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This 7 page Class Notes was uploaded by Jacquelyn Corpus on Wednesday March 2, 2016. The Class Notes belongs to Psy 202 at Oregon State University taught by Patti Watkins in Winter 2016. Since its upload, it has received 39 views. For similar materials see General Psychology in Psychlogy at Oregon State University.
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Date Created: 03/02/16
Chapter 16: Treatment of Psychological Disorders Why people cannot or will not seek treatment Personal costs and social burdens associated with mental disorders are enormous Impairment to social-occupational functioning - Anxiety Disorders equivalent to Chronic medical illnesses - Mental Disorders account for a large Proportion of workplace disability Claims - Only 30% of those with anxiety or depression get mental health treatment—many despite visiting a primary care physician - Panic Disorder Stigma People may not acknowledge they have a problem Even people who acknowledge they have a problem may not know where to look for services When people seek help, they sometimes do not receive the most effective treatments - Many people seeking treatment for anxiety disorders have previously received (ineffective) treatments other than cogintive-behavoiral therapy The Real World: Types of Psychotherapists There are a white variety of mental professionals - Psychologists (PhD or PsyD degree—Licensed byAPA) - Psychiatrists (MD degree—can prescribe medications) - Social Workers (MSW—Licensed to practice) - Counselors (great variation in training, competence) It is important to do your research and shop wisely before selecting a mental health professional - ConsultAPAwebsite Approaches to Treatment There are 3 categories of treatment - Psychotherapy: an interaction between a therapist and someone suffering from a psychological problem, with the goal of providing support or relief form the problem - Eclectic psychotherapy: treatment that draws on techniques from different form of psychotherapy, depending on the client and the problem - Medical/biological therapy - Combined psychotherapy and medical therapy Hydrotherapy: historic treatment approaches often did more harm than good Psychodynamic Therapy Psychodynamic psychotherapies: explore childhood events and encourage individuals to use this understanding to develop insight into their psychological problems - Goal to develop insight into unconscious drives that may be underlying (insight) - Psychoanalysis assumes that humans are born with aggressive and sexual urges that are repressed during childhood (defense mechanisms) - Therapy meant to overcome repression, bring unconscious material to light Insight may be developed through several techniques - Free association, dreams analysis, interpretations, analysis of resistance - Resistance: a reluctance to cooperate with treatment for fear of confronting unpleasant unconscious material - Catharsis: releasing intense, unconscious emotions in therapy - 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 analyst based on unconscious childhood fantasies Beyond Psychoanalysis Many contributions of those who followed Freud and broke away: - Carl Jung (1875-1961) emphasized the collective unconscious - AlfredAdler (1870-1937) linked emotional conflict to perceptions of inferiority - Inferiority complex - Melanie Klein (1882-1960) believed primitive fantasies of loss and persecution may underlie mental illness - Karen Horney (1885-1952) emphasized the differences between men and women in society and culture Interpersonal psychotherapy (IPT): a form of psychotherapy that focuses on helping clients improve current relationships - Focus on grief, role disputes, role transitions, interpersonal deficits Humanistic and Existential Therapies Humanistic and existential therapies assume that human nature is generally positive and emphasize the natural tendency to strike for personal improvement Person-centered therapy: assumes that all individuals have a tendency toward growth and this growth can be facilitated by acceptance and genuine reactions from the therapist Gestalt therapy: has the goal of helping the client become aware of his or her thoughts, behaviors, experiences, and feelings and to “own” or take responsibility for them Humanistic Therapy Carl Rogers - Person-centered therapy - Therapist shows unconditional positive regard for the patient - Genuine liking and empathy for the client, regardless of what he or she has said or done - Non directive approach Behavioral Treatment Uses principles of classical and operant conditions - Token economies: child behavior problems, schizophrenia, substance abuse - Operant conditioning - Skinner’s schedules of reinforcement - Systematic desensitization: anxiety disorders - Classical conditioning - Flooding/Exposure Therapy:Anxiety Disorders - Classical conditioning Behavior Therapies Behavior therapy: assumes that disordered behavior is learned that symptoms relief is achieved through changing overt maladaptive behaviors into more constructive behaviors—utilizes operant and classical conditioning - Eliminating unwanted behaviors: consequences - Promoting desired behaviors - Token economy: a form of behavior therapy in which clients are given “tokens” for fired behaviors, which they can later trade for rewards - Reducing unwanted emotional responses - Exposure therapy: involves confronting an emotion-arousing stimulus directly and repeatedly, ultimately leading to a decrease in the emotional response - Systematic desensitization: a procedure in which a client relaxes all the muscles of his or her body while imagining being in increasingly frightening situations Cognitive and Cognitive Behavioral Therapy Cognitive therapy: involves help a client identify and correct any distorted thinking abbot 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 thinking with more realistic and positive beliefs - Mindfulness meditation: teaches and individual to be fully present in each moment—to be aware of his or her thoughts, feelings, and sensations and to detect symptoms before they become a problem Cognitive Behavioral Therapy (CBT): a blend of cognitive and behavioral therapeutic strategies Cognitive and Cognitive-Behavioral Treatments Cognitive therapy - Works to restructure irrational thought patterns - Distorted thinking: stress, anxiety, depression - Overgeneralization, self-blame, catastrophizing, etc. Cogintive-Behavoiral therapy - Combines techniques for restructuring irrational thoughts with operant and classical conditions techniques to shape desirable behaviors - Video of panic, OCD, specific phobia, PTSD Groups in Therapy Couples therapy