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Chapter 13Chapter 13
Treatments for Mental Disorder
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Therapy for psychological disorders takes a variety of forms, but all involve some
relationship focused on improving a person’s mental,
behavioral, or social functioning
What is Therapy?What is Therapy?
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What is Therapy?What is Therapy?
Therapy – General term for any treatment process; in psychology and psychiatry, therapy refers to a variety of psychological and biomedical techniques aimed at dealing with mental disorders or coping with problems of living
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The Components of TherapyThe Components of Therapy
In addition to the relationship between the therapist and the patient/client, the therapeutic process typically involves some or all of the following processes:Identifying the problem
Identifying the cause of the problem or the conditions that maintain the problem
Deciding on and carrying out some form of treatment
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Contemporary Approaches to TherapyContemporary Approaches to Therapy
Psychological therapies –Based on psychological principles (rather than biomedical approach)
The psychological therapiesare often collectivelycalled psychotherapy
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Contemporary Approaches to TherapyContemporary Approaches to Therapy
Biomedical therapies –Treatments that focus on altering the brain, especially with drugs, psychosurgery, or electroconvulsive therapy
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Types of Mental Health Care Types of Mental Health Care ProfessionalsProfessionals
Counseling psychologistCounseling psychologist
Clinical psychologistClinical psychologist
PsychoanalystPsychoanalyst
Clinical social workerClinical social worker
PsychiatristPsychiatrist
Psychiatric nurse practitionerPsychiatric nurse practitioner
Pastoral counselorPastoral counselor
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Specialty:Specialty:
Problems of Problems of normal livingnormal living
Work setting:Work setting:
Schools, clinics, Schools, clinics, other institutionsother institutions
Credentials:Credentials:
Master’s in Master’s in counseling, PhD, counseling, PhD,
EdD, or PsyDEdD, or PsyD
Professional TitleProfessional Title
Counseling psychologistCounseling psychologist
Clinical psychologist
Psychoanalyst
Clinical social worker
Psychiatrist
Psychiatric nurse practitioner
Pastoral counselor
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Specialty:Specialty:
Those with severe Those with severe disordersdisorders
Work setting:Work setting:
Private practice, Private practice, mental health mental health
agencies, agencies, hospitalshospitals
Credentials:Credentials:
PhD or PsyDPhD or PsyD
Professional TitleProfessional Title
Counseling psychologist
Clinical psychologistClinical psychologist
Psychoanalyst
Clinical social worker
Psychiatrist
Psychiatric nurse practitioner
Pastoral counselor
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Specialty:Specialty:
Severe mental Severe mental disorders (often disorders (often
by means of drug by means of drug therapies)therapies)
Work setting:Work setting:
Private practice, Private practice, clinics, hospitalsclinics, hospitals
Credentials:Credentials:
MDMD
Professional TitleProfessional Title
Counseling psychologist
Clinical psychologist
Psychoanalyst
Clinical social worker
PsychiatristPsychiatrist
Psychiatric nurse practitioner
Pastoral counselor
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Specialty:Specialty:
Freudian therapyFreudian therapy
Work setting:Work setting:
Private practicePrivate practice
Credentials:Credentials:
MDMD
Professional TitleProfessional Title
Counseling psychologist
Clinical psychologist
PsychoanalystPsychoanalyst
Clinical social worker
Psychiatrist
Psychiatric nurse practitioner
Pastoral counselor
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Specialty:Specialty:
Nursing specialty; Nursing specialty; licensed to licensed to
prescribe drugsprescribe drugs
Work setting:Work setting:
Private practice, Private practice, clinics, hospitalsclinics, hospitals
Credentials:Credentials:
RN – plus special RN – plus special training in treating training in treating mental disorders mental disorders and prescribing and prescribing
drugsdrugs
Professional TitleProfessional Title
Counseling psychologist
Clinical psychologist
Psychoanalyst
Clinical social worker
Psychiatrist
Psychiatric nurse Psychiatric nurse practitionerpractitioner
Pastoral counselor
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Specialty:Specialty:
Social worker with Social worker with specialty in specialty in dealing with dealing with
mental disordersmental disorders
Work setting:Work setting:
Often employed Often employed by governmentby government
Credentials:Credentials:
MSWMSW
Professional TitleProfessional Title
Counseling psychologist
Clinical psychologist
Psychoanalyst
Clinical social workerClinical social worker
Psychiatrist
Psychiatric nurse practitioner
Pastoral counselor
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Specialty:Specialty:
Combines Combines spiritual guidance spiritual guidance
with practical with practical counselingcounseling
Work setting:Work setting:
Religious order or Religious order or ministryministry
Credentials:Credentials:
VariesVaries
Professional TitleProfessional Title
Counseling psychologist
Clinical psychologist
Psychoanalyst
Clinical social worker
Psychiatrist
Psychiatric nurse practitioner
Pastoral counselorPastoral counselor
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Psychologists employ two main forms of treatment:
the insight therapies and the behavioral therapies
How Do PsychologistsHow Do PsychologistsTreat Mental Disorders?Treat Mental Disorders?
