Psychology

Actually the bill is part

of your reality therapy.

Chapter 17
Treatment and Therapy for
Psychological Disorders

A Historical Perspective

Ancient Greeks and Romans

Roman times: sword wound of the head

was noted to relieve insanity

Early Theories

Music or singing was often used to

chase away spirits.
In some cases trepanning was
used: cutting a hole in the head of
the afflicted to let out the evil spirit.

Trepanning

Early Mental Hospitals

They were nothing more than barbaric prisons.
The patients were chained and locked away.
Some hospitals even charged admission for the public to see the mad
just like a zoo.

Philippe Pinel
A

French doctor
who was one of
the first to take
the chains off and
declare that these
people are sick and
a cure must be
found.

Dorothea Dix

American reformer who worked

to get better care for the
mentally ill

Defining Mental Disorder

Psychosurgery

Surgical procedures, usually directed

at the brain, used to affect
psychological reactions
Split-brain procedure epilepsy
Small lesions of limbic system violent
behaviors
Cingulotomy extreme anxiety and
symptoms of obsessive-compulsive
disorder
Surgical techniques Parkinsons

Psychosurgery

Lobotomy severs the major

neural connections between the
prefrontal lobes and the lower
brain centers

Problem: patients were

calm after the procedure
but also had changed
personality and drive
Creating permanently
lethargic, immature and
uncreative people

Electroconvulsive Therapy
ECT
(hyperlink)

ECT shock treatment) involves passing

an electric current between 70-150 (usually
100) volts across one of the brain
hemispheres

Anesthesia is given to minimize trauma

Mainly used for profound depression
No one knows exactly why it works

30 60 seconds of electrical current

Perhaps because of placebo effects, rebooting

the computer, calming neural centres?

No more than 10-12 treatments

rTMS Repetitive Transcranial

Magnetic Stimulation

Repeated pulses surge through a

magnetic coil held close to the skull
Painless and produces no seizures,
memory loss or other serious side effects
Studies have shown modest benefits
Unclear how it works but possibly because it
energizes the left frontal lobe
Repeated stimulation may cause nerve cells
to form new circuits

Deep Brain Stimulation

For patients whose depression has

resisted drugs and ECT
Experimental

treatment focusing on a neural

hub that bridges the frontal lobes to the limbic
system (over active in a depressed brain)
Electrodes are implanted
Excites neurons that inhibit activity
12 / 20 for three to six years follow up

Drug Therapy

Biomedical therapy may administer

drugs to improve abnormal behavior
Drug classes include:
Antianxiety drugs relieve muscle tension
Antipsychotic drugs improve thought
processes

Can have major adverse side effects

Antidepressant drugs can reverse

depression (hyperlink)

Tricyclics
MAO inhibitors
Selective Serotonin Reuptake Inhibitors (SSRIs)

Anti-Anxiety Drugs

Help reduce the felt aspect of

anxiety
Majority

are benzodiazepines (e.g.,

Valium, and Xanax), which act
directly on CNS
Very

effective and most commonly

prescribed of all medications
Dependency and addiction may develop
Muscle

relaxants (e.g., Miltown)

Antimanic compounds
Used for bipolar disorder
Lithium carbonate most effective
at treating the manic phase (once
the mania is eliminated, depression
usually does not follow).

Lithium

reduces risk of suicide

Do not fully understand why Lithium
works, but it does

Lithium side effects

Low level:
nausea,

vomiting, diarrhea, abdominal

pain; tremor, lethargy, impaired
concentration, dizziness; slurred speech,
ataxia, muscle weakness; memory
impairment; weight gain

Long term lithium use:

may

enlarge the thyroid, cause skin rashes,

and increase urine output; impair motor
activity, creativity, and cognitive activity.

