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Chapter 14 treatments of psychological disorders

by: Melantha Liu

Chapter 14 treatments of psychological disorders PSYCH 202

Marketplace > University of Wisconsin - Madison > Psychlogy > PSYCH 202 > Chapter 14 treatments of psychological disorders
Melantha Liu

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Hello, guys, this is one of the last chapters we have been learning so far! Are you ready for the final? My notes have consisted of valuable information from the book and the powerpoint in-class. Y...
Introduction to Psychology
Patricia Coffey
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This 16 page Study Guide was uploaded by Melantha Liu on Thursday December 10, 2015. The Study Guide belongs to PSYCH 202 at University of Wisconsin - Madison taught by Patricia Coffey in Fall 2015. Since its upload, it has received 87 views. For similar materials see Introduction to Psychology in Psychlogy at University of Wisconsin - Madison.


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Date Created: 12/10/15
Chapter 14 treatments of psychological disorders Yiting Liu Outline 1. Treatment: getting help to those who need it a. Why people cannot or will not seek treatment b. Approaches to treatment 2. Psychological therapies: healing the mind through interaction a. Psychodynamic therapy i. Psychoanalysis ii. Beyond psychoanalysis b. Behavioral and cognitive therapies i. Behavior therapy 1. Eliminating unwanted behaviors 2. Promoting desired behaviors 3. Reducing unwanted emotional response ii. Cognitive therapy iii. Cognitive behavioral therapy c. Humanistic and existential therapies i. Person-centered therapy ii. Gestalt therapy d. Groups in therapy i. Couples and family therapy ii. Group therapy iii. Self-help and support groups 3. Medical and biological treatments: healing the mind through the brain i. Antipsychotic medications ii. Antianxiety medications iii. Antidepressants and mood stabilizers iv. Herbal and natural products v. Combining medication and psychotherapy vi. Biological treatments beyond medications 4. Treatment effectiveness: for better or for worse i. Treatment illusions ii. Treatment studies iii. Which treatment work? 1. Treatment: getting help to those who need it a. Why people cannot or will not seek treatment i. Not realize that their disorders need to be treated 1. Illness is “hidden”, can not be diagnosed by blood or X-rays ii. Barriers to treatment beliefs and circumstances 1. Believe they can handle disorders themselves 2. Family discourage/ feel ashamed about the people who have disorders 3. Financial obstacles iii. Not know where to look for services (problems notified) 1. More difficult to find the right psychologist b. Approaches to treatment i. Psychotherapy (mind) ii. Biological treatments (brain) iii. In some cases, mental disorder is treated with drugs or surgery iv. Example 1. Lisa’s fear of flying’s solution: virtual reality therapy v. PPT Eclecticism, the integration of different approaches 2. Psychological therapies: healing the mind through interaction a. Definition: Psychotherapy: an interaction between a therapist and someone suffering from a psychological problem, with the goal of providing support or relief from the problem Eclectic psychotherapy: treatment that draws on techniques from different forms of therapy, depending on the client and the problem Psychodynamic psychotherapies: a general approach to treatment that explores childhood events and encourages individuals to develop insight into their psychological problems Resistance: a reluctance to cooperate with treatment for fear of confronting unpleasant unconscious material Transference: an event that occurs in psychoanalysis when the analyst begins to assume a major significance in the client’s life and the client reacts to the analysts based on unconscious childhood fantasies Behavior therapy: a type of therapy that assumes that disorders behavior is learned and that symptom relief is achieved through changing overt maladaptive behaviors into more constructive behaviors Token economy: a form of behavior therapy in which clients are given “tokens” for desired behaviors, which het can later trade for rewards Exposure therapy: an approach to treatment that involves confronting an emotion-arousing stimulus directly and repeatedly ultimately leading to a decrease in the emotional response Cognitive therapy: a form of psychotherapy that involved helping a client identify and correct any distorted thinking about self, others or the world Cognitive restructuring: a therapeutic approach that teaches clients to question the automatic beliefs, assumptions, and predictions that often lead to negative emotions and to replace negative thinking with more realistic and positive beliefs Mindfulness meditation: a form of cognitive therapy that