AS PSYCHOLOGY A SOCIAL SCIENCE
Chapter Fifteen- Reading Notes
Treatment of Psychological Disorders can be broken into three groups Insight Therapies "talk therapy" in tradition of Freud's psychoanalysis Behavioral Therapies based on the principles of learning, behavioral therapists make direct efforts to alter problematic responses Biomedical Therapies drug therapy and electroconvulsive (shock) therapy are the most common, usually only provided by physicians with a medical degree Two most common presenting problems are excessive anxiety and depression People often delay for many years before finally seeking treatment (median delay in bipolar was 6 years as well as drug dependence, 8 for depression and 10 for panic disorder) Women are more likely than men to receive therapy Two types of psychologists provide therapy Clinical Psychologists emphasize on treatment of full fledged disorders Counseling Psychologists specialize in treatment of everyday adjustment problems Psychiatrists Physicians, who specialize in diagnosis and treatment of psychological disorders, devote time to more severe disorders. Emphasize drug therapies Insight therapies verbal interactions intended to enhance clients' self-knowledge and thus promote healthful changes in personality and behavior Psychoanalysis insight therapy that emphasizes recovery of unconscious conflicts, motives, and defenses through techniques such as free association and transference. Studied neuroses IE phobic, panic, OCD and conversion disorders Free association clients spontaneously express their thoughts and feelings exactly as they occur with as little censorship as possible Dream Analysis therapist interprets the symbolic meaning of clients' dreams. Freud saw this as the most direct root into a persons inner most conflicts, wishes and impulses Interpretation therapists attempts to explain the inner significance of the clients thoughts, feelings and memories and behaviors Resistance largely unconscious defensive maneuvers intended to hinder progress of therapy Transference when clients unconsciously start relating their therapist in ways that mimic critical relationships in their lives Changes in psychoanalysis is known as psychodynamic approaches Client Centered Therapy insight therapy that emphasizes providing a supportive emotional climate for clients, who play a major role in determining the pace and direction of their therapy (Humanistic Perspective)Carl Rogers Rogers believes therapy must be provided in a warm, supportive and accepting environment that allows clients to confront their shortcomings without feeling threatened Therapists must provide three conditions Genuineness honesty Unconditional Positive Regard complete nonjudgmental acceptance of client
Empathy must understand the clients world from the clients point of view Group therapy came of age after WW II in the 1950's Group therapy simultaneous psychological treatment of several clients in a group. Group has 4-12 people, ideally 6-8 Creates a supportive atmosphere as everyone has the same problem Spontaneous Remission recovery from a disorder that occurs without formal treatment Behavior Therapy application of learning principles to direct efforts to change clients maladaptive behaviors Behavior Therapy evolved from Skinner, Eysneck and Wolpe Behavior therapies are based on the following assumptions, behavior is a product of learning, what as been learned can be unlearned Systematic Desensitization behavior therapy used to reduce phobic clients' anxiety responses through counter conditioning First patient creates an anxiety hierarchy, second they participate in deep muscle reaction and third the patient tries to work through the hierarchy, learning to remain relaxed while imagining each stimulus Aversion Therapy aversive stimulus is paired with a stimulus that elicits and undesirable response Social Skills Training behavior therapy designed to improve interpersonal skills that emphasizes modeling, behavioral rehearsal and shaping Cognitive Behavioral Treatments varied combinations of verbal interventions and behavior modification techniques to help clients change maladaptive patterns of thinking. IE Ellis's Rational Emotive Therapy and Beck's Cognitive Therapy Cognitive Therapy uses specific strategies to correct habitual thinking errors that underlie various types of disorders. Originally derived as a therapy for depression. Proponents of this say depression is rooted in errors in thinking Chlorpromazine was first effective antipsychotic drug Biomedical therapies physiological interventions intended to reduce symptoms associated with psychological disorders Psychopharmacotherapy treatment of mental disorders with medication Four catergories of drug therapies: 1) antianxiety drugs 2) antipsychotic drugs 3) antidepressant drugs and 4) mood stabilizing drugs Anxtianxiety drugs relieve tension, apprehension and nervousness. Valium (diazepam) and Xanax (alprazolam) Valium and Xanax are in benzodiazepine family, often called tranquilizers and have almost immediate effect when taken but effects last only for hours. Valium and Xanax also given to people who suffer from chronic nervous tension Side affects from benzodiazepine family include drowsiness, depression, nausea and confusion. Also have potential for abuse, dependence and overdose. Benzodiazepine family causes withdrawal symptoms when treatment is stopped Buspar (busiparone) which does not belong to benzodiazepine family is new drug used to treat general anxiety disorder. It is slower acting (1-3 weeks) and has fewer sedative side effects.
