Chapter 16 Psychology Notes PDF

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CHAPTER 16 PSYCHOLOGY NOTES TREATMENT OF ABNORMAL BEHAVIOUR • • • • • • •

The professional treatment of psychological disorders and problems is called psychotherapy. Although therapeutic procedures are exceedingly diverse, they can be classified into three broad categories: insight therapies behavioral therapies biomedical therapies These therapies can be used in individually or in combination. The form that treatment takes depends on the factors underlying or contributing to a person´s psychological disorder.

TREATMENT: A PSYCHOLOGICAL APPROACH • •

A treatment protocol is a specific approach to treating and managing a specific disorder. This approach allows the clinician to identify, modify and implement empirically supported treatment regimens.

WHO PROVIDES TREATMENT? •

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Psychologists who provide psychotherapy may have degrees in clinical or counselling psychology, specializing in the diagnosis and treatment of psychological disorders and everyday behavioural problems. Psychiatrists are medical doctors who specialize in the diagnosis and treatment of psychological disorders. They are, at present, the only psychotherapy administering profession to be able to prescribe medication, although psychologists are lobbying for prescription rights (given appropriate training). Clinical social workers generally have a master’s degree and are increasingly providing a wide range of therapeutic services as independent practitioners. Psychiatric nurses may hold a bachelor’s or master’s degree and often play a large role in hospital inpatient treatment. Counsellors are usually found working in schools, colleges, and assorted human service agencies. They typically have a master’s degree and often specialize in specific areas, such as vocational or marital counselling.

WHO SEEKS TREATMENT? • •

According to the recent US Surgeon General’s report on mental health (1999), about 15% of the US population uses mental health services in a given year. The two most common presenting problems are anxiety and depression. People vary considerably in their willingness to seek treatment, with women more likely to seek help than men, and people with higher educational levels doing so more frequently.

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Medical insurance is also related to treatment-seeking; having it increases the likelihood. Many people who need help don’t seek it, and the Surgeon General reports that the biggest roadblock is the “stigma surrounding the receipt of mental health treatment”. In South Africa, research on mental health issues are limited, but the Mental Health and Poverty Research Programme (2009) indicates the following: about 16.5% of the adult population suffers from mental illness 1% of the population with mental illnesses suffers from life debilitating symptoms approximately 23% of the population is directly exposed to trauma between 22% and 52% of homeless children smoke cannabis approximately 43% of people with HIV suffer from mental illness

INSIGHT THERAPIES • •

Insight therapies involve verbal interactions intended to enhance clients’ selfknowledge and thus promote healthful changes in personality and behaviour. The original insight therapy was psychoanalysis, which was devised over 100 years ago by Sigmund Freud. To appreciate the logic of psychoanalysis, we have to look at Freud’s thinking about the roots of mental disorders. He mostly treated anxietydominated disturbances that were then called neuroses.

PSYCHOANALYSIS •

Freud theorised that people depend on defense mechanisms to avoid confronting conflicts between the id, ego, and superego, but he asserted that defenses tend to be only partially successful, leaving neurotic individuals troubled by anxiety and guilt.

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In free association, clients spontaneously express their thoughts and feelings exactly as they occur, with as little censorship as possible, regardless of how trivial, silly, or embarrassing their thoughts might be. The analyst studies these free associations for clues about what is going on in the client’s unconscious.

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When dream analysis is used, clients are trained to remember their dreams, which they describe in therapy. The therapist then analyses the symbolism in these dreams to interpret their meaning.

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Resistance refers to largely unconscious defensive maneuvers intended to hinder the progress of therapy. Clients exhibit resistance because they don’t want to face up to the painful, disturbing conflicts that they have buried in their unconscious. The analyst must manage resistance very carefully.

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Transference is characterized by die unconscious redirection (projection) of feelings that a client had for his or her parents or other important figures onto their therapist. It is considered an important part of the therapeutic process to identify and explore these feelings. Eg: A client may find herself behaving in an over-compliant manner towards her therapist. These attempts to please and obey may be a significant feature in her relationship to her domineering mother. The analysis of this transference is the work that needs to be done, uncovering its meaning.