teaches an individual to be fully present in each moment; to be aware of his or her thoughts, feelings, and sensations; and t detect symptoms before they become a problem Cognitive behavioral therapy (CBT): a blend of cognitive and behavioral therapeutic strategies Person-centered therapy: an approach to therapy that assumes all individuals have a tendency toward growth and his growth can be facilitated by acceptance and genuine reactions from the therapist Gestalt therapy: an existentialist approach to treatment with the goal of helping the client to become aware of his or her thought, behaviors, experiences, and feelings and to “own” or take responsibility for them Group therapy: therapy in which multiple participants (who often do not iknow one another at the outset) work on their individual problems in a group atmosphere. b. Psychodynamic therapy (explore childhood experience, develop insights to psychological problems) (develop unconscious feelings that could underlie the problems) i. Psychoanalysis (Freud) 1. Presentations a. Face away from the analyst b. Talk and comment about feelings at that time c. Analysts express no opinions or judgments 2. Ways a. Free associations (patients sharing) (develop insight) i. Dream analysis: look for elements that symbolize unconscious conflicts or wishes ii. Recurring themes 3. Related terms a. Resistance: reluctance to cooperate with treatment or fear of confronting unpleasant unconscious material b. Transference: when the analyst begins to assume a major significance in the client’s life and the client reacts to the analyst based on unconscious childhood fantasies 4. Traditional psychoanalysis: 3—6 years with 4—5 sessions per week a. Psychoanalyst believes that i. Human are born with aggressive and sexual urges that repress the childhood development ii. Psychoanalysis if to bring the unrepressed conflicts into consciousness iii. So patients can understand and reduce the unwanted influences 5. PPT Video clip: psychodynamic and humanistic therapies a. Explore childhood memoriesà psychological difficultiesà Freud’s free association b. Techniques (explore the structure of the memory) i. Free association ii. Dream analysis iii. Interpretation of thoughts and actions iv. Analysis of resistance to psychological treatment c. Contents: i. Client lying down ii. Freud sitting behind his clients d. Contents for humanistic approach i. Facing each other ii. Genuinely accepting the client iii. Search for meaning 6. PPT Psychoanalytic approach a. Anger turned inwards b. Goal: insight, make the unconscious conscious, expand the ego’s control c. Ways i. Free association ii. Analysis of transference iii. Dream analysis 1. Transferring your feelings towards persons in your life to therapist ii. Beyond psychoanalysis 1. Disagreements a. Alfred Adler i. Insight involved unconscious conflicts about sec and aggression b. Jung i. Collective unconscious (culturally determined rather than gender or aggression determined knowledge) c. Melanie Klein i. Fantasies of loss and persecution are factors of mental illness 1. E.g.: parent-dying; Being bullied d. Karen Horney i. It should be the difference to society and culture rather than biology (gender differences) 2. Conclusions: a. All agree that society’s conflicts can reflect the individual’s role in the society 3. Differences between modern psychodynamic psychotherapies and classical psychoanalysis a. In modern i. Face-to-face ii. Weekly sessions that last for months rather than years iii. Goal to see the relief from symptoms iv. More likely to offer support v. Less likely to interpret patients’ statements iii. PPT Conclusion: 1. Not common anymore 2. Not research supporting for it 3. More in east coast than west coast c. Behavioral and cognitive therapies i. Behavior therapy (disordered behavior is learned through changing overt maladaptive behavior into more constructive behaviors) 1. Eliminating unwanted behaviors a. Operant conditioning: behavior can be predicted by its consequences (reinforcing or punishing events) b. Less reinforcing and more punishing c. Example: change 3-year-old boy’s habit of throwing tantrums at grocery store i. No candy (less reinforcing) ii. Period of time-out in the care (more punishing) 2. Promoting desired behaviors a. Token economy: giving clients “tokens” for desired behaviors, which they can later trade for rewards b. Learned behaviors are not usually maintained when the reinforcements are discontinued 3. Reducing unwanted emotional response a. Exposure theory: confronting an emotion-arousing stimulus directly and repeatedly unlimitedly leading to a decrease in the emotional response b. Process: habituation and response extinction c. Conclusion: fear decreases, the client progress to more difficult or frightening situations ii. Cognitive therapy (Correct distorted thinking about self, others and world.) 