Treatment of

Psychological Disorders
C:\Users\mburt\Desktop\AP Psych\psych disorders\video\Sheldon the Therapist - The Big Bang Theory.mp4

Introduction
History of treatment - Maltreatment of the
insane throughout the ages was the result of
irrational views. Many patients were subjected to
strange, debilitating, & downright dangerous
treatments.
C:\Users\mburt\Desktop\AP Psych\Therapy\239_Early_Treatment_Mental_Disorders.mp4

Philippe Pinel: France

Dorothea Dix: US/CA
founded humane movements to care for
the mentally sick.

Therapies
Psychotherapy involves an emotionally
charged, confiding interaction between a
trained therapist and a mental patient.
Biomedical therapy uses drugs or other
procedures that act on the patients nervous
system, treating his or her psychological
disorders.

An Eclectic approach uses various forms of

healing techniques depending upon the
clients unique problems.
4

The Psychological Therapies

4 Major Therapies

Psychoanalysis
Psychoanalysis

Sigmund Freuds
therapeutic technique. Freud believed the
patients free associations, resistances, dreams, &
transferences & the therapists interpretations of
them released previously repressed feelings,
allowing the patient to gain self-insight.

When energy devoted to id-ego-superego conflicts

is released, the patients anxiety lessens.

- 4:09 C:\Users\mburt\Desktop\AP Psych\psych disorders\video\Application of Psychoanalytic Therapy.flv

Aims of therapy
Childhood impulses & conflicts

Psychoanalysis
Methods

Free association
Resistance in psychoanalysis, the blocking
from consciousness of anxiety-laden material
Interpretation in psychoanalysis, analysts
noting supposed dream meanings,
resistances, & other significant behaviors &
events in order to promote insight of
the meaning
Dream analysis
Transference

Psychoanalysis:
Methods at work

During free association, the patient edits his

thoughts, resisting his or her feelings to
express emotions. Such resistance becomes
important in the analysis of conflict-driven
anxiety.
Eventually the patient opens up & reveals his
or her innermost private thoughts, developing
positive or negative feelings (transference)
towards the therapist.

C:\Users\mburt\Desktop\AP Psych\psych disorders\video\Psychoanalysis

- explained.mp4

Psychoanalysis
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Psychodynamic Therapy

therapy deriving from the Freuds psychoanalytic

tradition that views individuals as responding to
unconscious forces & childhood experiences, & that
seeks to enhance self-insight

Aims of psychodynamic therapy .

understand symptoms & themes across important
relationships in a patients life.

Similarities & Differences to psychoanalysis

Interpersonal psychotherapy, a variation of
psychodynamic therapy, is effective in treating
depression. It focuses on symptom relief here & now, not
an overall personality change.

Humanistic Therapies
Insight therapies a variety of therapies that aim
to improve psychological functioning by increasing the
clients awareness of underlying motives & defenses.

focus more on:

the present rather than the past
conscious rather than the unconscious
taking immediate responsibility
promoting growth instead of curing

Humanistic Therapies

Client-centered therapy (AKA personcentered therapy.) Humanistic therapy, developed by

Carl Rogers, the therapist uses techniques such as
active listening within a genuine, accepting, empathic
environment to facilitate clients growth.

Nondirective therapy
Genuineness, acceptance, & empathy

Active listening empathic listening in which the

listener echoes, restates, & clarifies.
Paraphrase
Invite clarification
Reflect feelings

Unconditional positive regard

Behavior Therapies
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Behavior Therapy- therapy that

applies learning principles to the elimination of
unwanted behaviors. Focus: the ACTION, not the
thought patterns associated with the behavior,
doesnt look for the inner cause

Classical conditioning techniques

We learn various behaviors & emotions via classical
conditioning

Operant conditioning techniques

Behavior modification reinforces desired behaviors &
withholding reinforcement for undesired behaviors or
punishments

Behavior Therapies
Classical Conditioning Therapies
Counterconditioning behavior therapy
procedure that uses classical conditioning to evoke
new responses to stimuli that are triggering unwanted
behaviors; Includes
242_Drug_Addiction.mp4

Exposure therapies behavior therapy procedure

that uses classical conditioning to evoke new responses
to stimuli that are triggering unwanted behaviors;
Includes

Systematic desensitization
Virtual reality exposure therapy
Aversive conditioning associates unpleasant state
(e.g. nausea) with unwanted behavior (e.g. alcohol).