PSYCHOANALYSIS APPROACHES • • • • • •

Human behaviour is motivated by unconscious drives and processes. People are not always aware of the forces that shape their behaviour (we are not rational beings) Early childhood experiences are fundamental in shaping how we react to the world (especially early caretaking). Symptoms of mental illness develop as a result of unconscious processes. Mental illness can be treated by developing insight and understanding (making the unconscious conscious). Transference and countertransference worked with in the therapeutic setting.

CLIENT-CENTRED THERAPY • • • • •

Client-centred therapy is an insight therapy that emphasises providing a supportive emotional climate for clients. Clients play a major role in determining the pace and direction of their therapy. Client-centred therapists help clients to realise that they do not have to worry constantly about pleasing others and winning acceptance. They encourage clients to respect their own feelings and values. They help people restructure their self-concept to correspond better to reality. Using a humanistic perspective, Carl Rogers developed client-centred therapy in the 40s and 50s.

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According to Roger’s theory, incongruence makes people feel threatened by realistic feedback about themselves, leading to recurrent anxiety. This anxiety often spawns defensive behaviour intended to protect one’s inaccurate self-concept. Hence, clientcentred therapists try to help clients restructure their self-concept to correspond better to reality. Rogers held that there are three main elements to creating this atmosphere: genuineness, or the therapist being completely honest and spontaneous with the client; unconditional positive regard, or a complete nonjudgmental acceptance of the client as a person; and empathy, an understanding of the client’s point of view.

POSITIVE PSYCHOLOGY • •

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The growth of the positive psychology movement has begun to inspire new approaches to insight therapy, such as well-being therapy. Positive psychotherapy attempts to get clients to: - recognize their strengths - appreciate their blessings - savor positive experiences - find meaning in their lives. Positive psychology operates on three different levels: - On a subjective, individual and societal level

GROUP THERAPY • • •

Group therapy involves the simultaneous treatment of several clients in a group, where the group members work to assist each other in their treatment. The role of the therapist in group therapy includes screening potential participants, facilitating the therapeutic process, and preventing potentially harmful interactions. Group therapy is not just a less costly alternative to individual therapy - it has strengths of its own.

GROUP, COUPLES & FAMILY THERAPY •

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Group therapy - Two or more patients participate - Patients share experiences, experience a sense of universality, and at times act as therapists to each other. Marital/ couples therapy - Assists partners in understanding what changes of behaviour and communication can support and develop their relationship. Family therapy - Family therapy involves treatment of a family unit as a whole. Therapists seek to understand the entrenched patterns of interaction that produce distress for their clients, view individuals as parts of a family ecosystem and attempt to help families improve their communication.

EVALUATING INSIGHT THERAPIES • • •

Evaluating any therapy is difficult business: some disorders go into spontaneous remission even without treatment. Studies of insight therapies’ effectiveness generally show that clients often see early improvement, within the first 13-18 weeks of treatment. The most important factors in therapy seem to be: (1) the development of a therapeutic alliance between client and therapist; (2) emotional support and empathy from the therapist; (3) hope, or positive expectation of a good outcome; (4) provision of a rationale that makes sense of the client’s problem and outlines a course of treatment; and (5) opportunity for the client to express feelings and “try out” new ideas, new insights, and possible solutions.

BEHAVIOUR THERAPIES

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Behaviour therapies involve the application of learning principles to direct efforts to change clients’ maladaptive behaviours. Behaviour therapies are based on two core assumptions: First, it’s assumed that behaviour is a product of learning. No matter how selfdefeating or pathological a client’s behaviour might be, the behaviourist believes that it’s the result of past learning and conditioning. Second, it’s assumed that learned behaviours can be unlearned. Behaviour therapists attempt to change clients’ behaviour by applying the principles of classical conditioning, operant conditioning and observational learning. Behaviour therapies are based on the principles of learning and conditioning. Behaviour therapists use classical conditioning, operant conditioning, and observational learning to change clients’ overt behaviours. The original behaviour therapy, systematic desensitisation, was devised by Joseph Wolpe in 1958. Systematic Desensitisation is used to reduce phobic clients’ anxiety responses.