1. Cognitive restructuring: question the automatic beliefs, replace negative thinking into realistic and positive ones 2. Mindfulness meditation: teach to be fully present in each moment, aware of thoughts, detect symptoms before they become a problem 3. Example 1 a. Dog bite may develop dog phobia b. Focus on the meaning of the event 4. Example 2 a. Never pass the college, based on the one poor grade b. Ways to solve: consider relevant evidence such as grades on previous exams iii. Cognitive behavioral therapy (CBT) à 1. Problem focused (specific)+ action oriented (do) 2. Blend of cognitive and behavior therapeutic strategies 3. Disorders: unipolar depression, generalized anxiety disorder, panic disorder, social phobia, post-traumatic stress disorder, childhood depressive and anxiety disorders 4. PPT Seligman’s ABCDE Model is example of cognitive- behavioral approach a. Adversity i. Negative event, objective b. Beliefs i. What did we think c. Consequences i. What did beliefs cause d. Dispute i. Distorted beliefs ii. Argue with yousrself iii. Dialogue internally e. Evaluate i. Learning to examine own thought process 5. PPT Beck’s “Cognitive Triad” (3 fundamental distortions in rational processing) a. Negative view of i. Self ii. World iii. Future b. Key errors in thinking i. All or nothing thinking 1. All good or all bad ii. Overgeneralization 1. Make mistakes and then assume “I never do anything right” 2. “Should” a. have a list of rules about how we and other people should act b. if people break the rules, we are angry c. if we violate others’ rules, we are guilty d. Humanistic and existential therapies i. Person-centered therapy/ client-centered therapy 1. All individuals have a tendency towards growth and that this growth can be facilitated by acceptance and genuine reactions from the therapist 2. Not to provide suggestions to patients 3. Clients will recognize the right things to do 4. Basic qualities (3) a. Congruence: open and honest in the therapeutic relationship; same message at the same level b. Empathy: trying to understand inside way of thinking i. Better appreciate the clients’ apprehensions, worries, or fears c. Unconditional positive regard i. Nonjudgmental, warm, accepting environment ii. Gestalt therapy 1. Goal of helping the client to become aware of his or her thoughts, behaviors, experiences, and feelings and to “own” or take responsibility for them 2. Emphasize experiences and behaviors at the particular moment in the therapy session 3. Technique: a. Focusing b. Empty chair technique (prevent there is somebody in an empty chair, in front of the client) (role-playing) (life- couching) e. Groups in therapy i. Couples and family therapy 1. Work on problems arising in the relationships 2. Target changes on both parties of the relationships 3. ii. Group therapy 1. Multiple participants (who often do not know one another at the outset) work on their individual problems in a grope atmosphere 2. Advantages: a. Practice relating to others b. Helpful for socially isolated people iii. Self-help and support groups 1. Discussion or internet chat groups, run by peers 2. Examples: a. AA (Alcoholics Anonymous); Gamblers Anonymous; Al- Anon (program for the family and friends of those with alcohol problems) b. Although this type of therapy can be helpful, it can still do more harm than good i. disruptive or aggressive or encourage one another to engage in behaviors that are counter therapeutic (avoiding feared situations or using alcohol to cope) 3. Medical and biological treatments: healing the mind through the brain a. Definition: Antipsychotic drugs: medications that are used to treat schizophrenia and related psychotic disorders Psychopharmacology: the study of drug effects on psychological states and symptoms Antianxiety medications: drugs that help reduce a person’s experience of fear or anxiety Antidepressants: a class of drugs that help lift people’s mood Electroconvulsive therapy (ECT): a treatment that involved inducing a mild seizure by delivering an electrical shock to the brain Transcranial magnetic stimulation (TMS): a treatment that involved placing a powerful pulsed magnet over a persons scalp which alters neuronal activity in the brain Phototherapy: a treatment for seasonal depression that involved repeated exposure to right light Psychosurgery: surgical destruction of specific brain areas b. Antipsychotic medications i. Treat schizophrenia and related psychotic disorders ii. Chlorpromazineà sedative; thioridazine (Mellaril), haloperidol (Haldol) iii. Psychopharmacology: the study of drug effects on psychological states and symptoms iv. Dopamine hypothesisà increased dopamine activity related to positive symptoms of schizophrenia such as hallucinations and delusions but decreased dopamine activity related to negative symptoms of emotional numbing and social withdrawal