2 Road Map gt Brief history of Mental Illness and Treatment gt Insight Therapy gt Behavior Therapy gt Cognitive-Behaviour Therapy gt Group Therapy (not going to cover in class) gt Biological Therapies (drugs and operations) 3 Mental Illness Time Animals Mental illness (abnormalities) has likely been around as long as we are and likely exists in the animal worlds as well. As one example killer whales generally exist in pods (extended families of sorts) and the pods have rights to the prime salmon runs. However members are sometimes kicked out of the pods and become rogues (sometimes by themselves sometimes in small groups). These rogues are the ones that eat seals and such. They are denied access to the good salmon. Why were they kicked out Mental Illness Psychopathy 4 Human History of Mental Illness One bit of evidence suggesting a history of human mental illness and attempted treatments of it come from skulls that have been found that bear man-made holes in them. Apparently these holes were cut into the skull to allow the evil spirits that had invaded the persons mind to leave allowing the person some sanity again. The notion of possessions and exorcisms also likely reflect age old attempts to treat schizophrenia or multiple- personality disorder. Witch hunts are another example with many cases of witches (e.g. salem) being directly attributable to the effects of a natural LSD like substance in bread. 5 More Humane Treatments In the not-to-distant past THE way to treat mental disorders was to literally chain the sufferer to a wall in an asylum or some similar demobilization technique. gt e.g. the tranquilizing chair in figure 18.2 Sometime around the French revolution people with mental disorders started to be thought of as patients suffering from some malady of the mind. One famous doctor named Pinel was largely responsible for this shift in attitude as a result of his liberation policies. The actual medical treatment of disorders largely began with the work of Mesmer Charcot Freud. 6 Insight Therapies - Generally Speaking The first really formal treatment method was that used by Sigmund Freud. His psychoanalysis is now viewed as one instance of a class of therapies termed insight therapies. These therapies rest on the assumption that the true causes of our maladaptive behaviours are largely (if not totally) unconscious. If these true causes could be brought to consciousness the problematic behaviours should cease. Thus the therapy is focussed on bringing the unconscious motivations to light mainly through talk. 7 Psychoanalysis Freud believed that although the conflicts that give rise to maladaptive behaviour are largely kept from awareness by unconscious defense mechanisms (the veil of amnesia) However hints of the conflict do get through these defenses. Examples of them getting through involve the latent (as opposed to the manifest) content of dreams and slips of the tongue. A trained practitioner who knows what to look for can interpret these things so long as the patient gives them something to interpret. When the conflict is discovered the veil is lifted. 8 Psychoanalytic Techniques Free association - the purpose of this technique is to encourage the patient to speak freely about things without censoring embarrassing or socially unacceptable thoughts. Explains typical couch situation. Dream analysis - the manifest content of a dream is assumed to hide the latent content in symbolic form. Via proper analysis the therapist can get to the latent content which gives clues to the underlying conflict. Hypnosis - early in his career Freud also supported the use of hypnosis as a way to get at underlying conflicts. However he eventually dropped it finding the other techniques more fruitful. 9 Things that Happen During Psychoanalysis Freud also specified certain reactions that can occur during psychoanalysis that he described in some detail including Resistance - at some point in therapy as the therapist begins to close in on the conflict patients normally back away a bit as the revelations they are experiencing are painful. Transference - sometimes during therapy the patient will use the therapist as a surrogate for someone else and will begin to react to them accordingly. Freud eventually saw this as useful to therapy. Countertransferenc e - the therapist is also human and may experience feelings of countertransference. These were seen as bad for therapy. Therapists should see therapists. 10 Humanistic Therapy A different insight therapy is based on the notions of self-actualization we discussed early. One example of this is Rogers client-centered therapy. The basic assumption of this therapy is that many of the psychological problems we have relate to the difference between the person we are and the person we wish to be. Rogers called this difference incongruence. The goal of the therapy is to reduce incongruence by encouraging experiences that will make the ideal self more realizable. 11 Techniques of Client-Centered Therapy The focus of this therapy is on the client and helping the client to realize the source of their problems with as little input from the therapist as possible. Thus the major technique involves something called reflection the sensitive rephrasing or mirroring of the clients statements. This is thought to allow the therapist to demonstrate empathy which is critical for encouraging the client to deal with the incongruence and attempt to lessen it. It is this type of therapy that is represented in computer therapy programs such as Eliza. 12 Weaknesses of Insight Therapies In order to benefit from insight therapies a person must intelligent articulate and sufficiently motivated to commit several hours a week for months or years. gt rules out psychotics people with low intelligence anyone who does not have the time or money. Hard to evaluate success because success is usually defined in terms of successful patients feeling better. What about the others There is also the insight escape clause that always allows a therapist a ready excuse for failures. Given the time and money that patients commit they may be biased to feel that the therapy is helping. 