Chapter 15 Psychological Treatment

Chapter 15: Psychological Treatment HOW ARE PSYCHOLOGICAL DISORDERS TREATED? 15.1 Some Types of Psychotherapy Focus on Providing Insight Psychotherapy- treatment for psychological disorders where a therapist works with clients to help them overcome their psychological problems and disorders Seven Approaches to Psychotherapy Approach Psychodynamic Therapy Humanistic Therapy Therapy Goals Therapy Methods Help clients become aware of unconscious conflicts and defense mechanisms Psychoanalysis with free association and dream analysis Client-centered therapy with active listening and unconditional positive regard Help clients fulfill their potential for personal growth Behavior Therapy Help clients replace harmful behaviors with beneficial ones Behavior modification, including rewards and punishment, token economies, social skills training, and modeling Cognitive Therapy Help clients eliminate distorted thoughts and replace them with more realistic ones Cognitive therapy that includes cognitive restructuring and/or rational-emotive therapy Cognitive-Behavioral Therapy Help clients change both disordered thoughts and maladaptive behavior May use a mix of any behavior therapy and cognitive therapy Group Therapy Provide support while also improving social skills costeffectively Often uses an eclectic mix of psychotherapy approaches Family Therapy Heal family relationships System approach; often uses an eclectic mix of psychotherapy approaches Psychodynamic Therapy- treatment for psychological disorders where a therapist works with clients to help them gain insight into how their unconscious process may be causing inner conflict and impairing daily functioning ● Psychoanalysis- a method by Freud, based on the idea that psychological disorders were caused by prior experiences, especially early traumatic experiences, that created unconscious conflicts in the people with the disorders ● Free Association- the client would say whatever came to mind and the therapist would look for signs of unconscious conflicts, especially where the client appeared resistant to discuss certain topics ● Dream Analysis- the therapist would interpret the hidden meaning o a clients dream Humanistic Therapy- treatment for psychological disorders where a therapist works with clients to help them develop their full potential for personal growth through greater insight ● Client-Centered Therapy- encourages people to fulfill their potential for personal growth through greater self-understanding ○ When clients gain insight into their problems, they have the chance to become the best people they can be ○ The creation of a safe and comfortable environment for clients is crucial in achieving this the good relationships between a client and their therapist ● Active Listening- the therapists listen attentive to clients, repeated the client’s concerns to help them clarify their feelings, and asks for further clarification when necessary ● Unconditional Positive Regard- the therapist does not direct the client’s behavior or pass judgment on their actions or thoughts, but instead, helps clients focus on their subjective experiences 15.1 Question: Why is insight important in psychodynamic and humanistic therapy? In psychodynamic therapy, insight makes people aware of their unconscious conflicts so that they can resolve them. In humanistic therapy, insight helps people see how they can fulfill their potential for growth and become the best person they can be. 15.2 Behavioral and Cognitive Treatments Ain to Change Behavior, Emotion, and/or Thought Directly Behavior Therapy- treatment for psychological disorders where a therapist works with clients to replace maladaptive behaviors with adaptive ones ● It is a method of helping people to learn desired behaviors and unlearn unwanted behaviors. Unwanted behaviors are ignored or punished (time-outs, groundings), while desired behavior are reinforced (small treats or praises ● Token Economies- people earn tokens for good behavior and can trade the tokens for rewards or privileges. ● Social Skills Training- a method therapists use to elicit desired behaviors ● Modeling- the client is encouraged to imitate the displayed behavior, rehearse it in therapy, and late use the learned behavior in real-world situations Cognitive Therapy- treatment for psychological disorders where a therapist works with clients to help them change distorted thought patterns ● Cognitive Restructuring- an approach where a clinician seeks to help clients recognize distorted thought patterns and replace them with ways of viewing the world that is more in tune with reality ● Rational-Emotive Therapy- an approach where the therapist acts as a teacher, explaining clients’ errors in thinking and demonstrating more adaptive ways to think and feel Cognitive Behavioral Therapy (CBT)- treatment for psychological disorders where a therapist incorporates techniques from cognitive therapy and behavior therapy to correct faulty thinking and maladaptive behaviors ● CBT tries to correct clients