. Prozac and Zoloft are two of the most widely used SSRIs. These two drugs have an increased effectiveness in reducing depression and they have fewer side effects than the antidepressants. Some of the side effects are insomnia, anxiety, headache, and diarrhea.
b. Antidepressants have been used to treat various psychological disorders such as generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, social phobia, and post-traumatic stress disorder.
c. Lithium is used to treat bipolar disorder. When taking lithium, the amount circulating in the bloodstream must be closely monitored, because the effective dosage is close to toxic level. Lithium is thought to stabilize moods by influencing norepinephrine and serotonin.
3. Antipsychotic Drugs
a. Antipsychotic drugs diminish agitated behavior, reduce tension, decrease hallucinations, improve social behavior, and produce better sleep patterns. They are used especially in individuals with schizophrenia.
b. The neuroleptics are the most widely used of the antipsychotic drugs because they block the dopamine system’s action in the brain. Schizophrenics have too much dopamine and so neuroleptics work well for that reason.
c. Neuroleptics do not cure schizophrenia; they only treat the symptoms of schizophrenia.
d. One side effect of neuroleptics is tardive dyskinesia, which is a neurological disorder resulting in involuntary movements of the facial muscles and mouth, as well as twitching of the neck, arms, and legs.
e. Atypical antipsychotic medications carry a much lower risk of the side effect, tardive dyskinesia. Clozapine (Clozaril) and risperidone (Risperdal) are two of the most well known of the atypical antipsychotic medications.
- Electroconvulsive Therapy
1. Electroconvulsive therapy (ECT) is also sometimes called shock therapy or shock treatments and is mainly used to treat severe depression.
2. The goal of ECT is to cause a seizure in the brain.
3. It is mainly given to individuals that have not responded to drug therapy or psychotherapy.
4. The individual is given an anesthetic and a muscle relaxer before the treatment and they basically sleep through the entire thing and therefore, there is little discomfort.
C. Psychosurgery
1. Psychosurgery involves removal or destruction of brain tissue to improve the individual’s adjustment.
2. One form of psychosurgery is a prefrontal lobotomy, where a surgical instrument is inserted into the brain and rotated, severing fibers between the thalamus and the frontal lobe. Thousands of these surgeries were performed between the 1930s and 1950s. Many individuals were cured, while others remained in a vegetative state. Prefrontal lobotomies are no longer performed.
VIDEO… www.youtube.com lobotomy – PBS Documentary on Walter Freeman *********************************
I. PSYCHOTHERAPY
- Psychotherapy is used by mental health professionals to help individuals with a mental disorder recognize, define, and overcome their psychological and interpersonal difficulties and improve their adjustment.
- Insight therapy characterizes both psychodynamic and humanistic therapies because they encourage insight and self-awareness.
- Psychodynamic Therapies
· Psychodynamic therapies stress the importance of the unconscious mind, extensive interpretation by the therapist, and the role of early-childhood experiences in the development of an individual’s problems.
· The goal is to help an individual recognize the maladaptive way in which they have been coping with their problems.
1. Freud’s Psychoanalysis
a. Psychoanalysis is what Freud used to analyze an individual’s unconscious thoughts. He believed that an individual’s problem could be traced back to a childhood experience, many of which had to do with a sexual nature.
a.
b. Although Freudian psychoanalysis is no longer practice, current day psychoanalysis and psychodynamic approaches continue to focus on helping individuals gain insight into their repressed conflicts. They use some of the same approaches and concepts such as the following:
· Free association involves encouraging individuals to say aloud whatever comes to their mind, no matter how trivial or embarrassing.
· Catharsis is the release of emotional tension an individual experiences when reliving an emotional and conflicting experience.
· Dream analysis is what psychoanalysts use to interpret dreams. They believe dreams hold information about unconscious thoughts and conflicts. Manifestcontentof dreams is the remembered, conscious content of dreams. Thelatentcontent is the unconscious, unremembered symbolic aspects of dreams
· Transference is the individual’s relating to the therapist in ways that reproduce or relive important relationships in the individual’s life.
· Resistance is the individual’s unconscious defense strategies that prevent the therapist from understanding the person’s problems. – for ex. Missing appointments…changing the subject….talking on and on about a trivial matter to avoid discussing their issues
- Humanistic therapies encourage people to understand themselves and to grow personally.