is when a married, cohabitation or dating couple is seen together in therapy to work on problems usually arising within the relationship Family therapy is psychotherapy involving family members in a dysfunctional family Group therapy is psychotherapy in which multiple participants (who often do not know one another at the outset) work on their individual problems in a group atmosphere - Universality-learning you are not alone with a problem—“in the same boat” as others - Learn new ways of coping from others with similar problems Self-help and support groups involve discussion or internet chat group that focus on a particular disorder or difficult life experiences and are often run by peers who have struggled with the same issues The Real World: History of Treating Mental Illness For much of history, mentally ill people have been mistreated imprisoned, or become homeless During the 18th century, asylums were developed to house and create the “insane” Benjamin Rush (1746-1813) and Dorothea Dix (1802-1877) championed the human treatment of the mentally ill Bedlam and abuse in asylums continued, despite Dix’s campaign Bedlam referred to as a “human zoo” Deinstitutionalization began in the 1960s Community mental health and drug treatments - Increased autonomy of sufferers Mental health funding decreased in 1980s - Resulted in homelessness, lack of support Antipsychotic Medications Psychopharmacology: the study of drugs effects of psychological states and symptoms Antipsychotic drugs: medications that are used to treat schizophrenia and related psychotic disorders - Block dopamine receptors—works well for positive symptoms - Atypical antipsychotics work on both dopamine and serotonin systems Drug Therapies Drug treatments for schizophrenia - TraditionalAntipsychotics (Haldol, Thorazine) - AtypicalAntipsychotics (Clozapine) - First choice of treatment - Block dopamine receptors in brain - Diminish hallucinations, confusion, agitation, and paranoia - AtypicalAntipsychotics have fewer side affects: twisting the tongue, chewing, sucking, puckering lips, blinking eyes, facial tics, etc. Anti-anxiety Medications Anti-anxiety medications: drugs that help reduce a person’s experience of fear or anxiety - Facilitates GABAaction - Issues of tolerance and withdrawal Antidepressants and Mood Stabilizers Antidepressants: a class of drugs that help lift people’s mood - Monoamine oxidase inhibitor (MAOI) tricyclic antidepressants, selective serotonin reuptake inhibitor (SSROI), serotonin and norepinephrine reuptake inhibitor (SNRI), norepinephrine and dopamine reuptake inhibitor Mood stabilizers used to treat bipolar disorder—used to suppress swings between mania and depression Drug Therapies Drug treatments for mood and anxiety disorders - Monoamine oxidase (MAO) inhibitors - Break down neurotransmitters in brain (e.g. serotonin) - Among first medications for depression - Dangerous side-effects (e.g. hypertension) - Tricyclic antidepressants - Block the reuptake of both serotonin and norepinephrine - Many side-effects (e.g. weight gain, irritability, dry mouth) - Selective serotonin reuptake inhibitors (SSRIs) - Block serotonin reuptake making more available in synapse - Fewer side-effects - E.g. Prozac, Zoloft, Lexapro, Celexa - Bupropion (Wellburtin) - Prescribed for depression - Inhibits reuptake of norepinephrine and dopamine - Benzodiazepine and barbiturates - Prescribed for anxiety (having calming effect) - Have risk of addiction and overdose - “Mother’s little helper” - E.g. Valium, Librium, Xanax - Lithium - Prescribed for mania associated with bipolar disorder - Mechanism unknown - May severe side-effects, risk of medical complications and overdose - Patients take regular blood tests to monitor possible toxicity Combining Medication and Psychotherapy Combination of treatment which is most effective depends on the individual and his or her disorder symptoms Research has shown that both therapy and medication affect brain regions associated with reaction to threat Coordination of both forms of treatment may require corporation between psychologists and psychiatrists Medications and Psychotherapy Works best for mood and anxiety disorders CBT combined with drugs has been used most effectively to manage depression Biological Treatments Beyond Medication Electroconvulsive therapy (ECT): a treatment that involves inducing a mild seizure by delivering an electoral shock to the brain - May be used to treat severe depression and/or mania —last resort treatment for severe depression - Creates some permanent memory loss and other cognitive damage - Used to treat severe depression when less invasive treatments are ineffective Transcranial magnetic stimulation (TMS): a treatment that involves placing a powerful pulsed magnet over a person’s scalp, which alters neuronal activity in the brain - May be used to treat depression - Fewer side effects than ECT Phototherapy: a therapy that involves repeated exposure to bright light - May be used to treat seasonal affective disorder Psychosurgery: the surgical destruction of specific brain areas Prefrontal lobotomy: connections are severed between the prefrontal cortex and th slower portion of the brain - Thought to modify behavior and possibly disengage disruptive thought patterns involved in hallucinations and confused thinking - Produced profound problems - Reduced some to a vegetative state - E.g. President Kennedy’s sister Rose Treatment Illusions People may improve mental health because of: - Natural improvement - Spontaneous remission - Non-specific treatment effects - Simply talking to someone - Placebo: an inert substance or procedure that has been applied with the expectation that a healing response will be produced Treatment Studies Outcome studies are designed whether treatment works —often in comparison to another treatment or control Process studies are designed to answer questions why a treatment works or under what conditions In double-blind experiments, both the patient and the researcher/therapist are uninformed about which treatment the patient is receiving Which Treatments Work? Today’s studies show the typical psychotherapy client is better off than three quarters of untreated individuals Empirically-validated treatments define two levels of support: well-established treatments and probably efficacious treatments Iatrogenic illness: a disorder or symptom that occurs as a result of a medical or psychotherapeutic treatment - Body image distress as a result of weight loss interventions Psychologists hold themselves to APAethical standards Cogintive-Behavoiral Therapies have best track of empirical support
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