faulty cognitions and trains them to engage in new behaviors ● It is one of the most effective therapies for many types of psychological disorders, especially anxiety disorders and depressive disorders 15.2 Question: Why is cognitive-behavioral therapy effective for many disorders, especially anxiety and depressive disorders? Cognitive-behavioral therapy is so effective because it treats both the distorted thoughts and maladaptive behaviors that are seen in both anxiety and depressive disorders 15.3 The Context of Therapy Matters Group Therapy- a type of therapy that involves a group of people that provide support, improving social skills, an opportunity to learn from other’s experiences, and is cost-effectively ● Group therapies vary in the types of clients enrolled in the groups, the duration of treatment, the theoretical perspective of the therapist running the group, and the group size Family Therapy- an attempt to include all family members in the process of therapy, often to help and support another family member ● Systems Approach- an individual is part of a larger context, and the change in individual behavior will affect the whole system ● Each person in a family plays a particular role and interacts with the other members in a specific way. So over the course of therapy, the way the individual thinks behaves, and interacts with others may change, and can greatly affect the family dynamic 15.3 Question: Why is a system approach important in family therapy? A systems approach is important in family therapy because all of the members of the family are interconnected with each other; if one person experiences a psychological disorder and gets treatment, then everyone is affected. 15.4 Biological Therapies Are Effective for Certain Disorders Biological Therapy- treatment for psychological disorders that is based on medical approaches to illness and disease Psychotropic Medication- drugs that affect mental processes and that can be used to treat psychological disorders Five Classes of Psychotropic Medications Drug Classification Treatment Provided Drug Type Anti-Anxiety Drugs Temporarily increase the client’ssense of calm Minor tranquilizers Drowsiness Addiction Valium, Xanax Ativan Antidepressant s Drugs Increased positive mood; reduce emotionality, impulsiveness, and arousal Selective serotonin reuptake inhibitors (SSRIs) Sexual Dysfunctions Weight Gain Prozac Paxil Zoloft Dizziness Digestive Problems Anafranil Tofranil Elavil Mood Stabilizer Drugs Helps even out moods, especially manic episodes Mineral Antipsychotic Drugs Reduce positive/ negative symptoms of schizophrenia (delusions, lack of emotions, disorganized speech) Controversial antipsychotics Tardive Dyskinesia Seizures Lethargy Thorazine Haldol Atypical antipsychotics Potentially fatal loss of white blood cells, heart rate problems Clozaril Risperdal Zyprexa Seroquel Stimulants Decrease hyperactivity, distractibility; Tricyclics Methylphenidate Side Effects Blunting of positive affect Reduced Appetite Body Twitches Drug Brand Names Lithium Ritalin increased attention, concentration Amphetamine Insomnia Weight Loss Nervousness Electroconvulsive Therapy (ECT)- treatment for psychological disorders that involve administering a strong electrical current to the client’s brain to produce a seizure; ECT is effective in some cases of severe depression ● Generally occurs under anesthesia, using a powerful muscle relaxant to eliminate muscular convulsions Transcranial Magnetic Stimulation (TMS)- treatment for psychological disorders that uses a magnetic field to interrupt function in specific regions of the brain ● This magnetic field creates an electrical current in the brain region directly below the coil, thereby interrupting the activity of neurons in that region. Deep Brain Stimulation (DBS)- treatment for psychological disorders that involves passing electricity through electrodes planted in the client;s brain to stimulate the brain at a certain frequency and intensity 15.4 Question: What is the main difference between ECT and TMS? Although both forms of these biological treatments disrupt brain activity, ECT uses electrical currents, whereas TMS uses a strong magnetic field. 15.5 Scientific Evidence Indicates Which Treatments Are Safe and Effective ● Three features characterize evidence-based psychological treatments: 1. Treatments vary according to the particular psychological disorder and the client’s specific symptoms 2. The techniques used in these treatments have been developed in the laboratory by psychologists, especially behavioral, cognitive, and social psychologists 3. Treatment is not guided by one singly theory about what causes the disorder, but is based on evidence of its effectiveness 15.5 Question: How can a person know whether a psychological treatment for a disorder is effective? If treatment for a psychological disorder is effective, then there should be research on the treatment showing that it works 15.6 Various Providers Assist in Treatment for Psychological Disorders Providers of Psychological