Psychological Science, 3rd EditionMichael Gazzaniga
Todd Heatherton Diane Halpern
Treating Disorders of the Mind and Body
15
Questions to Consider:
How Are Mental Disorders Treated?
What Are the Most Effective Treatments?
Can Personality Disorders Be Treated?
How Should Childhood and Adolescent Disorders Be Treated?
How Are Mental Disorders Treated?
Psychotherapy Is Based on Psychological Principles
Culture Can Affect the Therapeutic Process
Medication Is Effective for Certain Disorders
Alternative Biological Treatments Are Used in Extreme Cases
Pseudotherapies Can Be Dangerous
Learning Objectives
Recognize different styles of psychotherapy.
Describe the uses, mechanisms, and side effects of common psychotropic medications.
Psychotherapy Is Based on Psychological Principles
With over 400 psychological therapies available, the precise techniques used by individual therapists may vary widely
One factor known to affect the outcome of therapy is: The relationship between the therapist and the
client
Psychotherapy Is Based on Psychological Principles
Psychodynamic therapy focuses on insight:
Along with Josef Breuer, Sigmund Freud pioneered the method of psychoanalysis
Treatment involved uncovering unconscious feelings and drives that, Freud believed, gave rise to maladaptive thoughts and behaviors
Techniques included free association and dream analysis
Psychotherapy Is Based on Psychological Principles
The general goal of psychoanalysis is to increase clients’ awareness (insight) of these unconscious processes and how they affect daily functioning
Over the past few decades, psychodynamic therapy has become controversial due to:
Its expense, the length of time required for treatment, and the lack of evidence of effectiveness for most disorders
Psychotherapy Is Based on Psychological Principles
Humanistic therapies focus on the whole person:
Emphasizes personal experience, belief systems and the phenomenology of individuals
The goal of humanistic therapy is to treat the person as a whole
Psychotherapy Is Based on Psychological Principles
Key ingredients of client-centered therapy include:
Creating a safe and comforting setting, empathy, reflective listening, and unconditional positive regard
Many techniques advocated by Rogers are used currently to establish a good therapeutic relationship between practitioner and client
Psychotherapy Is Based on Psychological Principles
Cognitive-behavioral therapy targets thoughts and behaviors:
Many of the most successful therapies involve trying to change people’s behavior and cognition directly
Beck pioneered cognitive restructuring
Ellis promoted rational-emotive therapy
Psychotherapy Is Based on Psychological Principles
Examples of these treatments include: behavior modification, modeling, social skills training, cognitive therapy and cognitive behavior therapy (CBT)
Interpersonal therapy integrates insight therapy with cognitive therapy
CBT is one of the most effective treatments available for anxiety and mood disorders
Exposure is an effective treatment for phobias and relies on classical conditioning processes
Cognitive Restructuring
Cognitive restructuring involves replacing maladaptive thought patterns with more realistic, positive ones.
Psychotherapy Is Based on Psychological Principles
Group therapy builds social support:
Group and family therapy have become more widespread
Group therapy is less expensive than individual therapy
Offers the opportunity for practice of social skills and peer learning
Psychotherapy Is Based on Psychological Principles
Family therapy focuses on the family context:
Family therapy reflects an understanding of systems approaches—an individual is part of larger groups that can maintain or exacerbate behavior
Negative expressed emotion within families, for example, has been linked to higher relapse rates among those diagnosed with schizophrenia
Psychotherapy Is Based on Psychological Principles
Confession is good for the spirit:
Irrespective of type of therapy, evidence suggests that simply talking about (or writing about) one’s problems can have a positive effect
Culture Can Affect the Therapeutic Process
Culture impacts the way mental disorders are expressed, which people are likely to recover, and people’s willingness to seek help
Stigmas exacerbate the problem because people will often suffer in silence, failing to get the psychotherapy that can help them
Stigma varies from culture to culture
Culture Can Affect the Therapeutic Process
Culture also plays a critical role in:
Determining the availability, use, and effectiveness of different types of psychotherapy
Psychotherapy and definitions of mental health are based on the dominant cultural paradigm
Medication Is Effective for Certain Disorders
Drugs that affect mental processes are called psychotropic medications
The success of medication in the treatment of mental disorders is largely responsible for the era of deinstitutionalization
Scores of patients were discharged from mental hospitals and treated with drugs as outpatients
Medication Is Effective for Certain Disorders
Most psychotropic medications fall into three categories:
Anti-anxiety drugs
Antidepressants
Antipsychotics
Medication Is Effective for Certain Disorders
Anti-anxiety drugs Reduce anxiety and promote relaxation, but they
also induce drowsiness and are highly addictive They should be used sparingly
Antidepressants:
There are several classes including MAO inhibitors, tricyclic antidepressants, and the SSRIs
Selective Serotonin Reuptake Inhibitors
SSRIs, such as Prozac, work by blocking reuptake into the presynaptic neuron, thereby allowing
serotonin to remain in the synapse, where its effects on postsynaptic receptors are prolonged.