à, results that the psychotic medications do not relieve negative symptoms well v. Types: 1. Atypical antipsychotics: newer drugs such as clozapine (Clozaril), risperidone (Risperidal), olanzapine (Zyprexa) a. Block dopamine, serotonin receptions b. Serotonin: mood disorders c. So atypical ones can provide relief for both positive and negative symptoms 2. Conventional or typical antipsychotics: older drugs vi. Side effects: 1. Involuntary movements of the face, mouth, extremities c. Antianxiety medications i. Benzodiazepines: tranquiller facilitates the action of the neurotransmitter gamma-aminobutyric acid (GABA) ii. Side effects 1. Addictive 2. Drowsiness 3. Negative effects on coordination and memory 4. Benzodiazepines combined with alcohol can depress respiration,à accidental death d. Antidepressants and mood stabilizers (lift people’s moods) i. Monoamine oxidase inhibitors (MAOIs) 1. Prevent enzyme monoamine oxidase from breaking down neurotransmitter such as norepinephrine, serotonin, dopamine 2. Side effects: dizziness, loss of sexual interest, dangerous interactions with other common medications ii. Tricyclic antidepressants 1. Block the reuptake of norepinephrine and serotonin 2. Increase the amount available for synaptic space 3. Serious side effects a. Dry mouth, constipation, difficulty urinating, blurred vision, racing heart iii. SSRI (selective serotonin reuptake inhibitors) 1. Fluoxetine (Prozac), citalopram (Celexa), and paroxetine (Paxil) 2. Block the reuptake of serotonin in the brain 3. More serotonin in the synaptic spaces between neurons 4. Called “selective” a. Because it only works on serotonin rather than norepinephrine and serotonin like tricyclic antidepressants do iv. SNRI (serotonin and norepinephrine reuptake inhibitor) 1. Effexor v. NDRI (norepinephrine and dopamine reuptake inhibitor) 1. Wellbutrin vi. Attention! 1. Antidepressants are suitable for depressions but not suitable for bipolar disorders (depressive and manic episodes) a. Can trigger manic episode 2. Bipolar disorders should only be treated with mood stabilizers a. Suppress swings between mania and depression 3. e. Herbal and natural products i. Reasons for their usages: cheap, available ii. They are all nutritional supplements≈ foods iii. Herbal medications are worthy of researching but need close monitoring iv. Could still have serious side effects f. Combining medication and psychotherapy i. Schizophrenia and bipolar disorders: medications work the best ii. Anxiety disorders: medications and psychotherapy are the same iii. Conclusion: combination works the best iv. Study 1. Citalopram (SSRI) or CBT 2. Patients in both groups are to speak in public 3. Similar reeducations in activation in the amygdala, hippocampus and cortical areas 4. Hence: therapy and medication affect the brain in regions associated with a reaction to threat v. Occupations 1. Psychiatrist: administration of medicines 2. Psychologists: psychotherapy; can not prescribe mediation 3. Coordination of treatment often requires cooperation between psychologists and psychiatrists g. Biological treatments beyond medications i. Electroconvulsive therapy (ECT): “shock therapy”à inducing mild seizure by delivering an electrical shock to the brain (to the scalp for less than a second) 1. To treat severe depression, mania 2. Side effect 3. Impaired short-term memory 4. Headaches 5. Muscle aches 6. ECT is more effective ii. Transcranial magnetic stimulation (TMS) 1. Placing a powerful magnet over a person’s scale, which alters neuronal activity in the brain 2. Noninvasive 3. Side effects a. Mild headache b. Risk of seizure small c. No impact on memory or concentration 4. Treatments for a. Depression (which is unresponsive to medication) b. Auditory hallucinations in schizophrenia iii. Phototherapy (happy light) 1. Repeated exposure to bright light 2. Seasonal pattern to their depression 3. Seasonal affective disorder (SAD) 4. 2 hours per day for a weekà effective iv. Psychosurgery 1. Surgical destruction of specific brain areas a. Rarely used procedure b. Sever connections between the frontal loves and inner brain structures such as thalamus (emotions), reduce violence or agitation 2. Side effects a. Extreme lethargy/ Childlike impulsivity detracted from these benefits b. Example: i. Patients with OCD failed to respond to treatments [such as medications and cognitive-behavioral treatment(CBT)] ii. Benefit from the surgery iii. By destroying the cingulate gyrus and corpus callosum 3. Another method: a. Deep brain stimulation: battery-powered device is implanted in the brain b. Can treat OCD patients and sever depression that are otherwise untreatable 4. Treatment effectiveness: for better or for worse a. Definition: Placebo: an inert substance or procedure that has been applied with the expectation that a healing response will be produced. Iatrogenic