Behavior Therapies
Aversion Therapy

Behavior Therapies
Aversion Therapy

Behavior Therapies
Aversion Therapy

Short term
success
(66%)
Long term less
successful (33%)
Often used in
combo with other
treatments

Behavior Therapies
Operant Conditioning

Behavior modification- reinforce desired behaviors

withholding reinforcement for undesired behavior or
punishment. Can work b/c a behavior strongly influenced
by consequences. (effective with autism, retardation,
schizophrenia). Rewards used to modify behavior vary
from praise, to attention to more concrete rewards, food.
Raises ethical Questions

Token economy operant conditioning procedure.

People earn a token of some sort for exhibiting a desired
behavior & can later exchange tokens for various
privileges/treats. Successful in various settings, cultures,
& many mental disorders.

Cognitive Therapies

Cognitive therapy that teaches people new, more

adaptive ways of thinking & acting; based on the
assumption that thoughts intervene btwn events & our
emotional reactions

Aaron Becks therapy for depression

Catastrophizing beliefs- recurring negative
themes of loss, rejection, abandonment, self-blaming &
over generalizing that perpetuate existing feelings of
depression

Cognitive-behavioral therapy popular

integrative therapy that combines cognitive therapy
(changing self-defeating thinking) w/ behavior therapy
(changing behavior). Seeks to restructure thinking
(retrain) people to restructure negative thinking

249_OCD.mp4

Becks Therapy for Depression

Aaron Beck (1979) suggests that depressed
patients believe that they can never be happy
(thinking) and thus associate minor failings (e.g.
failing a test [event]) in life as major causes for
their depression.
Beck believes that cognitions such as I can never
be happy need to change in order for depressed
patients to recover. This change is brought about
by gently questioning patients.
19

Cognitive Therapy
Teaches people adaptive ways of thinking & acting
based on the assumption that thoughts intervene
between events & our emotional reactions.

20

Stress Inoculation Training

Meichenbaum trained people to restructure
their thinking in stressful situations.

Relax, the exam may be hard, but it will

be hard for everyone else too. I studied
harder than most people. Besides, I dont
need a perfect score to get a good grade.

21

Group & Family Therapies

Utilized by all Therapy Types accept Psychoanalysis

Group Therapy

saves therapists time & clients money.

As is often no less effective than individual therapy
Occurs 1 time a week for about 90 minutes
Unique benefit: the social context allows people both to
discover that others have problems similar to their own &
to receive feedback as they try out new ways of
behaving

Family therapy
treats the family as a system
guides family members toward positive relationships &

Group & Family Therapies

Methods & Goals & Participation
Family therapists work with family groups to heal
relationships and to mobilize family resources
to help family members discover the role they play
within their familys social system
To open up communication within the family or the
help family members discover new ways of preventing
or resolving conflicts
Self-help support groups are widely used & require a
high live of involvement for success
Great for stigmatized illnesses (AIDS, Alcoholism, Anorexia,
etc)

Comparison of Psychotherapies

Comparison of Psychotherapies

Comparison of Psychotherapies

Comparison of Psychotherapies

Comparison of Psychotherapies

Comparison of Psychotherapies

Evaluating Psychotherapies

Evaluating Therapies
Who do people turn to for help with psychological difficulties?

31

Is Psychotherapy Effective?
It is difficult to gauge the effectiveness of
psychotherapy because there are different levels upon
which its effectiveness can be measured.

1. Does the patient sense improvement?

2. Does the therapist feel the patient has improved?
3. How do friends and family feel about the patients
improvement?
32

Clients Perceptions
If you ask clients about their experiences of
getting into therapy, they often overestimate its
effectiveness. Critics however remain skeptical.
1.
2.
3.

Clients enter therapy in crisis, but crisis may subside over

the natural course of time (regression to normalcy).
Clients may need to believe the therapy was worth the effort.
Clients generally speak kindly of their therapists.

33

Clinicians Perceptions
Like clients, clinicians believe in therapys success.
They believe the client is better off after therapy than
if the client had not taken part in therapy.

1.
2.

3.

