Ch. 16 - Treatment of Psychological Disorders

Question 1

Exposure and response prevention (ERP)

Answer 1

In which a person learns to face the source of his or her fear and anxiety, have proven to be an effective way to treat anxiety disorders

Question 2

What are the 3 reasons that people fail to get treatment for a mental disorder?

Answer 2

1. People may not realize that they have a mental disorder that can be effectively treated
2. There may be barriers to treatment, such as beliefs and circumstances that keep people from getting help
3. Structural barriers prevent people from physically getting to treatment

Question 3

Treatments can be divided broadly into two kinds…

Answer 3

1. Psychological treatment, in which people interact with a clinician in order to use the environment to change their brain and behaviour
2. Biological treatment, in which the brain is treated directly with drugs, surgery, or some other direct intervention

In some cases, both treatments are applied

Question 4

Psychotherapy

Answer 4

An interaction between a socially sanctioned clinician and someone suffering from a psychological problem, with the goal of providing support or relief from the problem

Question 5

Eclectic psychotherapy

Answer 5

A form of psychotherapy that involves drawing on techniques from different forms of therapy, depending on the client and the problem.

Question 6

Approaches to psychotherapy in the 21st century

Answer 6

Cognitive behaviour = 40%
Humanistic/existential = 15%
Psychodynamic = 13%
Interpersonal = 12%
Family systems = 10%
Other = 10%

Question 7

Psychodynamic psychotherapies

Answer 7

Explore childhood events and encourage individuals to use this understanding to develop insight into their psychological problems.

Question 8

Techniques used by a psychologist to help a client “develop insight” …

Answer 8

Free association:
The client reports every thought that enters the mind, without censorship or filtering. Therapist looks for themes that recur across the sessions.

Dream analysis:
May treat dreams as metaphors that symbolize unconscious conflicts or wishes and that contain disguised clues that the therapist can help the client understand

Interpretation:
This is the process by which the therapist deciphers the meaning (ex. unconscious impulses or fantasies) underlying what the client says and does. During the process of interpretation, the therapist suggests possible meanings to the client, looking for signs that the correct meaning has been discovered.

Analysis of resistance:
In the process of “trying on” different interpretations of the client’s thoughts and actions, the therapist may suggest an interpretation that the client finds particularly unacceptable.

Question 9

Resistance

Answer 9

A reluctance to cooperate with treatment for fear of confronting unpleasant unconscious material.

Question 10

Transference

Answer 10

An event that occurs in psychoanalysis when the analyst begins to assume a major significance in the client’s life, and the client reacts to the analyst on the basis of unconscious childhood fantasies.

Question 11

Interpersonal psychotherapy

Answer 11

A form of psychotherapy that focuses on helping clients improve current relationships.

Question 12

Person-centered therapy (or client-centered therapy)

Answer 12

• A form of psychotherapy that assumes that all individuals have a tendency towards growth and that this growth can be facilitated by acceptance and genuine reactions from the therapist.
• Developed by Carl Rogers in the 1940’s and 1950’s
• The therapist tends not to provide advice or suggestions about what the client should be doing, but instead paraphrases the client’s words, mirroring the client’s thoughts and sentiments.
• Person-centered therapists believe that with adequate support, the client will recognize the right things to do.

-3 basic qualities for therapists to demonstrate:
congruence, empathy, and unconditional positive regard

Question 13

Gestalt therapy

Answer 13

• A form of psychotherapy whose goal is helping the client become aware of his or her thoughts, behaviours, experiences, and feelings and to “own” or take responsibility for them
• Founded by Frederick “Fritz” Perls in the 1940’s and 1950’s
• Gestalt therapists are encouraged to be enthusiastic and warm towards their clients. Gestalt therapists also reflect back to the client their impressions of the client
• Use a technique called “focusing,” to emphasize the experiences and behaviours that are occurring at that particular moment in the therapy session.
• Clients are also encourage to put their feelings into action, using the “empty chair technique”

Question 14

Behaviour therapy

Answer 14

-A type of therapy that assumes that disordered behaviour is learned and that symptom relief is achieved through changing over maladaptive behaviours into more constructive behaviours.

• Techniques include:
• operant conditioning procedures, which focus on reinforcement and punishment. Behaviour can be influenced by is consequences (the reinforcing or punishing events that follow)

-classical conditioning, which focus on extinction

Question 15

Token economy

Answer 15

A form of behaviour therapy in which clients are given “tokens” for desired behaviours, which they can later trade for rewards.

Question 16

Exposure therapy

Answer 16

• An approach to treatment that involves confronting an emotion-arousing stimulus directly and repeatedly, ultimately leading to a decrease in the emotional response
• “In vivo” (in life) exposure is more effective than imaginary exposure
• Easier situations are practiced first and as fear decreases, the client progresses to more difficult or frightening situations
• If they leave the situation before their anxiety decreases, this can reinforce their anxiety, because they fail to learn that the feared stimulus is not harmful and they learn that avoiding it decreases their anxiety.

Question 17

Cognitive therapy

Answer 17

• Focuses on helping a client identify and correct any distorted thinking about self, others, or the world
• Cognitive theorists might instead emphasize the “interpretation” of the event
• Cognitive and cognitive-behaviour therapies do well in preventing relapse because once people learn the skills taught in these therapies, they can continue to use them in future situations all on their own, without guidance from a clinician. This is in contrast to medications, which only work if they are present in the body.

