Treating Psychological DisordersChapter 15

Who Seeks Treatment? 15% of U.S. population in a

given year 4.5 million people

Most common presenting problems Anxiety and Depression

Demographics Women more than men Education level

Barriers to Treatment Medical insurance

Who Provides Treatment?

Clinical psychologists Counseling psychologists Psychiatrists Clinical social workers Psychiatric nurses Counselors

Types of Treatment Psychotherapy

Insight therapies “talk therapy”

Behavior therapies Changing overt behavior

Biomedical therapies Biological functioning

interventions Eclectic35%

Behavioral11%

Cognitive8%

Client-centered

6%

Other16%

Psychodynamic24%

Psychoanalysis Focuses on uncovering unconscious conflicts resulting from fixations at early

developmental stages Uses techniques such as...

Free association Dream analysis Interpretation

To minimize Resistance

and facilitate Transference

Goal is to rebuild personality

Client-Centered Treatment Believes disorders result from incongruence between self-concept and

reality or dependence on acceptance from others. Uses techniques such as

Unconditional positive regard Empathy Genuineness Reflection

Goal is to increase client self-acceptance (minimize incongruence)

Behavioral Therapies Believe disorders are maladaptive patterns of behavior that have

been learned. Use techniques such as

Conditioning (Classical & Operant) Aversion Systematic Desensitization Social Skills Training Biofeedback

To eliminate maladaptive behavior and replace with adaptive behavior.

Behavior Therapies

B.F. Skinner and colleagues Goal: unlearning maladaptive behavior and

learning adaptive ones Systematic Desensitization – Joseph Wolpe

Classical conditioning Anxiety hierarchy

Aversion therapy Alcoholism, sexual deviance, smoking, etc.

Figure 15.7 The logic underlying systematic desensitization

Behavior Therapy B.F. Skinner and colleagues

Social skills training Modeling Behavioral rehearsal

Cognitive-Behavioral Therapy Aaron Beck

Cognitive therapy Believe disorders result from

irrational assumptions and negative, self-defeating thoughts.

Use techniques such as Thought stopping Recording automatic thoughts Refuting negative thinking Reality testing Homework

Goal is to detect negative, irrational thinking and replace with realistic thinking

Cognitive-Behavioral Therapy Martin Seligman

Learned helplessness and depression Difficult to establish

helplessness-depression link

Cognitive-Behavioral Therapy Martin Seligman Explanatory style

a person’s habitual way of explaining events, typically assessed along three dimensions: internal/external, stable/unstable, and global/specific

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Biomedical TherapiesType Example Positive Effects Adverse Effects

Antianxiety Drugs Valium, Xanax

Quick acting Reduces anxiety

Nausea, drowsiness, confusion

Antipsychotic Drugs Thorazine, Haldol

Decrease psychotic symptoms

Tardive dyskinesia

Antidepressant Drugs

Elavil, Nardil, Prozac, Paxil, Zoloft

Reduce depressive symptoms

Dry mouth, Blurred vision, Constipation, Drowsiness

Bipolar Treatment Lithium Prevents mood swings

Kidney and Thyroid damage

ECT Reduces depressive symptoms

Memory loss, Impaired attention

Biomedical Therapies Psychopharmacotherapy

Antianxiety - Valium, Xanax, Buspar Antipsychotic - Thorazine, Mellaril, Haldol

Tardive dyskinesia Clozapine

Antidepressant: Tricyclics – Elavil, Tofranil Mao inhibitors (MAOIs) - Nardil Selective serotonin reuptake inhibitors (SSRIs) –

Prozac, Paxil, Zoloft

Figure 15.12 Antidepressant drugs’ mechanisms of action

Biomedical Therapies Psychopharmacotherapy

Mood stabilizers Lithium Valproic acid

Electroconvulsive therapy (ECT)

Current Trends and Issues in Treatment Managed care Empirically validated

treatments Blending Approaches to

treatment Multicultural sensitivity Deinstitutionalization

Revolving door problem Homelessness