“Actually the bill is part of your

Psychology reality therapy.”

Chapter 17
Treatment and Therapy for
Psychological Disorders
Early Theories
 Music or singing was
often used to chase
away spirits.
 In some cases
trepanning was
used: cutting a hole
in the head of the
afflicted to let out
the evil spirit.
 Philippe Pinel
A French doctor
who was one of
the first to take
the chains off
and declare that
these people are
sick and “a cure
must be found.”
Dorothea Dix
 American reformer who worked
to get better care for the
mentally ill
Defining Mental Disorder
Psychosurgery
 Surgical procedures, usually directed
at the brain, used to affect
psychological reactions
 Split-brain procedure – epilepsy
 Small lesions of limbic system – violent
behaviors
 Cingulotomy – extreme anxiety and
symptoms of obsessive-compulsive
disorder
 Surgical techniques – Parkinson’s
 Psychosurgery
 Lobotomy – severs the major
neural connections between the
prefrontal lobes and the lower
brain centers
Problem: patients were
calm after the procedure
but also had changed
personality and drive
 Creating permanently
lethargic, immature
and uncreative people
 Electroconvulsive Therapy–
ECT (hyperlink)

 ECT shock treatment) – involves passing

an electric current between 70-150
(usually 100) volts across one of the brain
hemispheres
 30 – 60 seconds of electrical current
 Anesthesia is given to minimize trauma
 Mainly used for profound depression
 No one knows exactly why it works
 Perhaps because of placebo effects, rebooting
the computer, calming neural centres?
 No more than 10-12 treatments
 rTMS Repetitive Transcranial
Magnetic Stimulation
 Repeated pulses surge through a
magnetic coil held close to the skull
 Painless and produces no seizures,
memory loss or other serious side effects
 Studies have shown modest benefits
 Unclear how it works but possibly because it
energizes the left frontal lobe
 Repeated stimulation may cause nerve cells
to form new circuits
 Deep Brain Stimulation
 For patients whose severe depression
has resisted drugs and ECT
 Experimental treatment focusing on a
neural hub that bridges the frontal lobes
to the limbic system (over active in a
depressed brain)
 Electrodes are implanted

 Excites neurons that inhibit activity

 12 / 20 experienced relief for three to six

years of follow up
 Drug Therapy
 Biomedical therapy may administer
drugs to improve abnormal behavior
 Drug classes include:
 Antianxiety drugs relieve muscle tension
 Antipsychotic drugs improve thought
processes
 Can have major adverse side effects
 Antidepressant drugs can reverse
depression (hyperlink)
 Tricyclics
 MAO inhibitors
 Selective Serotonin Reuptake Inhibitors (SSRIs)
 Anti-Anxiety Drugs
 Help reduce the felt aspect of
anxiety
 Majority are benzodiazepines (e.g.,
Valium, and Xanax), which act
directly on CNS
 Very effective and most commonly
prescribed of all medications
 Dependency and addiction may develop

 Muscle relaxants (e.g., Miltown)

