Treatment of Mental Disorders

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Treatment of Mental Disorders

• By Mr. C
  

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Key Questions for this Unit

• Whats the difference between a Psychiatrist,
  Clinical Psychologist and a Counselor?
• How do Psychoanalysts treat mental disorders?
• How do Behaviorists treat? How do Humanists
  treat? What is Cognitive therapy?

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What is a psychiatrist?

• Psychiatrists are MDs (medical doctors) with a
  specialty in treating mental disorders, usually
  with a biomedical therapy (medicine) and some
  talk therapy.
• You would see a shrink if you have
  schizophrenia, severe depression, suicidal
  thoughts, and other severe mental problems that
  need medication.

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What is a clinical psychologist?

• A clinical psychologist has a PhD in psychology
  (no medical school). They treat fairly serious
  mental illnesses with talk therapies.
• They might treat personality disorders, anxiety
  disorders, addictions using insight or talk
  therapy.

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What is a counselor?

• A counselor uses talk therapy to treat
  non-mental disorders like improving communication
  between family members, grief counseling, marital
  counseling, life strategies.
• Counselors have a Masters Degree with specialty
  training.

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• 2. In contrast to a clinical psychologist, a
  psychiatrist is more likely to
• a) engage in an eclectic
• b) use a biomedical/somatic treatment
• c) recognize the importance of group therapy
  with patients having the same disorder
• d) treat clients in community mental health
  centers exclusively

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Perspectives on Treatment

• Psychoanalytic
• Behavioral
• Humanistic
• Cognitive
• Biophysical

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What are Psychoanalytic methods?

• Dream Analysis Manifest content (actual
  content) AND Latent content (hidden)
• Transference strong emotional
  outburst/connection with therapist
• Hypnosis
• Free association talk about whatever and Dr.
  analyzes it
• All 5 rely on exposing unconscious thoughts and
  interpreting them.

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VII. Psychoanalysis (psychodynamic)

• Unconscious thoughts emotions are brought into
  awareness to be dealt with.
• Psychological problems the result of
  unconscious processes.
• Bringing unpleasant unconscious thoughts into to
  consciousness, produces catharsis.

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A. What are Psychoanalytic methods of therapy (4
of them on same card if possible)

• 1. Free Association patient reports
  anything that comes to his/her mind.
• The psychoanalyst takes whatever you say
• and treats it like a window into your
  unconscious mind.

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B. Dream analysis

• Dreams have two types of content
• Manifest content- actual events in dream.
• Latent content hidden message in dream.
• (latent hidden)
• Freud thought that each dream represents a
• form of wish fulfillment. The wish may be
• disguised, but it is always there.

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C. Transference

• Feelings of love or other emotions (hatred)
• are expressed toward the therapist.
• These feelings are actually unconsciously felt
• toward others the patient is projecting these
• feelings onto the therapist.
• This provides clues about the clients feelings
• about these other people.

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Hypnosis

• Hypnosis is a psychoanalytic therapeutic
  technique.
• Some people are more susceptible to hypnosis than
  others cant by hypnotized against your will.
• Whatever you think, patients report benefits from
  hypnosis.
• video

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• 5. The goal of psychoanalytical therapy is
• a) to change maladaptive behavior to
  more socially acceptable behavior
• b) to change negative thinking into more
  positive attributions
• c) to attain self-actualization
• d) to bring unconscious conflicts to
  conscious awareness and gain
• insight

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• In psychoanalysis, an emotional attachment to the
  therapist that symbolically represents other
  important relationships is called
• resistance.
• transference.
• c. identification.
• d. empathy

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• A psychoanalyst who believes in the theories of
  Freud would see mental disorders as caused by
• a. birth trauma.
• b. repressed sexuality and aggression.
• c. bizarre dreams.
• d. immature personal relationships.

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Psychoanalysis summary

• What causes mental disorders? unconscious
  (whatever)
• Treatment?
• Probing the unconscious mind (psychoanalysis)

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Behavioral Therapy
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Behavioral causes of disorders?