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Insight TherapiesInsight Therapies
Insight therapies –Psychotherapies in which the therapist helps patients/clients understand (gain insight into) their problems
Freudian Freudian psychoanalysispsychoanalysis
Cognitive therapiesCognitive therapiesHumanistic therapiesHumanistic therapies
Neo-Freudian Neo-Freudian therapiestherapies
Group therapiesGroup therapies
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Insight TherapiesInsight Therapies
Psychodynamic therapies –Insight therapies based on the assumption that mental disorder is caused by powerful (dynamic) mental forces and conflicts
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Insight Therapies:Insight Therapies: Psychodynamic Therapies Psychodynamic Therapies
Psychoanalysis –The form of psychodynamic therapy developed by Sigmund FreudAnalysis of transference –
Analyzing and interpreting the patient’s relationship with the therapist, based on the assumption that this relationship mirrors unresolved conflicts in the patient’s past
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Insight Therapies:Insight Therapies: Psychodynamic Therapies Psychodynamic Therapies
Neo-Freudian psychodynamic therapies –Therapies developed by psychodynamic theorists who embraced some of Freud’s ideas, but disagreed with others
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Insight Therapies:Insight Therapies: Humanistic therapies Humanistic therapies
Humanistic therapies –Techniques based on the assumption that people have a tendency for positive growth and self actualization, which may be blocked by an unhealthy environment
Client-centered therapy –Emphasizes healthy psychological growth through self-actualizationReflection of feeling –
Paraphrasing client’s words to capture the emotional tone expressed
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Insight Therapies:Insight Therapies: Cognitive therapies Cognitive therapies
Cognitive therapy –Emphasizes rational thinking as the key to treating mental disorder
Cognitive therapy for depression involvesEvaluating evidence
Situational factors
Alternative solutions
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Insight Therapies:Insight Therapies: Group therapies Group therapies
Group therapy – Psychotherapy with more than one client
Self-help support groups – Groups that provide social support and an opportunity for sharing ideas about dealing with common problems; typically organized/run by laypersons (not professional therapists)
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Insight Therapies:Insight Therapies: Group therapies Group therapies
For many issues, couples counseling or family therapy can often be more effective than individual therapy with one individual at a time
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Systematic Systematic desensitizationdesensitization
TokenTokeneconomieseconomies
Contingency Contingency managementmanagement
AversionAversiontherapytherapy
ParticipantParticipantmodelingmodeling
Behavior TherapiesBehavior Therapies
Behavior therapy – Any form of psychotherapy based on the principles of behavioral learning, especially operant conditioning and classical conditioning
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Classical Conditioning TherapiesClassical Conditioning Therapies
Systematic desensitization – Technique in which anxiety is extinguished by exposing the patient to an anxiety-provoking stimulus
Exposure therapy – Desensitization therapy in which patient directly confronts the anxiety-provoking stimulus (as opposed to imagining it)
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UCS(foul odor) UCR
(nausea)
CRCS(cigarette smoke)
Classical Conditioning TherapiesClassical Conditioning Therapies
Aversion therapy – Involves presenting individuals with an attractive stimulus paired with unpleasant stimulation in order to condition a repulsive reaction
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Operant Conditioning TherapiesOperant Conditioning Therapies
Contingency management – Approach to changing behavior by altering the consequences, especially rewards and punishments, of behavior
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Operant Conditioning TherapiesOperant Conditioning Therapies
Token economies – Applied to groups (e.g. classrooms, mental hospital wards) involving distribution of “tokens” contingent on desired behaviors; tokens can later be exchanged for privileges, food, or other reinforcers
