Chapter 14: Psychological Disorders Treatment & Therapies – Study Notes

Seeking Treatment & Important Factors in Treatment

Overview of Seeking Treatment

People seek psychological treatment when experiencing significant distress or impairment in daily functioning. Understanding the barriers and factors influencing treatment is essential for effective mental health care.

• Common reasons for seeking treatment:

  • Overwhelming or prolonged sadness

  • Difficulties with daily functioning

  • Actions that are harmful to self or others

• Access to treatment: Only about 68% of those with a serious mental illness receive treatment.

• Barriers to treatment: Stigma, cost, and lack of insurance are major obstacles.

• Consultation process: Involves assessment and selection of treatment options.

Demonstrating Treatment Effectiveness

Scientific research and experimental studies are crucial for evaluating the effectiveness of psychological treatments.

• Evidence-based medicine: Scientific research guides patient care decisions.

• Experimental studies: Use treatment and placebo groups to assess outcomes.

• Placebo effect: Improvement due to expectations rather than the treatment itself.

• Double-blind technique: Prevents bias by ensuring neither participants nor researchers know who receives the treatment.

• Demand characteristics: Cues that influence participants' behavior in studies.

Biologically Based Therapies

Overview

Biologically based therapies treat psychological disorders by targeting the body, often through medical interventions.

• Historical context: Treatments date back to ancient Egypt but became effective only in the 20th century.

• Psychosurgery: Surgical procedures on the brain, such as prefrontal lobotomy (rarely used today).

• Brain stimulation therapies: Electroconvulsive therapy (ECT) is used for severe depression, especially in institutionalized patients.

Drugs and the Therapeutic Process

Medications are commonly used to treat psychological disorders, often in combination with psychotherapy.

• Types of drugs:

  • Anxiolytic drugs: Used for anxiety (e.g., Xanax, Valium)

  • Antidepressant drugs: Used for depression and anxiety (e.g., SSRIs, SNRIs, tricyclics, MAO inhibitors)

  • Mood stabilizers: Used for bipolar disorder (e.g., Lithium)

  • Antipsychotic drugs: Used for psychotic disorders (e.g., phenothiazines, atypical antipsychotics)

• Tardive dyskinesia: A side effect of antipsychotic drugs, more common with older drugs and higher dosages.

• Risks: Dosage monitoring and long-term use may carry risks.

Psychodynamic Therapies

Sigmund Freud's Psychoanalysis

Psychoanalysis is an insight therapy aiming to uncover unconscious motives and conflicts through techniques such as free association and dream analysis.

• Key techniques:

  • Free association: Reporting thoughts without censorship.

  • Dream analysis: Interpreting dreams for unconscious meaning.

  • Interpretation: Providing context and meaning for feelings or behaviors.

  • Resistance: Patient's reluctance to provide information.

  • Transference: Therapist becomes the object of patient's emotions.

  • Working through: Repeated cycle of interpretation, resistance, and transference.

• Criticisms:

  • Followers often disagreed with Freud.

  • Modified approaches focus on reality testing and self-control.

  • Criticized for being unscientific, subjective, and time-consuming.

  • More effective with anxiety and verbal, well-educated patients.

Humanistic Therapies

Client-Centered Therapy

Developed by Carl Rogers, client-centered therapy helps clients evaluate their world from their own perspective, emphasizing personal growth and self-fulfillment.

• Key principles:

  • Focus on present and future, not the past.

  • Creativity and innate desire for fulfillment.

  • Use of the term "client" rather than "patient".

• Therapeutic relationship requires:

  • Unconditional positive regard: Acceptance and positive feelings toward clients.

  • Genuineness: Being real or authentic.

  • Empathic listening: Accurately sensing and communicating about clients' feelings.

• Outcomes: Clients become less defensive, more congruent, and open to new experiences.

• Criticisms: Focus on relationships, questions about long-term effectiveness.

Cognitive Therapy

Overview

Cognitive therapy focuses on how distorted or inaccurate thoughts affect coping strategies and mental health. Changing thoughts leads to changes in behavior.

• Key concepts:

  • Modifying faulty thought patterns.

  • Focus on current thoughts and behaviors.

• Examples:

  • Rational Emotive Therapy (RET): Developed by Albert Ellis, helps clients examine and change irrational beliefs.