illness: a disorder or symptom that occurs as a result of a medical or psychotherapeutic treatment. (doctors think normal people have disorders) b. Treatment illusions i. Natural improvement: tendency of symptoms to return t their mean or average level 1. People seeking help at their worst situation 2. No matter if the therapy works, they will still improve 3. They may think the therapy works 4. But in fact, not really ii. Nonspecific treatment effects 1. Knowing that you are going to get a treatment 2. Placebo effect : an inert substance or procedure that has been applied with the expectation that a healing response will be produced è Positive influences (sugar rather than Prozac for patients with OCD) 3. Study: a. Two groups of people getting sugar (placebo) and Prozac separately for the treatment of OCD b. Both of them showed improvements c. So the treatments which are specific to their disorders helped d. But people tend to think of the medicine worked (nonspecific treatment effects) 4. Reconstructive memory a. Patients consider improvements b. But they just misremembered their symptoms were worse than they are at that moment c. Treatment studies i. Outcome studies: evaluate whether a particular treatment works 1. Outcome of the treatment for depression, researcher might compare the self reported moods and symptoms of two groups of people who were initially depressed 2. Outcome study can determine whether this treatment had any benefit ii. Process studies: to answer questions regarding why a treatment works or under what circumstances it works iii. Both outcome and process studies can be plagues by treatment illusions, scientists try to overcome them 1. Random selection in the same population of the patients to avoid natural improvement and reconstructive memory 2. Double-blind experiment to avoid nonspecific effects d. Which treatment work? i. Typical psychotherapy client is better off than three quarters of untreated individuals ii. Drugs for treatment of depression may have side effect such as lack of sexual interest, anxiety for intoxication, agitation for lethargy dulled emotion iii. Iatrogenic illness: 1. Doctors or psychologists are convinced that normal people have certain disorders iv. So ethical standards can restrain the illness 1. Benefit clients and do no harm 2. Establish trusting relationships with clients 3. Maintain accuracy, honesty and truthfulness 4. Seeking fairness in treatment and taking precautions to avoid biases 5. Respecting the dignity and worth of all people 5. PPT Biological therapies are necessary for some disorders a. Psychotropic medications affect neurotransmitter processes b. Antianxiety drugs affect GABA (neurotransmitter) c. Depression drugs affect serotonin and norepinephrine d. Antipsychotic drugs affect dopamine i. Dopamine: affect feelings ii. Serotonin: situations iii. Norepinephrine: alertness e. People with schizophrenia delusion and hallucination can match the state of depression f. Antidepressant drugs i. Agonist (increase the level of neurotransmitter) ii. MAO inhibitors iii. Tricyclic’s iv. SSRI’sà norepinephrine 1. Selective serotonergic reuptake inhibitors 6. PPT Treatment for bipolar disorder a. Medication: lithium carbonate; anti-manic properties with 80% positive response in actively manic patients (also reduce depressions) i. Side effect 1. Reducing level of norepinephrine (too high will become manic episode) b. Adjunctive psychotherapy for i. Medication management ii. Family and social relationships iii. Education iv. Problem solving and “reality testing” 1. Also applies to schizophrenia 2. Adjust their perception about the unreal things in their heads c. Lithium is most effective for bipolar disorder i. Only 20% maintain their medications experience relapse ii. Stabilizes mood but the mechanisms are unclear iii. Greater on mania than depression iv. Discontinue medication due to “intoxicating pleasure” of manic states 7. PPT Summary of the most effective mood disorder treatments a. Anxiety disorders à behavior and cognition (learned component) b. DepressionàMany effective treatments c. Bipolar disorderà lithium d. Cognitive: OMG, I am going to have a panic attack! * 5 e. Counter cognition: its ok, I will be ok even if I have a panic attack! 8. PPT Common factors enhancing treatment a. Psychotherapy helps i. Caring therapists ii. Catharsis and confession 9. PPT A new approach to understanding mental disorders: RDoC a. Research domain criteria project i. Shift the focus ii. Away from classifying based on surface symptoms iii. To understanding of the processes that give rise to disordered behaviors iv. Study causes of abnormal functioning on 1. Biological factors: genes, cells, brain circuits 2. Psychological factors: learning, attention, memory 3. Social process and behavior


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