Treatment of Psychological Disorders

Question 1

A clinical psychologist works with people who have clinically diagnosed mental disorders (i.e. meet criteria in the DSM-IV); they are different to counseling psychologists because who work with people who have ‘everyday problems’; they follow the ‘scientist-practitioner model’ so they learn the science of psychology before they apply it to people in diagnosis and treatment; they often work in multidisciplinary teams; and they often work in mental health clinics that are integrated as part of the community (reflecting a move away from institutionalised care to more community-based care)

Answer 1

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Question 2

Psychodynamic therapies rest on two principles:

Answer 2

(i) insight and (ii) therapeutic alliance

Question 3

Insight refers to an understanding one’s own psychological processes, which helps address:

Answer 3

(i) maladaptive ways of viewing the self and interpersonal relationships, (ii) unconscious conflicts and compromises among competing wishes and fears and (iii) maladaptive ways of dealing with unpleasant emotions

Question 4

Therapeutic alliance refers to the relationship between the patient and therapist; if the patient feels comfortable to speak then you will get more disclosures about emotionally significant experiences and therefore aid the therapeutic process

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Question 5

There are three techniques psychodynamic therapists often use:

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(i) free association, (ii) interpretation and (iii) transference

Question 6

Free association means to speak freely about anything (e.g. thoughts, feelings, images, fantasies, memories, dreams) without censorship; then the patient and therapist work together to explore associations and networks and uncover any unconscious processes involved in symptom formation with the intention of relieving the symptoms by ‘making the unconscious conscious’

Answer 6

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Question 7

Interpretation is where the therapist helps the patient understand their symptoms because: (i) they have training, (ii) they have ‘an outsider’s perspective’ so they are not emotionally embroiled in the issues like the client is, and (iii) they can help patients overcome any resistance they have to uncovering their maladaptive patterns of thought and behaviour (which initially developed to avoid the anxiety they would otherwise provoke)

Answer 7

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Question 8

Transference occurs when people transfer the thoughts, feelings, fears, wishes and conflicts that are troubling them from the real source (e.g. father) to the therapist, allowing the person to get in touch with how they really feel and thus ‘uncover the unconscious’

Answer 8

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Question 9

Psychodynamic therapies are useful because they provide empathy and ‘a listening ear’ to the client but they are also very intensive, extensive and expensive and insight may still not be achieved; and if insight is achieved, this does not necessarily guarantee that the problems or symptoms will go away because the therapist is only trying to uncover patterns and associations and not teach them how to change their maladaptive thoughts or behaviours

Answer 9

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Question 10

Cognitive behavioural therapies (CBT) combine behaviorist and cognitive approaches to learning; unlike psychodynamic therapies, cognitive behavioural therapies: (i) are more short term, (ii) focus on the client’s current symptoms and behaviour and doesn’t try to uncover any childhood traumas/experiences that may be unconscious and underlying the conflicts and motives of the mental illness, (iii) are more directive (they suggest specific ways patients should change their thinking and behaviors, assign homework and structure sessions with questions and strategies etc., (iv) use behavioral analysis (by examining the stimuli or thoughts that precede or are associated with behavioural symptoms) and (v) address specific psychological processes

Answer 10

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Question 11

Two common techniques used in CBT that derive from behaviourism side and so focus on changing dysfunctional behaviours are: (i) systematic desensitisation and (ii) exposure techniques; and two common techniques used in CBT that derive from cognitive psychology and so focus on changing dysfunctional thoughts are: (i) Ellis’ rational-emotive therapy and (ii) Beck’s cognitive therapy

Answer 11

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Question 12

In systematic desensitisation, the patient gradually confronts the stimulus that causes them phobia in their mind while they are in a relaxed state that inhibits emotional anxiety; the assumption is that through classical conditioning, phobics have learned to fear what should actually be a neutral stimulus and as a result, have now learned to avoid the stimulus; that avoidance is highly resistant to extinction, and cognitive behavioural therapists teach them to change that avoidance behaviour; to extinguish the irrational fears, the patient undergoes four steps: (i) patient learns relaxation techniques (e.g. relaxing muscles and breathing exercises), (ii) therapist questions patient about their fears and develops a ‘hierarchy of fears’ (imagined stimuli/scenes that provoke mild anxiety to those induce intense fear), (iii) while relaxed, the patient imagines each scene in the hierarchy from least to most threatening until they can imagine that scene comfortably, (iv) therapist encourages patient to confront fears in real life and monitor the process; this technique is used widely to treat anxiety-related disorders (e.g. phobias, impotence, nightmares, OCD, social anxiety etc.)