Clinicians are aware of failures, but they believe

failures are the problem of other therapists.
If a client seeks another clinician, the former
therapist is more likely to argue that the client has
developed another psychological problem.
Clinicians are likely to testify to the efficacy of their
therapy regardless of the outcome of treatment.
34

Outcome Research
How can we objectively measure the
effectiveness of psychotherapy?

35

Is Psychotherapy Effective?

Client & Clinician perceptions of therapys effectiveness

are vulnerably to inflation from 2 Phenomena

Placebo effect &

Regression toward the Mean
the tendency for extreme or unusual scores to fall
back (regress) toward their average. Pg 702

Clients perceptions- justify & overly positive (placebo

effect or belief in a treatment = Placebo Treatment or
expectation of relief analogous with a reward)
Clinicians perceptions- seem to mainly recognize only other
clinicians failures
251_Therapeutic_Effectiveness.mp4

Outcome research
Meta-analysis a procedure for statistically
combining the results of many different research studies.

Outcome Research
Research shows that treated patients were 80% better
than untreated ones. Meta-analysis of a # of studies suggests that
1000s of patients benefit more from therapy than
those who did not go to therapy.

37

The Relative Effectiveness of

Different Therapies

Which psychotherapy would be most effective for

treating a particular & specific problem?
Disorder

Therapy

Depression, reducing
suicide risk

Behavior, Cognition, Interpersonal

Anxiety

Cognition, Exposure, Stress

Inoculation

Bulimia

Cognitive-behavior

Phobia, compulsions,
marital problems

Behavior

Bed Wetting

Behavior Modification

38

Evaluating Alternative Therapies

Eye movement desensitization &
reprocessing (EMDR) therapist attempts to
unlock & reprocess previous frozen traumatic memories
by waving a finger in front of the eyes of the client.
EMDR has not held up under scientific testing.

Light exposure therapy

Seasonal affective
disorder (SAD)
a form of depression, has been effectively treated by
light exposure therapy.

This form of therapy has been scientifically validated.

Commonalities Among Psychotherapies

Three commonalities shared by all forms of
psychotherapies are the following:

Hope for
demoralized people
A fresh perspective
An empathic,
trusting, caring
relationship

Culture & Values in Psychotherapy

Psychotherapists may differ from each other
& from clients in their personal beliefs,
values, & cultural backgrounds.
A therapist search should include visiting
two or more therapists to judge which one
makes the client feel more comfortable.

42

Therapists & Their Training

Clinical psychologists: They have PhDs mostly.
They are experts in research, assessment, and
therapy, all of which is verified through a
supervised internship.

Clinical or Psychiatric Social Worker (LCSW):

They have a Masters of Social Work.
Postgraduate supervision prepares some social
workers to offer psychotherapy, mostly to
people with everyday personal and family
problems.
43

Therapists & Their Training

Counselors: Pastoral counselors or abuse counselors
work with problems arising from family relations,
spouse and child abusers & their victims, &
substance abusers.
Psychiatrists: They are physicians who specialize in
the treatment of psychological disorders. Not all
psychiatrists have extensive training in
psychotherapy, but as MDs they can prescribe
medications.
44

The Biomedical Therapies

Introduction
Biomedical therapy - prescribed
medications or medical procedures that act
directly on the patients nervous system.

Drug therapy
Brain Stimulation (Electroconvulsive
therapy), Magnetic impulses
Psychosurgery
Psychiatrist

Drug Therapies

Psychopharmacology the study of the

effects of drugs on mind & behavior

Factors to consider with drug therapy

Normal recovery rate of untreated patients
Recovery due to Placebo effect
Double blind procedure
To test the effectiveness of a drug, patients are tested
with the drug & a placebo. 2 groups of patients & medical
health professionals are unaware of who is taking the drug
& who is taking the placebo.
In such studies several drugs have proven useful in
treating Psych Disorders`

Drug Therapies
Psychopharmacology is the study of drug effects on
mind & behavior.

Drug Therapies

Drug Therapies

Drug Therapies

Drug Therapies
However, many patients are left homeless on the
streets due to their ill-preparedness to cope
independently outside in society.