Antipsychotic drugs

The first generation were aimed at the

positive symptoms of schizophrenia dopamine receptor blockers

The dopamine hypothesis suggests that the

positive symptoms of schizophrenia are
caused by overactivity of DA synapses.
Atypical (second generation) antipsychotics
also impact the negative symptoms
e.g. Clozapine and Risperidone

Anticholinergic side effects

Dry mouth
Blurred vision
Rapid heart rate (tachycardia)
Urine retention
Constipation
Confusion and memory impairment
Tardive Dyskinesia
a movement disorder characterized by
involuntary movements of the face and neck

Drug Therapy

Antidepressant drugs elevate

the mood of persons who are
feeling depressed, and there are 3
major classes
1.
2.
3.

MAO (monoamine oxidase) inhibiters

Tricyclics
SSRIs (selective serotonin reuptake
inhibitors)

Drug Therapy: MAO Inhibiters

Inhibit the enzyme monoamine
oxidase, which normally breaks
down levels of serotonin,
norepinephrine, and dopamine in
the brain
Major drawback is that they can
be toxic and interact with foods
containing tyramine

Drug Therapy: Tricyclics

These drugs generally are safer
and more effective that the older
MAO inhibitors
They mainly affect the operation
of the neurotransmitters
serotonin and norepinephrine

Drug Therapy: SSRIs

These drugs act faster to relieve
symptoms and have fewer side
effects
Work by inhibiting the reuptake
of serotonin, increasing serotonin
levels, which elevates mood
Prozac, Zoloft, Luvox, and Paxil

Antidepressant drugs prolong the activity of the neurotransmitters

dopamine, norepinephrine, and serotonin. (a) Ordinarily, after the
release of one of the neurotransmitters, some of the molecules are
reabsorbed by the terminal button, and other molecules are
broken down by the enzyme monoamine oxidase (MAO). (b)
Selective serotonin reuptake inhibitors (SSRIs) prevent
reabsorption of serotonin. Tricyclic drugs prevent reabsorption of
dopamine, norepinephrine, and serotonin. (c) MAO inhibitors
(MAOIs) block the enzyme monoamine oxidase and thereby
prolong the effects of the neurotransmitters.

Drug Therapy
Antidepressants

Drawbacks:
Usually

take 2-4 weeks to show

any effect, and may take 6 weeks
to be effective
Unpleasant side effects
(hyperlink)

Who Provides Psychotherapy?

1.
2.
3.
4.
5.
6.

Clinical psychologist
Psychiatrist
Counseling psychologist
Licensed professional
counselor
Psychoanalyst
Clinical social worker

What is wrong with this picture?

How Do I Choose
the Right Therapist?

Many people and agencies can serve as good

resources
Check with your family physician, clergy
person, local mental health center, college
counseling center, psychology instructor,
family and friends
Give the therapist at least three to four
sessions to see if working together will be
effective
If you do not feel that you are benefiting
from therapy, discuss this with the therapist
and be prepared to change if necessary

Spotlight: Psychotherapy and

Minority Groups

Minority groups less likely to seek

help
Even

true for high-income minorities

Not all research studies address

ethnicity
African Americans are significantly
more likely than Caucasians to
terminate therapy once it has begun

Psychoanalytic Techniques

Psychoanalysis based on
several assumptions involving
conflict and the unconscious
mind

Freuds Couch

Psychoanalytic Therapy

Psychoanalytic Therapy

Freud saw many things as having sexual overtones

Psychoanalytic Techniques

techniques that move issues from the

unconscious to the conscious level for
resolution
therapy assumes that some issues may
relate to childhood experiences
The ego serves to keep these issues below
the level of consciousness (defense
mechanisms)
Catharsis is an emotional energy that is
released when early conflicts are relived

Psychoanalytic Techniques

Moving issues from the unconscious

to the conscious can be achieved
through
Free

association: patient says

whatever comes to mind
Dream analysis
: Dreams express
unconscious issues
(hyperlink)

Manifest

content: the actual content of a

dream
Latent content: symbols that are
disguised unconscious issues or motives

Psychoanalytic Techniques
Resistance:

