Psychology in Your Life

Transcription

1 Sarah Grison Todd Heatherton Michael Gazzaniga Psychology in Your Life SECOND EDITION Chapter 15 Psychological Treatments W. W. Norton & Company, Inc.

2 15.1 How Are Psychological Disorders Treated? (1) During the latter half of the Middle Ages, people with psychological disorders were placed in overcrowded institutions called asylums People in asylums were often chained up and lived in incredibly filthy conditions The treatments they received included starvation, beatings, and isolation 2

3 15.1 How Are Psychological Disorders Treated? (3) In 1793, Philippe Pinel, a French physician, argued that treatments should be based on what actually works to reduce psychopathology Moral treatment involves close contact with, and careful observation of, patients 3

4 15.1 How Are Psychological Disorders Treated? (3) Over the last century, the scientific methods of psychology have shown that some treatments are more successful than others What works for one psychological disorder may not work for another disorder The main approaches are used to treat disorders are 1.Psychotherapy 2.Biological Therapy like using Psychotropic Medications, and/or Alternative treatments 4

5 Psychotherapy Is Based on Psychological Principles (1) Psychotherapy Treatment for psychological disorders in which a therapist works with clients to help them understand their problems and work toward solutions Therapists generally use psychotherapy to change their clients patterns of thought or behavior The most successful therapists tend to be better at forging a therapeutic relationship with their clients 5

6 Psychotherapy Is Based on Psychological Principles (3) Psychodynamic therapy One of the first people to develop treatments for psychological disorders was Sigmund Freud Along with Josef Breuer, Freud pioneered the method of psychoanalysis Psychoanalytic treatment involved identifying unconscious conflicts in feelings and drives Freud s techniques included free association and dream analysis 6

7 Psychotherapy Is Based on Psychological Principles (5) Psychodynamic therapy: Treatment for psychological disorders in which a therapist works with clients to help them become aware of how their unconscious processes may be causing conflict and impairing daily functioning There is only weak evidence, however, for its effectiveness in treating most psychological disorders 7

8 Psychotherapy Is Based on Psychological Principles (6) Humanistic therapy Treatment for psychological disorders in which a therapist works with clients to help them develop their full potential for personal growth through greater self-understanding One of the best-known humanistic therapies is client-centered therapy, which includes A safe and comforting setting for clients Active listening Unconditional positive regard Clarifying feelings 8

9 Psychotherapy Is Based on Psychological Principles (8) Behavior and cognitive therapies Behavior therapy: Treatment for psychological disorders in which a therapist works with clients to help them unlearn behaviors that negatively affect their functioning Treatment often centers around the use of token economies, social skills training, and modeling 9

10 Psychotherapy Is Based on Psychological Principles (9) Cognitive therapies Cognitive therapy: Treatment for psychological disorders in which a therapist works with clients to help them change distorted thought patterns that produce maladaptive behaviors and emotions Aaron Beck has advocated cognitive restructuring Albert Ellis introduced rational-emotive therapy Most effective with relatively mild disorders whose origins are based in inaccurate belief systems 10

11 Psychotherapy Is Based on Psychological Principles (10) 11

12 Psychotherapy Is Based on Psychological Principles (11) Behavior and cognitive therapies Cognitive-behavioral therapy (CBT): Treatment for psychological disorders in which a therapist incorporates techniques from cognitive therapy and behavior therapy to correct faulty thinking and maladaptive behaviors CBT is one of the most effective therapies for many types of psychological disorders, especially anxiety disorders and mood disorders It is usually ineffective with disorders like schizophrenia where the client has hallucinations and / or delusions 12

13 Psychotherapy Is Based on Psychological Principles (12) Group therapy The most obvious benefit is cost, but there is also additional social support in group settings. Group therapies vary widely in the types of clients enrolled in the group, the duration of treatment, the theoretical perspective of the therapist running the group, and the group size Many groups are organized around a particular type of problem (e.g., social anxiety) or a particular type of client (e.g., adolescents) 13

14 Psychotherapy Is Based on Psychological Principles (13) Family therapy According to a systems approach, an individual is part of a larger context Any change in individual behavior will affect the whole system This effect is often easiest to see within families 14

15 Biological Therapies Are Effective for Certain Disorders (1) Biological therapy Treatment for psychological disorders that is based on medical approaches to illness or disease Psychotropic medications Drugs that affect mental processes and that can be used to treat psychological disorders Psychotropic meds act by changing brain chemistry Most psychotropic medications fall into five categories: anti-anxiety, anti-depressants, mood stabilizers, anti-psychotics, and stimulants 15

16 Biological Therapies Are Effective for Certain Disorders (5) Alternative treatments for extreme cases Electroconvulsive therapy (ECT): Treatment for psychological disorders that involves administering a strong electrical current to the client s brain to produce a seizure; ECT is effective in some cases of severe depression The general public has a very negative view of ECT Film, One Flew over the Cuckoo s Nest 16