 Antimanic compounds

 Used for bipolar disorder

 Lithium carbonate – most effective
at treating the manic phase (once
the mania is eliminated, depression
usually does not follow).
 Lithium reduces risk of suicide
 Do not fully understand why Lithium
works, but it does…
 Lithium side effects
 Low level:
 nausea, vomiting, diarrhea, abdominal
pain; tremor, lethargy, impaired
concentration, dizziness; slurred
speech, ataxia, muscle weakness;
memory impairment; weight gain
 Long term lithium use:
 may enlarge the thyroid, cause skin
rashes, and increase urine output;
impaired motor activity, creativity,
and cognitive activity.
 Antipsychotic drugs
 The first generation were aimed at the
positive symptoms of schizophrenia -
dopamine receptor blockers
 The dopamine hypothesis suggests that
the positive symptoms of schizophrenia
are caused by overactivity of DA
synapses.
 Atypical (second generation)
antipsychotics also impact the negative
symptoms
 e.g. Clozapine and Risperidone
 Anticholinergic side effects
 Dry mouth
 Blurred vision
 Rapid heart rate (tachycardia)
 Urine retention
 Constipation
 Confusion and memory impairment
 Tardive Dyskinesia
• a movement disorder characterized
by involuntary movements of the face
and neck
 Drug Therapy
 Antidepressant drugs – elevate
the mood of persons who are
feeling depressed, and there are 3
major classes
1. MAO (monoamine oxidase) inhibiters
2. Tricyclics
3. SSRIs (selective serotonin reuptake
inhibitors)
Drug Therapy: MAO Inhibiters
 Inhibit the enzyme monoamine
oxidase, which normally breaks
down levels of serotonin,
norepinephrine, and dopamine in
the brain
 Major drawback is that they can
be toxic and interact with foods
containing tyramine
 Foods with high levels of
tyramine
 strong or aged cheeses like cheddar, blue cheese, or
gorgonzola
 cured or smoked meats or fish, such as sausage or salami
 beers on tap or home-brewed
 some overripe fruits
 soy products like miso soup, bean curd, or tofu
 certain beans, such as fava or broad beans
 some sauces or gravies like soy sauce, teriyaki sauce, or
bouillon-based sauces
 pickled products like sauerkraut
 sourdough breads
Drug Therapy: Tricyclics
 These drugs generally are safer
and more effective that the older
MAO inhibitors
 They mainly affect the operation
of the neurotransmitters
serotonin and norepinephrine
Drug Therapy: SSRIs
 These drugs act faster to relieve
symptoms and have fewer side
effects
 Work by inhibiting the reuptake
of serotonin, increasing serotonin
levels, which elevates mood
 Prozac, Zoloft, Luvox, and Paxil
Antidepressant drugs prolong the activity of the
neurotransmitters dopamine, norepinephrine, and serotonin.
(a) Ordinarily, after the release of one of the
neurotransmitters, some of the molecules are reabsorbed by
the terminal button, and other molecules are broken down by
the enzyme monoamine oxidase (MAO). (b) Selective
serotonin reuptake inhibitors (SSRIs) prevent reabsorption of
serotonin. Tricyclic drugs prevent reabsorption of dopamine,
norepinephrine, and serotonin. (c) MAO inhibitors (MAOIs)
block the enzyme monoamine oxidase and thereby prolong
the effects of the neurotransmitters.
Drug Therapy –
Antidepressants
 Drawbacks:
 Usually take 2-4 weeks to show
any effect, and may take 6 weeks
to be effective
 Unpleasant side effects(hyperlink)
 Who Provides Psychotherapy?
1. Clinical psychologist
2. Psychiatrist
3. Counseling psychologist
4. Licensed professional
counselor
5. Psychoanalyst
6. Clinical social worker
 How Do I Choose
the Right Therapist?
 Many people and agencies can serve as
good resources
 Check with your family physician, clergy
person, local mental health center,
college counseling center, psychology
instructor, family and friends
 Give the therapist at least three to four
sessions to see if working together will
be effective
 If you do not feel that you are benefiting
from therapy, discuss this with the
therapist and be prepared to change if
necessary
 Psychoanalytic Techniques
 Psychoanalysis – based on
several assumptions involving
conflict and the unconscious
mind

Freud’s Couch
 Psychoanalytic Therapy
Psychoanalytic Therapy

Freud saw many things as having sexual overtones

 Psychoanalytic Techniques
 techniques that move issues from the
unconscious to the conscious level for
resolution
 therapy assumes that some issues may
relate to childhood experiences
 The ego serves to keep these issues below
the level of consciousness (defense
mechanisms)
 Catharsis is an emotional energy that is
released when early conflicts are relived
 Psychoanalytic Techniques
 Moving issues from the unconscious
to the conscious can be achieved
through
 Free association: patient says
whatever comes to mind
 Dream analysis : Dreams
(hyperlink)

express unconscious issues

 Manifest content: the actual content of
a dream
 Latent content: symbols that are
disguised unconscious issues or motives
 Psychoanalytic Techniques
 Resistance: Therapist looks for
evidence that the patient is avoiding an
issue
 Transference: Does the patient treat
the therapist in ways that are similar to
their parents?
 Interpretation: Therapist provides
analysis of the meaning of the thoughts,
behaviors, and dreams of the patient
 Interpretationleads to understanding and
resolution of unconscious issues
Post-Freudian Psychoanalysis
 Most significant change
is the concern for
shortening the length of
analysis
 Today’s analyst will take
a more active role in
therapy
 Focus on present,
rather than childhood
experiences
 Humanistic Techniques –
(also looking for insight)
 The 3 necessary elements of
humanistic therapy:
 Unconditional Positive Regard
 Genuineness
 Non-Directive Guidance
Humanistic Techniques
 Client-centered therapy –
goal is to help the individual
self-actualize (Carl Rogers)
 Focus is on the present
 Focuses on one’s feelings or affect

 Therapist attempts to mirror the

feelings of the person
 Humanistic Techniques (hyperlink)

 How Does One Mirror?