Answer 12

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Question 13

In exposure techniques, the patient confronts the stimulus so that they cannot avoid or escape it (response prevention); the three most common types of exposure are: (i) flooding, (ii) graded exposure and (iii) virtual reality exposure therapy.

Answer 13

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Question 14

In flooding, the patient confronts the phobia stimulus all at once, so there is inescapable exposure to the conditioned stimulus which eventually desensitises the patient through extinction; by preventing escape, the person is forced to realise that the situation is not that catastrophic and that they have the self-efficacy capacity to confront it

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Question 15

In graded exposure, the patient is gradually exposed to the phobic stimulus instead of all at once

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Question 16

In virtual reality exposure therapy, patients are not exposed to the real stimulus but only virtual images of it, which is helpful if it would be costly and time-consuming otherwise

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Question 17

In Ellis’ rational-emotive therapy (RET), Ellis proposes that clients can rid themselves of most psychological problems by maximising their rational and minimising their irrational thinking; the job of the therapist is to (i) continually point out the illogical or self-defeating thoughts to show how they are causing their problems and (ii) teach them alternative ways of thinking

Answer 17

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Question 18

According to RET, psychopathology is the result of: (i) A = Activating conditions, e.g. job loss, triggers, life events, (ii) B = Belief systems, e.g. I am not a worthy person unless I am very successful, maladaptive cognitive patterns, and (iii) C = Emotional consequences, e.g. depression as a result of A and B; Activating conditions (A) do not automatically lead to emotional consequences (C); it is the combination of both events and thoughts that influence our emotions

Answer 18

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Question 19

In Beck’s cognitive therapy, the therapist and patient work together to identify, challenge and change maladaptive patterns of thought and behavior/cognitive distortions and errors in thinking, so it uses an inclusive approach and tries to remove power differences between the therapist and patient; some of its key characteristics are that it is: (i) short term (usually complete in 12-20 highly structured sessions), (ii) goal-directed (an agenda is set from the outset) and (iii) educational (the theory behind the treatment is taught to the patient first)

Answer 19

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Question 20

According to the humanistic perspective, therapies focus on the phenomenological experience of the patient; that is, how they consciously experience themselves, their relationships and the world; it’s about getting people get in touch with their feelings, their ‘true selves’ and a sense of meaning in life; the two most common humanistic therapies are: (i) Gestalt therapy and (ii) Client-centered therapy

Answer 20

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Question 21

In Gestalt therapy there is emphasis on awareness of one’s own true, authentic, unsocialised feelings; that is, a focus on the ‘here and now’; e.g. in the ‘empty chair technique’, you pretend that the person you really want to talk to is in the other chair and in this safe environment, you discover what you really feel

Answer 21

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Question 22

In client-centered therapy there is a focus on everyday problems in living and how they have resulted from a discrepancy between a person’s self- concept (i.e. how they see themselves or how they’d like to see themselves) and who they really are and what they really feel; this technique uses unconditional positive regard – an attitude of fundamental and unconditional acceptance to create a supportive environment that allows the person to let go of who they think are and embrace who they really are

Answer 22

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Question 23

In group therapy multiple people work together to work towards a therapeutic goal; typically 5-10 people meet once a week for about 2 hours; these groups can be homogenous or heterogeneous; one benefit of this type of therapy is that members of the group doing well give other people hope and another benefit is that other group members validate one’s own negative emotions and behaviours

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Question 24

In family therapy, the aim is to change maladaptive family interaction patterns, and in couples/marital therapy, there is a focus on the relationship between members of a couple

