Treating Psychopathology Flashcards
Reasons for wanting to treat psychopathology
- they can provide relief from the distress caused by symptoms
- can provide the client with self-awareness and insight into their problems
- they enable the client to acquire coping and problem-solving skills that will prevent similar problems occurring in the future
- they attempt to identify and resolve the causes of the psychopathology, whether those causes are recognised as problematic ways of behaving, thinking, or dealing with or assimilating life experiences.
Treatment provided for psychopathology will depend on at least two factors…
- the theoretical orientation and training of the therapist
- the nature of the psychopathology
National Institute for Health and Care Excellence (NICE)
an independent UK organisation responsible for providing national evidence-based guidance on promoting good health and preventing and treating ill health.
Theoretical Approaches to Treatment
Psychodynamic Approaches
aim: to reveal unconscious conflicts that may be causing symptoms of psychopathology to help the individual understand the source of these conflicts as well as help them to gain control over their behaviour, feelings and attitudes.
several basic techniques used by psychoanalysts to achieve these goals:
- free association: the client is encouraged to verbalise all thoughts, feelings and images that come to mind.
- transference: the analyst is used as a target for emotional responses; clients behave towards the analyst as they would have behaved towards an important person in their lives.
- dream analysis: the analysis of dream content as a means of accessing unconscious beliefs and conflicts
- interpretation: helping the client to identify important underlying conflicts
psychoanalysis represents a quest for self-knowledge, individuals problems are viewed in the context of the whole person and any conflicts that may have repressed. can be helpful for people with moderate to severe anxiety or depression based problems.
it has been shown to only be more effective than control treatments that do not possess a specialised psychotherapy component, suggesting that the evidence for the effectiveness of long-term psychoanalytic therapy for psychopathology is still limited and at best conflicting.
Theoretical Approaches to Treatment
Behaviour Therapy
psychologists turned to conditioning (a form of associative learning on which behaviour therapies are based) after dissatisfaction with other models and approaches to psychopathology.
This helped develop what is known as behaviour therapy, interventions that attempt to change the client’s behaviour (largely based on principles from learning theory), whether the underlying principles are based on conditioning or not.
During the 1940’s and 50’s, psychologists believed that numerous psychological disorders were the result of faulty learning (a view that the symptoms of psychological disorders are acquired through the learning of pathological responses). involves the suggestion that symptoms are acquired through conditioning processes (classical/operant) as they can be used to help others unlearn problematic associations to the unwanted behaviour.
while the former group of therapies continues to be known as behaviour therapy, the latter group has also come to be known as behaviour modification (behavioural treatment methods based on operant conditioning principles, which assume that learnt psychopathology can be unlearnt using normal learning processes) or behaviour analysis (an approach to psychopathology based on the principles of operant conditioning, also known as behaviour modification)
Theoretical Approaches to Treatment
Behaviour Therapy
Therapies based on Classical Conditioning Principles
- extinction: a classical conditioning principle which assumes emotional problems can be unlearnt by disrupting the association between the anxiety-provoking cues or situations and the threat or traumatic outcomes with which they have become associated. the most famous behavioural therapy techniques to apply to extinction principles are flooding, counterconditioning, and systematic desensitization. these techniques have collectively come to be known as exposure therapies.
- exposure therapies: treatment in which sufferers are helped by the therapist to confront and experience events and stimuli relevant to their trauma and their symptoms.
- flooding: a form of exposure therapy for the treatment of phobias and related disorders in which the patient is repeatedly exposed to highly distressing stimuli.
- counterconditioning: a behaviour therapy technique designed to use conditioning techniques to establish a response that is antagonistic (hostile) to the psychopathology.
- systematic desensitization: a behaviour therapy based on classical conditioning used in the treatment of phobias and anxiety disorders, during which the client overcomes their fears through gradual and systematic exposure.
Wolpe (1958) introduced the principle of reciprocal inhibition, a principle of behaviour therapy in which anxiety is eliminated not just by distinguishing the relationship between the anxiety-inducing cue and the threatening consequence, but also by attaching a response to the anxiety-inducing cue which is incompatible with anxiety (e.g. relaxation).
aversion therapy: a treatment based on classical conditioning which attempts to condition an aversion (strong dislike) to a stimulus or event to which the individual is inappropriately attracted. For example for alcholism, the taste of alcohol is paired with aversive outcomes (e.g. sickness-inducing drugs) in order to condition an averse reaction to alcohol.
Theoretical Approaches to Treatment
Behaviour Therapy
Therapies based on Operant Conditioning Principles
operant conditioning is concerned with influencing the frequency of a behaviour by manipulating the consequences of that behaviour. three specific ways in which operant conditioning have been used in therapy PG106.
Functional analysis: an observational method for identifying the consistencies between problematic behaviours and the consequences that may be reinforcing them.
Response shaping: a reinforcement procedure that is used to develop new behaviours that are not already occurring at a reasonable frequency
behavioural self-control: the personal use of operant conditioning principles to change or control one’s own behaviour.
Theoretical Approaches to Treatment
Cognitive Therapy
The origins of cognitive therapy
understanding the cognitive factors that play an important role in causing and maintaining psychopathology. belief that psychological problems are the products of faulty ways of thinking about the world. two early forms of cognitive therapy were rational emotive therapy (RET) and Beck’s cognitive therapy.
RET - therapy technique developed by Albert Ellis (1962) which addresses how people construe themselves, their life and the world such as demanding perfection from oneself and others as well as expecting approval from others everything one does. RET attempts to challenge these irrational beliefs and to persuade the individual to set more attainable life goals.