  • Beck's approach: Focuses on identifying and changing negative thought patterns.

  • Meichenbaum's approach: Alters self-instructions to develop adaptive behaviors.

Behavioral Therapy

Overview

Behavioral therapy applies learning principles to change human behavior, focusing on observable actions rather than unconscious processes.

• Advantages:

  • Effective for specific problems (e.g., phobias).

  • Shorter duration and less expensive than other therapies.

  • Solution-focused for manageable issues.

• General procedures:

  1. Identify the problem behavior and its frequency.

  2. Use individually tailored treatment.

  3. Continually assess behavior change.

Common Behavioral Therapy Approaches

• Operant conditioning: Use of reinforcers to establish new behaviors (e.g., token economies).

• Bandura's modeling: Teaching new behaviors by imitation; risk of modeling inappropriate behaviors.

• Counterconditioning: Learning a new response to a stimulus (e.g., Wolpe's aversive counterconditioning).

• Systematic desensitization: Gradual exposure to anxiety-producing stimuli while practicing relaxation.

• Exposure therapy: Facing fear stimuli directly or virtually to eliminate unreasonable fear responses.

Cognitive Behavior Therapy (CBT)

Overview

CBT integrates cognitive and behavioral therapy, focusing on changing thoughts and behaviors. It is effective for a wide range of disorders, including depression and anxiety.

• Key features:

  • Combines focus on thoughts and behaviors.

  • Effective and brief compared to other therapies.

  • Includes techniques such as exposure, cognitive restructuring, and skills training.

Group Therapy

Overview

Group therapy involves several people meeting together with a therapist to receive psychological help. It is cost-effective and provides support through shared experiences.

• Features:

  • Originated in the early 20th century.

  • Addresses lack of therapists and lowers costs.

  • Group members share experiences, support each other, and try new behaviors.

  • Typically involves clients with compatible needs, continuing for several months.

Family Therapy

Family therapy involves two or more people committed to each other's well-being, focusing on family structure and relationships.

• Features:

  • May include couples or families.

  • Focus on family as a dynamic system.

  • Complicates research due to many variables.

  • Addresses issues of involvement, enmeshment, and spillover of individual problems.

Community Psychology

Overview

Community psychology provides psychological services to communities and empowers individuals to bring about social change.

• Focus:

  • Developing and strengthening community involvement.

  • Designing interventions and promoting skills and motivation.

  • Emphasis on prevention (reducing new cases) and early identification of mental disorders.

Mental Health Care & the Modern Health Care System

Overview

Mental health care has evolved from institutionalization to community-based care, with ongoing challenges related to stigma, access, and effectiveness.

• Historical context: Mistreatment was common before the 1900s; beliefs about mental illness have changed over time.

• Deinstitutionalization: Shift from inpatient to outpatient/community-based care.

• Challenges:

  • Inadequate staffing and social services.

  • Homelessness among those with mental illness.

  • Stigma and shame associated with mental health treatment.

  • Stigma affects men, young people, ethnic minorities, military personnel, and health professionals.

Table: Types of Psychological Therapies

Therapy Type	Main Focus	Key Techniques	Common Disorders Treated
Biologically Based	Body/brain interventions	Drugs, ECT, psychosurgery	Depression, bipolar, schizophrenia
Psychodynamic	Unconscious motives	Free association, dream analysis	Anxiety, personality disorders
Humanistic	Personal growth	Client-centered, unconditional positive regard	Self-esteem, adjustment issues
Cognitive	Thought patterns	Rational emotive therapy, cognitive restructuring	Depression, anxiety
Behavioral	Observable behavior	Operant conditioning, modeling, exposure	Phobias, OCD
CBT	Thoughts & behaviors	Combined cognitive and behavioral techniques	Depression, anxiety, PTSD
Group/Family	Interpersonal relationships	Group sessions, family systems	Relationship issues, adjustment

Key Equations and Concepts

• Placebo Effect: Improvement due to expectations, not the treatment itself.

• Double-Blind Technique: Prevents bias in experimental studies.

• Token Economy (Operant Conditioning): $\text{Number of tokens earned} = \text{Frequency of desired behavior} \times \text{Token value}$

Additional info: Some content was expanded for clarity and completeness, including definitions, examples, and a summary table.