 Therapist must be an active listener.

 Therapist needs to be empathetic –

able to understand and share the
essence of another’s feelings

 Therapist will try to express

unconditional positive regard
Active listening
 Paraphrase
 You DON’T say “I know how you
feel” but you summarize the
person’s words in your own words
 Invite clarification
 What is an example of that?
 Reflect feelings
 ‘It sounds frustrating’ could mirror
what you’re sensing from the body
language, tone, etc.
Behavioral Therapy
 Therapy that applies learning
principles (e.g. conditioning) to
the elimination of unwanted
behaviors.
Counterconditioning
 Classical conditioning used to
evoke a new response to the
trigger stimulus

 Example: relaxation paired with an

enclosed space like an elevator –
fear and relaxation are
incompatible

 Exposure therapies and aversive

conditioning
Behavioral Therapy
Systematic Desensitization
(an exposure therapy)
Behavioral Therapy

Flooding
 Behavioral Therapy – counter
conditioning – pairs trigger stimulus
with a new response
Aversion Therapy

Can happen naturally -

drinking at a party paired with Or artificially
throwing up. Just the smell Ipecac +
can make you sick. Alcohol =
Does it work? Short term yes! Nausea
 Exposure Therapy:
Virtual Reality Exposure Therapy
Like you are an avatar

Help with PTSD?

CNN Virtual Reality Battles PTSD 9 2011
http://www.youtube.com/watch?v=hjyRu1e-Jmo
 Behavioral Therapy
Modeling – client observes and imitates
appropriate behaviors
- Works well for children with phobias and
with assertiveness training
Operant Conditioning Therapy
-Shaping new behaviors
Token Economy: reward wanted behaviour
Punishment: making an aversive stimulus
contingent on the unwanted behavior
Extinction: removing all rewards for the
target behavior
 Cognitive Therapy

Constant
repetition of
negative
thoughts leads
to abnormality
Cognitive Therapy
Assumes that problem behaviors and
emotions result from faulty thought
processes and beliefs

Analyzes a person’s thought processes

Attempts to restructure thought

processes
 Changing thought patterns will in turn
alter problem behaviors and emotions
Cognitive Therapy –
change your self-talk
Nobody likes me 

I’m a moron 

I’m worthless 

My jokes are bad 

 Cognitive Therapy

Nobody likes me  Sue likes me – she is just

angry at me now.
I’m a moron  I’m smart. I just made a
mistake.
I’m worthless  I’m a good person.
My jokes are bad  It’s not my fault the class
has no sense of humour.
 Albert Ellis: Rational Emotive
Behavioral Therapy REBT
A confrontational cognitive therapy that
vigorously challenges people’s illogical
self-defeating attitudes and assumptions.
Group Approaches
 Group therapy – label applied
to a variety of situations in
which a number of people are
involved in a therapeutic setting
at the same time
 Group Approaches
 Benefits of group therapy:
 Economy: group therapy is less
expensive
 Group support: there is comfort in
knowing that others have similar
problems
 Feedback: group members learn from
each other
 Behavioral rehearsal: group members
can role-play the activities of the key
persons in a member’s life
Group Approaches
 Family Therapy – the roles,
interdependence, and
communication skills of family
members are addressed
 Part of a system; all impact one
another
 Improper family communication =
problems
Evaluating Psychotherapy
 Difficult task
 Sometimes spontaneous remission
of symptoms
 Difficult to agree on what is meant
by recovery or care
 The large, meta-analysis studies
showed positive results for
psychotherapy
 Evaluating Psychotherapy
 No evidence that any one type of
therapy is universally better than
others – an eclectic approach is
probably best
 Some types of therapy are better
suited for some problems than others
 Which therapy is best for what
disorder is one of the most active
areas of research
 Some therapists are more effective
than others