13 Behaviour Therapy Behaviour therapies are based on the basic principles of learning theories (classical and operant conditioning). Recall that learning theory holds that a response (CR) can be learned to a previously neutral stimuli (CS) if that stimulus predicts the occurrence of some other stimulus (UCS) that is linked to some response (UCR). The CR is similar though not identical to the UCR. From a behaviourist standpoint this view accounts for the formation of adaptive and maladaptive behaviours. Given this assumption it should be possible to alter maladaptive behaviours using learning principles. Note that focus is on the behaviours themselves 14 Reward and Punishment At their most basic level these therapies involve administering either rewards punishments or both. As an example of a reward therapy (gone wrong) Steve will now relate his story about when he served as a reinforcer. As an example of the use of punishment Steve will now relate some of the plotline of Clockwork Orange hopefully without spoiling the ending for you. Also flooding In some cases the use of behaviourist principles are more complicated ... 15 Systematic DesensitizationReplacing the bad CR with a better one In situations where the client suffers from an anxiety disorder (e.g. a phobia) the problematic CR is the anxiety response. An opposite response to this would be relaxation. If clients could be reinforced for relaxing in the presence of the phobic-stimulus this incompatible relaxation response could replace the negative anxiety response. To be successful this procedure seems to require a slow approach to the actual phobic stimulus via a hierarchy (Steve will explain). This procedure is VERY successful at treating anxiety disorders taking an average of 11 sessions. 16 Other Positive Reinforcement StrategiesToken Economies One behavioural method that seems to work fairly well within institutional situations (e.g. youth offender centers) is something called token economies. Essentially a token economy is a situation wherein people are given some form of reward (e.g. poker chips) for performing good behaviours. These chips can then be turned in for positive rewards such as special snacks or activities (e.g. access to a games room). - Mix99 Interactive Screen Saver This notion can also include a punishment factor whereby people would lose chips for behaving inappropriately. 17 Techniques Based on Extinction Recall that if the some behaviour is no longer rewarded that behaviour tends to stop occurring. - Extinction By the same token if the reinforcing nature of some maladaptive behaviour can be figured out and that reinforcer can be prevented from occurring the maladaptive behaviour should extinquish. This is the basis of a several techniques including a technique termed time-out in which social attention is withdrawn anytime a person (or child) performs a bad behaviour that is meant to draw attention to them. 18 A Slightly Different Kind of Extinction A therapy called implosion therapy uses a slightly different kind of extinction to treat anxiety disorders. Rather than allowing a client to escape some fear-inducing stimulus (and thereby reward it via negative reinforcement) impl osion therapy involves forcing the client to have very close contact with the anxiety producing stimulus and not allowing them to escape. The idea is that the client will eventually come to realize that the stimulus will not harm them though this realization may not come until after the person experiences a certain amount of terror. 19 Modeling A Kinder/Gentler Implosion Therapy For some anxiety disorders a kinder/gentler version of implosion therapy is just as effective. Modeling involves having an authority figure slowly demonstrate to the client that a fear-inducing stimulus is in fact not to be feared. This is a gradual process that proceeds at whatever pace the client is comfortable with. It is often very effective and does not involve the high levels of stress that often accompany implosion therapy. 20 Cognitive-Behaviour Therapy Some psychologists think that maladaptive (and adaptive) behaviours are due to more than just environmental variables Rather they believe that the clients thoughts expectations percepti ons and self-statements interact with the environment to determine behaviour. gt Steves SM example Given this viewpoint they believed that the best therapy would be one that combines behavioural treatments with a consideration of the cognition the person brings to bear. Sometimes it may be the cognition that needs changing. 21 Rational-Emotive Therapy Developed by Ellis (circa 50s) rational-emotive therapy is based on the assumption that psychological problems are based on the way people think about upsetting events and situations. The therapy is therefore based on changing peoples beliefs. It is a very direct and confrontational therapy. The therapist assesses the situation then tells the client how they should change. Ellis identified several irrational beliefs that many people share. He would try hard to show the client that these beliefs were irrational and should not be bought into. 22 Sample Irrational Beliefs Wanting to be loved by everyone. Believing you must be completely competent efficient and goal directed in everything you do. Believing that unhappiness is externally caused and therefore out of your control. Believing that your past behaviour completely determines your future behaviour. Believing there is a best solution to every problem and that bad things happen if that solution is not