Antipsychotic drugs primarily used to treat schizophrenia and other severe mood disorders. Types include Thorazine (chlorpromazine), Mellaril (thioridazine) and Haldol (haloperidol). Antipsychotic drugs used to gradually reduce psychotic symptoms including hyperactivity, mental confusion, hallucinations and delusions Appear to decrease activity at certain subtypes of dopamine synapses Reduce symptoms in about 70% of patients Their effect is gradual, patients usually respond within 2 days to a week but improvement may occur over several months. Also can reduce likelihood of a relapse Side effects include: drowsiness, constipation and cotton mouth. Also may produce side effects similar to Parkinson's disease including muscle tremors, muscular rigidity and impaired motor coordination Many people stop taking their medication after leaving the hospital because of the side effects and leads to relapse Tardive dyskinesia occurs in 20-30% of patients Tardive dyskinesia neurological disorder marked by involuntary writhing and tic like movements of the mouth, tongue, face, hands or feet. Once it appears there is no cure, although sometimes spontaneous remission occurs when treatment is stopped Atypical antipsychotic drugs (clozapine, olanzapine and quetiapine). Roughly as effective as reg. treatments and can help patients who don't respond to reg. treatments. Fewer unpleasant side effects but may increase patients vulnerability to diabetes and cardiovascular problems Antidepressant drugs gradually elevate mood and help bring people out of a depression Prior to 1987 two principle classes 1) tricylclics (Elavil) 2) MAO inhibitors (Nardil) 2/3 benefit of depressed patients Only 1/3 of patients treated for depression experience complete resolution of symptoms Tricylcics have fewer problems with side effects and complications than MAO inhibitors Antidepressants exert their effects gradually over a period of weeks Newer, more likely to be prescribed antidepressants called Selective Sertonin Reuptake Inhibitors (SSRI's). Drugs include Prozac (fluoxetine), Paxil (paroxetine) and Zoloft (sertaline). SSRI's yield therapeutic gains similar to tricylcics but have fewer unpleasant or dangerous side effects SRRI's can also treat OCD, panic disorders and other anxiety disorders SSRI's may cause an increased risk for suicide (especially right after treatment is begun in) but there is not definite data Mood stabilizers used to control mood swings in patients with bipolar disorders Lithium used to be only drug used, helpful in preventing future episodes of both mania and depression and can also be used to bring people out of such states Side effects of lithium can include kidney and thyroid gland complications and also death if managed improbably Newer drugs include an anticonvulsant agent called valproate, about as widely used as lithium now. Has less side effects and is better tolerated by patients than lithium
Criticisms to drug therapies include that they produce short-lived curative effects and do not really solve problems but just provide temporary relief from an unpleasant symptom. Relapse rates are high when treatment is discontinued. Drugs are over prescribed and patients are over medicated. Studies are slanted towards drugs being good because most researchers are influenced by pharmaceutical industry. Industry financed drug trials are also too short usually to determine long term risks associated with the drugs. CONFLICT OF INTERESTS BETWEEN RESEARCHERS AND PHARMASUETICAL COMPANIES Electroconvulsive therapy (ECT) biomedical treatment in which electric shock is used to produce a cortical seizure accompanied by convulsions In ECT electrodes are attached to skull over the temporal lobes and electricity is applied to either right, left or both sides of brain for about a second which causes a brief (30 seconds) convulsive seizure. Immediate side effects include confusion, disorientation and nausea. People typically receive 6-12 treatments over a period of a month ECT use peaked during 40's and 50's, declined in 60's and 70's and has had a resurgence as of late ECT primarily used to treat depression ECT relapse rates are over 50% within 6-12months of treatment Don't really know why ECT works but opponents say it works because ECT is so aversive patients muster all their willpower to climb out of depression to avoid further ECT treatment Fee-for-service system hospitals, physicians, psychologists and other