AP Psych Prep 13 - Disorders- Treatment

Psychological Psychological Disorders: TreatmentDisorders: Treatment

AP Psych Prep 13AP Psych Prep 13

IntroductionIntroduction

We looked at a variety of mental We looked at a variety of mental disorders in the previous chapter. disorders in the previous chapter. Now we will learn about some of Now we will learn about some of the therapies used to try to help the therapies used to try to help people who suffer from people who suffer from psychological disorders.psychological disorders.

IntroductionIntroduction

There are a variety of different There are a variety of different ideas about the causes of mental ideas about the causes of mental disorder, and therefore a variety of disorder, and therefore a variety of different therapies and treatments. different therapies and treatments.

Some of this will be a bit of a Some of this will be a bit of a review of things we’ve talked review of things we’ve talked about a little before. about a little before.

OutlineOutline

History of Psych. TreatmentHistory of Psych. Treatment

Psychoanalytic TherapiesPsychoanalytic Therapies

Humanistic TherapiesHumanistic Therapies

Behavioural TherapiesBehavioural Therapies

Cognitive + Cog.-Behavioural Cognitive + Cog.-Behavioural TherapiesTherapies

Somatic TherapiesSomatic Therapies

Other NotesOther Notes


a long time ago, people often a long time ago, people often thought mental disorders were thought mental disorders were caused by evil spirits or possession caused by evil spirits or possession by evil spiritsby evil spirits

Earliest psych treatment Earliest psych treatment we know about: we know about: TrephiningTrephining - cut hole in - cut hole in head to let evil spirits out.head to let evil spirits out.


For a long time people with For a long time people with mental diseases were treated very mental diseases were treated very badly by society.badly by society.

Early 1900’s, reformers in the U.S. Early 1900’s, reformers in the U.S. fought to create better treatment fought to create better treatment for these people. Led to creation for these people. Led to creation of mental institutions.of mental institutions.


Around 1950s, drugs for psych. Around 1950s, drugs for psych. treatment led to treatment led to deinstitutionalizationdeinstitutionalization - where people were released from - where people were released from institutions (to save money), people institutions (to save money), people supposed to live at home, and be supposed to live at home, and be cared for by local doctors.cared for by local doctors.


However, care for patients has not However, care for patients has not been great, and many people been great, and many people can’t take care of themselves, can’t take care of themselves, they don’t get the care they need, they don’t get the care they need,

and many end up and many end up homeless, or in homeless, or in jails...jails...


Another historical trend - Another historical trend - Preventive Preventive CareCare - try to take action before a - try to take action before a problem is very severe, to better problem is very severe, to better help people, and save money (early help people, and save money (early care is usually cheaper than fixing a care is usually cheaper than fixing a bigger problem later)bigger problem later)

Three types:Three types:


Primary PreventionPrimary Prevention - reduce - reduce possible possible causescauses of mental of mental health problems (likehealth problems (likehomelessness, homelessness, abuse, etc) to try to abuse, etc) to try to stop the problems stop the problems from starting from starting beforebefore they happen.they happen.

History of Psych. TreatmentHistory of Psych. TreatmentSecondary PreventionSecondary Prevention - working with - working with people who are at risk for developing people who are at risk for developing problems to help prevent them (e.g. problems to help prevent them (e.g. people who have suffered trauma people who have suffered trauma like soldiers coming like soldiers coming back from war, back from war, abuse victims, abuse victims, people genetically people genetically predisposed to predisposed to some mental some mental disorder, etc)disorder, etc)


Tertiary PreventionTertiary Prevention - trying to help - trying to help people that already have mild people that already have mild problems, to try to stop the problem problems, to try to stop the problem from becoming more severefrom becoming more severe

e.g. school councillor helping e.g. school councillor helping students with mild depression students with mild depression issuesissues

Treatment and TherapiesTreatment and Therapies

There are lots of types of therapy. There are lots of types of therapy. Therapists often refer to people Therapists often refer to people they are trying to help as they are trying to help as patientspatients or or clientsclients

PsychotherapyPsychotherapy vs. vs. Somatic Somatic TreatmentsTreatments (biological treatments) (biological treatments)

Psychoanalytic TherapyPsychoanalytic Therapy (Freudian)(Freudian)

psychoanalytic perspective views psychoanalytic perspective views cause as unconscious conflicts. So cause as unconscious conflicts. So to cure, need to find out what is to cure, need to find out what is causing the problem down in the causing the problem down in the unconscious.unconscious.


