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prevalence of mental disorders

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one in five suffer from mental disorder

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three problems that cause people to fail to get treatment

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1. People may not realize their disorders need to be treated 2. Barriers to treatment 3. May not know where to look for services

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two kinds of treatments

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psychotherapy, medical or biological treatment

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psychotherapy

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(psychological therapy) an interaction between a therapist and someone suffering from a psychological problem, with the goal of providing support or relief from the problem

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eclectic therapy

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a form of psychotherapy that involves drawing on techniques from different forms of therapy, depending on the client and the problem

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four major branches of psychotherapy

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1. Psychodynamic therapy 2. Behavioral and cognitive therapies 3. Humanistic and existential therapies 4. Group therapy

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psychodynamic therapies

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Explore childhood events and encourage individuals to use this understanding to develop insight into their psychological problems Path to overcoming psychological problems is to develop insight into the unconscious memories, impulses, wishes, and conflicts that are assumed to underlie these problems Roots in Freud's psychoanalytical oriented theory of personality

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traditional psychoanalysis

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Psychoanalysis takes place over 3-6 years, 4-5 sessions per week Client reclines on a couch, facing away from analyst - asked to express thoughts/feelings that come to mind Analyst may comment, but does not express his or her values and judgments Goal of psychoanalysis is for client to understand unconscious by developing insight

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techniques for developing insight

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Free association: client reports every thought that enters the mind, therapist looks for recurring themes Dream analysis: therapist looks for dream elements to symbolize unconscious conflicts or wishes

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resistance

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reluctance to cooperate with treatment for fear of confronting unpleasant unconscious material - psychoanalysts assess clients' resistance

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transference

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when the analyst begins to assume a major significance in the client's life and the client reacts to the analyst based on unconscious childhood fantasies; very important according to Freud

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Carl Jung and Alfred Adler

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psychodynamic therapists, agreed with Freud that insight was a key therapeutic goal, but disagreed that insight usually involves unconscious conflicts about sex and aggression

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Carl Jung

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psychodynamic therapist, emphasized collective unconscious: the culturally determined symbols and myths that are shared among all people

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Alfred Adler

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psychodynamic therapist, believed that emotional conflicts are the result of perceptions of inferiority - psychotherapy should help people overcome problems resulting from inferior social status, sex, roles, and discrimination

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Melanie Klein

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psychodynamic therapist, believed that primitive fantasies of loss and persecution were important factors underlying mental illness

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Karen Horney

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psychodynamic therapist, disagreed with Freud about inherent differences in psychology of men and women - traced such differences to society and culture rather than biology

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modern psychodynamic therapies vs. classical psychoanalysis

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Therapists and clients sit face-to-face Therapy is less intensive Modern psychodynamic therapists see relief from symptoms as goal for therapy, as well as insight - offer support/advice in addition to interpretation Therapist now are less likely to interpret statements as sign of unconscious sexual or aggressive impulses Similarities: transference and fostering insight into unconscious remain

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behavioral therapy

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assumes that disordered behavior is learned and that symptom relief is achieved through changing overt maladaptive behaviors into more constructive behaviors

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goals of behavioral therapy

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eliminating unwanted behavior, promoting desired behaviors, reducing unwanted emotional responses

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consequences

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reinforcing or punishing event that follow behavior - operant conditioning shows that behavior can be predicted by its consequences

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token economy

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positive reinforcement; involves giving clients "tokens" for desired behaviors, which they can later trade for rewards - sometimes used in psychiatric hospitals

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exposure therapy

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Confronting an emotion-arousing stimulus directly and repeatedly, ultimately leading to a decrease in the emotional response Depends on process of habituation and response extinction that were discovered in classical conditioning

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cognitive therapy

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focuses on helping a client identify and correct any distorted thinking about self, others, or the world; developed by Aaron T. Beck, Ph.D.

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cognitive restructuring

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involves teaching the clients to question the automatic beliefs, assumptions, and predictions that often lead to negative emotions and to replace negative thinking with more realistic and positive beliefs

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mindfulness meditation

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teaches an individual to be fully present in each moment; to be aware of his or her thoughts, feelings, and sensations; and to detect symptoms before they become a problem

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cognitive behavioral therapy (CBT)

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A blend of cognitive and behavioral therapeutic strategies; used by most therapists working with anxiety and depression "Problem focused": undertaken for specific problems "Action oriented": the therapist tries to assist the client in selecting specific strategies to help address those problems

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humanistic and existential therapies

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share assumption that psychological problems stem from feelings of alienation and loneliness and that these feelings can be traced to failure to reach one's potential (in humanistic approach) or failure to find meaning in life (in existential approach)

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person-centered therapy

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(Client-centered therapy) humanistic therapy that assumes that all individuals have a tendency toward growth and that this growth can be facilitated by acceptance and genuine reactions from the therapist Therapist tends not to provide advice, but paraphrase the client's words

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three qualities of person-centered therapist

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1. Congruence 2. Empathy 3. Unconditional positive regard

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Gestalt therapy

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Existential therapy, has the goal of helping the client to become aware of his or her thoughts, behaviors, experiences, and feelings and to "own" or take responsibility for them Therapists encouraged to be enthusiastic and warm Also reflect their impressions of the client back to the client to help facilitate awareness Emphasizes the experiences and behaviors that are occurring at that particular moment in the therapy session Clients encouraged to put feelings into action (empty chair technique)

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couples and family therapy

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problems and solutions are seen as arising from the interaction of individuals, rather than from any one party

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group therapy

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technique in which multiple participants (who often do not know one another at the outset) work on their individual problems in a group atmosphere

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self-help groups and support groups

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discussions or Internet chat groups that are often run by peers who have themselves struggled with the same issues (e.g. AA) - important offshoot of group therapy