Treatment Adderall Specialty Clinical Psychologists Psychiatrists Training Degree 4-6 years of graduate school developing clinical skills to treat people with psychological disorders, followed by 1 year of internship 4 years of medical school with 3-5 years of addiction specialization in residency programs to treat people with psychological disorders and prescribe psychotropic medications Employment PsyD Private Practice Medical Settings Mental health centers MD Hospitals Substance Abuse Programs Academics Private Practice Counseling psychologists 3-6 years of graduate school developing clinical skills to treat clients’ adjustments and life stress problems (academics, relationships, work) but not psychological disorders Master’s degree of PhD University student health clinics Mental health centers Wellness programs Rehabilitation facilities Psychiatric social workers 2-3 years of graduate training on directing clients to appropriate social and community agency resources, plus specialized training in mental health care MSW Mental Health Centers Private Practice Hospitals Social Service Agencies Psychiatric Nurses 2 years for an associate’s degree (ASN, RN), 4 years for a bachelor’s degree (BSN), or 2-3 years of graduate training (MSN) but all focus on nursing plus special training in the care of clients ASN RN BSN MSN Hospitals Mental health centers Residential treatment programs with psychological disorders Paraprofessionals Work under supervision to assist those with mental health problems in the challenges of daily living Limited advanced training, no advanced degree Community outreach programs Crisis Centers, Substance abuse centers, ● Choosing the right treatment provider is extremely important for ensuring successful treatment. That professional must have the appropriate training and experience for the specific psychological disorder or life problem, and the person seeking help must believe the therapist is trustworthy and caring 15.6 Question: Can all treatment providers prescribe psychotropic medications? In most places, only psychiatrists can prescribe psychotropic medications WHAT ARE THE MOST EFFECTIVE TREATMENTS? Types of Treatment for Common Psychological Disorder Category Anxiety Disorders Example of Specific Disorders Specific Phobia: fear of something out of proportion to the threat Types of Treatment CBT Depressive Disorders Changing thoughts about feared stimulus Exposure Cognitive restructuring about panic attacks Panic Disorder: sudden attacks of overwhelming terror ObsessiveCompulsive and related disorders Sample of Possible Techniques OCD: frequent anxiety-provoking intrusive (obsessions) and actions that are performed repeatedly to reduce anxiety (compulsions) CBT Major Depressive Disorder- a severe The depression Psychotropic medications Psychotropic Medications Alternative treatments Cognitive restructuring to recognize that all people have intrusive thoughts Exposure DBS Antidepressants Alter thinking to prognosis plus other symptoms CBT Alternative treatments Bipolar and related disorders Schizophrenia spectrum and other psychotic disorders Bipolar Disorders: elevated mood that can range from mild (hypomania) to severe (mania), possible with symptoms of depression Psychotropic medications Schizophrenia: a psychotic disorder with motor, cognitive, behavioral, and perceptual abnormalities Psychotropic medications address cognitive triad of negative thoughts Phototherapy Lithium Atypical antipsychotic Antidepressants may be used cautiously for symptoms of depression Behavior therapy Atypical antipsychotics Social skills training Behavioral training for life skills 15.7 Anxiety and Obsessive-Compulsive Disorders Are Best Treated with Cognitive- Behavioral Therapy Exposure- therapy techniques that involve repeatedly exposing a client to an anxiety-producing stimulus or situations and has the goal of reducing the clients fear ● By confronting feared stimuli in absence of negative consequences, the person learns new, non-threatening clients sense associations Systematic Desensitization- therapy technique that involves exposing a client to increasing anxiety-producing stimuli or situations while having the client relax at the same time ● Fear Hierarchy- a list of situations in which fear develops from least fear to greatest ● First, the client makes a fear hierarchy ● Second, the client learns to alternate muscular tension with muscular relaxation and to use other relaxation techniques ● Exposure therapy is often the next step Cognitive Restructuring- a technique used in cognitive therapy to address ways of reacting to the symptoms of a panic attack ● First, the clients identify their specific fears ● Second, the clients estimate how many panic attacks they have experienced Exposure and Response Prevention- exposing a client to a stimulus that causes anxiety because it triggers obsessive thoughts and then preventing the client from engaging in compulsive behavior to reduce that anxiety ● The goal is to break the conditioned link between a particular stimulus