Psychology Chapter 17 Treatment of Mental Disorders – Flashcards

versions of mental disorders that don't meet the criteria for diagnosis, but that may nonetheless cause significant problems Ex. A person may experience much difficulty with disturbing, unwanted thoughts and may experience feelings of sadness that may impair his ability to enjoy various activities, but may not qualify for a diagnosis of OCD or depression. This person might still benefit from therapy, but has a __________ ______

understanding how a patient's beliefs, values, and expectations for therapy are shaped by his cultural background; a therapist with this cultural understanding can modify the goals of therapy so as to conform to the values appropriate for that patient Ex. A therapist who is insensitive to the values of the patient's culture risks offending the patient and endangering the therapy. Also, a therapist who emphasizes values that are opposed to the individual's cultural traditions can be counterproductive

an approach to therapy that subscribes to neo-Freudian views or to related approaches, such as ego-psychology; although they endorse many of Freud's claims, they tend to emphasize current interpersonal and cultural factors rather than the psychological traumas of early childhood; may seek to identify how the patterns of interaction established in childhood influence current choices; conscious thoughts receive as much scrutiny as unconscious conflicts, and therapist and patient work together to help the patient develop a coherent and complete sense of self, and to find ways of relating to others that are undistorted by past conflicts or maladaptive defense mechanisms; regard sessions as a microcosm of the patient's entire life and recommend that the patient actively attempt to apply the lessons learned in therapy to the rest of her life Ex. Henry's therapist was focused on helping him develop a sense of self and improve his interrelationships

in therapy, the patient's tendency to respond to the analyst in ways that recreate her responses to major figures in her own life; powerful therapeutic tool Ex. The patient ends up loving the analyst just as she loved her mother. These feelings are transferred to the analyst as a kind of repetition of the unresolved problems of the patient's childhood. The therapist allows herself to temporarily stand in for the significant characters in the patient's early family drama, but will not let herself be drawn into the play--she will not respond as the cast of characters from the patient's childhood did, so that she can help the patient see that the old patterns need not be repeated, and can create a new life script with better lines and more acceptable outcomes

mode of therapy originally intended as a brief method to counter depression, but now extended to other disorders; in this therapy, the focus is on the patient's gaining an understanding of how she interacts with others, and then learning new and more beneficial ways of interacting and communicating: a brief (12-t0-16 session) treatment that builds on the claim that mental disorders are often created by a social isolation that cuts a person off from the emotional sustenance provided by healthy relationships Ex. often used as a treatment for depression, the therapist will assess what factors changed in the person's life at the time depression began (i.e. graduation from college, getting married), will help patient learn to act the new part and fill the expectations of the other people involved in the newly entered social setting, will help the patient understand the advantages and disadvantages of both the old and the new roles, and will hep the patient gain an understanding of how he interacts with others, and then help him learn and more beneficial ways of interacting and communicating

a type of therapy developed by Carl Rogers based on the humanistic approach that seeks to help a person accept himself as he is and to be himself with no pretense or self-imposed limits Ex. Tammy, who has always been filled with self-loathing, was learning to accept herself as she was, with both her faults and her strangths

sharing authentic reactions with the patient Ex. When the client-centered therapist reflects back to the patient what the patient seems to be struggling with, it is important that the therapist's reactions are genuine so that the patient can trust the therapist

nonjudgemental and accepting stance Ex. It is important for the client-centered therapist's reactions to be nonjudgemental and accepting so that the patient will continue to share his thought and feeling without fear of rejection

sensing what it must be like to be in the patient's shoes Ex. It is important for the client-centered therapist's reactions to be empathic so that the patient believes the therapists understands and cares about him

a brief, nonconfrontational client-centered intervention designed to change problematic behavior (such as alcohol or other drug use) by reducing ambivalence and clarifying discrepancies between how individuals are actually living and how they say they would like to live Ex. Terrance's therapist was working on helping him see how drugs were interfering with his life, and was motivating him to make changes in his life