found. gt Steve read passage from pp. 617 23 Becks Depression Therapy Beck believed that sometimes bad cognition was caused by faulty logic as well as holding false beliefs. He found that if you challenged a depressed patient to expand on some depressing comment they made you would often find that there was little evidence to support the comment. Perhaps if the patients logical thinking could be more focussed they could evaluate depressing thoughts and perhaps dispel some of them. 24 Evaluation of Cognitive/Behavioural Therapy Insight therapists criticize the manner in which behaviour based therapies focus on the symptoms as opposed to underlying causes. They worry that if one symptom is removed the underlying conflict will simply produce another a process called symptom substitution. gt Bed-wetting example against substitution By and large these therapies appear very successful AND they can document their success with behavioural evidence. 25 Group Therapies The textbook discusses the issue of group therapy at this point. Time does not permit me to go into detail on group therapy so I leave that section to you. I will now go on to talk about biological treatments. gt Psychosurgery gt Drugs 26 Biological Treatments The basic premise behind biological treatments of mental disorders is that the disorder is due to some biological problem with the brain. Perhaps the brain is not constructed properly or perhaps there is some kind of imbalance in the neurotransmitters that pass around communication in the brain. If this is true then it might be possible to treat the disorder by restructuring the brain or by affecting the way neurotransmitters work. Similar to insight therapies in terms of treating cause but different as well (no psychodynamic stuff). 27 Psychosurgery One class of biological procedure that used to be quite common is called Psychosurgery and includes such procedures as Electroconvulsive Therapy (ECT) and Frontal Lobotomies. Weve basically went through the story of frontal lobotomies already so I wont take that up much more. However the Electroconvulsive Therapy story is a different and interesting one. 28 Electroconvulsive Therapy (ECT) It was noticed that schizophrenics who were epileptic tended to feel better than normal after a seizure. As a result physicians wondered if inducing seizures could relieve the symptoms of schizophrenia nope. However they noticed that the convulsive treatment did tend to elevate the mood of the patients. So it is now used to treat depression especially as a quick fix until a drug treatment can become effective. Why does it elevate mood Possibly it does so by somehow reducing REM sleep depressed people tend to get too much REM sleep. 29 Dangers of Psychosurgery Psychosurgery involves making permanent changes to the structure and/or functioning of the brain usually it involves damaging the brain. Clearly this is a procedure of last resort and should only be used when no other treatment options are available. Given this the more common biological treatment for mental disorders is no longer psychosurgery it is now drugs. 30 Pharmacotherapy Our bodies are electro-chemical mechanisms which means that they pass information as electrical synapses which are transmitted via chemical reactions. Given this it should not be surprising that chemicals (drugs) can strongly affect the way our machinery works. Thus in line with the biological viewpoint mental disorders may simply reflect imbalances in chemicals. If the balance could be restored perhaps the problematic behaviours would go away. Here is a sample of some drugs used to treat mental disorders ... 31 Antipsychotic Drugs These drugs are mainly given to schizophrenics as they are quite effective at easing the positive symptoms of that disorder (as we talked about re Chlorpromazine) They do so by blocking the dopamine receptors in the brain thereby effectively reducing the influence of dopamine in the brain. Unfortunately they do so in a global fashion. The parts of the brain thought to be responsible for schizo symptoms (cerebral cortex and limbic system) are positively effected. However so are other areas one of which is involved in motor movements. Antipsychotics actually cause problems for that area which can lead to Parkinsons symptoms (motor problems tardive dyskinesia). 32 Antidepressant Drugs Tricyclics Similar to ECT one class of antidepressants called tricyclics were originally developed in hopes they would benefit schizophrenics they did not help the symptoms of schizophrenia but they did make the schizos feel better. It is thought that depression may result deficiencies in the neurotransmitters norepinephrine and sarotonin. The drugs slow the re-uptake of these neurotransmitters thereby making it as if there were more. Unfortunately tricyclics have many side effects including dizziness sweating weight gain constipation increased pulse poor concentration and dry mouth. 33 Antidepressant Drugs Prozac As many of you likely know the new wonder drug for treating depression is called prozac. Prozac also inhibits the re-uptake process but its effects are limited to the serotonin neurotransmitter. For some reason this seems to mostly take care of the depression while causing many fewer side effects (perhaps targeting the emotion without mobilizing the body). The lower incidents of side effects allows larger doses to be used. 34 End of Chapter 18 The text discusses a number of other drug therapies including drugs to help gt mania gt bipolar disorder gt anxiety disorders It lays out the pros and cons of drug therapy but it most cases the moral is gtHow well do we understand the biological causes gtCan we find a drug that targets those causes only gtSo far there has been some success in some areas. Now moving forward to the past Chapter 15
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