AVERSION THERAPY • • •

Aversion therapy is the most controversial of the behaviour therapies, where an aversive stimulus is paired with a stimulus that elicits an undesirable response. Alcoholics, for example, have had emetic drugs paired with their favourite drinks, with the subsequent vomiting creating a conditioned aversion to alcohol. This technique has been used with alcohol and drug abuse, sexual deviance, smoking, shoplifting, gambling, stuttering, and overeating.

COGNITIVE-BEHAVIOURAL THERAPY (CBT) • • • • • • •

CBT emphasizes recognizing and changing negative thoughts and maladaptive beliefs. It combines behaviourism and cognitive approaches. Researcher Aaron Beck devised cognitive oriented therapies. Basic assumptions of CBT: Human behavior is a function of how we perceive the ourselves, others and the world. Mental illness is the result of faulty thought processes, misperceptions and core beliefs. Treatment involves changing core beliefs and helping clients learn more adaptive thought processes (better problem solving and different ways of viewing the world)

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Symptoms are seen as the problem. The goal of these therapy is: - To change the way clients think - detecting and recognizing negative thoughts - reality testing - devising behavioural “homework assignments” that focus on changing overt behaviours

PSYCHOPHARMACOLOGY According to the biomedical model of mental illness, human behavior, emotions, and cognitions are a function of biological and neurological processes. • Abnormal behavior is therefore conceptualized as disease. • Psychopharmacology is a mode of treatment that stems from this view of mental illness. These treatments consist of physiological interventions intended to reduce symptoms associated with psychological disorders. • There are three standard psychopharmacology approaches to psychotherapy: - Drug therapy - Electroconvulsive (shock) therapy (ECT) - Brain stimulation •

ANTIANXIETY DRUGS • •

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Drugs used in the treatment of psychological disorders fall into three major groups: antianxiety drugs, antipsychotic drugs, and antidepressant drugs. Antianxiety drugs, such as Valium and Xanax, relieve tension, apprehension, and nervousness. These drugs can alleviate anxiety almost immediately, but their effects are measured in hours. Valium and similar drugs bind to benzodiazepine receptor sites within GABA synapses, where they facilitate the binding of GABA to its receptors. The net result is that these drugs indirectly increase inhibitory activity in the GABA system, which helps keep a lid on anxiety.

ANTIPSYCHOTIC DRUGS

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Antipsychotic drugs, such as Thorazine and Haldol, are used primarily in the treatment of schizophrenia. Antipsychotic drugs are used to gradually reduce psychotic symptoms, including hyperactivity, mental confusion, hallucinations, and delusions. Traditional antipsychotic drugs dampen activity at dopamine synapses. They appear to do so by binding to dopamine receptor sites without causing a postsynaptic potential, thus blocking normal dopamine activity at these sites. Antipsychotic medication does not work for everyone, but about 70% of psychotic patients respond.

EFFECTIVENESS:

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Some antipsychotic drugs produce unfortunate side-effects such as symptoms of Parkinson’s disease and tardive dyskinesia, an incurable neurological disorder marked by involuntary writhing and tic-like movements of the mouth, tongue, face, hands, or feet. Newer drugs, which have a different mechanism of action, such as clozapine, have fewer motor side effects but are costly, and not risk free. Some side effects include – drowsiness, constipation, tremors, muscular rigidity, impaired coordination

ANTIDEPRESSANT

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Antidepressant drugs gradually elevate mood and help bring people out of a depression. The most frequently prescribed antidepressants are selective serotonin reuptake inhibitors (SSRIs), which slow reuptake at the serotonin synapse. A newer type of drug, SNRIs, have stronger antidepressant effects than SSRIs, but with more side effects.