a type of therapy developed by Fritz Perls based on the humanistic approach that aims to help the patient achieve self-integration by increasing self-awareness and self-acceptance; Perls believed that psychological difficulties stemmed from the failure to integrate mutually inconsistent aspects of self into an integrated whole or gestalt (inspired by the gestalt theory of perception); techniques were aimed at helping his patients become aware of, and then integrate, previously disparate aspects of self Ex. Perls was famous for asking his patients about what they were feeling in the moment and for pointing out apparent discrepancies between what they said they felt and how they appeared to be feeling

technique developed by Fritz Perls in which a patient imagines that he is seated across from another person, such as his parents or his partner, and tells him or her honestly what he feels; this technique helps patients acknowledge and confront their feelings Ex. Using this technique, Harold told his father how disappointed he was that he never came to any of his sporting events

a family of therapies (integrated modern versions of the humanistic therapies) that, in general, seek to create a genuinely empathic and accepting atmosphere in therapy and also challenge the patient to deepen his experience; all humans are viewed as beings oriented toward growth and full development of their potential, and the therapist uses a number of techniques to encourage this growth and development; involves a genuine concern and respect for the person, with an emphasis on all of her qualities, and not just those symptoms that led to a particular diagnosis; focuses on the person's subjective experience--therapist seeks to be as empathic as possible in order to understand that experience Ex. Experiential therapists reject Freud's notion of transference. They feel that the relationship between patient and therapist is a genuine connection between two people that provides the patient with an opportunity for a new, emotionally validating experience

also called exposure therapy a type of behavior therapy developed by Joesph Wolpe in which the therapist seeks not only to break the connection between the phobic stimulus and the fear response (based on extinction procedures), but to create a new connection (counterconditioning) between the stimulus and a different response (one that is incompatible with fear and will therefore displace it, like deep muscular relaxation--once the patient has learned to relax deeply on cue, this relaxation response is conditioned to the stimuli that have been invoking fear) Ex. Patient starts out by imagining the first scene in the hierarchy (like being on the first floor of a tall building) while in a state of deep relaxation--patient keeps imagining the scene while relaxing until she no longer feels any anxiety (counterconditioning). Next, the patient imagines the second scene in the hierarchy (like looking out a fourth-floor window in the tall building) while in a state of deep relaxation until she no longer feels any anxiety. The process continues, climbing up the anxiety hierarchy until the patient finally can imagine the most frightening scene of all ( leaning over the railing of the building's observation tower more than 100 floors above the ground) and still be able to relax.

feared situations are identified, and then ranked from least to most anxiety provoking; hierarchy is used to set the sequence for therapy. See example for exposure therapy.

a type of exposure therapy that follows the same steps, but instead of using mental images in the anxiety hierarchy, the patient is gradually exposed to instances in the real world that are anxiety provoking; sometimes for patients to successfully desensitize (countercondition) the fear-provoking objects/situations rather than just imagine them; this procedure is also often used after exposure therapy using mental images to support/strengthen the desensitization learned in therapy Ex. can be performed with the therapist present, as guided homework assignments, or in a virtual-reality version of the frightening stimulus (using interactive computer graphics). After completing exposure therapy in his therapist's office, Donald was now ready to gradually expose himself to situations that previously evoked extreme anxiety. He was given homework assignments to help him carry out his plans (so he wouldn't continue to avoid those situations as he had done before receiving therapy).

an operant conditioning technique in which tokens are earned for desirable behaviors (like making his bed, being neatly dressed, or performing various chores) and can be exchanged for rewards (like snacks or the opportunity to watch TV); undesirable behaviors are not rewarded

a form of behavior therapy in which the environment is structured such that certain behaviors are reliably followed by well-defined consequences Ex. A child who is oppositional can be presented with a list of "good behaviors" and "bad behaviors," with an associated reward and penalty for each. The idea is to show the child that her actions have consequences and change the way people react to her. Ideally, her changed behavior will result in a more positive social environment that will motivate the child to continue engaging in "good behaviors."

a behavioral technique in which someone learns new skills, or changes his behavior, by imitating another person; models can include the therapist or other children Ex. can be applied to overt behaviors (like sharing toys), thought processes or decision-making strategies (in which the therapist might "think out loud" about commonplace decisions and situations, _______ how the patient should consider similar setting), and emotional responses (like fearlessness in the presence of some phobic stimulus to diminish a phobia)

a behavioral procedure in which the model experiences some good outcome after exhibiting the desired be behavior or emotional reaction; increases the likelihood that the person in therapy watching the model will later produce the same behavior or reaction Ex. After watching her classmate receive a gold star for making no mistakes on a spelling test, Shana decided to study harder for her next spelling test so she could get a gold star on her paper.