Les Snider/ The Image Works

52

Drug Therapies
Antipsychotic drugs drugs used to treat
schizophrenia & other forms of severe thought disorder

Psychoses
Chlorpromazine (Thorazine) classical
antipsychotic : remove a number of positive
symptoms associated with schizophrenia, such as
agitation, delusions, & hallucinations (dampens the
responsiveness to irrelevant stimuli)

Patients with negative symptoms, (withdrawal or

apathy) often do not respond well to these drugs

Drug Therapies
Antipsychotic drugs

Dopamine Block this neurotransmitter. Molecules are

small enough to occupy the dopamine receptor sites,
blocking its activity. This reinforces the belief that
overactive dopamine system contributes to
schizophrenia.
Side Effects : tremors, sluggishness, twitches, & Tardive
dyskinesia involuntary movements of the facial
muscles/tongue/limbs; possible neurotoxic side effect of
long-term use of drugs that target certain dopamine
receptors. (D2 receptors)
NEW GENERATION of Anti psychotic drugs- target D1 receptors &
have fewer side effect. BUT these drugs (clorazipine, Risperdal,
Zyprxa) not more effective & increase risk of obesity & diabetes
& require extreme monitoring to manage the proper dosage

Atypical Antipsychotic
Clozapine (Clozaril) blocks receptors for dopamine &
serotonin to remove the negative symptoms of
schizophrenia. Eg. apathy, jumbled thoughts,
concentration difficulties, & difficulties in interacting with
others
Also helps those with
positive symptoms that
did not respond to other
drugs.
Side Effect:
May cause toxic effect on
white blood cells

55

Drug Therapies
Antianxiety Drugs
Antianxiety drugs drugs used to control
anxiety & agitation

Xanax, Ativan,
cycloserine
Physiological

D-

dependence

Antianxiety Drugs
Antianxiety drugs (Xanax & Ativan) depress the central
nervous system & reduce anxiety & tension by elevating the
levels of the Gamma-aminobutyric acid (GABA)
neurotransmitter.

57

Drug Therapies
Antidepressant Drugs
Antidepressant drugs drugs used to treat
depression; also increasingly prescribed for anxiety.
Different types work by altering the availability of
various neurotransmitters.

Use with mood & anxiety disorders

Fluoxetine (Prozac), Paxil
Selective-serotonin-reuptake
inhibitors (SSRI)
Neurogenesis

Side effects of antidepressants

Drug Therapies
Antidepressant Drugs

Antidepressant drugs like Prozac, Zoloft, & Paxil are Selective

Serotonin Reuptake Inhibitors (SSRIs) that improve the mood
by elevating levels of serotonin by inhibiting reuptake.

Drug Therapies
Mood-Stabilizing Medications
Mood-stabilizing medications
Lithium
Depakote
Lithium Carbonate, a
common salt, has been used
to stabilize manic episodes
in bipolar disorders.
It moderates the levels of
norepinephrine & glutamate
neurotransmitters.

Brain Stimulation
Electroconvulsive Therapy
Electroconvulsive therapy (ECT) used
for severely depressed patients who do not
respond to drugs.

Procedure- The patient is

anesthetized &given a muscle
relaxant. Patients usually get a
100 volt shock that relieves
them of depression.

Severe depression
Problems/side effects

Brain Stimulation
Electroconvulsive Therapy

Brain Stimulation
Alternative Neurostimulation Therapies
Magnetic Stimulation
Repetitive transcranial magnetic
stimulations (rTMS) - the application of
repeated pulses of
magnetic energy to the
prefrontal regions brain;
used to stimulate
or suppress brain activity

Deep-Brain
Stimulation

Brain Stimulation
Alternative Neurostimulation Therapies

Psychosurgery
Psychosurgery was
popular even in Neolithic
times.

http://www.epub.org.br

Although used sparingly

today, about 200 such
operations do take place
in the US alone.

67

Psychosurgery
Psychosurgery is used as a last resort in alleviating
psychological disturbances.
Psychosurgery is irreversible. Removal of brain tissue
changes the mind.

68

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

Lobotomy a now-rare psychosurgical procedure

once used to calm uncontrollably emotional or
violent patients. The procedure cut the nerves
connecting the frontal lobes to the emotioncontrolling centers of the inner brain

History
Procedure
Side effects
Use today

Preventing Psychological Disorders

It is better to prevent than cure.
Peruvian Folk Wisdom

Preventing psychological disorders means

removing the factors that affect society.
Those factors may be poverty, meaningless
work, constant criticism, unemployment,
racism, & sexism.
70

Preventing Psychological
Disorders

Therapeutic Life-Style Change

Integrated biopsychosocial system
Therapeutic life-style change
Aerobic exercise
Adequate sleep
Light exposure
Social connection
Anti-rumination
Nutritional supplements

Preventing Psychological Disorders

Resilience the personal strength that
helps most people cope with stress and
recover from adversity and even trauma.

