Ch. 9 How do mental health professionals treat psychological disorders PDF

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Dr. Melina Ciccocioppo...

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Ch. 9 How do mental health professionals trea psychological disorders? Thursday, November 12, 2020

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Types of therapies - Psychotherapy: trained therapist uses psychological techniques to assist someone seeking to overcome a psychological difficulty or achieve personal growth (ex: social workers, licensed counselors) ○ Eclectic approach: using a blend of psychotherapies - Biomedical therapy: medication or other biological procedures are used to al an individual's physiology (ex: psychiatrists, psychiatric nurses) Psychotherapy - Psychoanalysis (Freud) ○ Goal: reduce growth-impeding inner conflicts by bringing repressed feelings to conscious awareness ○ Techniques § Free association: a patient lying on a couch and talking § Analyst notes resistance (pausing, changing the subject, etc.) and transference (becoming hostile towards the psychoanalyst is they' feeling hostile about what they’re saying) § Dream analysis (Freud thought dreams were very insightful into th person's unconscious thoughts) ○ Critique § Not supported by scientific research (can't really prove that it work § Time-consuming and expensive - Psychodynamic Therapy ○ Similarity with psychoanalysis § Helps clients gain insight into feelings and conflicts they may not b fully aware of ○ Differences from psychoanalysis § Focus on current symptoms § Meet with therapist face-to-face § Number of sessions are limited ○ Interpersonal psychotherapy § Focus on improving relationships - Client-centered Therapy (aka humanistic or person-centered therapy)

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○ Goal: reduce growth-impeding conflicts by helping clients gain new insights § Focus on growth rather than illness ○ Techniques § Nondirective § Active listening □ Paraphrase □ Invite clarification □ Reflect feelings - Cognitive Therapies ○ Goal: teach people more constructive ways of thinking ○ Techniques: identify and challenge catastrophizing and irrational thoug

- Behavior Therapies ○ Goal: replace maladaptive behaviors with constructive ones ○ Techniques § Use principles of classical and operant conditioning to help clients unlearn learned behaviors

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○ Classical Conditioning § Counterconditioning: pair trigger stimulus with new response □ Exposure therapy: expose people to what they normally avoi Pair anxiety producing stimuli with relaxation. ® E.g. systematic desensitization ® Image below: flooding (starting at the top of the fear hierarchy, potentially risky and can make the phobia worse, or could be more efficient in combatting fears)

○ Operant Conditioning § Pairing a behavior with its consequences § Behavior modification: reinforce desired behaviors and withhold

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reinforcement or punish undesired behaviors □ Token economy: tokens given to reinforce good behavior of people in an institutional setting - Cognitive-Behavioral Therapy (CBT) ○ Combines cognitive and behavioral therapy techniques § Cognitive: increase awareness of irrational thoughts § Behavioral: practice challenging behaviors with therapist and at home (homework)

- Multicultural Therapy ○ Melba J.T. Vasquez model for multicultural therapy 1. Cultural sensitivity: awareness and appreciation for cultural divers awareness of cultural biases 2. Cultural knowledge: having general knowledge about cultural variations, being open to learn about new cultures 3. Cultural empathy: willingness to connect emotionally with a client's cultural experiences

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Evaluating Psychotherapies - Empirical research ○ Randomized clinical trials: people on a waiting list are randomly assign to therapy or no therapy conditions ○ Meta-analysis reveals average therapy client ends up better than 80% o untreated individuals

- Overall no statistical differences found in effectiveness of different types of psychotherapies or different types of therapies ○ Training of therapist doesn't seem to matter but ability of therapist to establish empathetic, trusting relationship with clients does - Psychotherapy technique may be suited for specific disorders ○ Behavioral therapy: specific behavioral problems, phobias, compulsions marital problems, sexual disorders

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○ Psychodynamic: depression and anxiety ○ Client-centered: mild/moderate depression ○ Cognitive and CBT: anxiety, PTSD, OCD, and depression - Commonalities among psychotherapies ○ Hope for demoralized people ○ Offers a new perspective ○ Provides an empathic, trusting, caring relationship

Drug Therapy Psychopharmacotherapy

- Psychopharmacotherapy ○ Psychopharmacology: the study of the effects of drugs on the mind and behavior - Antipsychotic drugs ○ Use: Treatment of psychoses, i.e. schizophrenia; ex: Thorazine, Haldol ○ Physiological effect § Dampen responses to irrelevant stimuli by blocking the actions of dopamine § Atypical antipsychotics (ex. Clozaril): target dopamine and seroton receptors ○ Side effects § Sluggishness, tremors, twitches § Tardive dyskinesia: involuntary movements of facial muscles, tongue, and limbs (looks like Parkinson's disease) - Mood-stabilizing medication ○ Use: treatment of Bipolar Disorder § Ex: Lithium (simple salt), unclear why it works § Effectively reduces manic episodes of 7 of 10 patients § Lesser effect on depression symptoms, but it reduces likelihood o suicide - Antianxiety drugs ○ Use: treatment of anxiety disorders, ex: Xanax, Ativan (benzos) ○ Physiological effect § Depresses central nervous system activity ○ Side effects § Can lead to psychological and physiological dependence □ Stopping after heavy use may lead to increased anxiety and insomnia - Antidepressant drugs ○ Use: treatment of depression and anxiety disorders, ex: Prozac, Zoloft, Paxil ○ Physiological effect: Increases the availability of norepinephrine and/or serotonin § Selective Serotonin Reuptake Inhibitors (SSRIs)

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□ Prevalence ® In 2017, 12.7% of Americans over the age of 12 took an antidepressant in the past month □ Effectiveness ® Double-blind studies: both participants and experimente are unaware of participant's condition (drug vs. placebo ◊ 75% of SSRI's effect accounted for by placebo effect- less for patients with severe depression ◊ Statistical significance vs. clinical significance: clinically significance means you can actually tell difference in patients Drug Therapy: Pros and Cons - Pros ○ May help patient get to a state where psychotherapy can be more effective ○ Helps keep people out of mental wards

○ Quick and cheap compared with psychotherapy - Cons ○ Negative side effects ○ Treats symptoms but perhaps not the root of the problem ○ Can be abused Biomedical Therapy Electroconvulsive Therapy (ECT)

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- Electroconvulsive Therapy (ECT) ○ Use: Typically for treatment of severe depression or schizophrenia ○ Procedure § 30-60 seconds of electrical current sent through electrodes placed on forehead ○ Effectiveness: 80% show improvement ○ Physiological effect: Boosts production of new brain cells

- Psychosurgery ○ Surgery that removes or destroys brain tissue in an effort to change behavior § Lobotomy: cut nerves connecting the frontal lobes to the emotioncontrolling centers of the inner brain (no longer performed, had ve negative effects) Preventative Treatment for Mental Health - Community Psychologists are using research and social action to change environmental circumstances that can lead to psychological disorders ○ i.e. poverty, meaningless work, constant criticism, unemployment, racis and sexism - Therapeutic Lifestyle Change ○ Aerobic exercise (30 min/day at least 3x a week) ○ Adequate sleep (7-8 hours every night)

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Light exposure (sunlight or light box) Establishing good social connections Avoid rumination and negative thinking Daily fish-oil supplements with Omega-3 fatty acids Eat a "Mediterranean diet" heavy on vegetables, fish, and olive oil...