a type of cognitive therapy developed by Albert Ellis based on his view that beliefs (i.e. my roommate should always be friendly to me) link activating events (i.e. being ignored at a party by a roommate) to consequences (i.e. feeling angry), and these beliefs are often the cause of the problems that lead people to seek therapy; some people have irrational beliefs that Ellis believed were the source of the person's problems, and so he targeted them with his clinical intervention: A (activating event) - b (irrational belief) - C (consequence) - D (disputing the irrational beliefs) - E (substituting more effective beliefs); Ellis used a direct method of argument and instruction to dispute (D) the patient's beliefs (B) and offer specific and effective substitutes (E)

a therapy developed by Aaron beck based on his view that dysfunctional cognitions play a key role in the development of mental disorders and these cognitions are targeted for change; Beck proposed that depressed people have negative beliefs about themselves ("I am unlovable"), the world ("It's a cruel world out there"), and the future ("Things are only going to get worse"); these beliefs are supported by distorted thought processes, such as all-or-nothing thinking ("Now that I've lost the election, I'm worthless"), overgeneralization ("I lost my car keys--that's just like me, I lose everything!"), disqualifying the positive ("My doing well on the test today was just a fluke"), and emotional reasoning ("I feel it, therefore I know it's true").

a set of techniques developed by Beck for challenging someone's beliefs or habits of interpreting the world in order to change a person's behaviors and how she thinks about the world; techniques include outright efforts at persuasion, confrontation of their maladaptive beliefs, and strategies for keeping certain thoughts readily available (to be applied instead of more destructive or distressing interpretations of life's events) Ex. Taylor's belief that she was unlovable was challenged in therapy, She was asked if she could name a single person who did love her at some point in her life. When she admitted that her mother did love her before she died, she was able to start altering her irrational belief.

an approach that blends together behavioral and cognitive techniques; this approach is now far more common than either behavioral or cognitive therapy; these types of therapists are present-focused and are concerned with identifying and solving problems the patient wishes to address; therapy sessions are highly structured, and the patient is often expected to do homework, which may consist of practicing new skills or new ways of thinking that he has learned during the therapy sessions Ex. Taylor was asked to continue challenging her irrational belief of being unlovable by not looking at the number of people who love her, but by changing her behaviors that promote negative reactions from others

a form of therapy that deliberately weaves together multiple types and multiple forms of therapy; in the United States, the therapeutic approach that most psychotherapists identify with is eclectic/integrative Ex. Marsha Linehan's dialectical behavior therapy (DBT) for borderline personality disorder includes elements from cognitive, behavioral, humanistic, and psychodynamic therapies. This therapy allows the therapist flexibility to tailor his approach to the specific interventions that seem to be working, and to back off from interventions that seem ineffective. Because mental disorders rarely have a single cause, this type of therapy approach makes sense theoretically.

medications that control, or at least moderate, the manifestations of mental disorders; these drugs have had enormous impact on mental health care by allowing patients with many different disorders to be treated successfully, often without hospitalization; the development of __________ ____ goes hand in hand with advances in our understanding of mental illness (as we learn more about the causes of each disorder, we are able to develop new drug treatments, and conversely, new drug treatments have often allowed us to test claims about what the causes might be) Ex. Franny took __________ ____ to control her symptoms of schizophrenia.

a movement intended to obtain better and less expensive care for chronically mentally ill patients in their own communities rather than at large, centralized hospitals; was at best a partial success; positive effects: the number of patients in mental hospitals decreased dramatically and medications made it possible to discharge patients with schizophrenia more quickly than ever (average stay in the mental hospital dropped to about two months, whereas previously, many people with schizophrenia spent most of their lives in mental hospitals); negative effects: many individuals with serious mental illnesses do not find appropriate care in community settings, nor were they integrated into the community in terms of employment, social relations, or social services Ex. As a result of this, some 200,000 of the deinstitutionalized mentally ill are homeless, and an equal number are housed in jail, often for minor crimes. Thousands more are in marginal living situations, and re-admission to the hospital for short stays has increased by 80% since the 1960s

medications designed to counteract depression Ex. Types of ____________ include MAO inhibitors, tricyclic __________, SSRIs, and atypical ___________.

