Treatment of psychological disorders

1
Treatment of psychological disorders

• Chapter 16

2
Types of Treatment

• Analyze This and Analyze That - misconceptions
• Types of therapies
• Insight therapies
• talk therapy
• Behavior therapies
• Changing overt behavior
• Biomedical therapies
• Biological functioning interventions

3
Who Seeks Treatment?

• 15 of U.S population in a given year
• Most common presenting problems
• Anxiety and Depression
• Treatment seeking for various disorders Figure
  15.1
• Mood disorders
• Utilization rates Figure 15.2
• Women more than men
• Medical insurance
• Education level
• Psychological Disorders and professional
  treatment Figure 15.3

4
Figure 15-1 Treatment seeking for various
disorders
5
Figure 15-2 Therapy utilization rates Olfson
et al. (2002)
6
XX 15.3
7
Who Provides Treatment?

• Clinical psychologists
• Counseling psychologists
• Psychiatrists
• Clinical social workers
• Psychiatric nurses
• Counselors
• On-line treatment?

8
(No Transcript)
9
Insight Therapies Psychoanalysis

• Sigmund Freud and followers
• Goal discover unresolved unconscious conflicts -
  Figure 15.4
• Free association
• Dream analysis
• Interpretation
• Resistance and transference
• Psychodynamic Therapies

10
Insight Therapies Client Centered Therapy

• Carl Rogers
• Cause Figure 15.5
• Goal restructure self-concept to better
  correspond to reality
• Therapeutic Climate
• Genuineness
• Unconditional positive regard
• Empathy

11
Therapies Inspiredby Positive Psychology

• Martin Seligman
• Uses theory and research to better understand the
  positive, adaptive, creative, and fulfilling
  aspects of human existence
• well-being therapy
• positive psychotherapy
• can be an effective treatment for depression F
  15.6

12
Figure 15.6 Positive psychotherapy for depression
13
Other issues

• Groups therapy
• Group size
• Advantages social dimension of change
• Effectiveness of Insight therapies Figure 15.7
• Spontaneous remission
• Talk therapies or other approaches?
• Common factors contribute to progress in those
  treated

14
Figure 15.7 Recovery as a function of number of
therapy sessions
15
Behavior Therapies

• B.F. Skinner and colleagues
• Goal unlearning maladaptive behavior and
  learning adaptive ones
• Systematic Desensitization Joseph Wolpe
• Classical conditioning Figure 15.8
• Anxiety/Fear hierarchy Figure 15.9
• Aversion therapy Figure 15.10
• Alcoholism, sexual deviance, smoking, etc.
• Social skills training
• Modeling
• Behavioral rehearsal
• Biofeedback
• Operant conditioning flooding
• Classical conditioning

16
XXX 15.8
17
XXX 15.10
18
Cognitive-Behavioral Therapy

• Aaron Beck
• Cognitive therapy
• Depression and negative thinking Figure 15.11
• Albert Ellis
• Rational-emotive therapy
• Goal to change the way clients think
• Detect and recognize negative thoughts
• Reality testing
• Effectiveness of Behavior Therapies
• Efficacy of behavioral interventions for a
  variety of disorders

19
XXX 15.11
20
Biomedical Therapies

• Psychopharmacotherapy
• Antianxiety - Valium, Xanax, Buspar
• Antipsychotic - Thorazine, Mellaril, Haldol
• Tardive dyskinesia
• Atypical antipsychotic reduce motor effects and
  other neurotransmitters
• Time course Figure 15.12
• Antidepressant - Actions - Figure 15.13
• Tricyclics Elavil, Tofranil
• Mao inhibitors (MAOIs) - Nardil
• Selective serotonin reuptake inhibitors (SSRIs)
  Prozac, Paxil, Zoloft side effects Table 15.1
• Risk of suicide Figure 15.14
• Mood stabilizers
• Lithium, Valproic acid
• Electroconvulsive therapy (ECT)
• Transcranial Magnetic Stimulation
• Deep brain stimulation

21
Figure 15.13 Antidepressant drugs mechanisms of
action
22
Figure 15.15 Deep brain stimulation
23
Current Trends and Issues in Treatment

• Managed care
• Empirically validated treatments
• Blending Approaches to treatment Figure 15.17
• Conjunctive therapy Figure 15.16
• Multicultural sensitivity
• Deinstitutionalization
• Dorthea Dix - Figure 15.18
• Changes in population Figure 15.19
• Factors treatments, legal, service delivery
  model
• Revolving door problem Slide 26
• Homelessness
• Increase use of criminal justice system

24
Figure 15.17 The leading approaches to therapy
among psychologists
25
Figure 15-16 Relapse rates in Reynolds et al.
(1999) study
26
XX 15.19
27
Slide 26 Percentage of psychiatric inpatient
admissions that are readmissions
28
Somatic Therapies

• Psychopharmacology
• Antipsychotics (thorazine, haldol)
• Anti-anxiety (valium, barbiturates, Xanax)
• Mood Disorders (serotonin reuptake inhibitors)
• Bipolar (lithium)

29
Somatic Therapy

• Electroconvulsive Therapy (ECT)- for depression
• Psychosurgury
• - Prefontal lobotomy

30
Looking for at therapist

• Factors to consider
• Sources of services Table 15.2
• Profession
• Gender
• Theoretical approach
• Comparison of approaches for effectiveness -
  Figure 15.20

31
Table 15-2, p. 626
32
Figure 15.20 Estimates of the effectiveness of
various approaches to psychotherapy.