Week 7: Treatment of
Psychological Disorders
THERAPY
There are over 400
brands/types/approaches
Why so many?
No agreement on what is best theory to base treatment on
No clear evidence that one treatment is "best"
Some problems remain
intractable; people keep
coming up with new approaches
in quest to improve success
TYPES OF THERAPY
NOTE: Usually tied to a
particular theory of etiology
Psychodynamic
Psychoanalysis (Freud brand, lie on couch, takes years)
Psychodynamic psychotherapy (generic & many other brands, sit in chair)
Short term focused (12-50
sessions, sit in chair, goals)
Free association & insight "psychotherapeutic alliance"
(relationship) *transference*
[example insight/transference]
Intellectual understanding +
Emotional realization +
Replaying of relationships
(Learning by doing)
Etiology? Unconscious conflicts
among drives, motives; conflict
between conscious and
unconscious. To address these
conflicts, must first discover
what they are.
Cognitive-Behavioral
Classical conditioning (behav)
Systematic desensitization (visualization)
Exposure (encounter)
[Example: limitations?]
Operant conditioning (behav)
Rewards and fines
Token economy
Modelling & Skills
Social learning
Training
Cognitive therapy
Focus on present thoughts
Counter faulty thinking
Etiology? Behavioral analysis--problems are learned ways of
acting that are dysfunctional.
Example: bad event becomes
associated with all kinds of
other elements, and generalized.
Desensitization reverses the
process of learning. Cognitive
analysis--negative self-defeating thoughts contribute to
negative feelings and problems.
Humanistic
Gestalt
* Get in touch with emotions
* Listen to inner voice
* Focus on here & now
* Empty chair technique
Client-centered
Client instead of patient
Problem-solving
Growth focus
Unconditional positive regard
Etiology? Socialization leads us
to act in ways that cut us off
from our true self.
Group
Therapist/facilitator led
Learn from others like self
Self-help group (AA)
Hope
* Social support
Etiology? No formal etiology
associated with this, but the
understanding is certainly that
your social network can
reinforce negative ways of
behaving (go out and get drunk)
or can support healing and
recovery.
Family
Structural & Strategic
Analyse patterns of interaction
Interventions, directive
Intergenerational approach
Patterns passed down
Genogram (p. 640)
Marital or couples therapy
Etiology? Problems indicate a dysfunctional system: need to address the whole family system.
Biological
Drug treatment
Psychotropic drugs for:
Psychosis (schizophrenia)
Depression (many)
Bipolar (lithium is tricky, other drug combos also used)
Anxiety (Valium/Xanax &
antidepressants)
Problem: relapse. Not a cure.
Electroconvulsive therapy (ECT)
Psychosurgery
Lobotomy
Split brain
Etiology? Genetic, congenital,
brain/nervous system
malfunctioning leads to problems
in feeling/thinking/action.
Effectiveness:
Bad news: Some problems
[schizophrenia, bipolar] are
treatable but not curable; even
people receiving good treatment
continue to suffer & die, often
from suicide
Good news: Symptoms tend to
improve over time for most
patients, even without
treatment. 30-40% of people
recover with no treatment. Why?
Confusing news: Treatments based
on radically different theories
often have similar success rates
Qualification: If we look at
particular problems, some
approaches work better for some
problems, some for others
Integration: Eclectic approach, "common factors" approach
Suicide:
8th leading cause of death (U.S.)
40-70% of suicides suffer from
mood disorders
15% of people with mood
disorders commit suicide (U.S.)
Suicide is leading cause of
death for schizophrenics (U.S.)
Anxiety: 1/3 of deaths before
age 70 due to suicide (Sweden)
Demographics:
More women than men attempt
suicide (why?); more men are
successful (why?)
19-24% of suicides have a prior
attempt
Married people have lowest rate; divorced highest (by 3 times)
Relative match of problems to
treatments:
Drugs clearly help with
psychosis, depression, bipolar,
anxiety. Controls symptoms
instead of cure, however; often
used in combination with some
form of therapy.
ECT used for severe depression
Cog-behavioral works well for
phobias and panic (better than
humanistic), also helpful for
depression (but not severe
depression).
Psychodynamic: Longer treatments
more effective than short
treatments. Useful for mood
disorders and adjustment
disorders. Best match for
serious personality disorders
(?--poor success rate, typically
screened out of studies)
NIMH study (1989)p. 652
N = 250 people, major depression
IV:
*cognitve therapy
*short psychodynamic
*drug with clinical management
*placebo with clinical support
DV: patient improvement
Results:
Drug & psychodynamic better than
placebo
Cognitive higher than placebo,
(not statistically significant)
not statistically different from
drug & psychodynamic
Cognitive also ineffective for
severe depression
Most patients continued to improve; few recovered fully
Eclectic or integrative
approaches combine techniques
from several traditions.
Drug treatment of symptoms often
combined with psychodynamic or
cog-behavioral therapy
Group therapy often paired with
individual therapy
Some researchers also have
developed blended approaches
that focus on common factors
Common factors in successful
therapy:
Empathy; warm relationship; instill hope or efficacy