• Behaviorists believe that mental problems are
  caused by classical conditioning (for example,
  phobias), operant conditioning (addictions,
  depression), and observational learning (we watch
  our parents and friends suffer so we copy them).
• Treatment they change maladaptive behavior.

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What are classical conditioning techniques?

• Systematic desensitization (gradual exposure) to
  your phobia or germs (for OCD and phobias)
• Flooding overexposure to what bugs you
• Aversive conditioning associate bad things with
  your maladaptive behavior (shock testicles) video

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Operant conditioning treatment

• Token economy (operant conditioning) Therapists
  will reward desirable behaviors with a reward
  system. This is usually applied to groups like
  hospital mental wards or classrooms or
  workplaces.

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• Systematic desensitization is a technique based
  on
• a) classical conditioning
• b) instrumental conditioning
• c) operant conditioning
• d) aversive conditioning

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• The owner of a chicken ranch ends a pet dog's
  habit of stealing and eating eggs by allowing the
  dog to "find" and eat several eggs laced with
  Tabasco sauce. The ranch owner's approach is
  similar to
• covert sensitization.
• aversion therapy.
• c. implosive therapy.
• d. desensitization techniques.

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Behaviorism summary

• What causes mental disorders? - We are
  conditioned to be sick (classical, operant,
  observational learning)
• Treatment? We change the behavior through
  conditioning.

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Humanistic Perspective of Psychology
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Humanism

• What is the root word of Humanism?
• After years of psychoanalysts saying we are a
  bunch of id-driven animals and years of
  behaviorists studying rats in a cage, the
  Humanists came along in the 60s.

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What is Humanism?

• Major perspective of psychology.
• Focuses on maximizing human potential, free will.
• Important people Carl Rogers, Abraham Maslow.

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Humanistic therapy?

• Who is Carl Rogers? Carl Rogers was the founder
  of person-centered therapy, reflective listening,
  unconditional positive regard, empathy.
• The patient/client has all the answers and the
  means to treat themselves. In person-centered
  therapy, the therapist acts as a sounding board
  for the patient, sometimes rephrasing what the
  patient says (reflective listening). Empathy is
  important!

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Reflective listening

• Patient to Rogerian therapist Im really
  depressed.
• Therapist I see. Yes. You are depressed.
• Patient Nothing is going well.
• Therapist Nothing well.
• Patient I feel like killing myself.
• T Youre thinking of killing yourself.
• P Yes, Im going to do it NOW.
• T You want to do it now.
• P Jumps out window.
• T Woosh. Splat

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Person-Centered Therapy(Client-centered or
Rogerian)

• Show the client unconditional positive regard
  accepting and valuing self (and people)
  regardless of their behavior
• Allow the client to take responsibility for his
  life
• Mirror the clients emotions and thoughts so that
  he/she can decide their path in life
• Be congruent (honest, genuine, vulnerable)
• Show empathy

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Maslows hierarchy of needs
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Maslows hierarchy of needs

• People cannot maximize their potential unless
  their more basic needs are met.
• If a familys home just got destroyed by a
  tornado, can they focus on their communication
  skills?
• If you are hungry, can you worry about your self
  esteem?

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Humanistic Therapy

• Humanists are really touchy-feely, but without
  them we are just rats in a cage.
• Rogers and Maslow put the human element back
  into psychology and therapy.
• Their philosophy We are all humans striving to
  maximize our potential. A therapists job is to
  remove obstacles to self-actualization.

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Humanism treatment summary

• What causes mental disorders?
• Barriers to self actualization.
• How to treat mental disorders?
• Person-centered therapy, reflective listening,
  unconditional positive regard.

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• Vic is encouraged to take charge of the therapy
  session and his therapist uses an active
  listening approach to mirror back the feelings he
  hears from him. Which therapy is most likely
  being described?
• a) client-centered therapy
• b) cognitive therapy
• c) psychodynamic therapy
• d) existential therapy

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• When a therapist attempts to see the world
  through the client's eyes and to feel some part
  of what he or she is feeling, the therapist is
  using
• a. authenticity. b. empathy.
• c. reflection. d. ego-centering.

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• A therapist that engages in reflective listening,
  non-directive therapy, and has unconditional
  positive regard for the client is probably
• a. cognitive b. behavioral
• c. humanistic. d. psychodynamic

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What is cognitive therapy?

