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Treatment of Mental Illness

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Title: Treatment of Mental Illness


1
Treatment of Mental Illness
2
True or False??
  1. Regardless of their theoretical orientation,
    therapists agree that self-awareness is the key
    to overcoming psychological problems.
  2. Most people who suffer from psychological
    problems become worse without therapy
  3. The training and experience of the therapist is a
    crucial factor in determining therapeutic success
  4. The use of drugs has enabled thousands of
    schizophrenia patients who had been hospitalized
    to return to near-normal lives

3
Therapy
  • Class exercise
  • How would you treat a depressed friend?

4
Therapy
  • Psychological therapy
  • Structured interaction between therapist and
    client with problem
  • Delivered by
  • Clinical Psychologists
  • Psychiatrists
  • Social workers
  • Counselors

5
Psychoanalysis
  • Psychological problems fueled by unconscious,
    repressed impulses and conflicts
  • Psychoanalyst brings conflicts into consciousness
    and offers interpretations -- self-awareness
    brings cure

Sigmund Freud 1856 - 1939
6
Psychoanalysis
  • Key terms
  • Free association
  • Resistance
  • Dream interpretation
  • Transference

7
Freuds Legacy
  • Positive
  • Promoted tolerance/ destigmatization of mental
    illness
  • "Freud's technique of listening to distressed
    people over long periods rather than giving them
    orders or advice has formed the foundation of
    most modern forms of psychotherapy, with benefits
    to both patients and practitioners" Anthony
    Storr

8
Freuds Legacy
  • Negative
  • Psychoanalysis was fundamentally untestable
    (pseudo-scientific)
  • Concept of repressed memories has been
    criticized

9
Freuds Legacy
  • Psychoanalysis descendents
  • Psychodynamic therapy
  • Interpersonal therapy

10
Humanistic Therapy
  • Carl Rogers client-centered therapy
  • Assumptions
  • Mental illness derives from attempting to earn
    others positive regard
  • Self-awareness and self-acceptance will lead to
    cure

Carl Rogers 1902 - 1987
11
Client-centered Therapy
  • Experience is, for me, the highest authority.
    The touchstone of validity is my own experience.
    No other person's ideas, and none of my own
    ideas, are as authoritative as my experience. It
    is to experience that I must return again and
    again, to discover a closer approximation to
    truth as it is in the process of becoming in me.
    Neither the Bible nor the prophets -- neither
    Freud nor research --neither the revelations of
    God nor man -- can take precedence over my own
    direct experience. My experience is not
    authoritative because it is infallible. It is the
    basis of authority because it can always be
    checked in new primary ways. In this way its
    frequent error or fallibility is always open to
    correction. - On Becoming a Person, Carl Rogers

12
Client-centered Therapy
  • Methods
  • Nondirective approach
  • Active listening
  • Provide unconditional positive regard
  • Carl Rogers video clip

13
Rogers Legacy
  • Minuses
  • Client-centered therapy has been criticized as
    being subjective, unscientific, and
    pseudo-religious
  • Directive therapies found to be more effective
    for many problems
  • Pluses
  • Many of Rogers insights on therapeutic
    relationship (eg, active listening) still
    retained
  • Rogers one of the first to systematically analyze
    therapy outcome

14
Behavior Therapy
  • Learning principles applied to the treatment of
    mental illness

Joseph Wolpe 1915-1997
15
(No Transcript)
16
Behavior Therapy
  • Systematic desensitization

17
Behavior Therapy
  • National Geographic Channel exposure treatment of
    claustrophobic
  • Exposure and Response Prevention (ERP) treatment
    of Compulsive Washer

18
Behavior Therapy
  • Aversive Conditioning

Aversion therapy for alcoholics
19
Behavior Therapy
  • Token economy
  • Based on principles of
  • operant conditioning

20
Behavior Therapy
  • Criticisms
  • Approach only treats symptoms, leaving the
    underlying causes untouched.
  • But"symptom substitution" rarely occurs.
  • Ignores beliefs/interpretations which may be
    important maintaining factors
  • Strengths
  • Exposure-based treatment very effective with
    anxiety disorders
  • Relatively easy to administer

21
Cognitive Therapy
  • Cognitive Therapy
  • Based on the assumption that thoughts intervene
    between events and our emotional reactions
  • Present-focused

