Psych Chapter 15 – Treatment of Psychological Disorders – Flashcards
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How many people have a psychological disorder?
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1 in 5
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Why don't people seek treatment?
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20-30% of people with psychological disorders seek treatment •People may be unaware they have a disorder - e.g., psychologists who treat borderline personality disorder usually have family members & friends of the person with BPD as patients (BPD - cleaves the world into for me or against me, polar opinions of people) •Social stigma and personal shame - most people explicitly state that there's no shame in having a disorder & getting treatment, but stigma & shame still exist •Cost - psychiatrist: ~$250 for 30 minutes (prescribe drugs) clinical psychologist: ~$200 for an hour social worker: ~$90 for an hour
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Treatments
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psychotherapy: person interacts with psychotherapist (mind) medical/biological treatments: mental disorder is treated with drugs or surgery (brain/body)
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Psychotherapy
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An interaction between a therapist and someone suffering from a psychological problem, with the goal of providing support or relief from the problem. Currently 400 systems of psychotherapy exist.
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Eclectic Psychotherapy
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A survey of 1,000 therapists describe their main theoretical orientation - 1/3 report using eclectic. A form of psychotherapy that involves drawing on techniques from different forms of therapy, depending on the client and the problem. Apply an appropriate theoretical perspective that is suited to the problem at hand rather than adhering to a single theoretical perspective for all clients and all types of problems.
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Psychodynamic Psychotherapies
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A general approach to treatment that explores childhood events and encourages individuals to develop insight into their psychological problems. Freud, Jung, Klein, Horney (more egalitarian, feminist version of Freud); Still popular, especially among MSWs and in South America
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Psychoanalysis
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Assumes that humans are born with aggressive and sexual urges that are repressed during childhood development through the use of defense mechanisms. Psychoanalysts encourage their clients to bring these repressed conflicts into consciousness so that the clients can understand them and reduce their unwanted influences. Focus on childhood events b/c urges and conflicts likely to be repressed during this time. 3-6 years, 4-5 sessions per week, faces away from analyst, express whatever thoughts and feelings come to mind
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Freud: Developing Insight
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Free Association: client reports every thought that enters the mind, without censorship or filtering Dream Analysis: dreams as metaphors that symbolize unconscious conflicts/wishes Interpretation: therapist deciphers meaning underlying what the client says and does. Analyst suggests possible meanings, looking for signs that the correct meaning has been discovered.
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Resistance
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A reluctance to cooperate with treatment for fear of confronting unpleasant unconscious material
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Transference
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An event that occurs in psychoanalysis 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. Freud: clients would develop an unusually strong attachment to him, almost as though they were viewing him as a parent or a lover. Successful psychoanalysis involves analyzing the transference so that the client understands this reaction and why it occurs.
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Jung: Collective Unconscious
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The culturally determined symbols and myths that are shared among all people, that, he argued, could serve as a basis for interpretation beyond sex or aggression.
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Interpersonal Psychotherapy (IPT)
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A form of psychotherapy that focuses on helping clients improve current relationships. Therapist and client typically sit face-to-face, less intensive, meet once a week for several months not years.
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Behavior Therapy
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A type of therapy that assumes that disordered behavior is learned and that symptom relief is achieved through changing overt maladaptive behaviors into more constructive behaviors. Based on Skinnerian principles: effective in changing the behavior but may not treat underlying cause.
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Token Economy
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A form of behavior therapy in which clients are given "tokens" for desired behaviors, which they can later trade for rewards.
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Exposure Therapy
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An approach to treatment that involves confronting an emotion-arousing stimulus directly and repeatedly, ultimately leading to a decrease in the emotional response.
