Treatment (11.17 Lecture) Flashcards
view of mental illness treatment: prehistoric times-middle ages
mental illness occurred in people who were possessed by demons. Treatment: prayer, flogging, drilling holes in the skull to “release” evil demons.
view of mental illness treatment: renaissance (middle ages-industrial revolution)
mental illness was the loss of capability to reason (people will illnesses would be sent to Saint Mary’s of Bethlehem and worsen their condition)
Philippe Pinel
thought mental illness was not evil (1800s, industrial revolution)
- was put in charge of Parisian hospital system
- wanted to remove the patients’ shackles and chains and give them a chance to exercise and get fresh air (French government grudgingly made changes and US followed)
Dorothea Dix
lobbied for better treatment of people with mental illness (1800s, industrial revolution)
- a retired school teacher, became a big advocate
- led to dramatic growth of state-supported institutions for psychological care
view of mental illness treatment: industrial revolution - early/ mid 20th century
mental illness is unconscious conflict between self (Freud) breakdown in brain
view of mental illness treatment: early/ mid 20th century - modern times
drug therapy (advertized to women for “housewives,” to feel less anxious
Egas Moniz
(early/ mid 20th century)
believed schizophrenia was an agitative loop in the brain (study that damaging PFC of moneys led to less symptoms) so he damaged the PFC of patients with schizophrenia. patients were calmer but no executive functions
- procedure took off, (freeman and Watts) “frontal lobotomy,” went through eye to improve the procedure (wasn’t open skull, “ice pick” lobotomy)
- spread worldwide, 1949 Moniz won nobel prize
- procedure was usually don’t without consent (inmates, etc.)
insight-oriented treatment
humans can heal with more self-awareness
psychodynamic approach
(insight-oriented treatment)
long-buried unconscious conflicts are uncovered and resolved
- originated from Freud , psychoanalytic approach (talking cure) –> psychodynamic
what does a healthy mind look like under a psychodynamic approach?
A trio of musicians playing in harmony together
what does an unhealthy mind look like under a psychodynamic approach?
discordant parts (id, ego, superego)
what are some psychodynamic techniques
- free-association: allow patient to relax and freely say what comes to mind (revealing)
- dream analysis: deep unconscious aspects of self
- resistance: ways patient is actively resisting therapy
- transference: whatever issues having in life, will bring into therapy and transfer onto the therapist
- interpretation: pull together clues
humanist approach
(insight-oriented treatment)
goal: what needs are not being met and how do we get rid of obstacles – Maslow’s hierarchy of needs
what does a healthy mind look like in a humanist approach?
plant wants to grow as long as their basic needs are met
what does an unhealthy mind look like in a humanist approach?
plant isn’t given what it needs to grow
Carl Rodgers and the humanist approach
client-centered therapy
*remember video with women in therapy
- the client isn’t considered a patient
- client needs to heal themselves
videoed all his sessions and did research
1. genuineness (needs to be authentic)
2. unconditional positive regard (like the client no matter what)
3. accurate empathic understanding (listening and understanding) … she said smth he said it back to her
action-oriented treatments
people can’t always solve their own psychological problems
healthy mind with action-oriented treatment
software that works
unhealthy mind with action-oriented treatment
“buggy code” software glitches or sometimes its the wrong software for the situation
what is the role of a therapist in action-oriented treatment?
a therapist fixes errors in the code and understands why there are errors
cognitive approach
(action-oriented treatment)
thinking processes
Aaron beck(depression) and Albert Ellis(errors in thinking)
originally: activating event –> consequence
*but assumes everyone acts in the same way to the same experience
CA: activating event –> belief –> consequence
techniques used in cognitive approach
- identifying dysfunctional beliefs and logical errors in thinking
- challenging these beliefs and errors
how to remember cognitive approach?
A, B, C “a”ctivating event, “b”elief, “c”onsequence
Gloria example with Ellis
he targeted her belief of confronting someone rejecting her
behavioral approach
(action-oriented treatment)
faulty learning, reinforced or not punished for unhealthy behaviors
exposure therapy
(behavioral approach)
classical conditioning
- gradually exposing someone to what they fear to learn the fearful thing won’t lead to a negative outcome
exposure therapy ex. (OCD harm compulsions)
(ex. “S” had OCD harm compulsions where he would randomly want to kill his wife. He quit his job and couldn’t suppress thoughts. Used exposure therapy, focused on violent thought, breath deeply –> recondition a relaxation response. Therapist had him directly confront fear and hold a knife to his neck to show him they’re just thoughts)
token economy
(behavioral approach)
operant conditioning
- reinforcement and punishment (learn rewards for using new, good behavior) used a lot in autistic children
- contingency management – individuals learn certain behaviors will be followed by strict consequences
modeling
(behavioral approach)
observational learning
- see someone else do something you’re afraid of doing (ex. afraid of snakes but see someone handling snakes without danger)
- vicarious reinforcement – client watches as model experiences some good outcome after exhibiting desired behavior or emotional reaction
how can action-oriented therapy be used together?
Cognitive/ Behavioral Therapy (CBT), most therapists combine cognitive and behavioral approach
biological treatments
focus on the hardware and how to intervene directly to fix it
pharmacotherapy (drug therapy)
intervene and the level of synapse and the impact of neurotransmitters
benefits of pharmacotherapy over psychotherapy?
- more affordable because easier to get insurance to cover it
- easier to access and privacy (don’t have to leave to go to therapy frequently)
benefits of psychotherapy over pharmacotherapy?
- less short-term, changes in mindset can be more permanent
- fewer negative side effects
sometimes synergistic effect if put together
electroconvulsive therapy (ECT)
(biological treatment)
- Ladislas Meduna – didn’t have schizophrenia with epilepsy
- didn’t work with schizophrenia but works with depression
- perceived scary bc convulsions (stimulates both sides of brain) but life-saving for extreme depression
transcranial magnetic stimulation (TMS)
(biological treatment)
- can be used with depression to stimulate parts of the frontal lobe to rewire parts of the brain
- effective for autism
deep brain stimulation
(biological treatment)
- implanting electrodes deep in the brain (last resort) for severe depression
- Helen Mayberg
- doesn’t work for everyone
how to evaluate treatment
needs to be evidence-based, diverse setting, represent diverse participants, rigorous method, reviewed by experts
the dodo bird verdict
(in Alice in Wonderland had a race but didn’t remember number of laps/ starting point so said they all won)
different psychotherapies produce equivalent outcomes
common mechanisms across therapies
- placebo effect
- therapeutic alliance
- providing hope and reassurance
- fostering new ways of thinking, feeling, and behaving
different mechanisms lead to the same outcomes
depression is an imbalance between amygdala and PFC. Can quiet amygdala or amplify PFC to produce the same outcome
*but not always true, effectiveness can depend on disorder