If you only fight the outward If you only fight the outward symptoms, but don’t deal with the symptoms, but don’t deal with the unconscious conflict cause, the unconscious conflict cause, the person is expected to suffer from person is expected to suffer from symptom substitutionsymptom substitution - if you cure - if you cure a symptom, but not cause, new a symptom, but not cause, new symptom will appear....symptom will appear....


Remember, our unconscious is hidden, Remember, our unconscious is hidden, so finding the cause isn’t easy. so finding the cause isn’t easy. Psychoanalysts might use methods Psychoanalysts might use methods like: like:

HypnosisHypnosis - though we could - though we could more freely access our more freely access our unconscious when hypnotized; unconscious when hypnotized; we’re less likely to hold we’re less likely to hold repressed memories repressed memories tightly in our unconscious.tightly in our unconscious.


Free-associationFree-association - say whatever - say whatever comes into your mind, no matter comes into your mind, no matter what, without censoring yourself. what, without censoring yourself. To try to stop ourselves from hiding To try to stop ourselves from hiding

things from ourselves things from ourselves and others and others

(often uses(often usesstarting cues from starting cues from therapist)therapist)


Dream analysisDream analysis - as discussed in - as discussed in Chapter 5, psychoanalysts think Chapter 5, psychoanalysts think the manifest content of dreams the manifest content of dreams might be hints to our real secret might be hints to our real secret unconscious minds (latent content)unconscious minds (latent content)

All of these are often used, but all All of these are often used, but all are very are very subjectivesubjective (and (and scientifically unsupported) scientifically unsupported)


Psychoanalysts also look for clues in Psychoanalysts also look for clues in resistance and transference. resistance and transference.

ResistanceResistance - because things hidden - because things hidden in our unconscious are often painful, in our unconscious are often painful, troubling, etc., it’s thought that troubling, etc., it’s thought that patients are likely to patients are likely to resistresist the the treatment process to protect treatment process to protect themselves. We don’t want to themselves. We don’t want to uncover the hidden things.uncover the hidden things.


Patients can resist by disagreeing Patients can resist by disagreeing with the psychologist, but psych. will with the psychologist, but psych. will probably think “If they are resisting probably think “If they are resisting this, I must be getting close to the this, I must be getting close to the source of the problem.”source of the problem.”

Resistance = evidence that thing Resistance = evidence that thing being discussed is really part of the being discussed is really part of the problem.problem.


TransferenceTransference - when person’s strong - when person’s strong feelings from other important feelings from other important relationships are transferred onto relationships are transferred onto the therapist. the therapist.

Patient might feel love, anger, Patient might feel love, anger, hatred, etc.hatred, etc.

Psychologist tries to figure out where Psychologist tries to figure out where the feelings are being transferred the feelings are being transferred fromfrom, to better understand the , to better understand the person.person.


Try to help people accept Try to help people accept themselves, and work towards themselves, and work towards self-self-actualizationactualization (remember Maslow and (remember Maslow and Roger’s idea that the main goal of Roger’s idea that the main goal of people is to become the best they people is to become the best they can be)can be)

Assumes people are good, and have Assumes people are good, and have free willfree will (vs. deterministic views) (vs. deterministic views)

Self-ActualizationSelf-Actualization


Carl Rogers - famous humanistic Carl Rogers - famous humanistic therapisttherapist

Created Created Person/Client Centered Person/Client Centered TherapyTherapy - therapist provides - therapist provides unconditional positive regardunconditional positive regard. . Unconditional acceptance, caring Unconditional acceptance, caring and support for the client. and support for the client.

Helps client to control their lives Helps client to control their lives and move toward self-actualization.and move toward self-actualization.


Is usually Is usually non-directivenon-directive - the - the therapist doesn’t direct of choose therapist doesn’t direct of choose the path... the client does. Client the path... the client does. Client does most of the talking, and does most of the talking, and should be in control should be in control of the process.of the process.


Also use Also use Active ListeningActive Listening - where - where therapist listens carefully and therapist listens carefully and showsshows they are listening by they are listening by repeating ideas back to the repeating ideas back to the person.person.

Common phrase in active listening Common phrase in active listening is “What I’m hearing you say is...”is “What I’m hearing you say is...”