• Cognitive therapy focuses on changing how the
  client/patient thinks.
• The therapist focuses on changing/fixing the
  maladaptive thoughts of the patient
• It can be confrontational
• Cognitive therapy also educates the client,
  teaches him/her proper behaviors/thoughts

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Cognitive perspective

• We are depressed because we are irrational. Our
  expectations are too high and misplaced. We want
  everyone to love us and accept us. We want every
  thing to go our way. We stay angry about stuff
  that happened a looong time ago. WE MUST CHANGE
  THE WAY WE THINK TO BE HAPPY AND SUCCESSFUL.

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Who are famous cognitive therapists?

• Aaron Beck reality therapy
• Albert Ellis rational emotive therapy

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Aaron Beck? Cognitive therapy

• Distorted thinking has a negative effect on our
  behavior no matter what type of disorder (Aaron
  Beck, 1997).

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Albert Ellis Rational Emotive Behavioral Therapy

• vigorously challenges peoples illogical,
  self-defeating attitudes and assumptions a
  confrontational therapy

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Rational Emotive Therapy Ellis

• A-B-C theory of dysfunctional behavior
• A Activating event
• B Belief
• C emotional Consequence based on that belief.

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Example of Rational Thinking

• A fail a midterm examination
• BIts unfortunate that I failed-I did not study
  hard enough and I must make sure that I study
  harder for the final
• Cno consequences (no emotional disturbance)

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Example Irrational Thinking leads to Emotional
Disturbance

• A Fail exam
• B Im stupid, Ill never be able to pass this
  course and I will fail this course
• Cdepression

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Rational Emotive Therapy

• Identify patients irrational beliefs
• Add D and E to A-B-C theory
• Teach the patient to Dispute the beliefs and
  substitute logical and rational beliefs
• Evaluate the effects of disputing their
  irrational beliefs

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CBT Effective for Which Disorders?

• Empirically supported treatment for
• Depression
• Generalized anxiety disorder
• Obsessive compulsive disorder
• Panic disorder

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Cognitive summary

• What causes mental disorders?
• Irrational thoughts and beliefs
• How to treat disorders?
• Change the thoughts and beliefs

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• In rational-emotive therapy,
• a.clients are encouraged to take responsibility
  for their own choices.
• b.clients learn to challenge irrational beliefs.
• c.the therapist seeks to have the client discover
  rational insights on his or her own.
• d.irrational elements of the unconscious are made
  to conform to reality.

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• One difference between psychoanalytic and
  cognitive models of treatment is that cognitive
  therapists
• Say little during sessions
• Emphasize the primacy of behavior
• Focus on the present
• View repressed thoughts about ones childhood as
  the root of most problems
• Do not face their clients

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• Who would suggest that cognitive distortions or
  errors in logic that are blown out of proportion
  could lead to psychological disorders?
• A. Sigmund Freud
• B. Ivan Pavlov
• C. Carl Rogers
• D. Aaron Beck
• E. Tommy Chong

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Eclectic therapy? uses tools from cognitive,
behavioral and humanistic perspectives
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Group Therapy
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Benefits of Group Therapy?

• Is cheap, effective. (only 1 professional is
  needed)
• It allows people to gain insight into their own
  behaviors and thoughts
• People dont feel like they are the only one with
  their problem they can witness the therapist
  treat others with similar problems.
• You can cure yourself while curing others.

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• All of the following are potential benefits of
  group therapy EXCEPT
• a) it is often more economical than 11
  treatment
• b) it does not require the services of a mental
  health professional
• c) clients with similar problems can provide
  helpful insight and feedback to peers
• d) group members can see how their problems
  might impact others

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What is the biomedical approach to
treatment?Drugs, surgery, ECT
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Types of drugs?
Antipsychotics (schizophrenia) can lead to
tardive dyskinesia Antidepressants (Prozac,
Zoloft, Wellibutruin) Antianxiety can lead to
drowsiness (Xanax, Paxil)
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Somatic therapy (Drug Therapy)

