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Chapter 15
Treatment of Psychological Disorders – 8th Edition
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Types of Treatment
Analyze This and Analyze That - misconceptions
Types of therapies
– Insight therapies
• “talk therapy”
– Behavior therapies
• Changing overt behavior
– Biomedical therapies
• Biological functioning interventions
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Who Seeks Treatment?
15% of U.S population in a given year
Most common presenting problems
– Anxiety and Depression
– Treatment seeking for various disorders – Figure 15.1
• Mood disorders
Utilization rates – Figure 15.2
Women more than men
Medical insurance
Education level
Psychological Disorders and professional treatment –
Figure 15.3
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Figure 15-1 – Treatment seeking for various disorders
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Figure 15-2 – Therapy utilization rates – Olfson et al. (2002)
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XX 15.3
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Who Provides Treatment?
Slide 8
Clinical psychologists
Counseling psychologists
Psychiatrists
Clinical social workers
Psychiatric nurses
Counselors
On-line treatment?
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XXXXX Slide 8
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Insight Therapies: Psychoanalysis
Sigmund Freud and followers
– Goal: discover unresolved unconscious conflicts - Figure 15.4
• Free association
• Dream analysis
• Interpretation
– Resistance and transference
Psychodynamic Therapies
Figure 15.4 Freud’s view of the roots of disorders
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Insight Therapies: Client Centered Therapy
Carl Rogers
– Cause: Figure 15.5
– Goal: restructure self-concept to better correspond to reality
– Therapeutic Climate
• Genuineness
• Unconditional positive regard
• Empathy
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Therapies Inspired by Positive Psychology
Martin Seligman
Uses theory and research to better understand the
positive, adaptive, creative, and fulfilling aspects of
human existence
– well-being therapy
– positive psychotherapy
• can be an effective treatment for depression – F 15.6
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Table of Contents Figure 15.6 Positive psychotherapy for depression
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Other issues
Groups therapy
– Group size
– Advantages – social dimension of change
Effectiveness of Insight therapies – Figure 15.7
– Spontaneous remission
Talk therapies or other approaches?
– Common factors contribute to progress in those treated
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Figure 15.7 – Recovery as a function of number of
therapy sessions
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Behavior Therapies
B.F. Skinner and colleagues
– Goal: unlearning maladaptive behavior and learning adaptive ones
– Systematic Desensitization – Joseph Wolpe
• Classical conditioning – Figure 15.8
• Anxiety/Fear hierarchy – Figure 15.9
– Aversion therapy – Figure 15.10
• Alcoholism, sexual deviance, smoking, etc.
– Social skills training
• Modeling
• Behavioral rehearsal
– Biofeedback
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XXX 15.8
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XXX 15.10
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Cognitive-Behavioral Therapy
Aaron Beck – Cognitive therapy
– Depression and negative thinking – Figure 15.11
Albert Ellis – Rational-emotive therapy
Goal: to change the way clients think – Detect and recognize negative thoughts
– Reality testing
Effectiveness of Behavior Therapies – Efficacy of behavioral interventions for a variety of
disorders
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XXX 15.11
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Biomedical Therapies
Psychopharmacotherapy – Antianxiety - Valium, Xanax, Buspar
– Antipsychotic - Thorazine, Mellaril, Haldol
• Tardive dyskinesia
• Atypical antipsychotic – reduce motor effects and other neurotransmitters
• Time course – Figure 15.12
– Antidepressant: - Actions - Figure 15.13
• Tricyclics – Elavil, Tofranil
• Mao inhibitors (MAOIs) - Nardil
• Selective serotonin reuptake inhibitors (SSRIs) – Prozac, Paxil, Zoloft – side effects – Table 15.1
• Risk of suicide – Figure 15.14
– Mood stabilizers
• Lithium, Valproic acid
Electroconvulsive therapy (ECT) – pages 642-643
Transcranial Magnetic Stimulation
Deep brain stimulation – Figure 15.15
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Figure 15.13 Antidepressant drugs’ mechanisms of action
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Figure 15.15 Deep brain stimulation
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Current Trends and Issues in Treatment
Managed care
Empirically validated treatments
Blending Approaches to treatment – Figure 15.17
– Conjunctive therapy – Figure 15.16
Multicultural sensitivity
Deinstitutionalization
– Dorthea Dix - Figure 15.18
– Changes in population – Figure 15.19
• Factors – treatments, legal, service delivery model
– Revolving door problem – Slide 26
– Homelessness
– Increase use of criminal justice system
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Figure 15.17 The leading approaches to therapy among psychologists
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Figure 15-16 – Relapse rates in Reynolds et al. (1999) study
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XX 15.19
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Slide 26 – Percentage of psychiatric inpatient admissions that
are readmissions
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Looking for at therapist
Factors to consider
– Sources of services – Table 15.2
– Profession
– Gender
– Theoretical approach
Comparison of approaches for effectiveness - Figure
15.20
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Table 15-2, p. 626
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Figure 15.20 Estimates of the effectiveness of various approaches to psychotherapy.