This helps show therapist is This helps show therapist is listening, and can help the client listening, and can help the client make sure their true thoughts and make sure their true thoughts and feelings are being communicated feelings are being communicated (avoid misunderstandings)(avoid misunderstandings)

Note: active listening can be used Note: active listening can be used by us all the time, in our real lives. by us all the time, in our real lives. It’s not just for therapists. It’s not just for therapists.

Less Common Humanistic Less Common Humanistic TherapiesTherapies

Gestalt TherapyGestalt Therapy - remember - remember gestalt means “the whole”gestalt means “the whole”

Focusing on all the person’s Focusing on all the person’s feelings, behaviours, and thoughts feelings, behaviours, and thoughts and trying to understand and help and trying to understand and help them all work together in them all work together in harmony. harmony.

Less Common Humanistic Less Common Humanistic TherapiesTherapies

Will look at small body actions and Will look at small body actions and feelings that client isn’t clearly feelings that client isn’t clearly aware of, and pushes “living in the aware of, and pushes “living in the present time” to help people present time” to help people experience the whole of their experience the whole of their experience.experience.

Existential TherapiesExistential Therapies - Trying to help - Trying to help people develop a strong idea of people develop a strong idea of meaning for their lives.meaning for their lives.


Remember, behaviourists think our Remember, behaviourists think our behaviour comes from learning, so behaviour comes from learning, so they think disorders can come from they think disorders can come from our past learning experiences our past learning experiences

Classical conditioning, operant Classical conditioning, operant conditioning, modelling / conditioning, modelling / observational learning (see Chapter observational learning (see Chapter 6)6)


CounterconditioningCounterconditioning - like - like relearning; to change a negative relearning; to change a negative response to a positive one. response to a positive one. Developed by Mary Cover Jones. Developed by Mary Cover Jones.

There are a few different types of There are a few different types of counterconditioning that counterconditioning that therapists use.therapists use.


A famous example of A famous example of counter-conditioning: counter-conditioning:

Joseph Wolpe - Joseph Wolpe - systematic systematic desensitizationdesensitization - client with phobia - client with phobia re-learns to replace the response of re-learns to replace the response of fear with one of relaxation when fear with one of relaxation when they think they think of or meet the feared thing...of or meet the feared thing...

Systematic Desensitization:Systematic Desensitization:

Step 1: teach client to relax and Step 1: teach client to relax and practice relaxing. e.g. deep practice relaxing. e.g. deep breathing, meditation, breathing, meditation,

Step 2: Create Step 2: Create anxiety hierarchyanxiety hierarchy - - a list of things that cause fear, a list of things that cause fear, listed from the least frightening up listed from the least frightening up to the most frightening.to the most frightening.

Systematic Desensitization:Systematic Desensitization:e.g. Anxiety Hierarchy: Globophobia e.g. Anxiety Hierarchy: Globophobia

think about balloonsthink about balloons

seeing balloon across the roomseeing balloon across the room

seeing someone play with balloonseeing someone play with balloon

someone try to give you balloonsomeone try to give you balloon

touching a balloontouching a balloon

someone hitting you with balloonsomeone hitting you with balloon

someone popping balloon near yousomeone popping balloon near you

many balloons falling on youmany balloons falling on you


Step 3: do least scary thing on list, Step 3: do least scary thing on list, and practice relaxation techniques and practice relaxation techniques (to condition relaxation response(to condition relaxation response insteadinstead of fear response). of fear response).

Step 4: once you can relax at step Step 4: once you can relax at step one of hierarchy, move up to the one of hierarchy, move up to the next step, and practice that. next step, and practice that.


This process continues until you can This process continues until you can do most scary thing while relaxing.do most scary thing while relaxing.

Can use either “Can use either “in vivo in vivo desensitizationdesensitization””(real life, real balloons, actually (real life, real balloons, actually doing the things on the list)doing the things on the list)

Or “Or “covert desensitizationcovert desensitization” (just ” (just imagining the things on the list)imagining the things on the list)


Might first do covert first, and later Might first do covert first, and later move to in vivo. move to in vivo.

Another treatment is Another treatment is floodingflooding - where - where you go to the you go to the mostmost frightening thing frightening thing firstfirst

Hope that even though this causes a lot Hope that even though this causes a lot of anxiety, the person will realize fear is of anxiety, the person will realize fear is irrational, and fear will be irrational, and fear will be extinguishedextinguished. .


