Treatment Methods

1
Treatment Methods

• Abnormal Psychology

2
Treatment in the textbook

• chapter 3 is an overview of general issues
  involved in treatment
• each chapter on specific disorders will include a
  section on treatment

3
How should we think about psychotherapy?

• is it a form of entertainment (like
  palm-reading)?
• a service (like investment counseling or SAT
  preparation)?
• a medical treatment (like a drug or surgery)?

4
Basic principles for treatment

• goal is to help person change
• use treatments proven to work first
• recommend treatments that work rather than what
  therapist likes
• treatment works for many problems
• it does not work for some problems

5
Forms of psychotherapy

• Psychoanalytic therapy
• Behavior therapy
• Cognitive therapy
• Client-centered therapy

6
Client-centered therapy

• Carl Rogers (and others)
• genuineness, accurate empathy, and unconditional
  positive regard
• the basic building blocks of therapy

7
Common elements of psychotherapy

• an intense, personal, confiding relationship
• a myth, which includes
• an explanation for the cause, and
• an explanation for the solution

8
Common elements ofpsychotherapy

• provision of information about the problem or the
  clients behavior
• the placebo effect
• success experiences and support

9
Assumptions in psychoanalysis

• symptoms are symbolic of underlying conflict
• symptoms are determined by defense mechanisms
• insight will relieve symptoms

10
Psychoanalytic procedures

• free association
• dream interpretation
• analysis of the transference

11
Behavior therapy assumptions

• behavior is determined by antecedents and
  consequences
• these are the causes (BT does worry about
  causes)
• changing behavior can lead to emotional changes
• insight is not enough

12
Behavior therapy procedures

• exposure and response prevention
• progressive muscle relaxation
• skills training or behavioral rehearsal (e.g.,
  assertiveness training parent skills training
  communication training for couples)

13
Cognitive therapy assumptions

• emotions determined by self-statements (not
  events themselves)
• people aware of, and can discuss, cognitive
  events
• intensity and duration of negative emotions can
  be diminished by teaching more rational cognitions

14
Cognitive therapy procedures

• recognize maladaptive (irrational)
  self-statements
• substitute adaptive cognitions
• rehearsal (e.g., keeping daily diaries)

15
Psychopharmacology (OCD)

• tricyclic antidepressants (TCAs)
• clomipramine (Anafranil)
• selective serotonin reuptake inhibitors (SSRIs)
• fluoxetine (Prozac)

16
Medication and mental disorders

• most discovered by accident
• many are useful with various types of mental
  disorders
• there are sometimes (often?) side-effects of
  varying levels of severity
• compliance is an issue

17
Medication and mental disorders

• they are seldom miracle cures
• non-specific effects (e.g., anti-depressants work
  for panic)
• some people dont respond at all
• relapse rates are sometimes high following
  discontinuation

18
The need for treatment research

• this field is notorious for embracing new
  treatments without data
• lobotomy in the 1930s
• eye-movement desensitization EMDR

19
Evaluating psychotherapy

• must ask specific questions
• what kind of treatment?
• for what kind of problem?
• administered by whom?

20
The experimental method

• investigator has control of the independent
  variable
• allows strong causal inferences
• outcome research is one of the only situations in
  psychopathology that allows experiments to be done

21
Efficacy vs effectiveness

• efficacy does it work in a pure laboratory
  environment?
• effectiveness does it work in the real world?

22
Meta-analysis

• lumping together results from several studies

23
How was change measured?

• clinicians judgments of overall adjustment?
• self-report of symptoms by clients?
• other peoples ratings of social and occupational
  functioning?

24
Who gets counted?

• everyone who started treatment?
• only those who finished?
• what about dropouts?

25
Control groups included?

• no treatment group?
• placebo control group?
• can expectations be equated?
• are waiting list groups ethical?

26
How was treatment defined?

• were procedures manualized?
• was compliance by therapists monitored?
• how many sessions were employed?

27
Who were the therapists?

• what kind of training?
• how much experience?
• how were clients assigned to therapists?

28
Who were the clients?

• how impaired or severely disturbed?
• were people with co-morbid conditions excluded?

29
When was outcome measured?

• at the end of treatment?
• after a 1-year followup?
• was maintenance treatment required or allowed?
  what kind?