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Question 25

Biological treatments reflect the view that psychological disorders are the result of pathology of the brain; biological treatments include: (i) pharmacotherapy (e.g. antipsychotic medication, anti-depressant and mood stabilising medications, antianxiety medications), (ii) electroconvulsive therapy (ECT) and (iii) pychosurgery; most biological treatments can only be administered by medical doctors (e.g. psychiatrists)

Answer 25

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Question 26

Antipsychotic medications are used to address psychotic disorders like schizophrenia; they are also known as ‘major tranquillisers’ because they are highly sedating; they work by inhibiting dopamine because this neurotransmitter is implicated in the positive symptoms of schizophrenia (e.g. hallucinations); they are not so effective for the negative symptoms of schizophrenia (e.g. flat mood) because dopamine is not implicated in the negative symptoms; the most serious side effect of antipsychotic medications is a movement disorder known as tardive dyskinesia characterised by involuntary twitching including in the tongue, face and neck

Answer 26

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Question 27

Antidepressant and mood stabilising medications work by increasing the amount of norepinephrine and/or serotonin in the synapses; three common types are: (i) tricyclic antidepressants, (ii) MAO (monoamine oxidase) inhibitors and (iii) SSRIs (selective serotonin reuptake inhibitors)

Answer 27

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Question 28

Tricyclic antidepressants work by blocking the reuptake of norepinephrine and serotonin in the presynaptic membrane, so they force the neurotransmitters to stay in the synapse for longer

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Question 29

MAO (monoamine oxidase) inhibitors work by preventing the chemical MAO from breaking down neurotransmitters while they are inside the pre-synaptic neuron, so there are more neurotransmitters available to be released into the synapse; MAO inhibitors are more effective that tricyclic antidepressants for people who are diagnosed with a comorbid personality disorder (especially borderline personality disorder); they tend only to be prescribed as a last measure because there is a lot of associated food restrictions and they can be lethal if used in a suicide attempt

Answer 29

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Question 30

SSRIs (selective serotonin reuptake inhibitors) are the most commonly used first type of medical treatment prescribed because they have fewer side effects and are better tolerated over longer periods, e.g. Prozac and Zoloft; they work by preventing the reuptake of serotonin from the synapse back into the presynaptic neuron so they keep the neurotransmitter serotonin active in the synapse for longer

Answer 30

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Question 31

Antianxiety medications are also known as benzodiazepines; they are especially useful for short-term treatment for anxiety and are often used in combination with other types of therapies such as psychotherapy or exposure-based therapies; the most common examples are Valium and Xanax but SSRIs are also effective is treating anxiety and they are fast-acting (usually within one week); the main problem with anti-anxiety medication is that patients can become physiologically and psychologically dependent, and this is supported by the high relapse rate after people stop using antianxiety medication

Answer 31

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Question 32

Two types of biological treatments that are used as a last report when pharmacotherapy fails are: (i) electroconvulsive or electroshock therapy (ECT) and (ii) psychosurgery

Answer 32

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Question 33

ECT refers to the intentional induction of a brain seizure by giving a person an electric shock either to one or both of their hemispheres; it is usually used to treat people with major depression who also show signs of psychosis, but it may also be used in severe cases of bipolar disorder, schizophrenia, and catatonia; it is a controversial method and people are highly resistant to it but now it is used more safely and effectively than in the past; it has the capacity to improve mood in the same way that antidepressants can, even though people still don’t fully understand how; the main side effect of ECT is memory loss and another is cognitive impairment (in particular, slowed information-processing)

Answer 33

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Question 34

Unlike ECT is which there is intentional stimulation to the brain, in psychosurgery there is intentional lesioning or cutting of the brain part thought to be involved in producing the psychological symptoms; the most common type of psychosurgery is a lobotomy; psychosurgery is different to neurosurgery in that alterations to the brain are for known medical reasons (e.g. remove a tumor or a blood clot) and not psychological ones; the main side effects of lobotomies include apathy, loss of self control and ability to think abstractly; now, psychosurgery is a criminal offence in Australia and permission is required; it is mostly used for patients with severe major depression or OCD

Answer 34

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