17 Biological Therapies Are Effective for Certain Disorders (7) Transcranial magnetic stimulation (TMS): Treatment for psychological disorders that uses a magnetic field to interrupt function in specific regions of the brain When rapidly switched on and off, this magnetic field creates an electrical current in the brain region directly below the coil, thereby interrupting the activity of neurons in that region 17

18 Biological Therapies Are Effective for Certain Disorders (8) 18

19 Biological Therapies Are Effective for Certain Disorders (9) Deep brain stimulation (DBS): Treatment for psychological disorders that involves passing electricity through electrodes planted in the client s brain to stimulate the brain at a certain frequency and intensity DBS may be especially valuable for treating severe obsessive-compulsive disorder (OCD) and depression 19

20 Scientific Evidence Indicates Which Treatments Are Safe and Effective (1) Some treatments widely believed to be effective not only lack scientific support, but are actually counterproductive It is important to recognize the difference between evidence-based psychotherapies and fringe therapies The only way to determine whether a treatment is valid is to conduct empirical research using randomized clinical trials 20

21 Scientific Evidence Indicates Which Treatments Are Safe and Effective (3) Three features characterize evidence-based psychological treatments 1. Treatments vary according to the particular psychological disorder and the client s specific symptoms 2. The techniques used in these treatments have been developed in the laboratory by psychologists, especially behavioral, cognitive, and social psychologists 3. No overall grand theory guides treatment. Instead, adoption of a specific treatment is based on the 21 evidence of its effectiveness

22 Various Providers Assist in Treatment for Psychological Disorders (1) Nearly half of all Americans meet Diagnostic and Statistical Manual (DSM) criteria for a psychological disorder at some point in their lives In any given year, 25 percent of the population meets these criteria 22

23 Various Providers Assist in Treatment for Psychological Disorders (2) Choosing the right treatment provider is extremely important for ensuring successful treatment The professional must have the appropriate training and experience for the specific psychological disorder or life problem, and the person seeking help must believe the therapist is trustworthy and caring 23

24 Various Providers Assist in Treatment for Psychological Disorders (3) Medication is normally prescribed only by psychiatrists, who hold an MD Efforts are under way to give more practitioners, such as clinical psychologists, the ability to prescribe medications The most important features to look for in a provider are empathy and experience in the methods known to be effective in treating specific psychological disorders 24

25 Anxiety and Obsessive-Compulsive Disorders Are Best Treated With Cognitive-Behavioral Therapy (1) There is accumulated evidence that most adult anxiety disorders are best treated with a combination of cognitive and behavior therapies Anti-anxiety drugs are also beneficial in some cases because they have a sedative effect that makes people feel calmer The effects of cognitive-behavioral therapy (CBT) persist long after treatment; this remains the best treatment in general for anxiety disorders 25

26 Anxiety and Obsessive-Compulsive Disorders Are Best Treated With Cognitive-Behavioral Therapy (2) Specific phobia Learning theory suggests that specific phobias are acquired either by experiencing a trauma or by observing similar fear in others Behavior techniques are the treatment of choice, along with approaches to changing the client s thoughts about the fearful stimulus 26

27 Anxiety and Obsessive-Compulsive Disorders Are Best Treated With Cognitive-Behavioral Therapy (3) Exposure: Therapy technique that involves repeatedly exposing clients to an anxietyproducing stimulus or situation, with the goal of reducing fear Systematic desensitization: Therapy technique that involves exposing clients to increasingly anxiety-producing stimuli or situations while coaching them to relax. The most important component still appears to be exposure to the feared stimulus. 27

28 Anxiety and Obsessive-Compulsive Disorders Are Best Treated With Cognitive-Behavioral Therapy (5) A recent alternative is to expose clients to fearful situations without putting them in danger by using computers to simulate the environments and the feared objects 28

29 Anxiety and Obsessive-Compulsive Disorders Are Best Treated With Cognitive-Behavioral Therapy (7) Psychotropic medication treatments for phobias often include anti-anxiety drugs that are calming CBTs are the treatments of choice for phobia Antidepressants may be useful for social phobia (social anxiety disorder) 29

30 Anxiety and Obsessive-Compulsive Disorders Are Best Treated With Cognitive-Behavioral Therapy (8) Panic disorder It has multiple components and each symptom may require a different treatment Cognitive restructuring is used in cognitive therapy to address reactions to the symptoms of a panic attack In the treatment of panic attacks, CBT appears to be as or more effective than medication Obsessive-compulsive disorder Exposure and response prevention: This teaches clients to relax as they are gradually exposed to increasingly fear-inducing stimuli The goal of treatment is to reduce fear 30

31 Anxiety and Obsessive-Compulsive Disorders Are Best Treated With Cognitive-Behavioral Therapy (11) Exposure and response prevention proved superior to the use of a specific tricyclic antidepressant, and both were better than placebos CBT may be more effective at treating OCD than medication, especially over the long term Deep brain stimulation (DBS) may be an effective treatment for people with OCD 31