medications that increase serotonin turnover in the brain and are widely used as effective treatments for depression, anxiety disorders like obsessive-compulsive disorder and panic disorder, eating disorders, and many other disorders; fewer side effects than earlier antidepressants Ex. Popular types include Prozac, Zoloft, and Paxil.

a recently developed group of medications that work in varied ways on serotonin, norepinephrine, and dopamine systems to combat the symptoms of depression Ex. Popular types include Wellbutrin, Effexor, and Serzone.

medications used to treat or prevent manic, mixed or depressive states in bipolar disorder Ex. Lithium carbonate is a commonly used ____ _______ for treating bipolar disorders.

drugs that alleviate the symptoms of anxiety (also called tranquilizers); actions: work by increasing neurotransmission at synapses containing the neurotransmitter gamma-aminobutric acid (GABA) Ex. Alcohol is the most commonly used. patients medicate themselves for their anxiety as part of their lifestyle, inviting the risk of alcohol abuse.

a medication intended to control autonomic arousal and often used in the treatment of anxiety disorders Ex. Popular types include propranolol (Inderal) and metaprolol (Lopressor)

a class of medications used to combat anxiety; useful as short-term treatments (usually taking effect in 30 or 40 minutes) for generalized anxiety disorder, panic disorder, post-traumatic stress disorder, alcohol withdrawal, insomnia, muscle spasms, tension headaches, and various other stress-related disorders; rarely used for long-term treatment, however, because they are highly addictive, interact dangerously with alcohol, and like alcohol, can cause profound fetal damage if the patient is pregnant; concern regarding "rebound" effect--once a person ceases taking the this medication, she may end up more anxious than she was prior to taking the drug Ex. Popular types include Valium, Xanax, and Klonopin.

neurosurgery performed to alleviate manifestations of mental disorders that cannot be brought under control using psychotherapy, medication, or other standard treatments; aims to alter thinking or behavior y removing brain areas, or disconnecting them from each other; some procedures aim at removing a tumor that has been disrupting brain function and has produced symptoms of mental illness; some procedures aim at relieving the fluid pressures in the brain by draining a buildup of cerebrospinal fluid; some procedures aim at manipulating the nervous system directly, but they do so by creating very precise lesions in specific brain areas instead of disconnecting or destroying whole lobes or regions Ex. typically reserved for patients who are severely disabled and show n improvement after all other treatment alternatives have been exhausted. It has been used successfully in patients with intractable depression and epilepsy, severe obsessive-compulsive disorder and chronic pain.

a treatment used mostly for cases of severe depression, in which a brief electric current is passed through the brain to produce a convulsive seizure; modern _ _ _ is much tamer than earlier administrations--used electrical current of moderate intensity and patient are given short-acting anesthetics and muscle relaxants; _ _ _ works for as many as 70-90% of patients who have not responded to any antidepressant medication or who cannot take such medications because of overdose potential for other medical problems; advantages: acts more quickly than antidepressant medications, and also seems quite effective in treating acute mania as well as various psychotic states associated with drug intoxication; mechanisms of action are unclear, but it is more clearly effective than the placebo; modern _ _ _ is one of the most effective treatments for depression ever developed disadvantages: may produce memory impairment, but these cognitive side effects are diminished if the _ _ _ is delivered to just one side of the brain during therapy; despite the many advantages, use of _ _ _ remains controversial and is generally reserved for use only after medication has failed or when there seems to be a serious chance of suicide

a type of biomedical treatment that involves implanting a battery-powered simulator in the chest just underneath the skin that carefully delivers calibrated electrical pulses to the vagus nerve, which has broad afferent and efferent projections Ex. has FDA approval for use with treatment-resistant depression, but information about its short and long term efficacy is still being gathered