Medication Is Effective for Certain Disorders
Antipsychotics (neuroleptics) Block the effects of dopamine Antipsychotics are not always effective They have significant side effects that can be
irreversible Tardive dyskinesia
These drugs are not useful for treating the negative symptoms of schizophrenia Such as apathy and social withdrawal
Alternative Biological Treatments Are Used in Extreme Cases
Alternative biological methods often are used as last resorts because they are more likely to have serious side effects than will either psychotherapy or medication
Alternative Biological Treatments Are Used in Extreme Cases
Lobotomies: One of the earliest formal procedures used on
patients with severe mental illness was psychosurgery Areas of the frontal cortex were selectively damaged
These prefrontal lobotomies were used to treat severe mental disorders, including: Schizophrenia, major depression, and anxiety
disorders
Alternative Biological Treatments Are Used in Extreme Cases
Patients who received lobotomies were often listless and had flat affect
The procedure often impaired many important mental functions, such as abstract thought, planning, motivation, and social interaction
With the development of effective pharmacological treatments in the 1950s, the use of lobotomy was discontinued
Alternative Biological Treatments Are Used in Extreme Cases
Electroconvulsive therapy (ECT): Common in the 1950s and 1960s to treat mental
disorders including schizophrenia and depression
ECT now generally occurs under anesthesia with powerful muscle relaxants
ECT is particularly effective for some cases of severe depression, although there are some risks to its use
Alternative Biological Treatments Are Used in Extreme Cases
Transcranial magnetic stimulation and deep brain stimulation are newer techniques that may be promising
Especially in relation to depression and OCD
In TMS, current flows through a wire coil placed over the scalp area to be stimulated.
Deep Brain Stimulation
Pseudotherapies Can Be Dangerous
Some treatments widely believed to be effective are actually counterproductive:
Including encouraging people to describe their experiences following major trauma
Scaring adolescents into going straight Having police officers run drug education
programs (DARE) Using hypnosis to recover painful memories
Pseudotherapies Can Be Dangerous
It is important to recognize the difference between evidence-based psychotherapies and “alternative” or “fringe” pseudotherapies
The latter can prevent people from getting effective treatment and may even be dangerous
What Are the Most Effective Treatments?
Treatments That Focus on Behavior and on Cognition Are Superior for Anxiety Disorders
Many Effective Treatments Are Available for Depression
Lithium Is Most Effective for Bipolar Disorder Pharmacological Treatments Are Superior for
Schizophrenia There Are Important Considerations in Selecting
a Psychotherapist Critical Thinking Skill: Avoiding the Sunk Costs
Fallacy
Learning Objectives
Identify the therapies most effective for treating specific disorders.
What Are the Most Effective Treatments?