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antipsychotic drugs

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Treat schizophrenia and related psychotic disorders Believed to block dopamine

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psychopharmacology

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the study of drug effects on psychological states and symptoms

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effect of dopamine of schizophrenia

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Dopamine overactivity is related to positive symptoms of schizophrenia (hallucinations, delusions) However, negative symptoms (emotional numbing, social withdrawal) may be related to dopamine underactivity

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atypical antipsychotics

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New class of antipsychotic drugs that appear to block both dopamine and serotonin receptors - can provide relief for both positive and negative symptoms Milder side effects than conventional/typical antipsychotics

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antianxiety medications

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drugs that help reduce a person's experience of fear or anxiety; most common are benzodiazepines

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benzodiazepines

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Most common antianxiety medication; type of tranquilizer that works by facilitating the action of gamma-aminobutyric acid (GABA) Doctors are cautious about prescribing

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antidepressants

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a class of drugs that help lift people's moods

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Monoamine oxidase inhibitors (MAIOs)

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Early antidepressants; prevent the enzyme monoamine oxidase from breaking down neurotransmitters such as norepinephrine, serotonin, and dopamine

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Tricyclic antidepressants

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early antidepressants; block the reuptake of norepinephrine and serotonin

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most commonly used antidepressants today

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Selective serotonin reuptake inhibitors (SSRIs): work by blocking reuptake of serotonin Effexor (venlafaxine): example of a serotonin and norepinephrine reuptake inhibitor (SNRI) Wellbutrin (bupropion): a norepinephrine and dopamine reuptake inhibitor

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effect of antidepressants on other disorders

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Relieve symptoms of depression, anxiety disorders, eating disorders Not recommended for treating bipolar disorder - may trigger manic episode Bipolar disorder is commonly treated with mood stabilizers: medications used to suppress swings between mania and depression

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effects of medicine vs. drugs

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Similar reductions in activations of amygdala, hippocampus, and neighboring cortical areas (involved in memory for emotional information) Therapy and medication affect brain in regions associated with reaction to threat

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electroconvulsive therapy (ECT)

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a treatment that involves inducing a mild seizure by delivering an electrical shock to the brain; primarily for severe depression

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transcranial magnetic stimulation (TMS)

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a treatment that involves placing a powerful magnet over a person's scalp, which alters neuronal activity in the brain

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phototherapy

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involves repeated exposure to bright light - may be helpful for people who have seasonal pattern to their depression

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psychosurgery

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the surgical destruction of specific brain areas - rarely used

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lobotomy

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first psychosurgery, inserting instrument into brain through eye socket or holes drilled in head - objective was to sever connections between frontal lobes and inner brain structures, such as thalamus (involved in emotion), and thereby reduce violence or agitation

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psychosurgery for OCD

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OCD can be treated with surgery that destroys parts of the cingulate gyrus and corpus callosum or that disrupt pathway between caudate nucleus and putamen

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deep brain stimulation

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psychosurgery in which a small, battery-powered device is implanted in the brain - treatment for OCD and other disorders

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three potential illusions of treatment

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1. Natural improvement 2. Nonspecific treatment effects 3. Reconstructive memory

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natural improvement

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the tendency of symptoms to return to their mean, or average, level

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nonspecific treatment effects

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not related to specific mechanisms by which treatment is supposed to work; e.g. placebo

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reconstructive memory

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mistakenly believing that your symptoms before treatment were worse than they actually were

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outcome studies

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designed to evaluate whether a particular treatment works, often in relation to some other treatment or a control condition

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process studies

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designed to evaluate why a treatment works or under what circumstances it works

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double-blind experiment

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a study in which both patient and the researcher/therapist are uninformed about which treatment the patient is receiving

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two levels of empirical support

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well-established treatments (those with high level of support) and probably efficacious treatments (those with preliminary support)

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latrogenic illness

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a disorder or symptom that occurs as a result of a medical or psychotherapeutic treatment itself

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psychologists' ethical standards

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1. Striving to benefit clients and taking care to do nor harm 2. Establishing relationships of trust with clients 3. Promoting accuracy, honesty, and truthfulness 4. Seeking fairness in treatment and taking precautions to avoid biases 5. Respecting the dignity and worth of all people

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three major components of CBT

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1. Psychoeducation: education about behaviors, thoughts, and emotions and how these factors contribute to psychological disorders 2. Cognitive restructuring 3.Exposure

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3 component model of psychoeducation

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1. Physical sensation/feelings 2. Thoughts 3. Behaviors

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common "thinking traps"

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Probability overestimations: overestimating the probability that things will go wrong or that something bad will happen Catastrophizing: tendency to anticipate extreme outcomes or to view unfortunate events as catastrophic Addressed with cognitive restructuring

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Conflict Theory

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modern Freudian approach Focus on conscious and unconscious conflicts among desires to be controlling, depending, aggressive, or sexual; relieving feelings of guilt, shame, anxiety, and jealousy Today, emphasis is more on ego functioning than instinctual drives Mental health signaled by ability to "mentalize" or hold simultaneously in mind one's own and other's perspectives and thus relate well to others

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early attachments

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Current problems stem from unresolved conflicts in pasts; disruptions to our sense of security with our early attachment figures Early traumas may have been repressed BUT they continue to influence our internal templates for all relationships

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therapy as "holding" environment

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Provides safe, secure, dependable relationship in which clients might work through early relationship conflicts Creates a natural, empathic, supportive relationship that fosters a degree of attachment without complete dependence The goal is to provide a secure environment with clear boundaries; allows client to explore nature of relationships with others as well as with therapist

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key misconceptions regarding treatment

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1. Only crazy people go to therapy 2. A good therapist can cure you of anything 3. Psychotherapy is not based on science 4. Drug treatment is unnecessary and creates dependance

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