and compulsive behavior. When this happens, the avoidance response to stimuli that cause obsessive thoughts is eventually extinguished 15.7 Question: Why is exposure therapy a part of treatment for anxiety disorders? Exposure to a feared object in a safe environment helps the person extinguish a learned fear that is associated with that object 15.8 Many Effective Treatments Are Available for Depressive Disorders ● Selective Serotonin Reuptake Inhibitors (SSRIs) have fewer serious side effects than other drugs used to treat depression. They are designed to leave more serotonin in the synapse to bind with the postsynaptic neurons ● Cognitive-Behavioral Therapy (CBT) is just as effective as antidepressants in treating depressive disorders. the goal of CBT for depression is to identify, reevaluate, and change negative thoughts associated with depression ○ Ultimately, this approach helps the client think more appropriately and eliminate the cognitive triad of negative thoughts ● Phototherapy- treatment for depressive disorder with seasonal pattern, informally called seasonal affective disorder (SAD), through which the client is exposed to high-intensity light each day ● Electroconvulsive Therapy (ECT) might be a preferred treatment for some reasons. It works quickly and may work with pregnant women because there is no evidence that the seizures harm a developing fetus ○ ECT, however, does have serious limitations, including memory impairment and a high rate of relapse. Some clients may experience substantial permanent memory loss. 15.8 Question: For depressive disorders, what psychotherapy treatment can be just as effective as antidepressants? For depressive disorders, the psychotherapy treatment of cognitivebehavioral therapy (CBT) can be just as effective as antidepressants 15.9 Psychotropic Medications Are Most Effective for Bipolar Disorders ● Lithium, a naturally occurring mineral, has been found to stabilize mood by moderating neurotransmitter levels, balancing excitatory and inhibitory activities ● Quetiapine is an atypical antipsychotic commonly prescribed for bipolar disorders ● Clients with bipolar disorder may stop taking their medication because they miss the “highs” of their manic episodes 15.9 Question: What two classes of psychotropic drugs are best for the treatment of the elevated moods seen in bipolar disorders? The two classes of psychotropic drugs that are best for the treatment of the elevated moods seen in bipolar disorders are mood stabilizer drugs (such as lithium) and antipsychotics (such as Seroquel). 15.10 Atypical Antipsychotic Medications Are the Best Treatment for Schizophrenia Conventional Antipsychotics- early antipsychotic drugs that reduced the positive symptoms of schizophrenia, like delusions, hallucinations, disorganized speech and behavior ● They had significant side effects, like muscle spasms, uncontrollable salivation, shuffling walk, and lack of movement in facial muscles ● Tardive Dyskinesia- the involuntary movement of body parts Atypical Antipsychotics- introduced in the late 1980s, this new group of drugs differs from conventional antipsychotic medications in three main ways: 1. They act on different neurotransmitters 2. They are beneficial in treating both the positive symptoms of schizophrenia and some of the negative symptoms 3. Few signs of tardive dyskinesia appeared in clients taking this drug ● Early versions had serious side effects, including seizures, heart rate problems, large weight gain, and a fatal reduction in white blood cells ● Evidence confirms that atypical antipsychotics are extremely valuable in the short term for people experiencing psychotic symptoms Behavior Therapy- helps clients replace harmful behaviors with beneficial ones and learn appropriate ways to act in specific social situations. ● These clients can also benefit from intensive training in regulating their expressions of emotions, recognizing social cues, and predicting the effects of their behavior in social situations. ● Behavioral interventions can focus on areas such as grooming and bathing, managing medications, and financial planning Prognosis- a prediction of the likely course of a psychological (or physical) disorder) ● The prognosis of schizophrenia depends on age. The longer a person with psychotic symptom does not receive treatment, the worse the person’s prognosis 15.10 Question: What are the three differences between the atypical antipsychotics and the conventional antipsychotics used to treat schizophrenia? The three differences between atypical antipsychotics and conventional antipsychotics are that the atypical antipsychotics: (1) act on different neurotransmitters; (2) reduce negative, not just positive, symptoms of schizophrenia; and (3) do not produce the side effect of tardive dyskinesia. CAN PERSONALITY DISORDERS BE TREATED? Types of Treatment for Specific Personality Disorders Category Cluster B: dramatic, emotional, or erratic behavior Examples of Specific Disorders Borderline Personality Disorder: intense, unstable moods, relationships, and