• Antipsychotic drugs
• alleviate the symptoms of severe disorders such
  as schizophrenia ExamplesThorazine,
• many work by blocking dopamine receptor sites
• Can lead to tardive dyskinesia, (tremors)

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Drug Therapy

• Psychopharmacology The prescribed use of drugs
  to help treat symptoms of mental illness
  ostensibly to ensure that individuals are more
  receptive to talk therapies

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Drug Therapy

• Antidepressants and mood stabilizers
• Include Prozac, monoamine oxidase (MOA)
  inhibitors,
• lithium carbonate is a mood stabilizer (effective
  against bipolar disorder)
• Treat depression and bipolar disorder
• Usually affect serotonin and/or norepinephrine

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SSRIs block the reuptake of serotonin between 2
neurons
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Drug Therapy

• Antianxiety drugs
• work by depressing central nervous system
  activity
• Most common side effect - drowsiness
• highly addictive, can be fatal when mixed with
  alcohol
• sudden cessation after long-term use can result
  in severe withdrawal symptoms, including
  seizures, increased anxiety,
• and in rare cases, death
• Xanax, Paxil

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Drug Therapy in ADHD

• Stimulants suppress activity level in persons
  with attention-deficit/hyperactivity disorder
  (ADHD)
• There is controversy from concern that the causes
  and boundaries of ADHD are vague and the
  potential exists for overdiagnosis

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• _______ is any technique involving surgical
  alteration of the brain.
• Ablation lesioning
• Psychosurgery
• c. Deep ECT
• d. Psychic surgery

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• 4. The MOST commonly cited side effect
  associated with anti-anxiety drugs is
• a) insomnia
• b) blurred vision
• c) drowsiness
• d) tachycardia

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• 9. Prozac and other modern antidepressant
  medications work to
• a) block dopamine receptors
• b) decrease the level of acetylcholine
• c) break down the MAO enzymes
• d) block the reuptake of seratonin

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• 11. Valium is
• a) an antidepressant drug
• b) an MAO inhibitor
• c) an antipsychotic drug
• d) an antianxiety drug

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Psychosurgery

• Psychosurgery The general term for surgical
  intervention in the brain to treat psychological
  disorders
• The infamous prefrontal lobotomy is no longer
  performed
• Severing the corpus callosum, however, can reduce
  life-threatening seizures

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Brain-Stimulation Therapies

• Electroconvulsive therapy ECT is used for the
  treatment of severe depression
• Transcranial magnetic stimulation, a possible
  alternative to ECT, can also be used for the
  treatment of depression, schizophrenia, and
  bipolar disorder

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Transcranial magnetic stimulation

• Video

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• 1930s-1950s
• Frontal lobotomy
• Became Prefrontal lobotomy
• Muniz won Nobel prize for procedure
• Procedure eventually banned
• Destruction of personality
• Replaced in 1954 by first anti-psychotic
  Thorazine

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• Treating disorders with drugs or surgery is known
  as
• cognitive therapy
• humanistic therapy
• c. biomedical therapy
• d. psychoanalysis

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• Carl Rogers is responsible for
• client-centered therapy.
• psychoanalysis.
• c. directive therapy.
• d. existential therapy.

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• The aim of cognitive-behavioral therapy is to
  _____
• Discover unconscious motives for behavior
• Change the way people behave
• Change the way people think and behave
• Change peoples negative thinking patterns

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• Ann is suffering from depression and no
  psychological or drug therapies are working to
  alleviate her symptoms. The biomedical technique
  of ____ may be used as a last resort.
• Flooding
• Systematic desensitization
• Electroconvulsive therapy
• psychosurgery

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• Modern antidepressants, such as Prozac, work to
  block the reuptake of which neurotransmitter?
• Dopamine
• Serotonin
• Acetylcholine
• GABA

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• John is a 12-year-old who is having trouble
  dealing with his familys relocation to a new
  city. He most likely first sees a ______
• Psychiatrist
• Counselor
• Clinical psychologist
• Registered nurse
• Psychoanalyst

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• In aversion therapy a person __________ to
  associate a strong aversion with an undesirable
  habit.
• knows
• learns
• wants
• hopes