According to Barlow, three features characterize psychological treatments:
They vary according to the client and disorder The techniques used in these treatments have
been developed in the laboratory by psychological scientists
No overall grand theory guides treatment Treatment is based on evidence of its effectiveness
Behavioral and Cognitive Treatments Are Superior for Anxiety Disorders
Cognitive-behavioral therapy (CBT) works best to treat most adult anxiety disorders
Anxiety-reducing drugs are also beneficial in some cases
Although there are risks of side effects and, after drug treatment is terminated, the risk of relapse
Behavioral and Cognitive Treatments Are Superior for Anxiety Disorders
Specific phobias:
Systematic desensitization is most effective
Brain imaging data indicate that successful treatment with CBT alters the way the brain processes the fear stimulus
Behavioral and Cognitive Treatments Are Superior for Anxiety Disorders
Findings suggest that psychotherapy effectively “rewires” the brain
Both Prozac and CBT are effective in treating social phobia
However, those taking Prozac report more physical complaints, such as a lack of sexual interest
Behavioral and Cognitive Treatments Are Superior for Anxiety Disorders
Panic attacks: Imipramine prevents panic attacks
But does not reduce the anticipatory anxiety that occurs when people fear they might have an attack
CBT Helps break the learned association between the
physical symptoms and the feeling of impending doom Cognitive restructuring addresses ways of reacting to
the symptoms of a panic attack
Behavioral and Cognitive Treatments Are Superior for Anxiety Disorders
In the short term:
CBT alone and imipramine alone were effective for treating panic disorder, and they did not differ in results
However, six months after treatment had ended:
Those who received psychotherapy were less likely to relapse than those who had taken medication
Behavioral and on Cognitive Treatments Are Superior for Anxiety Disorders
OCD: SSRIs and CBT are effective treatments
Researchers imaged the brains of patients with OCD who were being treated either with Prozac or with CBT Patients in both treatment groups showed the same
changes in neural activity CBT may be a more effective way of treating OCD
than medication, especially over the long term
Treatments for OCD can include the drug clomipramine, exposure, and ritual prevention, with varying rates of success.
ZAPS: The Norton Psychology Labs
ObsessiveCompulsive Disorder
Behavioral and Cognitive Treatments Are Superior for Anxiety Disorders
Deep brain stimulation may be an effective treatment for those with OCD who have not found relief from CBT or medications
DBS leads to a clinically significant reduction of symptoms and increased daily functioning in about two-thirds of those receiving treatment
Many Effective Treatments Are Available for Depression
Pharmacological treatment:
Early antidepressant medication – MAO inhibitors and tricyclics: Fairly effective in reducing depression but had serious
side effects
Prozac, an SSRI, was developed in the 1980s and lacks the serious side effects of earlier antidepressant drugs
Many Effective Treatments Are Available for Depression
Approximately 60 to 70 percent of patients who take antidepressants experience relief from their symptoms
Some evidence suggests that tricyclics might be beneficial for the most serious forms of depression But SSRIs are generally considered first-line
medications because they have the fewest serious side effects
Many Effective Treatments Are Available for Depression
Cognitive-behavioral treatment of depression:
Just as effective as biological therapies in treating depression
The goal of CBT is to help the client think more adaptively
Although CBT can be effective on its own, combining it with antidepressant medication is significantly more effective than either one of these approaches alone
Many Effective Treatments Are Available for Depression
As with other mental disorders, treatment of depression with psychotherapy leads to changes in brain activation similar to those observed for drug treatments
In slightly different areas of the brain
Many Effective Treatments Are Available for Depression
Alternative treatments: Phototherapy is the treatment of choice for those
experiencing SAD Regular aerobic exercise can reduce depression
and prevent recurrence
Incidence of SAD varies by latitude.
Many Effective Treatments Are Available for Depression
Electroconvulsive therapy has been effective for some people with major depression
Although ECT frequently results in an amelioration of depressed mood, the mechanism by which this occurs is unknown
ECT does have some serious limitations, including a high relapse rate (often necessitating repeated treatments), and memory impairments
Many Effective Treatments Are Available for Depression
Transcranial magnetic stimulation can reduce depressive symptoms
A series of studies has demonstrated that TMS over the left frontal regions results in a significant reduction in depression
In October 2008, TMS was approved by the U.S. Food and Drug Administration for the treatment of major depression in patients who are not helped by traditional therapies
Many Effective Treatments Are Available for Depression
Deep brain stimulation:
As with OCD, recent case studies indicate that DBS might be valuable for treating severe depression when all other treatments have failed
Many Effective Treatments Are Available for Depression
Gender issues in treating depression: Female-specific stressors:
The way work and family interact to place additional burdens on women
The biological realities of reproduction and of menopause
Men are reluctant to admit to depression and even more reluctant to seek appropriate therapy Efforts are being made to help men stop masking their
depression with alcohol, isolation, and irritability
Lithium Is Most Effective for Bipolar Disorder
Only about 20% of patients maintained on lithium will experience relapses