providers charge fees for whatever health care services are needed and most of these fees are reimbursed by private insurance or the government Managed care systems people enroll in prepaid plans with small co-payments for services, typically run by health maintenance organizations (HMO's) which agree to provide ongoing health care for a specific sum of money. Consumers pay lower prices but give up much of their freedom to choose providers and obtain whatever treatments they feel necessary With HMO's mental health care has suffered because it is harder to deem what is medically necessary Mental health care restriction is sometimes in form of straight denial but also can include under diagnosing conditions, failing to make needed referrals to specialists and arbitrarily limiting length of treatment HMO's change goal of treatment from fully fixing problem over long-term to establishing a reasonable level of functioning as quick and as cheaply as possible 79% of psychologists in a national survey said HMO's had a negative effect on quality of treatment HMO's outsource patients to less-well-trained providers such as masters-level counselors to cut cost and also prescribe older, cheaper drugs Eclecticism practice of therapy that involves drawing ideas from two or more systems of therapy instead of committing to just one system
Theoretical integration two or more systems of therapy are combined or blended to take advantage of the strengths of each. This lead to: Technical eclecticism (Paul Wachtel's) borrowing ideas and insights and techniques from a variety of sources while tailoring ones intervention strategy to the unique needs of each client Modern psychotherapy emerged during second half of 19th century in Europe and America Highly culture-bound origins of modern therapies have raised questions to their use in non-Western cultures and even ethnic minorities within Western cultures. Which is due to: 1) Cultural barriers some cultural groups are reluctant to turn to formal, professional sources of assistance, prefer to rely on family members. Also distrust large, intimidating, foreign institutions 2) Language barriers effective communication is key to therapy yet most mental health agencies and hospitals aren't adequately staffed with therapists who speak the language of minorities 3) Access barriers minorities suffer from elevated rates of joblessness and poverty. They also may not have health insurance 4) Institutional barriers therapists are trained almost exclusively to deal with white, middle-class Americans and are not familiar with culture and customs of ethnic groups Mental hospital medical institution specializing in providing inpatient care for psychological disorders (movement started by Dorothea Dix in 1840's) In 1950's experts began to realize that hospitalization often contributed to the development of pathology instead of curing it. Hospitals usually over booked and understaffed and hospitals served large geographic regions but were rarely placed near major population centers causing patients to be uprooted for their community and isolated from their social support networks Community mental health movement emerged in 1960's and emphasized: 1) local, community-based care 2) reduced dependence on hospitalization 3) prevention of psychological disorders 1963- JFK was first president to address nation on subject of mental health. Wanted to decentralize mental health care. Emphasis on community mental health centers Deinstitutionalization refers to transferring treatment of mental health illness from inpatient institutions to community-based facilities that emphasize outpatient care. This was shift was feasible because of: 1) Emergence of effective drug therapies for severe disorders 2) Deployment of community mental health centers to coordinate local care Shift from placing people in psychiatric hospitals for long periods to placing them in local, general hospitals for brief periods Deinstitutionalization has left two major problems 1) revolving door or people who flow in and out of psychiatric facilities (admission rates have actually climbed, stay duration is just less) 2) left a sizable population of homeless mentally ill people
Over 2/3 of all psychiatric inpatient admissions involve rehospitalizing a former patient Roughly 1/3 of the homeless suffer from mental illness Deinstitutionalization helps people with mild disorders and is less helpful to those that have severe disorders