Chapter 14Treating Psychological Disorders

Christina Graham, Ph.D.

Outline: Therapy Does Therapy Work? Approaches Psychoanalytic Therapy Humanistic Therapy Cognitive-Behavioral Therapy

Treatment for Mood Disorders Treatment for Anxiety Disorders

Outline: Therapy Does Therapy Work? Approaches Psychoanalytic Therapy Humanistic Therapy Cognitive-Behavioral Therapy

Treatment for Mood Disorders Treatment for Anxiety Disorders

Psychotherapy Effectiveness

Q: Does psychotherapy work?

A: Yes.*

*Need to think critically about why studies say it works, and how effectiveness is measured

Effectiveness: Key Points

Most problems usually get better on their own…but they’re likely to improve faster with psychotherapy.

Two key ingredients of successful psychotherapy are: Quality of relationship with the therapist The client’s belief that s/he will improve

In general, no particular therapeutic approach is superior

However, certain therapies work much better for specific problems

Outline: Therapy Does Therapy Work? Approaches Psychoanalytic Therapy Humanistic Therapy Cognitive-Behavioral Therapy

Treatment for Mood Disorders Treatment for Anxiety Disorders

Approaches Q: How should we treat psychological

disorders? A: Depends on our assumptions about

etiology (what causes the disorders)

Approaches: Theoretical Perspectives What causes psychological disorders? Is it…

…unconscious conflicts stemming from childhood relationships with parents (psychodynamic perspective)?

…not living to one’s full potential (humanistic)? …learned behaviors and responses

(behavioral)? …thinking a certain way (cognitive)? …neurochemistry and biology (biological)?

Outline: Therapy Does Therapy Work? Approaches Psychoanalytic Therapy Humanistic Therapy Cognitive-Behavioral Therapy

Treatment for Mood Disorders Treatment for Anxiety Disorders

Psychoanalytic therapy (psychoanalysis)

Assumes conflicts are unconscious

Free association = allowing the client to verbalize everything that comes to mind without censoring anything

Sessions are often frequent over a long period of time Expensive!

Psychoanalytic therapy (psychoanalysis) cont’d

Therapist looks for signs of transference (client acts toward the therapist in ways suggestive of unconscious conflicts)

http://www.youtube.com/watch?v=yTHM2o3dvao

Countertransference is also an issue A therapist’s own conflicts can

change how s/he acts toward the client

Outline: Therapy Does Therapy Work? Approaches Psychoanalytic Therapy Humanistic Therapy Cognitive-Behavioral Therapy

Treatment for Mood Disorders Treatment for Anxiety Disorders

Humanistic Therapy Sometimes called client-

centered therapy Therapist provides

unconditional positive regard

Therapist is empathic Encourages client to be

genuine Most therapists –

regardless of orientation – employ these humanistic principles

Carl Rogers (1902-1987)

Outline: Therapy Does Therapy Work? Approaches Psychoanalytic Therapy Humanistic Therapy Cognitive-Behavioral Therapy

Treatment for Mood Disorders Treatment for Anxiety Disorders

Cognitive-Behavioral Therapy (CBT) Integrates assumptions from both the

behavioral and cognitive perspectives Basic model:

Cognitions

EmotionsBehaviors

Using a CBT model, how might a therapist treat depression?

CBT model of depression

Cognitions

EmotionsBehaviors

“I’m no fun…nobody wants to hang out

with me.”

Avoiding friends, avoiding

social events, staying home

alone

Feeling lonely, depressed

“If I go out I won’t have a good

time...people will think I’m such a

jerk”

Treatment for depression: Changing attribution styles

Depressed people tend to attribute events in ways that are inaccurate and maladaptive (Beck’s Cognitive Triad of Depression) Beliefs about the self – negative events are

attributed to internal causes Beliefs about the world – negative events

are seen as having global effects Beliefs about the future – negative events

are seen as stable and unchanging

Treatment for depression: Changing attribution styles

Depressive Non-Depressive

Internal“It’s all my fault”

Global“Everything is going

wrong”

Stable“Things will always

be lousy”

External“That was just bad

luck”

Specific“This is just one lousy

situation”

Unstable“This won’t last

forever”

Some Maladaptive Cognitions Overgeneralization = arbitrarily concluding

that an event will happen to you over and over again

All-or-nothing thinking = tendency to evaluate personal qualities in black/white categories

Mind-reading = assuming you know what others are thinking of you (inaccurately)

Mental filter = dwelling on the negative and ignoring the positive

Magnification = exaggerating the importance of a negative action

Using a CBT model, how might a therapist treat a Specific Phobia?

Treatment of phobias: Systematic Desensitization Feeling relaxed is incompatible with

feeling anxious The therapist helps the client construct a

‘fear hierarchy’ The client is asked to practice coping by

using relaxation strategies in the presence of fearful stimuli

Exposure to the feared stimulus lasts until the fear level drops to a very low level

Sample fear hierarchy Sitting on Santa’s lap – 10 Touching Santa’s beard – 9 Talking to Santa 5 ft away – 8 Hearing Santa say “Ho Ho Ho!” – 6 Seeing a red Santa suit on a hanger – 4 Touching a toy Santa - 4 Seeing a chubby man with a bushy

white beard – 3 Hearing “Jingle Bells” - 2

Using a CBT model, how might a therapist treat OCD?

Treatment of OCD:Exposure and Response Prevention

Compulsions (behaviors) are negatively reinforcing because they decrease anxiety

Client with OCD is exposed to a situation that triggers obsessions (thoughts) and is prevented from performing compulsions

Client learns that anxiety will eventually decrease over time without performing the compulsion Client is negatively reinforced for doing other

things, like distracting self or relaxing)

Stress Inoculation Combination of systematic desensitization

(classically conditioning relaxation response with anxiety-provoking stimuli) with cognitive responses

Use of self-talk to facilitate relaxation and coping (“I can get through this OK”, “Just one step at a time”, “Fear is natural, it won’t always be this bad and I can get through this.”)

Coping skills (self-talk and relaxation) are practiced prior to encountering the stressors

Questions?