Lithium seems to modulate neurotransmitter levels Balancing excitatory and inhibitory activities
Although lithium is effective in stabilizing mood, it has unpleasant side effects including thirst, hand tremors, excessive urination, and memory problems
Lithium Is Most Effective for Bipolar Disorder
Because lithium works better on mania than on depression, patients often are treated with both lithium and an antidepressant SSRIs are preferable to other antidepressants
because they are less likely to trigger episodes of mania
CBT can help increase compliance with medication regimens
ZAPS: The Norton Psychology Labs
Bipolar Disorder
Pharmacological Treatments Are Superior for Schizophrenia
Pharmacological treatments:
Early antipsychotic drugs such as haloperidol and chlorpromazine allowed those suffering from psychotic disorders to be released from hospitals
These drugs, however, created major side effects and only addressed the positive symptoms of the patients
Pharmacological Treatments Are Superior for Schizophrenia
Clozapine is different from previous antipsychotic medications in a number of ways:
Acts not only on dopamine receptors but also on those for serotonin, norepinephrine, acetylcholine, and histamine
Beneficial in treating the negative as well as the positive symptoms of schizophrenia
No signs of Parkinson’s symptoms or of tardive dyskinesia appeared in any of the patients taking the drug
Pharmacological Treatments Are Superior for Schizophrenia
Clozapine’s side effects are serious:
Seizures, heart arrhythmias, substantial weight gain, a fatal reduction in white blood cells
More recently, second-generation antipsychotics have been introduced that do not reduce white blood cell counts
Pharmacological Treatments Are Superior for Schizophrenia
Psychosocial treatments:
Medication does not substantially affect patients’ social functioning
Social skills training is an effective way to address some deficits in schizophrenics
Initial studies using CBT indicate that it is more effective than other psychological treatments in reducing symptoms
Pharmacological Treatments Are Superior for Schizophrenia
Prognosis in schizophrenia:
One long-term study followed participants for an average of 32 years: Between half and two-thirds were recovered or had
considerable improvement in functioning on follow-up
The prognosis for schizophrenic patients depends on factors including age of onset, gender, and culture
There Are Important Considerations in Selecting a Psychotherapist
The major types of specialized mental health practitioners include the following:
Clinical psychologists Psychiatrists Counseling psychologists Psychiatric social workers Psychiatric nurses Paraprofessionals
There Are Important Considerations in Selecting a Psychotherapist
The right therapist must have the appropriate training and experience for the specific mental disorder, and the person seeking help must believe the therapist is trustworthy and caring
Critical Thinking Skill
Avoiding the sunk cost fallacy
People often stick with something because they have already invested so much in it, even if it’s not working
The investment is gone, you cannot get it back Instead, you should focus on deciding what is the
best option for the future
Can Personality Disorders Be Treated?
Dialectical Behavior Therapy Is Most Successful for Borderline Personality Disorder
Antisocial Personality Disorder Is Difficult to Treat
Learning Objectives
Explain why personality disorders are difficult to treat.
Dialectical Behavior Therapy and Borderline Personality Disorder
The most successful treatment approach to date for borderline personality disorder was developed by Marsha Linehan in the 1980s
Dialectical behavior therapy (DBT) combines elements of the behavioral, cognitive, and psychodynamic approaches
Dialectical Behavior Therapy and Borderline Personality Disorder
Therapy proceeds in three stages: In the first stage, the therapist targets the patient’s
most extreme and dysfunctional behaviors Replacing these behaviors with more appropriate ones
In the second stage, the therapist helps the patient explore past traumatic experiences that may be at the root of emotional problems
In the third stage, the therapist helps the patient develop self-respect and independent problem-solving skills
Dialectical Behavior Therapy and Borderline Personality Disorder
Those undergoing DBT are more likely to remain in treatment and less likely to be suicidal than are patients in other types of therapy
SSRIs are often prescribed along with DBT to treat feelings of depression
Antisocial Personality Disorder Is Difficult to Treat
Therapeutic approaches for antisocial personality disorder
Stimulants prescribed to normalize arousal levels
Evidence indicates that these drugs are beneficial in the short term but not the long term
Antisocial Personality Disorder Is Difficult to Treat
Anti-anxiety drugs may lower hostility levels somewhat, and lithium has shown promise in treating the aggressive, impulsive behavior of violent criminals who are psychopathic
Overall, however, psychotropic medications have not been effective in treating this disorder
Antisocial Personality Disorder Is Difficult to Treat
Behavioral approaches
Seems to work best when the therapist controls reinforcement, the client cannot leave treatment, and the client is part of a group
Cognitive approaches have also been tried for antisocial personality disorder with some promising results
Antisocial Personality Disorder Is Difficult to Treat
The prognosis for antisocial personality disorder: The prognosis that patients will change their
behaviors as a result of therapy is poor Fortunately for society, antisocial individuals
without psychopathy typically improve after age 40 But many continue to commit crimes and exhibit the
callousness and manipulativeness characteristic of this disorder
For this longitudinal study, the percentage of participants in prison during each five-year period is shown.
