Treating Disorders of the Mind and Body

1
Treating Disorders of the Mind and Body
2
Overview of Chapter Questions

• How Is Mental Illness Treated?
• What Are the Most Effective Treatments?
• Can Personality Disorders Be Treated?
• How Should Childhood Disorders Be Treated?

3
How Is Mental Illness Treated?

• Psychotherapy Is Based on Psychological
  Principles
• Biological Therapies Are Necessary for Some
  Disorders
• Common Factors Enhance Treatment

4
Psychotherapy Is Based on Psychological Principles

• Psychodynamic therapy focuses on insight
• Humanist therapies focus on the whole person
• Behavioral therapy focuses on observable behavior
• Cognitive-Behavioral therapy focuses on faulty
  cognitions
• Group therapy builds social support
• Family therapy focuses on family context

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Psychodynamic therapy focuses on insight

• Freudian psychoanalysis uses free association
  and dream analysis to bring unconscious
  unresolved conflict into focus
• The goal is to produce insight, which leads to
  behavior change and symptom improvement
• Post-Freudian reformulations are called
  psychodynamic approaches

6
Humanist therapies focus on the whole person

• Rogers Client-centered therapy uses reflective
  listening to help persons clarify their deeply
  held personal concerns
• Rogers approach also promotes unconditional
  positive regard as a therapeutic element
• Rogers approach aims to achieve
  fully-functioning persons who are
  self-actualized as described by Maslow

7
Behavioral therapy focuses on observable behavior

• Behavior is learned and can be unlearned
• Behavior Modification uses operant conditioning
• But social learning perspectives are used in
  practice (social-skills, modeling, etc)
• Exposure treatments, like systematic
  desensitization, focus on phobic avoidance

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Cognitive-Behavioral therapy focuses on faulty
cognitions

• Cognitive therapy sees disorder as rooted in
  distorted thoughts
• Cognitive restructuring targets maladaptive
  thought patterns
• Ellis Rational-Emotive-Therapy pioneered
  cognition as cause and cure
• CBT integrates cognitive and behavioral
  interventions

9
Group therapy builds social support

• Group therapies offer specific advantages
• Groups vary in structure and orientation
• Groups vary in degree of focus on insight, social
  support, and cognitive or behavioral change

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Family therapy focuses on family context

• Family systems approaches recognize that
  individual change is contextual, so why not
  engage the whole system?
• Studies of schizophrenic families show that high
  levels of expressed emotion (EE) are associated
  with risk for relapse, and reducing EE reduces
  relapse! (see figure 14.4)

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Fig. 14.4
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Biological Therapies Are Necessary for Some
Disorders

• Psychotropic medications affect neurotransmitter
  processes
• Anti-anxiety drugs affect GABA

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Biological Therapies Are Necessary for Some
Disorders

• Antidepressant drugs
• MAO inhibitors
• Trycyclics
• SSRIs (see fig 14.5)
• Antipsychotic drugs

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Fig. 14.5
15
Common Factors Enhance Treatment

• Psychotherapy helps, and common underlying
  factors contribute to all psychological
  approaches
• Caring Therapists
• Catharsis and Confession

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What Are the Most Effective Treatments?

• Treatments That Focus on Behavior and Cognition
  Are Superior for Anxiety Disorders
• Many Effective Treatments Are Available for
  Depression
• Lithium Is Most Effective for Bipolar Disorder
• Pharmacological Treatments Are Superior for
  Schizophrenia

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Treatments That Focus on Behavior and Cognition
Are Superior for Anxiety Disorders

• For specific phobias, the sources of anxiety are
  better addressed with cognitive-behavioral
  approaches than with medication
• Systematic Desensitization uses fear
  hierarchies (see fig 14.7) to help people learn
  to manage dimensions of fear
• Virtual treatments can reduce fear responses

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Fig. 14.7
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Treatments That Focus on Behavior and Cognition
Are Superior for Anxiety Disorders

• SSRIs help social phobia, but cognitive and
  behavioral methods are treatments of choice
• Panic Disorder treatments often combine
  medication and CBT, but relapse is less with CBT

20
Treatments That Focus on Behavior and Cognition
Are Superior for Anxiety Disorders

• OCD treatments blend medication and CBT with a
  focus on exposure and response prevention
  (see fig 14.10)

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Fig. 14.10
22
Many Effective Treatments Are Available for
Depression

• MAO-inhibitors, tricyclics, and SSRIs provide
  relief to 60-70 of depressed persons
• Cognitive-Behavioral Treatments are just as
  effective, and target the automatic irrational
  thoughts that accompany depression (see fig
  14.11)

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Fig. 14.11
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Many Effective Treatments Are Available for
Depression

• Seasonal Affective Disorder (see fig 14.12)
  responds to phototherapy
• Exercise helps depression too
• Electroconvulsive therapy (ECT) is the single
  most effective treatment for severe depression,
  and it saves lives, negative public views
  notwithstanding
• Transcranial magnetic stimulation (TMS)

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Fig. 14.12
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Lithium Is Most Effective for Bipolar Disorder

• Only 20 of bipolar patients who maintain their
  medications experience relapse
• Lithium stabilizes mood, but the mechanisms are
  unclear, and the effect is greater on mania than
  depression
• But many patients discontinue medication, perhaps
  because of the intoxicating pleasure of manic
  states

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Pharmacological Treatments Are Superior for
Schizophrenia

• Haloperidol and Chlorpromazine revolutionized the
  treatment of schizophrenia
• But significant sedative and motor side effects,
  resembling Parkinsons disease, make treatment
  unpleasant for many patients
• Tardive dyskinesia
• Clozapine (see fig 14.15)

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Fig. 14.15
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Pharmacological Treatments Are Superior for
Schizophrenia

• Despite the superiority of pharmacology,
  psychosocial treatments improve functioning
  beyond drug treatments (see fig 14.16)

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Fig. 14.16
31
Can Personality Disorders Be Treated?

• Dialectical Behavior Therapy Is Most Successful
  for Borderline Personality Disorder
• Antisocial Personality Disorder Is Difficult to
  Treat (see figure 14.19)

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Fig. 14.19
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How Should Childhood Disorders Be Treated?

• Children with ADHD Can Benefit from a Variety of
  Approaches
• Autistic Children Benefit from a Structured
  Treatment Approach

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Children with ADHD Can Benefit from a Variety of
Approaches

• Methylphenidate (ritalin) targets under active
  brains and reduces negative behaviors (see fig
  14.20)
• Side effects and lack of long-term efficacy limit
  the utility of ritalin
• Behavioral Treatments, though time-consuming,
  augment medication and help social skills,
  academics, and family relationships

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Fig. 14.20
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Autistic Children Benefit from a Structured
Treatment Approach

• Generalization of skills must be taught
  explicitly
• Applied Behavior Analysis (ABA) is time intensive
  but raises IQ points by 20 on average
• The long-term prognosis for autism is poor