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Systematic Desensitization
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A procedure in which a client relaxes all of the muscles of his/her body while imagining being in increasingly frightening situations
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Cognitive Therapy
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A form of psychotherapy that involves helping a client identify and correct any distorted thinking about self, others, or the world. Change and redirect irrational thoughts - particularly effective for depression and eating disorders. Where behaviorists might explain a phobia as the outcome of a classical conditioning experience such as being bitten by a dog, cognitive theorists might instead emphasize the meaning of the event - the individual's beliefs and assumptions about the event and the feared stimulus - focus on a person's new or strengthened belief that dogs are dangerous to explain fear.
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Cognitive Restructuring
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A therapeutic approach that teaches 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. Examine evidence for and against a particular belief or be more accepting of outcomes that may be undesirable but manageable.
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Mindfulness Meditation
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A form of cognitive therapy that 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. Helpful in preventing relapse in depression.
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Cognitive Behavioral Therapy (CBT)
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A blend of cognitive and behavioral therapeutic strategies. CBT is also becoming a blanket term for cognitive therapy and REBT. Confront irrational thoughts and determine how to move on and change behavior. Almost all cognitive therapy is now CBT, most effective, first name basis, empowering the person with ways to over come their problem, Judith -Acknowledges that there are behaviors that people cannot control through rational thought but also that there are ways of helping people think more rationally when thought does play a role
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Humanistic/Existential Therapies
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Growth and human potential - can be useful for people who do not have severe symptoms. Reaction to negative views that psychodynamic psychotherapies hold about human nature which emphasize unconscious drives toward sex and aggression. Humanistic/existential therapies assume that human nature is generally positive, and they emphasize the natural tendency of each individual to strive for personal improvement.
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Person-Centered Therapy
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(client-centered therapy) an approach to therapy that assumes all individuals have tendency toward growth and that this growth can be facilitated by acceptance and genuine reactions from the therapist.
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Gestalt Therapy
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An existentialist approach to treatment with the goal of helping the client become aware of his or her thoughts, behaviors, experiences, and feelings and to "own" or take responsibility for them. Clients may be encouraged to imagine that another person is sitting across from them in a chair. The client then moves from chair to chair, role-playing what he or she would say to the imagined person and what that person would answer. Enthusiastic and warm towards their clients, help facilitate awareness by reflecting back to the client their impressions
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Albert Ellis & Rational Emotive Behavior Therapy (REBT)
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•Trained in psychoanalysis •Influenced by Freud, Jung, & Horney •Broke from psychoanalyst tradition •Overcame his own anxiety by talking to strangers on a park bench •Three tenets of Ellis' approach 1.You largely upset yourself 2.No matter when you started, you continue telling yourself B.S. 3.You need to continue the rest of your life!
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Aaron Beck and Cognitive Therapy
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•Trained as a psychodynamic psychiatrist (father of cognitive therapy) •Wanted to experimentally test psychodynamic theories •Although he thought he would be able to provide support for the theories, all of his studies failed •Decided there needed to be a new approach to therapy •While working with depressed patients, realized harmful rumination was at the heart of disorder
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Group Therapy
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•Can be as affective as individual therapy •Particularly helpful for drug and alcohol addiction - people have become accountable for each other (sponsors) o European and Asian countries prefer to talk about how to manage alcohol intake not stop it all together • Can be comforting and healing to know that others suffer from the same problems • Is usually less expensive, sometimes free • Disadvantages: going but not engaging won't help - need to open up, one "bad apple" can destroy group dynamics • Talking about problems can sometimes tempt people back into them
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Summary
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Psychodynamic Therapy: including psychoanalysis emphasize helping clients gain INSIGHT into their unconscious conflicts Behavior Therapy: learning PRINCIPLES to specific behavior problems Cognitive Therapy: aims at CHALLENGING irrational thoughts CBT: CONFRONT irrational thoughts and determine how to move on and CHANGE behavior Humanistic/Existential: helping people to develop a sense of PERSONAL WORTH (growth and human potential) REBT: 1)you upset yourself 2) no matter when you started, you continue telling yourself BS 3)You need to continue the rest of your life!