ModellingModelling can also be used, where can also be used, where a person watches a person watches someone elsesomeone else calmly interacting with the feared calmly interacting with the feared thing (thing (observational learningobservational learning))


Reinforcement and operant Reinforcement and operant conditioning are also used conditioning are also used sometimes: e.g. sometimes: e.g. token economytoken economy, , discussed in earlier discussed in earlier chapter; used to try chapter; used to try to change behaviour.to change behaviour.

Cognitive / Cog.-Behaviorist Cognitive / Cog.-Behaviorist

If thoughts are the cause of If thoughts are the cause of disorder, then the therapist needs disorder, then the therapist needs to change the person’s thinking.to change the person’s thinking.

Cognitive therapies try to do this. Cognitive therapies try to do this.

Therapist will challenge negative, Therapist will challenge negative, harmful ways of thinking, help harmful ways of thinking, help person change their thinking person change their thinking patterns.patterns.


E.g. E.g. attributional styleattributional style (discussed (discussed previously); change attributions previously); change attributions from internal to external.from internal to external.

Aaron Beck’s Cognitive Therapy - Aaron Beck’s Cognitive Therapy - tries to change beliefs and tries to change beliefs and thoughts related to the cognitive thoughts related to the cognitive triad (self, world, future)triad (self, world, future)


Cognitive-Behavioural Therapies Cognitive-Behavioural Therapies (CBT)(CBT)

Cognitive + BehaviourCognitive + Behaviour

One example is Rational Emotive One example is Rational Emotive Behaviour Therapy (REBT); Behaviour Therapy (REBT); developed by Albert Ellisdeveloped by Albert Ellis


REBT - expose and challenge REBT - expose and challenge irrational thoughts, but also irrational thoughts, but also watching and trying to change watching and trying to change behaviour. (sometimes including behaviour. (sometimes including journaling journaling about behaviour, about behaviour, behaviour behaviour homeworkhomework

Cognitive / Cog.-Cognitive / Cog.-Behaviourist Behaviourist

Usually challenge both the Usually challenge both the chances of negative things chances of negative things

happening (how likely will you get happening (how likely will you get embarrassed in public?) embarrassed in public?)

and also what the consequences and also what the consequences would be if it did happen (if you would be if it did happen (if you

become embarrassed, why is become embarrassed, why is that so bad?)that so bad?)

Somatic Therapies Somatic Therapies (Biological)(Biological)

Biological Perspective sees causes of Biological Perspective sees causes of disorder in neurotransmitters, brain disorder in neurotransmitters, brain differences, genetics, hormones, etc.differences, genetics, hormones, etc.

1. 1. Drug TherapiesDrug Therapies: (also called : (also called psychopharmacology, psychopharmacology, chemotherapy)chemotherapy)

Drugs often used to treat Drugs often used to treat psychological disorderspsychological disorders

Somatic Therapies - DrugsSomatic Therapies - Drugs

SchizophreniaSchizophrenia - - antipsychotic antipsychotic drugsdrugs - e.g. thorazine, Haldol, - e.g. thorazine, Haldol,

usually these block receptor sites usually these block receptor sites for dopamine (remember for dopamine (remember dopamine hypothesisdopamine hypothesis); reduces ); reduces dopamine actiondopamine action

Side effects include tardive Side effects include tardive dyskinesia (as discussed in Ch 12)dyskinesia (as discussed in Ch 12)


Depression - Depression - tricyclic tricyclic antidepressants, serotonin-antidepressants, serotonin-reuptake-inhibitor drugs (i.e. SSRIs reuptake-inhibitor drugs (i.e. SSRIs e.g. Prozac), monoamine oxidase e.g. Prozac), monoamine oxidase (MOA) inhibitors (MOA) inhibitors

Bipolar Disorder - Bipolar Disorder - manic phase - manic phase - often lithium is used to helpoften lithium is used to help


Anxiety Disorders - Anxiety Disorders - anxiety believed anxiety believed to come from an over-excited to come from an over-excited nervous system, so nervous system, so central nervous central nervous system depressantsystem depressant drugs are used. drugs are used.