Therapist looks for evidence

that the patient is avoiding an issue
Transference: Does the patient treat the
therapist in ways that are similar to their
parents?
Interpretation: Therapist provides
analysis of the meaning of the thoughts,
behaviors, and dreams of the patient
Interpretation

leads to understanding and

resolution of unconscious issues

Post-Freudian Psychoanalysis
Most significant change
is the concern for
shortening the length of
analysis
Todays analyst will take
a more active role in
therapy
Focus on present, rather
than childhood
experiences

Humanistic Techniques
(also looking for insight)

The 3 necessary elements of

humanistic therapy:

Unconditional Positive Regard

Genuineness
Non-Directive Guidance

Humanistic Techniques

Client-centered therapy
goal is to help the individual
self-actualize (Carl Rogers)
Focus

is on the present
Focuses on ones feelings or affect
Therapist attempts to mirror the
feelings of the person

Humanistic Techniques

(hyperlink)

How Does One Mirror?

Therapist

must be an active

listener.
Therapist needs to be empathetic
able to understand and share the
essence of anothers feelings
Therapist will try to express
unconditional positive regard

Behavioral Therapy

Therapy that applies learning

principles (e.g. conditioning) to
the elimination of unwanted
behaviors.

Behavioral Therapy
Systematic Desensitization

Behavioral Therapy
Flooding

Behavioral Therapy counter

conditioning pairs trigger stimulus
with a new response
Aversion Therapy

Can happen naturally drinking at a party paired with

throwing up. Just the smell
can make you sick.
Does it work? Short term yes!

Or artificially
Ipecac +
Alcohol =
Nausea

Exposure Therapy:
Virtual Reality Exposure Therapy
Like you are an avatar

Help with PTSD?

CNN Virtual Reality Battles PTSD 9 2011
http://www.youtube.com/watch?v=hjyRu1e-Jmo

Behavioral Therapy
Modeling client observes and imitates
appropriate behaviors
- Works well for children with phobias and
with assertiveness training
Operant Conditioning Therapy
-Shaping new behaviors

Token Economy: reward wanted behaviour

Punishment: making an aversive stimulus
contingent on the unwanted behavior
Extinction: removing all rewards for the
target behavior

Cognitive Therapy
Constant
repetition of
negative
thoughts leads
to abnormality

Cognitive Therapy
Assumes that problem behaviors and
emotions result from faulty thought
processes and beliefs
Analyzes a persons thought processes
Attempts to restructure thought
processes
Changing

thought patterns will in turn alter

problem behaviors and emotions

Cognitive Therapy
change your self-talk
Nobody likes me
Im a moron

Im worthless

My jokes are bad

Cognitive Therapy
Nobody likes me Sue likes me she is just
angry at me now.
Im a moron

Im smart. I just made a

mistake.

Im worthless

Im a good person.

My jokes are bad Its not my fault the class

has no sense of humour.

Albert Ellis: Rational Emotive

Behavioral Therapy REBT
A confrontational cognitive therapy that
vigorously challenges peoples illogical
self-defeating attitudes and assumptions.

Group Approaches

Group therapy label applied

to a variety of situations in
which a number of people are
involved in a therapeutic setting
at the same time

Group Approaches

Benefits of group therapy:

Economy: group therapy is less expensive

Group support: there is comfort in
knowing that others have similar problems
Feedback: group members learn from
each other
Behavioral rehearsal: group members can
role-play the activities of the key persons
in a members life

Group Approaches

Family Therapy the roles,

interdependence, and
communication skills of family
members are addressed
Part

of a system; all impact one

another
Improper family communication =
problems

Evaluating Psychotherapy

Difficult task
Sometimes

spontaneous remission
of symptoms
Difficult to agree on what is meant
by recovery or care

The large, meta-analysis studies

showed positive results for
psychotherapy

Evaluating Psychotherapy

No evidence that any one type of

therapy is universally better than others
an eclectic approach is probably best
Some

types of therapy are better suited for

some problems than others
Which therapy is best for what disorder is
one of the most active areas of research
Some therapists are more effective than
others