1. Client-Centered Therapy
a. Carl Rogers developed client-centered therapy. The therapist provides a warm, supportive atmosphere to improve the client’s self-concept and encourage the individual to gain insight into problems.
b. The goal is not to unlock the deep secrets of the unconscious, but to help the individual identify and understand their genuine feelings. One way of doing this is through reflective speech, where the therapist mirrors the individual’s own feelings back to the individual.
c. The therapist must be in a close personal relationship with the individual.
d. The therapist engages in unconditional positive regard, which involves creating a warm and caring environment and never disapproving of the individual.
e. The therapist’s role is nondirective, meaning they do not lead the individual to any particular revelation.
2. Gestalt Therapy
a. Gestalt therapy involves having the individual help themselves become more aware of their feelings and face their problems.
a. The therapist pushes the individual into deciding whether they will continue to allow the past to control their future or whether they will choose, right now, what they want to be in the future.
b. The therapist sets examples, encourages congruence between verbal and nonverbal behavior, and uses role playing. To stimulate change, the therapist openly confronts the individual.
c. Ex. Empty chair technique
E. Behavior Therapies
- Behavior therapies use the principles of learning to reduce or eliminate maladaptive behavior.
- Behavior therapists assume that the overt symptoms are the problem.
1. Classical Conditioning Techniques
· If fears can be learned, then they should be able to be unlearned also.
· Counterconditioning is a technique used to unlearn fears that have been learned. There are two forms of counterconditioning: systematic desentization and aversive conditioning.
a. Systematic Desensitization
· Systematic desensitization involves the individual to associate deep relaxation with increasingly intense anxiety-producing situations.
· It is often used as an effective treatment for phobias.
· Flooding is a more intense form of systematic desensitization where the individual is exposed to the feared stimuli to an excessive degree while not allowing them to avoid the stimuli.
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b. Aversive Conditioning
· Aversive conditioning consists of repeated pairings of the undesirable behavior with aversive stimuli to decrease the behavior’s rewards.
· Electric shocks, nausea-inducing substances, and verbal insults are used as stimuli in aversive conditioning.
· Ex. was used in earlier treatment of pedophiles – ammonia capsules
2. Operant Conditioning Approaches
a. Therapy for operant conditioning involves conducting an analysis of the individual’s environment to determine which factors need to be modified.
b. One technique is behavior modification where the main goal is to replace unacceptable, maladaptive behaviors with acceptable, adaptive ones. Acceptable behaviors are reinforced and unacceptableones are not.
c. The token economy is used as one behavior modification technique. Here, tokens are given for good behavior and they can later be exchanged for desired rewards, such as candy or money.
F. Cognitive Therapies
- Cognitive therapies emphasize that an individual’s thoughts are the main source of abnormal behavior and psychological problems.
- Cognitive therapy is less concerned with the cause of the problem and more concerned with the structure of the individual’s thoughts.
- Cognitive therapists guide individuals in identifying their irrational and self-defeating thoughts. They ask the individual questions to help them gain understanding about their negative thinking.
1. Rational-Emotive Behavior Therapy
a. Rational-emotive behavior therapy (REBT) says that individuals develop psychological disorder because of their beliefs, especially irrational and self-defeating beliefs.
b. Individuals construct three basic demands: they absolutely must perform well and win the approval of other people, other people have to treat the individual kindly and fairly, and their life conditions should not be frustrating, but should be enjoyable.
c. The goal is to get the individual to eliminate self-defeating beliefs by rationally examining them.
1. Beck’s Cognitive Therapy
a. Beck believes that psychological problems result when people think illogically about themselves, the world they live in, and the future.
b. In the beginning of therapy, individuals are taught to make connections between their patterns of thinking and their emotional responses. They learn about the logical errors in their thinking and learn to challenge the accuracy of these automatic thoughts.
2. Cognitive-Behavior Therapy
a. Cognitive-behavior therapy involves a combination of cognitive therapy, with emphasis on reducing self-defeating thoughts, and behavior therapy, with emphasis on changing behavior.
b. Self-efficacy is the concept that individuals can master a situation and produce positive outcomes.
c. Self-instructional methods are aimed at teaching individuals to modify their own behavior. The therapist gives the individual examples of constructive statements, known as reinforcing self-statements that they can repeat in order to take positive steps to cope with stress or meet a goal. – self-talk
1. Using Cognitive Therapy to Treat Psychological Disorders
a Cognitive therapy has been an effective use with some anxiety disorders, mood disorders, schizophrenia, and personality disorders.