Aaron Beck 1921 -
22
Cognitive Therapy
A cognitive perspective on depression
Relationship breakup
Depression
23
Cognitive Therapy
A cognitive perspective on anxiety
Spider
Anxiety
Spider
24
Cognitive Therapy
  • Methods
  • Identify negative/maladaptive beliefs
  • Socratic questioning to challenge maladaptive
    thoughts
  • I have to be perfect
  • What does it mean if you are not perfect? Is
    perfection possible?
  • Behavioral exposures/experiments

25
Cognitive Therapy
  • Strong research support for CT for many disorders
  • However
  • Clients must have certain level of insight,
    intelligence
  • Cognitive techniques can be difficult to implement

26
Therapy
  • Class demonstration

27
Who Does Therapy?
  • Where do people turn for help?

28
Does Therapy Work?
  • Based on the results of 475 studies (Smith et
    al., 1980), the average psychotherapy client
    shows more improvement than 80 of those in the
    no-treatment control group.

29
Consumer Reports 22,000
  • Rate laundry detergents Breakfast cereals home
    appliances, automobiles
  • AND
  • If at any time over the past 3 years, you
    experienced stress of other emotional problems
    for which you sought help
  • How much did it help?
  • Were you satisfied?

30
What percentage of patients?
  • 2,900 (40) sought help from psychologist,
    psychiatrist, social worker, or marriage counselor
  • Indicated treatment made things
  • A lot worse
  • Somewhat worse
  • No different
  • Somewhat better
  • A lot better
  • Indicated they were
  • Not satisfied at all
  • Fairly satisfied
  • Highly satisfied

31
Most people
  • Indicated treatment made things
  • Somewhat better
  • A lot better
  • Indicated they were
  • Fairly satisfied
  • Highly satisfied

86
89
32
Does Therapy Work?
  • Consumer Reports survey
  • Almost half who reported very poor emotional
    health were now feeling good
  • Psychotherapy alone did not differ from
    medication plus psychotherapy
  • No specific form of psychotherapy did better than
    any other for any disorder
  • No differences in effectiveness between
    psychologists, psychiatrists, and social workers
  • All did better than marriage counselors

33
Biomedical Therapies
  • Mental illness caused by underlying biological
    disorder or disease

Schizophrenic brain
34
Biomedical Therapies
  • Antidepressants
  • Used for depression, anxiety, panic
  • Prozac (fluoxetine) is a Serotonin-Selective
    Reuptake Inhibitor widely used effective for
    moderate depression

35
Biomedical Therapies
36
Biomedical Therapies
  • Lithium
  • chemical that provides an effective drug therapy
    for the mood swings of bipolar (manic-depressive)
    disorders
  • Anti-psychotics
  • Drugs before and after video file

37
Biomedical Therapies
  • Criticisms
  • Drugs don't cure they only provide symptom
    relief
  • Drug treatment often must be continued
    indefinitely to avoid relapse
  • Side effects
  • The drugs are not consistently effective a
    patient may need to try several before finding
    one that is effective.

38
Biomedical Therapies
  • Electroconvulsive Therapy (ECT)
  • therapy for severely depressed patients in which
    a brief electric current is sent through the
    brain of an anesthetized patient
  • ECT video clip

39
Discussion
  • First, pick a partner.
  • Now, pick a disorder

-Depression -Bipolar Disorder -Schizophrenia -Pani
c Disorder -Generalized Anxiety
Disorder -Obsessive Compulsive Disorder -Post-Trau
matic Stress Disorder -Dissociative Identity
Disorder -Personality Disorder -Specific
Phobia -Social Phobia
3. Write down your partners chosen disorder.
40
Discussion
  • Assignment
  • Imagine you are a psychologist, and your partner
    comes in to discuss his/her concerns.
  • WRITE AT LEAST ONE PAGE ANSWERING EACH OF THE
    FOLLOWING QUESTIONS
  • What type of symptoms would you expect to see?
  • What kinds of questions will be important for you
    to ask to determine a diagnosis (differential
    diagnosis)?
  • Based on your knowledge up to this point, Write
    out a treatment plan for this person. Discuss
    specifics (for example, how many sessions, social
    support, medication concerns, etc.). Also
    discuss what specific issues or concerns do you
    think could hinder your treatment plan.
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