DEPRESSION, MOOD STABILIZERS & SUICIDE •

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There has been concern regarding SSRIs and an increased risk of suicide - data suggest that the risk of suicidal behaviour is slightly elevated, especially in adolescents. This graph indicates that the risk of suicide declines with the onset of treatment. However, the issue is complex, and people, particularly adolescents, taking SSRIs should be monitored closely.

MOOD STABILIZERS • • • •

Lithium and valproate are common mood stabilizers used to treat bipolar patients. Lithium is very successful at preventing future episodes of mania and depression. It can be toxic and requires careful monitoring. Valproate has become more common than lithium, has fewer side effects, and is better tolerated by patients.

ELECTROCONVULSIVE THERAPY Electroconvulsive therapy (ECT) is a biomedical treatment in which electric shock is used to produce a cortical seizure accompanied by convulsions. Although the use of ECT peaked in the 1940s & 1950s, there’s been a recent resurgence in this therapy. • While there is evidence to suggest that it is helpful in the treatment of major depressive disorder, some researchers claim that it is in fact no better than a placebo. • Right now, the evidence justifies conservative use of ECT for depression DEEP BRAIN STIMULATION •

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Electroconvulsive therapy (ECT) is a biomedical treatment in which electric shock is used to produce a cortical seizure accompanied by convulsions. Although the use of ECT peaked in the 1940s and 1950s, there has been a recent resurgence in this therapy. While there is evidence to suggest that it is helpful in the treatment of major depressive disorder, some researchers claim that it is in fact no better than a placebo. Right now, the evidence justifies conservative use of ECT for depression

TRANSCRANIAL MAGNETIC STIMULATION •

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Electroconvulsive therapy (ECT) is a biomedical treatment in which electric shock is used to produce a cortical seizure accompanied by convulsions. Although the use of ECT peaked in the 1940s and 1950s, there has been a recent resurgence in this therapy. While there is evidence to suggest that it is helpful in the treatment of major depressive disorder, some researchers claim that it is in fact no better than a placebo. Right now, the evidence justifies conservative use of ECT for depression.

TREATMENT IN TRANSITION •

Treatment in transition provides an overview of psychopathology and culture, making a diagnosis, deinstitutionalization, utilization of services and stigmatization.

PSYCHOPATHOLOGY & CULTURE The relationship between culture and psychopathology is complex and multi-layered. Culture plays a role in: • • • • •

Ways of speaking about mental pain (idioms of distress) Defining normality and deviance Causing certain culture-bound syndromes The prevalence, presentation and course of mental disorders Reaching out for treatment Practitioners need to be aware of and sensitive to the role that culture may play in a therapeutic setting.

MAKING A DIAGNOSIS • •

Making a diagnosis involves matching a set of signs and symptoms to a particular mental disorder Practitioners use the most current version of classification systems such as the DSM or the ICD. Making a diagnosis involves:

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A diagnostic interview, observation, gathering additional information from known others, and clinical judgement. Making a diagnosis is necessary in order to:

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Create or match a person´s presentation with a treatment protocol Research which treatments are most effective Collect epidemiological data about mental disorders

ISSUES AROUND THE UTILISATION OF MENTAL HEALTH SERVICES IN SOUTH AFRICA • • •

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One of the most common reasons for not seeking support from mental health services may be the individual’s perception pertaining to the need for assistance. The individual’s need may be clouded by a lack of knowledge, cognitive impairments, the nature of the mental illness, social taboo and cultural reformulation. Barriers such as accessibility of mental health services are also common reasons associated with the reluctance to seek and continue utilizing mental health-care services. The availability of psychological and psychiatric services remains insufficient at primary and secondary levels, resulting in an influx and shortage of resources on a tertiary level.

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This poses a serious challenge to the accessibility of mental healthcare within a community setting.

STIGMA & MENTAL ILLNESS IN SOUTH AFRICA •

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Stigma refers to a person being perceived in a negative way, and socially discredited as a result of being diagnosed with a mental illness. Unfortunately, negative attitudes to people who have mental illnesses are common. Discrimination follows as a result of stigma. It entails a person being treated in a negative way as a result of being diagnosed with a menta...