Preventing psychological disorders

Psychological Disorders are

Biopsychosocial in Nature

74

The End

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Eclectic Approach
= an approach to psychotherapy that,
depending on the clients problems, uses
techniques from various forms of therapy.

Psychotherapy
= treatment involving psychological
techniques; consists of interactions
between a trained therapist and someone
seeking to overcome psychological
difficulties or achieve personal growth.

Psychoanalysis
= Sigmund Freuds therapeutic technique.
Freud believed the patients free
associations, resistances, dreams, and
transferences and the therapists
interpretations of them released
previously repressed feelings, allowing the
patient to gain self-insight.

Resistance
= in psychoanalysis, the blocking from
consciousness of anxiety-laden material.

Interpretation
= in psychoanalysis, the analysts noting
supposed dream meanings, resistances,
and other significant behaviors and events
in order to promote insight.

Transference
= in psychoanalysis, the patients transfer to
the analyst of emotions linked with other
relationships (such as 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 seeks to
enhance self-insight.

Insight Therapies
= a variety of therapies that aim to improve
psychological functioning by increasing the
clients awareness of underlying motives
and defenses.

Client-centered Therapy
= a humanistic therapy, developed by Carl
Rogers, in which the therapist uses
techniques such as active listening within
a genuine, accepting, empathic
environment to facilitate clients growth.
(Also called person-centered therapy.)

Active Listening
= empathic listening in which the listener
echoes, restates, and clarifies. A feature
of Rogers client-centered therapy.

Unconditional Positive Regard

= a caring, accepting, nonjudgmental
attitude, which Carl Rogers believed would
help clients to develop self-awareness and
self-acceptance.

Behavior Therapy
= therapy that applies learning principles to
the elimination of unwanted behaviors.

Counterconditioning
= a behavior therapy procedure that used
classical conditioning to evoke new
responses to stimuli that are triggering
unwanted behaviors; includes exposure
therapies and aversive conditioning.

Exposure Therapies
= behavioral techniques, such as systematic
desensitization, that treat anxieties by
exposing people (in imagination or
actuality) to the things they fear and avoid.

Systematic Desensitization
= a type of exposure therapy that associates
a pleasant relaxed state with gradually
increasing anxiety-triggering stimuli.
Commonly used to treat phobias.

Virtual Reality Exposure

Therapy
= an anxiety treatment that progressively
exposes people to simulations of their
greatest fears, such as airplane flying,
spiders, or public speaking.

Aversive Conditioning
= a type of counterconditioning that
associates an unpleasant state (such as
nausea) with an unwanted behavior (such
as drinking alcohol).

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.

Cognitive Therapy
= 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-behavioral Therapy
= a popular integrative therapy that
combines cognitive therapy (changing selfdefeating thinking) with behavior therapy
(changing behavior).

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

Regression Toward the Mean

= the tendency for extreme or unusual
scores to fall back (regress) toward their
average.

Meta-analysis
= a procedure for statistically combining the
results of many different research studies.

Evidence-based Practice
= clinical decision-making that integrates the
best available research with clinical
expertise and patient characteristics and
preferences.

Biomedical Therapy
= prescribed medications or medical
procedures that act directly on the
patients nervous system.

Psychopharmacology
= the study of the effects of drugs on mind
and behavior.

Antipsychotic Drugs
= drugs used to treat schizophrenia and
other forms of severe thought disorder.

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.

Antianxiety Drugs
= drugs used to control anxiety and
agitation.

Antidepressant Drugs
= drugs used to treat depression; also
increasingly prescribed for anxiety.
Different types work by altering the
availability of various neurotransmitters.

Electroconvulsive Therapy
(ECT)
= a biomedical therapy for severely
depressed patients in which a brief electric
current is sent through the brain of an
anesthetized patient.

Repetitive Transcranial
Magnetic Stimulation (rTMS)
= the application of repeated pulses of
magnetic energy to the brain; used to
stimulate or suppress brain activity.

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

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

Resilience
= the personal strength that helps most
people cope with stress and recover from
adversity and even trauma.