15.1 how are psyc disorders treated? Two categories of techniques: psyc and bio. Psychotherapy: formal psyc
treatment, interactions btwn practitioner and client, help client understand symptoms, provide solutions. Bio
therapies: treatment based on medical approaches to illness / disease, based on notion that mental disorders result
from abnormalities in neural/bodily processes.
Psychotherapy based on psyc principles: aimed at changing patterns of thought/behavior
o Psychodynamic therapy focuses on insight: therapist out of view, client less inhibited, free association/
dream analysis. insight: goal, patient’s awareness of unconscious psyc processes, how they affect daily
functioning, symptoms diminish as result of reducing unconscious conflicts. Psychodynamic therapy:
reformulation of Freud ideas, help patient examine needs/defenses/motives to understand why
distressed. Not very affective, expensive and time-consuming.
o Health benefits of talking, expression emotion: reduces blood pressure, muscle tension, skin
conduction, improves immune function
o Humanistic therapies focus on whole person: Client-centered therapy: encourages to fulfill individual
potentials for personal growth through greater self-understanding, reflective listening. Motivational
interviewing - short period of time.
o Cognitive and behavioral therapies target thoughts/behaviors: treat thoughts/behaviors as problem
(instead of maladaptive behavior considered result of underlying problem). Behavior therapy: based
on premise that behavior learned, can be unlearned through use of classical/operant conditioning.
Social skills training used to elicit desired behavior, modeling. Cognitive therapy: based on theory
that distorted thoughts produce maladaptive behaviors/emotions, treatment strategies attempt to modify
these thought patterns. Cognitive restructuring: help patients recognize maladaptive thoughts patterns
and replace them with ways of viewing world that are more in tune with reality. Rational-emotive
therapy: therapist acts as teacher, explains client errors in thinking, show more-adaptive ways to think/
behave. These therapies assume maladaptive behavior is result of individual belief systems and ways
of thinking, not objective conditions. In interpersonal therapy, focus on circumstances. Mindfulness-
based cognitive therapy: people who recover from depression continue to be vulnerable to faulty
thinking, goal of therapy is to help them become more aware of these feelings when they are
vulnerable to learn to disengage from ruminative thinking through meditation. Cognitive-behavioral
therapy (CBT): incorporates techniques from cognitive and behavior therapy to correct faulty
thinking, change maladaptive behaviors. Exposure: repeated exposure to anxiety-producing
stimulus/situation. Exposure and response prevention, systematic desensitization.
o Group therapy builds social support: popular after WWII, less expensive, opp to improve social skills,
learn from others’ experiences. Usually very structured in behavioral and cognitive-behavioral groups,
specific goals/techniques to modify thought/behavior patterns of group members.
o Family therapy focuses on family context: systems approach: individual is part of larger context.
Expressed emotion: pattern of negative actions by client’s family members, includes critical
comments, hostility, emotional over-involvement. Patterns of expressed emotion that affect relapse
differ across countries/cultures, b/c some behaviors more acceptable in some cultures, which affects
relationship between expressed emotion and relapse.
Culture can affect therapeutic process: stigma, level of acceptance for psychotherapy, etc.
Medication is effective for certain disorders: psychotropic medications: drugs that affect mental processes,
change brain neurochem by inhibiting action potential or altering synaptic transmission to increase/decrease
action of particular neurotransmitters. Anti-anxiety drugs/tranquilizers: used for short-term treatment of
anxiety. Benzodiazepines increases GABA activity, most pervasive inhibitory neurotransmitter.
Antidepressants: used for depression. Monoamine oxidase (MAO) inhibitors first, enzyme that breaks down
serotonin in synapse, when inhibited, more serotonin. Tricyclic antidepressants: inhibit reuptake of certain
neurotransmitters, resulting in more available in synapse. Selective serotonin reuptake inhibitors (SSRIs) such
as Prozac inhibit reuptake of serotonin but act on other neurotransmitters to lesser extent. Antipsychotics/
neuroleptics: used to treat schizophrenia and other disorders w/ psychosis, reduce symptoms. Bind to
dopamine receptors to block effects. Side effects: tardive dyskinesia – involuntary muscle twitching.
Clozapine acts on dopamine receptors and serotonin, norepinephrine, acetylcholine and histamine receptors,
but affects white blood cells. Lithium good for bipolar disorder. Alternative bio treatments used in extreme cases: treatment-resistant people may try brain surgery, magnetic
fields, electrical stimulation, all alter brain function, last resort. Psychosurgery: areas of frontal cortex
selectively damaged to treat mental disorders (schizophrenia, depression, anxiety). Moniz prefrontal lobotomy
– severing nerve-fiber pathways in prefrontal cortex, impairs many important mental functions.
o Electroconvulsive therapy ECT: strong current to brainseizure, for severe depression.
o Transcranial magnetic stimulation (TMS): powerful current magnetic field, rapidly switched on/off,
induces electrical current in brain, interrupting neural function. Single pulse TMS: disruption of
brain activity occurs during period of stimulation. Repeated TMS: disruption can last
o Deep brain stimulation DBS: surgically implanting electrodes deep in brain, then mild electricity used
to stimulate brain at optimal frequency/intensity, used on Parkinson’s successfully.
Therapies not supported by scientific evidence can be dangerous: encouraging people to describe post-
traumatic experiences, scaring adolescent straight, using hypnosis, screaming, questionable self-help books
Variety of providers can assist in treatment for psychological disorders: clinical psychologists (phD,
emphasizes research and use of treatments), PsyD (emphasizes clinical skills), psychiatrists (MD, authorized
to prescribe drugs), counseling psychologists (PhD in counseling, deal w/ problems of adjustment and life
stress that don’t involve mental illness), psychiatric social workers (master’s degree, specialized training in
mental health care), psychiatric nurses, paraprofessionals. Important to find right therapist w/ appropriate
training/experience for specific mental disorder, should be trustworthy/caring. Not enough in the world.
Technology-based treatments have minimal contact w/ therapists.
15.2 what are the most effective treatments? People often show natural improvement no matter what therapy received
Effectiveness of treatment is determined by empirical evidence: randomized clinical trials. Evidence-based
treatments; psyc disorders should always be treated in ways that scientific research has shown to be effective
(psyc treatments vs. psychotherapy – any kind). Three features characterize psyc treatments – vary according
to particular disorder and client’s specific symptoms; techniques have been developed in lab by psychologists,
no overall theory guides treatment, but based on evidence of effectiveness
Treatments that focus on behavior and on cognition are superior for anxiety disorders: cognitive-behavioral
therapy works best to treat most adult anxiety disorders, effects last longer than drugs
o Specific phobias: behavioral techniques are best treatment. Systematic desensitization – client makes
fear hierarchy, then relaxation training, then exposure therapy, relaxation response eventually replaces
fear response – may be exposure to object rather than relxation that extinguishes phobic response.
Psychotherapy “rewires” brain, affects underlyinb iology of mental disorders like medication –
decreased activation in frontal brain region involved I nregulation of emotion.
o Panic disorder: goal of therapy is to break connection between trigger symptom and resulting panic,
via exposure treatment. CBT perspective that attacks continue because of conditioned response to
trigger, e.g. shortness of breath
o Obsessive-compulsive disorder: combination of recurrent intrusive thoughts (obsessions) and behavior
that individuals feels compelled to perform repeatedly (compulsions). Partly genetic, can be treated