I. SOCIO-CULTURAL APPROACHES AND ISSUES IN TREATMENT
- Group Therapy
1. There is a good reason to believe that individuals who share a psychological problem may benefit from the empowering effect of observing others cope with a similar problem and that helping others cope can help improve the individual’s feelings of competence and efficacy.
2. The six features that make group therapy an attractive treatment are:
3. 1. Information – getting helpful information about the disorder
1. universality – others feel like they do – they are not alone
2. altruism – group members support one another
3. corrective recapitulation of the family group – group leaders represent parents and members represent sibling – can experience a healthier family setting thereby healing old wounds
4. development of social skills – get feedback from other group members about how they communicate and
5. interpersonal learning – group is a training ground for practicing new behaviors and relationships
B. Family and Couples Therapy – demonstrate family sculpting
1. Family therapy is group therapy, but with family members and couples therapy is either therapy with one couple or group therapy with married or unmarried couples whose major problem is within their relationship.
2. Four of the most used family therapy techniques are:
1. validation - therapist validates and supports each person within the family
2. reframing – therapist helps the family to reframe the problem as a family problem, not an individual’s problem…i.e. looks at how each family member contributes to the problem
3. structural change – the family therapist tries to restructure the coalitions within the family for ex. In mother-son coalition, therapist would give the father more responsibility for the son or more time with the son and
4. de-triangulation – triangulation is when two members gang up on or make another member the scapegoat…so therapist would work on shifting the focus away from the scapegoat
3. Couples therapy proceeds in much the same way as family therapy. Most of the problem in couples’ therapy resides in miscommunication.
D. Community Mental Health
1. The community mental health approach includes training teachers, ministers, family physicians, nurses, and others who are in direct contact with community members to offer counseling and workshops.
2. It is believed that the best way to treat a psychological disorder is to prevent it from happening in the first place.
1. With primary prevention, efforts are made to reduce the number of new cases of psychological disorders. With secondary prevention, screening for early detection of problems and early intervention may take place. In tertiary prevention, an effort is made to treat psychological disorders that were not prevented or arrested early in the course of the disorders. Halfway houses are an example of a tertiary program.
2. Previously we talked about deinstitutionalization that occurred in the 1970’s when state schools for the developmentally disabled and state hospitals for the mentally ill were closed and residents were returned to families or to group home settings.
The following video provides a view of one of the consequences of closing state hospitals for the mentally ill:
VIDEO – www.pbs.org The New Asylums *****************************
I. THE EFFECTIVENESS OF PSYCHOTHERAPY see pages 592 and 593
1. See Figure 15.11 In a recent review of studies, more than 70% of individuals who saw a therapist for treatment improved, as compared to 40% who improved in the placebo groups (saw therapists but for just talking) and 20% who improved from no treatment.
2. Research consistently shows that therapy works well for many psychological disorders. However, no one therapy has been shown to be significantly better than another.
3. See Figure 15.12 In a recent study, people in therapy rated their well-being before each session ( based on symptoms, interpersonal relations, and quality of life). By the 10 session, 1/3 had shown improvement, by the 20 session, 50% had shown improvement, and by the 45 session, 70% had shown improvement from when they entered therapy.
1. The therapeutic alliance is the relationship between the therapist and the individual. – and research shows that a therapeutic alliance in which the client has confidence and trust in the therapist is essential to effective psychotherapy.
2. Research indicates that it is the therapeutic alliance more so than the type of therapy that is the better predictor of a positive outcome.
C. Therapy Integration
1. Integrative therapy is a combination of techniques from different therapies based on the therapist’s judgment of which particular techniques will provide the greatest benefit for the individual….not making the client conform to the therapy.
2. Up to 50% of therapists practice integrative therapy.
D. Funding and Finding Therapy
1. Most therapy is affordable only with insurance. Although some therapists will take on clients for a reduced fee – it’s always worth asking. For clients without insurance, community mental health centers provide sliding fee counseling services which are not inferior to private practice therapy services. Many therapists in community mental health centers are in private practice part-time and at the mental health center part-time. More case coordination and case review is offered at a community mental health center. More supervision of the therapists takes place within community mental health centers. In private practice, supervision is not required.
2. Also, college counseling centers offer counseling services for no fees or reduced fees. Also, many offer group counseling and seminars on mental health issues. Licensing and supervision requirements help to ensure quality services.
A. The Client’s Role in Therapeutic Success
1. Through meta-analysis, one thing that came up with all types of therapy was that the major factor in predicting therapeutic outcome was the individual themselves. It is the person’s strengths, abilities, skills, and motivation that account for therapeutic success.