self-image, impulsivity Antisocial Personality Disorder (APD): disregard for and violation of the rights of others; manipulativeness; lack of guilt Types of Treatment Sample of Possible Techniques Cognitivebehavioral therapy (CBT) Dialectical behavior therapy (DBT) Psychotropic medications Antidepressant Behavior Therapy Operant procedures 15.11 Dialectical Behavior Therapy is the Best Treatment for Borderline Personality Disorder Dialectical Behavior Therapy (DBT)- a form of therapy, used to treat borderline personality disorder, that combines behavior theory, cognitive therapy, psychodynamic therapy, and a mindfulness approach ● Phase 1: Therapists target the clients’ most extreme and dysfunctional behaviors. ○ The client learn problem-solving techniques and effective ways of coping with their emotions ● Phase 2: therapist helps the client explore past traumatic experiences that may be at the root of their emotional problems ● Phase 3: therapists help the client develop self-respect and independent problem-solving. ○ This phase is crucial because clients with borderline personality disorder depend heavily on others for support and validation 15.11 Question: What role does mindfulness play in dialectical behavior therapy (DBT)? Mindfulness meditation is used in the first stage of dialectical behavior therapy (DBT) to help the person control attention to focus on the present to replace extreme behaviors. 15.12 Antisocial Personality Disorder Is Extremely Difficult to Treat ● Clients that have APD can lie without thinking twice about it, care little for other people’s feelings, and lice for the present without considering the future, making it difficult to treat them ● Individuals with this disorder are often more interested in manipulating their therapists than in changing their own behaviors, so therapists working with these clients must constantly be on guard ● Psychotropic medications have not been effective in treating this disorder Operant Procedures- form of therapy used to treat antisocial personality disorder (APD) where a therapist helps the client learn to associate certain behaviors with specific desirable outcomes ● These approaches tend to work best when the therapist controls reinforcement, the client cannot leave treatment and the client is part of a group. ● Therapy for APD is most effective in a residential treatment center or a correctional facility ● Prognosis for individuals with this disorder is poor because it is unlikely clients will change their behaviors as a result of any therapy 15.12 Question: What is the general prognosis for those with antisocial personality disorder (APD)? Few therapies work for people with antisocial personality disorder (APD), but most people with APD show a reduction in antisocial behavior after about age 40 HOW CAN DISORDERS BE TREATED IN CHILDREN AND ADOLESCENTS? Types of Treatment for Children and Adolescents Experiencing Psychological Disorders Category Examples of Specific Types of Treatment Sample of Possible Disorders Depressive Disorders Neurodevelopment al Disorders Techniques Major Depressive Disorder: severely depressed mood or loss of interest in pleasurable activities for two weeks or more, plus other symptoms, such as changes in weight of in sleep Psychotropic medications Cognitivebehavioral therapy (CBT) Changing negative thoughts associated with depression Autism Spectrum Disorder: persistent unresponsiveness; impaired social interaction, language, and cognitive development; restricted and repetitive behavior; symptoms begin in early childhood Behavior therapy Applied behavioral analysis Psychotropic medications Antidepressants Stimulants Behavior therapy Attention-deficit/ hyperactivity disorder (ADHD): hyperactivity, inattentiveness, and impulse behavior with social or academic impairment; begins before age 12 15.13 Using Medication to Treat Depressive Disorders in Adolescents is Controversial ● Studies with adults found that SSRIs caused some people to feel restless, impulsive, and suicidal 15.13 Question: According to the initial and follow-up studies of TADS, were drugs or CBT most effective in treating adolescent depression? Both were equally effective over the long term. 15.14 Children with Autism Spectrum Disorder Benefit from Structured Behavior Therapy Applied Behavior Analysis- an intensive behavior therapy used to treat autism; this treatment is based on operant conditioning Operant procedures 15.14 Question: What is the most successful treatment for autism spectrum disorder, and what is the major drawback of that treatment? Applied behavior analysis is the most successful treatment, especially when combined with symbolic play or joint attention, but it requires great commitment from the client and the client’s family because it is very intensive and takes years. 15.15 Children with ADHD Can Benefit from Various Approaches 15.15 Question: What is a possible reason that stimulants can help reduce ADHD? These drugs stimulate brain regions involved in behavioral control and paying attention.