Becks cognitive therapy - an intervention derived by Becks view that depression is maintained by a negative schema that leads depressed individuals to hold negative views about themselves, their future and the world (the ‘negative triad’). requires clients to provide evidence for their biased views of the world.
cognitive behaviour therapy (CBT) - an intervention for changing both thoughts and behaviour. CBT represents an umbrella term for many different therapies that share the common aim of changing both cognitions and behaviour. CBT has 4 characteristics of what the client is encouraged to do (PG108)
new forms of CBT have evolved out of earlier ones which are known now as the ‘third wave’ of CBT techniques. the ‘first wave’ occurred between 1950-1960, represented largely by behaviour therapy techniques based on learning theory and conditioning principles. the ‘second wave’ happened between 1970-1980 as we learned we are also influenced by our cognitions, and how we think affects ours emotions. the ‘third wave’ of CBT methods emphasises mindfulness and acceptance (these include MBCT and ACT).
Mindfulness-based cognitive therapy (MBCT) - a direct extension of traditional CBT in which treatments emphasise achieving a mental state characterised by present-moment focus and non-judgemental awareness. the purpose of this is to improve emotional wellbeing by increasing awareness of how automatic cognitive and behavioural reactions to thoughts, sensations and emotions can cause distress.
Acceptance and Commitment therapy (ACT) - a ‘third wave’ CBT intervention that adopts some aspects of mindfulness, but has developed more from the Skinnerian approach to understanding behaviour. teaches clients to notice, accept and embrace their thoughts.
Theoretical Approaches to Treatment
Humanistic therapies
attempt to consider the whole person and not just the individual symptoms of psychopathology. 5 common factors of humanistic therapies (PG110)
holistic therapies: therapies in which emphasise the need to consider the whole person and not just the individual symptoms of psychopathology.
Client-centred therapy focuses on the individuals immediate conscious experience and critical to this is the creation of a therapeutic climate that allows the client to progress to become independent, self-directed and to pursue self-growth. Carl Rogers viewed empathy as the most important in this kind of therapy.
the two main principles in client centred therapy: empathy unconditional positive regard not directive (i.e. more of a listener) congruence (i.e. consistency)
Theoretical Approaches to Treatment
family and systematic therapies
family therapy - a form a intervention involving family members that is helpful as a means of dealing with psychopathology that may result from the relationship dynamics within the family. family therapy has 3 purposes (PG111).
How it is conducted: therapist meets with family and tries to identify family interaction patterns that the family may not be aware of and to suggest to them different ways of responding to each other.
Family therapy may apply systems therapy:
systems therapy - approach that attempts to understand the family as a social system
Theoretical Approaches to Treatment
Drug Treatments
to alleviate the symptoms of psychopathologies.
provided by GP’s and doctors to tackle anxiety and mood-based problems.
main types of drug treatments for psychopathology: antidepressent drug (treats symptoms of depression and mood disorder) anxiolytic drug (treats symptoms of anxiety and stress) antipsychotic drug (treats symptoms of psychosis and schizophrenia spectrum disorders)
Drugs for depression:
tricyclic antidepressents
monoamine oxidase inhibitors (MAOIs)
selective serotonin reuptake inhibitors (SSRIs)
Drugs for anxiety:
benzodiazepines
serotonin-norepinephrine reuptake inhibitors (SNRIs)
Drugs for psychosis:
antipsychotic drug
Problem with drug treatments:
- lead people to believe anxiety/depression are diseases that will not be alleviated until medical treatment has been sought
- may be ineffective for people with only mild symptoms
- long term prescription users may believe their symptoms are unchangeable and they will be dependent on the drugs
- drug treatment may worsen the long term course of a disorder, for example antidepressent drugs may increase vulnerability to relapse over the longer term.
Modes of Treatment Delivery
Group Therapy
therapy taken in the form of a group, usually when individuals share similar problems or psychopathologies.
the standard mode of psychotherapy delivery is in one-to-one, face-to-face meetings or sessions between a therapist and a client. this section will look at modes of delivery developed to supplement the traditional one-to-one therapist-client model.
group therapies can be useful for when a group of individuals share similar problems or when there is a need to treat an individual in the presence of others who might have a role in influencing the psychopathology.
advantages of group therapies:
work out their problems
may need comfort and support from others
acquire therapeutic benefits from observing others
different types of group therapies:
encounter groups - encourages therapy and self growth
through disclosure and interaction
self-help groups - brings people together who share a problem in an attempt to support one another
Modes of Treatment Delivery
Counselling
aims both to promote personal growth and productivity and to alleviate any personal problems that reflect underlying psychopathology
helps individuals understand and clarify their views of their lifespace, learn to reach their goals through making good choices and resolution of problems of an emotional/interpersonal nature.
main theoretical approaches adopted by counsellors:
- psychodynamic counsellors - focus on insight
- cognitive behavioural counsellors - focus on managing behaviours/symptoms
- humanistic counsellors - focus on promote self-acceptance and freedom
Modes of Treatment Delivery Computerised CBT (CCBT)
definition: highly developed software packages that can be delivered via an interactive computer interface on a personal computer, over the internet or via the telephone using interactive voice response (IVR) systems.
two CCBT packages recommended in the UK:
- Beating the Blues: used in the management of mild and moderate depression
- Fear Fighter: used in the management of panic and phobia
Modes of Treatment Delivery
E-therapy
a treatment method which involves the use of email and internet technology. Email is useful in 4 ways (PG115).
however, little evidence on the effectiveness of online services or potential benefits of email communication
limitations: miscommunication in emails and online communication makes it difficult to intervene effectively in severe emergencies.