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Antipsychotic Drugs
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Medications that are used to treat schizophrenia and related psychotic disorders. Completely changed the way schizophrenia was managed. Before the introduction of antipsychotics people with schizophrenia were kept in asylums. Believed to block dopamine receptors in parts of the brain
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Psychopharmacology
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The study of drug effects on psychological states and symptoms.
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Antianxiety Medications
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Drugs that help reduce a person's experience of fear or anxiety. Most common = benzodiazepines (facilitates action of the neurotransmitter GABA). Have potential for abuse, associated with development of tolerance - need for higher dosage over time to achieve the same effects. •Benzodiazepines facilitate GABA action in the brain - reducing anxiety, relaxing muscles, and reduced heart rate •Effective in the short run (immediately effective), but can be both psychologically and physiologically addictive •In the long term, can paradoxically increase aggression, insomnia, and anxiety •Safer than barbiturates, but when mixed with alcohol or other drugs, can be deadly
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Antidepressants
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A class of drugs that help lift people's mood. First introduced in the 1950s - MAOI, tricyclic antidepressants. Most common - selective serotonin reuptake inhibitors or SSRIs
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Antidepressants work, but...
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•Anti-depressants have been shown to be highly effective •SSRI (selective serotonin reuptake inhibitor):inhibit the neurotransmitter's breakdown and block reuptake - make more neurotransmitters available for release and leave more in the synaptic gap to activate the receptor sites on th postsynaptic neuron •Although they take 2 weeks-month to work, friends/family notice differences weeks before patient •However, they may not be treating the cause, and may be treating the symptoms only •The causes may need to be dealt with through therapy •Also, anti-depressants may keep people in bad situations •Since they make people feel less negative, people may continue to be in bad relationships, jobs, etc.
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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. •Early electric shock therapy was extreme, lengthy, and often done against the will of the patient and without anesthesia •Today, electroconvulsive therapy (ECT) is done at a lower watts, for less than a second, with anesthesia •ECT has been shown to be effective •However, the mechanism is unknown - it may be related to memory and unlearning irrational fears and responses •Furthermore, the effect is not permanent - people have to return to ECT when symptoms return treats severe depression and mania
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Transcranial Magnetic Stimulation (TMS)
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A treatment that involves placing a powerful pulsed magnet over a person's scalp, which alters neuronal activity in the brain - treatment for depression
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Phototherapy
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A therapy that involves repeated exposure to bright light - helpful for Seasonal Affective Disorder
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Psychosurgery
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Surgical destruction of specific brain areas - used for OCD
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Lobotomies
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• Although there was some initial evidence that lobotomies decreased aggression • Other problems would emerge like low self-control, incontinence (not having control of bladder), etc. • Moniz was nominated by Walter Freeman for the Nobel prize (and won) • Freeman performed 3,400 ice pick lobotomies until the late 1960s • Many patients died; most were left worse off than pre-surgery
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Placebo
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An inert substance or procedure that has been applied with the expectation that a healing response will be produced. For example, if you take a sugar pill that does not contain any painkiller for a headache thinking its tylenol, this pill is the placebo.
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Placebo Effect
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Observing improvement during treatment does not necessarily mean that the treatment was effective; it might instead reflect natural improvement, nonspecific treatment effects (placebo effect), and reconstructive memory processes
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Iatrogenic Illness
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A disorder symptom that occurs as a result of a medical or psychotherapeutic treatment. When a therapist thinks a client has a disorder that they in fact do not have. Being treated for a disorder can show signs of disorder. Patients influenced thru hypnosis and repeated suggestions in therapy to believe that they have dissociative identity disorder.
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Why is the sexual abuse of people with Dissociative Identity Disorder rarely corroborated?
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• Different people inhabiting one body, very different people in one body • Almost always report some sexual abuse but never corroborated • It could be that it never happened and that people with DID are very sensitive and can't tell reality from fiction (enema triggers feelings of sexual abuse) • It could be that they have DID because their abuse was denied by the people around them