How Should Childhood and Adolescent Disorders Be Treated?
The Use of Medication to Treat Adolescent Depression Is Controversial
Children with ADHD Can Benefit from Various Approaches
Critical Thinking Skill: Evaluating Alternatives in Decision Making
Autistic Children Benefit from a Structured Treatment Approach
Learning Objectives
Explain key arguments in the debate about prescribing medication to children with depression and ADHD.
Understand that sometimes behavioral treatments are best for biological disorders such as autism.
The Use of Medication to Treat Adolescent Depression Is Controversial
Fewer than 30 percent of children who have mental health problems receive any type of treatment
Twice as many of those taking SSRIs reported having suicidal thoughts (4 percent) as those taking a placebo (2 percent) None of the children or adolescents committed
suicide
The Use of Medication to Treat Adolescent Depression Is Controversial
The FDA voted in 2004 to require manufacturers to add to their product labels a warning that antidepressants increase the risk of suicidal thinking and behavior in depressed children and adolescents
The Use of Medication to Treat Adolescent Depression Is Controversial
The Treatment of Adolescents with Depression Study provides clear evidence that the SSRI Prozac is effective in treating adolescent depression
Although the combined group had the best outcomes (86% improvement), improvement with CBT alone (81%) was similar to that with Prozac alone (81%)
The Use of Medication to Treat Adolescent Depression Is Controversial
All treatment groups experienced a reduction in thoughts of suicide compared with the baseline
Participants in the Prozac group were twice as likely to have serious suicidal thoughts or intentions compared with those undergoing other treatments Although prescribing drugs without CBT might be cost
effective, it may not be in the best interests of depressed children
Children with ADHD Can Benefit from Various Approaches
Pharmacological treatment of ADHD The most common treatment is a central-nervous-
system stimulant, Ritalin
Children on Ritalin experience an increase in positive behaviors and a decrease in negative behaviors
Side effects include sleep problems, reduced appetite, body twitches, and temporary growth suppression
Children with ADHD Can Benefit from Various Approaches
Evidence indicates that although stimulants are beneficial in the short term, their benefits may not be maintained over the long term
In addition, there is a very real risk of abuse
Numerous cases of children and adolescents buying and selling these stimulants
Children with ADHD Can Benefit from Various Approaches
Behavioral treatment of ADHD:
Aims to reinforce positive behaviors and ignore or punish problem behaviors
Medication plus behavioral therapy is more effective than either approach alone. Medications may be important in the short term;
psychological treatments may produce superior outcomes that last
Critical Thinking Skill
Evaluating alternatives in decision making:
The first step to good decision making is to frame the question that needs deciding
Then evaluate each alternative along many dimensions
Putting the process on paper allows you to consider multiple alternatives without being limited by working memory
Autistic Children Benefit from a Structured Treatment Approach
Behavioral treatment for autism:
Applied behavioral analysis (ABA)
Developed by Ivar Lovaas and his colleagues One of the best-known and perhaps most effective
treatments for autistic children Based on principles of operant conditioning This very intensive approach requires a minimum of
40 hours of treatment per week
Autistic Children Benefit from a Structured Treatment Approach
Although the ABA program has been demonstrated to be effective, it has some drawbacks:
Time commitment Financial and emotional drains on the family Other children may feel neglected or jealous because
of the amount of time and energy expended on the disabled child
Autistic Children Benefit from a Structured Treatment Approach
Biological treatment for autism:
SSRIs have been tried as a treatment for autism because:
SSRIs such as Prozac reduce compulsions in patients diagnosed with obsessive-compulsive disorder
Autism involves compulsive and repetitive behavior Some evidence indicates abnormal serotonin
metabolism in autistic children
Autistic Children Benefit from a Structured Treatment Approach
Indeed, in some autistic children Prozac reduces repetitive motor behavior and self-injury and improves social interactions
More recent research has focused on oxytocin
Autistic Children Benefit from a Structured Treatment Approach
Prognosis for children with autism:
Long-term prognosis is poor
Studies indicate that nearly three-quarters of adults with autism had severe social difficulties and were unable to live and work independently
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