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Participant Modeling: An Participant Modeling: An Observational-Learning TherapyObservational-Learning Therapy
Participant modeling – Therapist demonstrates and encourages a client to imitate a desired behavior
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Cognitive-Behavioral Therapy: Cognitive-Behavioral Therapy: A SynthesisA Synthesis
Cognitive-behavioral therapyCombines cognitive emphasis on thoughts
with behavioral strategies that alter reinforcement contingencies
Assumes irrational self-statements cause maladaptive behavior
Seeks to help the the client develop a sense of self-efficacy
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Cognitive-Behavioral Therapy: Cognitive-Behavioral Therapy: A SynthesisA Synthesis
Rational-emotive behavior therapy – Based on the idea that irrational thoughts and behaviors are the cause of mental disorders (REBT)
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Evaluating the Psychological Evaluating the Psychological TherapiesTherapies
Eysenck proposed that people with nonpsychotic problems recover just as well with or without therapy
Reviews of evidence have shown:That therapy is better than no therapy
It appears advantageous to match specific therapies with specific conditions
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Mental “First Aid”Mental “First Aid”
If someone asks you for help, keep in mind that serious problems (especially those involving suicide or threats) require immediate professional treatment
Otherwise, your best tools may involveListeningAcceptanceExploring alternatives
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How Is the BiomedicalHow Is the BiomedicalApproach Used toApproach Used to
Treat Mental Disorders?Treat Mental Disorders?
Biomedical therapies seek to treat mental disorders by
changing the brain’s chemistry with drugs, its
circuitry with surgery, or its patterns of activity with pulses
of electricity or powerful magnetic fields
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Drug TherapyDrug Therapy
Antipsychotic drugsInclude chlorpromazine, haloperidol, and
clozapine
Usually affect dopamine pathways
May have side effects
Tardive dyskinesia – Incurable disorder of motor control resulting from long-term use of antipsychotic drugs
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Drug TherapyDrug Therapy
Antidepressants and mood stabilizersInclude Prozac, monoamine oxidase (MOA)
inhibitors, and lithium carbonate (effective against bipolar disorder)
Treat depression and bipolar disorder
Usually affect serotonin and/or norepinephrine
The use of antidepressants to deal with general feelings of unease is highly controversial
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Drug TherapyDrug Therapy
Antianxiety drugsInclude barbiturates and benzodiazepinesMay include some antidepressant drugs which
work on certain anxiety disordersShould not be used to relieve ordinary
anxieties of everyday lifeShould not be taken for more than a few days
at a timeShould not be combined with alcohol
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Drug TherapyDrug Therapy
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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PsychosurgeryPsychosurgery
Psychosurgery –The general term for surgical intervention in the brain to treat psychological disordersThe infamous prefrontal lobotomy is no longer
performed
Severing the corpus callosum, however, can reduce life-threatening seizures
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Brain-Stimulation TherapiesBrain-Stimulation Therapies
Electroconvulsive therapy 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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Hospitalization andHospitalization andthe Alternativesthe Alternatives
Therapeutic community –Program of treating mental disorder by making the institutional environment supportive and humane for patients
Deinstitutionalization – Policy of removing patients, whenever possible, from mental hospitals
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Hospitalization andHospitalization andthe Alternativesthe Alternatives
Community mental health movement –Effort to deinstitutionalize mental patients and to provide therapy from outpatient clinics
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