Treatment Modalities for Psychological Disorders

“Brutal” to “Gentle” Transition

• Dorothea Dix and Philippe Pinel (mid 1800s)–Advocates of mental hospitals to provide

more human treatment• Mid 1950s: exodus from mental hospitals:– Introduction of therapeutic drugs–Community-based treatment programs

Two Main Treatment Modalities

• Psychotherapy• Biomedical therapy• Combination of the two• 50% of psychotherapists say they use an

“ecclectic approach,” using a blend of therapies

4 Main Psychological Therapies• 1. Psychoanalysis• Sigmund Freud

• 2. Humanistic• Carl Rogers

• 3. Behavioral• Pavlov/Skinner

• 4. Cognitive• Aaron Beck

1. Psychoanalysis• Psychological problems = • Repressed impulses and conflicts from

childhood• Aim: work through ‘buried’ feelings and take

responsibility for their own growth• Release energy ‘wasted’ on id-ego-superego

conflicts

1. Psychoanalysis• How does it work?• Free association• But watch out for “resistance”… blocks in the

flow of free association• Therapist would interpret the ‘meaning’ of

your resistance• Interpretation of latent content in dreams

1. Psychoanalysis• One result of therapy: • Transference

• Occasionally followed by “Countertransference”

• This is why the APA has a “Code of Ethics”!

1. Psychoanalysis• Be ready to open you wallet!

• Traditional psychoanalysis is 3-4 visits/week for several years

• Conservatively speaking, at $125/hour, this is $68,250 for 3 years

• Maybe just take a few nice vacations!

1. Psychoanalysis• Modern “alternative” is:–Psychodynamic Therapy

• Goal is to understand current symptoms in terms of childhood and important relationships

• Face-to-face; generally once a week for several months

2. Humanistic Therapy• Carl Rogers (1902-1987)• “Client-centered therapy” (Not “patient”)–Aim is to grow in self-awareness and

acceptance• Focus is on:– Dealing with present & future– Conscious thoughts rather than unconscious– Taking responsibility for one’s feelings & actions

2. Humanistic Therapy• Therapists strive to exhibit :–Genuineness–Acceptance– Empathy

• Which leads to “unconditional positive regard”

• Mechanism: “Active Listening”

3. Behavior Therapies

• You don’t need “self-awareness” to heal from psychological problems!

• A. Classical Conditioning Techniques

• B. Operant Conditioning Techniques

3A. Classical Conditioning

• “Counter-conditioning”: Pair the trigger stimulus with a new response (relaxation)

• Idea: can’t be both fearful AND relaxed• Two techniques:– Exposure therapy– Aversive conditioning

3A. Classical Conditioning

• Exposure Therapy/Response Prevention (ERP)

3A. Classical Conditioning

• Aversive Conditioning: Substitute an aversive response for a positive response to a harmful stimulus

Also, Faradic aversion conditioning!

3B. Operant Conditioning

• Behavior Modification• Use positive reinforcers to shape behavior

3B. Operant Conditioning

• Token Economies

3B. Operant Conditioning

• Concerns with Behavior Modification• How ‘durable’ are the effects?• It is OK for one human to control

another’s behavior?

4. Cognitive Therapy

• Works with the assumption that our thoughts color our feelings

• Aaron Beck: Expose irrational thinking, and then persuade the person to remove the dark glasses through which they view life

4. Cognitive Therapy

Therapies to Avoid!• Energy therapy – manipulating invisible

energy fields• Recovered-memory therapy• Rebirthing therapy• Facilitated communication• Crisis debriefing

Biomedical Therapies: Drugs• Antipsychotic Drugs• Antianxiety Drugs• Antidepressant Drugs• Mood-Stabilizing Drugs

Biomedical Therapies: Adjuncts or Alternatives to Drugs

• Electroconvulsive Therapy• Magnetic Stimulation• Deep-Brain Stimulation

Biomedical Therapies: Drugs• Antipsychotic Drugs• Most common drugs help alleviate

“positive” symptoms of schizophrenia• Ex. Chlorpromazine (Thorazine)• Work by blocking activity of dopamine• Major side-effects: tardive dyskinesia,

obesity, diabetes

Biomedical Therapies: Drugs

• “Atypical” Antipsychotic Drugs• Help alleviate ‘negative’ symptoms of

schizophrenia• Ex. clozapine (Clozaril)

Biomedical Therapies: Drugs

• Anti-anxiety Drugs• Examples: Xanax, Atavan, Valium• ALL depress the central nervous system• Anti-anxiety drugs plus ________ make a

lethal combination?

–ALCOHOL!

Biomedical Therapies: Drugs

• Anti-anxiety Drugs• Criticisms:– 1. do not treat underlying problem, just symptoms– 2. Psychological dependence: “popping a Xanax”– 3. Physiological dependence: cessation of drug can

lead to great anxiety and insomnia

–New standard drug treatment for anxiety….

Biomedical Therapies: Drugs

• Antidepressant Drugs• Also successfully treat anxiety disorders

in addition to depression• Selective-serotonin-reuptake inhibitors

(SSRIs)–Prozac (fluoxetine), Zoloft (sertraline),

Paxil (paroxetine)

Biomedical Therapies: Drugs

Biomedical Therapies: Brain Stimulation• Electroconvulsive Therapy• 1938: 100 volts administered to wide-

awake patient• Today: general anesthesia, muscle

relaxant, 30 second electrical stimulation• Refractory Depression: 80% of patients

improve with ECT, but 4 in 10 relapse within 6 months

Biomedical Therapies: Brain Stimulation• Electroconvulsive Therapy

Biomedical Therapies: Brain Stimulation• Alternative Neurostimulation• 1. Magnetic Stimulation: repetitive transcranial

megnetic stimulation (rTMS)

Biomedical Therapies: Brain Stimulation• Alternative Neurostimulation• 2. Deep-Brain Stimulation

Biomedical Therapies: Psychosurgery• Frontal Lobotomy• 1930s, Portuguese physician, Dr. Moniz• In the U.S. during 1950s: 35,000

lobotomies performed• J.F. Kennedy’s sister, Rosemary, received a

lobotomy–No longer performed–Nobel Peace Prize awarded to Moniz

Therapeutic Life-Style Change

• Aerobic exercise: 30 min. 3x a week• Adequate sleep: 7-8 hours per night• Light exposure• Social connection• Anti-rumination• Nutritional supplements: omega-3 fatty

acids