Barbiturates (e.g. Miltown), Barbiturates (e.g. Miltown), benzodiazepine (e.g. Xanax, benzodiazepine (e.g. Xanax, Valium)Valium)

Somatic Therapies Somatic Therapies

2. 2. Electroconvulsive Therapy Electroconvulsive Therapy (ECT)(ECT) - - Very rarely used for very Very rarely used for very severe cases of depression that severe cases of depression that drugs don’t seem to helpdrugs don’t seem to help

Pass electricity throughPass electricity throughthe brain (either one the brain (either one hemisphere (hemisphere (unilateralunilateral)) or both hemispheres or both hemispheres ((bilateralbilateral))

Somatic Therapies - ECTSomatic Therapies - ECT

Causes a mild seizure (muscle Causes a mild seizure (muscle relaxant helps reduce danger of relaxant helps reduce danger of injury)injury)

Possible side effects include some Possible side effects include some memory loss.memory loss.

Psych. don’t understand how this Psych. don’t understand how this therapy works; possibly connected therapy works; possibly connected to blood flow changesto blood flow changes

Somatic Therapies Somatic Therapies

3. 3. PsychosurgeryPsychosurgery - purposeful - purposeful destruction of parts, or separation destruction of parts, or separation of parts of the brain to help a of parts of the brain to help a person, change behaviourperson, change behaviour

VeryVery rare, and used only as a rare, and used only as a last last resortresort. We need to be very careful . We need to be very careful about changing people’s brains....about changing people’s brains....

Somatic Therapies - Somatic Therapies - PsychosurgeryPsychosurgery

A historically used surgery was A historically used surgery was prefrontal lobotomyprefrontal lobotomy - removing - removing connections between the connections between the prefrontal lobe and the rest of the prefrontal lobe and the rest of the brain. brain.

Strongly calms the person down, Strongly calms the person down, but also greatly reduces but also greatly reduces functioning and awareness.functioning and awareness.

Prefrontal LobotomyPrefrontal Lobotomy

Somatic Therapies - Somatic Therapies - PsychosurgeryPsychosurgery

A lot of people were permanently A lot of people were permanently damaged (and some killed) simply damaged (and some killed) simply because doctors and psychologists because doctors and psychologists were ignorant. were ignorant.

H.M’s hippocampus surgery and split H.M’s hippocampus surgery and split brain surgery should brain surgery should notnot be be considered psychosurgery, because considered psychosurgery, because the goal of those surgeries was not the goal of those surgeries was not to change behaviour, but to fix a to change behaviour, but to fix a medical (not psych) problemmedical (not psych) problem


Group TherapyGroup Therapy vs. vs. Individual Individual TherapyTherapy

those we talked about are usually those we talked about are usually individual therapies, but some individual therapies, but some psych. also do group therapies, with psych. also do group therapies, with more than one patient at oncemore than one patient at once

e.g. Alcoholics Anonymous (AA) - a e.g. Alcoholics Anonymous (AA) - a “self-help” group that helps people “self-help” group that helps people deal with addiction to alcoholdeal with addiction to alcohol


Another example, Family Therapy Another example, Family Therapy - to help with whole family - to help with whole family problems, sometimes caused by a problems, sometimes caused by a member’s disorder, or member’s disorder, or sometimes for sometimes for other reasonsother reasons


Eclectic View of TreatmentEclectic View of Treatment - - psychologists often use more than psychologists often use more than one kind of therapy, just one kind of therapy, just depending on the situationdepending on the situation

Maybe even more than one type Maybe even more than one type with the same person.with the same person.

e.g. Depression often e.g. Depression often bothboth psychotherapy and psychotherapy and psychopharmacology usedpsychopharmacology used


Types of Therapists:Types of Therapists:

PsychiatristsPsychiatrists - medical doctors with - medical doctors with special psychological training; special psychological training; often only people who can often only people who can prescribe medication for disordersprescribe medication for disorders

Clinical psychologistsClinical psychologists - (Ph.D. in - (Ph.D. in psychology with internship) usually psychology with internship) usually deal with people with pretty severe deal with people with pretty severe disordersdisorders


Counselling TherapistsCounselling Therapists - (some - (some graduate school work, internship), graduate school work, internship), often deal with relatively less severe often deal with relatively less severe problems. Might become school problems. Might become school psychologists, family, counsellors, psychologists, family, counsellors, etc.etc.

PsychoanalystsPsychoanalysts - name for people - name for people with training in Freudian theories with training in Freudian theories and methodsand methods

ConclusionConclusion

Treatment of Psychological Treatment of Psychological Disorders has changed a Disorders has changed a lot over the years, and it is lot over the years, and it is sure to change more as we sure to change more as we learn more about psychology, learn more about psychology, especially with new advanced especially with new advanced internal imaging technologies...internal imaging technologies...

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AP Psych Prep 13 - Disorders- Treatment