a type of biomedical treatment that involves implanting electrodes in the brain areas (limbic system region known as the subgenual cingulate cortex) of patients whose severe depressions have not responded to any conventional interventions; use _ _ _ to disrupt abnormal patterns of activity, thereby normalizing the activity of this portion of the brain; this treatment is based on the finding that severe forms of psychopathology are often associated with abnormalities in the activation levels of certain brain systems; initial research finding show clear signs of benefit from this treatment Ex. is currently being evaluated by other groups, both for depression or other disorders, such as medication-resistant obsessive-compulsive disorder

a type of biomedical treatment where rapid pulses of magnetic stimulation from a hand held coil close to the scalp are used to alter neuronal activity in fully awake participants; treatments last 20 to 30 minutes for several weeks, the procedure is painless, and is not associated with cognitive side effects Ex. has been used to treat medication-resistant depression and has been shown to be as effective as ECT. Because this treatment doesn't require anesthesia and has minimal cognitive side effects, its results are very promising

the relationship that is established between the patient and the therapist that helps most patient believe that they can really conquer their difficulties and achieve better lives; patient gains an ally against his problems; may be the single most important ingredient in the effectiveness of psychotherapy and biomedical treatments Ex. provides the patient with an intimate, confiding connection with another person, reassuring the patient that there is at least one other person in the world he can trust who will help him. It also provides a safe place to say things that otherwise might never be said.

treatments that are based on solid research Ex. Practitioners want to make certain that they are providing benefits and doing no harm, so they seek ways of validating their therapy to make certain it does work

when patients get better on their own, whether they receive treatment or not Ex. Sometimes patients will call for an appointment with a therapist but will cancel the appointment in a couple of weeks due to feeling better.

treatment versus no treatment assessment that uses random assignment of participants to groups Ex. tests for placebo effects by giving the patient a medically neutral substance (the placebo). Placebos often diminish symptoms, but since the substance is medically neutral, the beneficial effects therefore have to be understood as a product of the patient's own beliefs

the influence of a patient's beliefs and expectations in bringing about a cure Ex. In the study of mental disorders, we need to take placebo effects seriously because it is plausible that the patient's distress might be alleviated by her belief in the cure rather than the cure itself

participants are randomly assigned to receive either immediate or delayed treatment (put on waiting list) in order to control for the placebo effects of receiving any kind of treatment at all Ex. the immediate treatment participants responses to treatment are evaluated by comparing them to the delayed treatment participants' responses--who have not yet started therapy.

standardizes a particular therapy for use in research Ex. When a particular therapy is being studied, a treatment manual is developed that tells the therapist exactly how to proceed with the therapy during the study--what steps to take in therapy, what instructions to offer, and so on.

whether a treatment works (obtains desirable outcomes) in carefully designed tests Ex. According to many _______ studies, the effectiveness of DBT therapy for patients with borderline personality disorder is supported by research

whether a treatment works (obtains desirable outcomes) in more typical circumstances Ex. Dr. Smith has had great success with DBT therapy for his patients with borderline personality disorder.

the tendency for different forms of mental disorder to occur together in the same individual; for example, there is considerable _________ between anxiety and depression disorders Ex. RCT data may tell us what happens in therapy with patients with "pure" cases, but not what happens in the much more common mixed cases (like patients with anxiety and ADHD) encountered in most clinics

a statistical technique for combining the results of many studies, even when the studies used different methods to collect the data; this technique is useful in many areas, including studies on the outcome of psychotherapy Ex. ___-______ by Smith et al. reviewed 475 studies. The conclusion, drawn by averaging the percentage relationships across the 475 studies, was that the "average person who receives therapy is better off at the end of it than 80% of the persons who do not"

patients who have some of the signs and symptoms of major depression, but not enough to be diagnosed as having the disorder Ex. in a study looking at impairments suffered from the presence of major depression, individuals were classified into three groups: normals, those with diagnosable major depression, and those with ___________ _________. The findings show that, compared with "normal" subjects on most measures, the people with ________ ________ and major depression were equally impaired.

an expression often used to summarize the comparison of the effectiveness of different forms of psychotherapy; according to the dodo bird in Alice in Wonderland, "Everyone has won, and all must have prizes"--regarding psychotherapy, the statement is understood to mean that all the major forms of psychotherapy are equally effective Ex. A wide variety of treatments, including cognitive therapy, cognitive-behavioral therapy, ECT, and antidepressants, are all effective in treating depression.