Question 18

Cognitive restructuring

Answer 18

• A therapeutic approach that teaches clients to question the automatic beliefs, assumptions, and predictions that often lead to negative emotions and to replace negative thinking with more realistic and positive beliefs.
• In therapy sessions the cognitive therapist will help the client to identify evidence that supports, and fails to support, each negative thought in order to help the client generate more balanced thoughts that accurately reflect true state of affairs.

Question 19

Mindfulness meditation

Answer 19

Teaches an individual to be fully present in each moment; to be aware of his or her thoughts, feelings, and sensations; and to detect symptoms before they become a problem.

Question 20

Cognitive behavioural therapy (CBT)

Answer 20

• A blend of cognitive and behavioural therapeutic strategies
• CBT is “problem focused”, meaning that it is undertaken for specific problems, and “action oriented,” meaning that the therapist tries to assist the client in selecting specific strategies to help address those problems. The client is expected to “do” things, such as engage in exposure exercises, practice behaviour change skills, or use a diary to monitor relevant symptoms
• CBT is “transparent” in that nothing is withheld from the client
• CBT has moderate but less substantial effects for marital distress, anger, somatic disorders, and chronic pain

Question 21

Group therapy

Answer 21

• A type of therapy in which multiple participants (who often do not know each other at the start), work on their individual problems in a group atmosphere.
• Group therapy is not an approach in itself, but a mode of delivering treatment

Advantages:
-clients realize they are not alone in their suffering

Disadvantages:

• May b e difficult to assemble a group of individuals who have similar needs
• some group members can dominate the discussions, threaten other group members, or make others uncomfortable (ex trying to date someone in the group_
• Clients get less attention than they would in individual therapy

Types of group therapy:

• Self-help groups
• Support groups

Question 22

Antipsychotic drugs

Answer 22

Medications that are used to treat schizophrenia and related psychotic disorders

Some medications include:

• Mellaril
• Haldol

Question 23

Psychopharmacology

Answer 23

The study of drug effects on psychological states and symptoms

Question 24

Mesolimbic pathway

Answer 24

A pathway paved with dopamine neurons extending from the ventral tegmental area (VTA) to the nucleus accumbens in the basal ganglia.

Question 25

Antianxiety medications

Answer 25

Drugs that help reduce a person’s experience of fear and anxiety.

Some medications include:

• bensodiazepines such as
• valium
• ativan
• xanax

Question 26

Antidepressants

Answer 26

• A class of drugs that help lift people’s moods.
• Iproniazid is a monoamine oxidase inhibitor (MAOI), a medication that prevents monoamine oxidase from breaking down neurotransmitters such as norepinephrine, serotonin, and dopamine.
• A second category of antidepressants in the tricyclic antidepressants, which includes Tofranil and Elavil, which block the reuptake of norepinephrine in the synaptic space between neurons
• Side effects for both classes include increased blood pressure, constipation, difficulty urinating, blurred vision, and racing heart
• Most commonly used antidepressants today are selective serotonin reuptake inhibitors (SSRI’s), which include Prozac, Celexa, and Paxil.

Question 27

Phototherapy

Answer 27

A therapy that involves repeated exposure to bright light

Question 28

Electroconvulsive therapy (ECT)

Answer 28

• A treatment that involves inducing a brief seizure by delivering an electrical shock to the brain
• The shock is applied to the persons scalp for less than a second.
• ECT is primarily used to treat severe depression, but it may also be used for treating bipolar disorder
• Main side effect is impaired short term memory, which usually improves after the first month or two. Other side effects include headaches and muscle aches.

Question 29

Transcranial magnetic stimulation (TMS)

Answer 29

• A treatment that involves placing a powerful pulsed magnet over a person’s scalp to alter neuronal activity in the brain.
• As a treatment for depression, the magnet is placed just above the right or left eyebrow in an effort to stimulate the right or left prefrontal cortex (areas of the brain implicated in depression).
• Side effects include mild headache and a small risk of seizure, but has no impact on memory or concentration.
• TMS can also be used to treat auditory hallucinations in schizophrenia

Question 30

Psychosurgery

Answer 30

• Surgical destruction of specific brain areas.
• Antonio Egas Moniz
• Psychosurgery is sometimes used in severe cases of OCD in which the person is completely unable to function in daily life, and psychological treatment and medication are not effective.

Question 31

Deep brain stimulation (DBS)

Answer 31

Combines the use of psychosurgery with the use of electrical currents

Question 32

Treatment illusions

Answer 32

1. Natural improvement is the tendency of symptoms to return to their mean or average level.
   - The illusion in this case happens when you conclude mistakenly that a treatment has made you better when you would have gotten better anyway
2. Placebo Effects - Nonspecific treatment effects that are not related to the specific mechanisms by which treatment is supposed to be working. Ie maybe the pill wasn’t the active ingredient in your cure, but rather yours and your doctor’s positive attitude
3. Reconstructive Memory - The client’s motivation to get well causes errors in reconstructive memory for the original symptoms. You might think that you’ve improved because of a treatment when, in fact, you’re simply misremembering, mistakenly believing that your symptoms before treatment were worse than they actually were.
   - Conway and Ross dubbed this motivated reconstruction of the past “Getting What You Want by Revising What You Had.” ie recalling symptoms worse then they actually were, thereby making the treatment seem effective

Question 33

iatrogenic illness

Answer 33

A disorder or symptom that occurs as a result of a medical or psychotherapeutic treatment itself. Being treated for a disorder can, under certain conditions, make a person show signs of that very disorder - and so iatrogenic illness is born.

Question 34

What are the 4 ethical principles in therapy?

Answer 34

1. Respect for the dignity of persons
2. Responsible caring
3. Integrity in relationships
4. Responsibility to society