32 Anxiety and Obsessive-Compulsive Disorders Are Best Treated With Cognitive-Behavioral Therapy (12) 32

33 Many Effective Treatments Are Available for Depressive Disorders (1) There is no best way to treat depression Psychotropic drug treatment Researchers have attempted to determine how particular types of people will respond to antidepressants Since selective serotonin reuptake inhibitors (SSRIs) have the fewest serious side effects, they tend to be used as the first-line medication 33

34 Many Effective Treatments Are Available for Depressive Disorders (2) The use of antidepressants is based on the belief that depression is caused by an imbalance in neurotransmitters or problems with neural receptors Approximately 60 to 70 percent of clients who take antidepressants experience relief from their symptoms, as compared with about 30 percent who respond to placebos The most effective antidepressants with the least severe side effects work by increasing the level of Serotonin (and sometimes other monoamines). 34

35 Many Effective Treatments Are Available for Depressive Disorders (3) Cognitive-behavioral treatment Research has shown that cognitive-behavioral therapy (CBT) is just as effective as antidepressants at treating depression The CBT approach helps the client think more adaptively and eliminate Beck s cognitive triad of negative thoughts about self, situation, and the future. CBT can be effective on its own, but combining it with antidepressant medication may be more effective than either approach alone 35

36 Many Effective Treatments Are Available for Depressive Disorders (4) Alternative treatments Phototherapy: Treatment for seasonal affective disorder (SAD) through which the client is exposed to high-intensity light each day Aerobic exercise on a regular basis helps many clients with mild to moderate depression. Treatment that alters the brain s electrical function, such as Electroconvulsive Therapy (ECT), may be very effective for some people who are severely depressed and do not respond to conventional treatments 36

37 Many Effective Treatments Are Available for Depressive Disorders (6) Studies have demonstrated that changing brain function by using transcranial magnetic stimulation (TMS) over the left frontal regions of the brain also reduces depression significantly DBS may be valuable for treating severe depression when all other treatments have failed Several studies have been done using DBS for treatment-resistant depression, and each time at least half the clients benefited from the treatment 37

38 Psychotropic Medications Are Most Effective for Bipolar Disorders (1) Bipolar disorders are one of the few psychological disorders for which there is a clear optimal treatment The best practice is to use psychotropic medications, especially the mood stabilizer lithium The process by which lithium stabilizes mood is not well understood, but the drug seems to modulate neurotransmitter levels Lithium has unpleasant side effects, including thirst, hand tremors, excessive urination, and memory problems 38

39 Psychotropic Medications Are Most Effective for Bipolar Disorders (2) The drug quetiapine (better known as Seroquel) is an antipsychotic and is now the most commonly prescribed drug for bipolar disorders, as combining lithium with quetiapine improves treatment outcomes As with all psychological disorders, compliance with drug therapy can be a problem for various reasons 39

40 Antipsychotic Medications Are Superior Treatments for Schizophrenia (1) Psychotropic drug treatments Early antipsychotic drugs called conventional antipsychotics reduced the positive symptoms of schizophrenia, such as delusions, hallucinations, and disorganized speech and behavior These medications have little to no effect on the negative symptoms Tardive dyskinesia involuntary movement of body parts is another devastating side effect of these medications and is irreversible once it appears 40

41 Antipsychotic Medications Are Superior Treatments for Schizophrenia (2) Atypical antipsychotics act on different neurotransmitters. They are beneficial in treating both the positive symptoms of schizophrenia and some of the negative symptoms Atypical antipsychotics can have serious side effects including seizures, heart rate problems, and substantial weight gain Some of these drugs can cause a fatal reduction in white blood cells 41

42 Antipsychotic Medications Are Superior Treatments for Schizophrenia (3) 42

43 Antipsychotic Medications Are Superior Treatments for Schizophrenia (4) Behavior therapy Can include social skills training to elicit desired behavior, such as appropriate ways to act in specific social situations If a client s self-care skills are poor, behavioral interventions can focus on areas such as grooming and bathing, managing medications, and financial planning 43

44 Antipsychotic Medications Are Superior Treatments for Schizophrenia (5) Prognosis (predicted long term outcomes) in schizophrenia Most clients diagnosed with schizophrenia experience multiple psychotic episodes over the course of the disorder Most clients with schizophrenia also experience a reduction in symptoms as they get older People with later onset tend to have a more favorable prognosis Women tend to have a better prognosis than men In developing countries, schizophrenia often is less severe than in developed countries 44

45 15.3 Can Personality Disorders Be Treated? (1) Most therapists agree that personality disorders are very difficult to treat Some therapies have proven to be helpful for two of the most disruptive personality disorders Borderline personality disorder Antisocial personality disorder 45

46 Dialectical Behavior Therapy Is Most Successful for Borderline Personality Disorder (1) Traditional psychotherapy approaches have been largely unsuccessful Dialectical behavior therapy (DBT): Form of therapy used to treat borderline personality disorder DBT combines elements of behavior, cognitive, and psychodynamic therapies with a mindfulness approach based on Eastern meditative practices 46

47 Antisocial Personality Disorder Is Extremely Difficult to Treat (1) Treating people with antisocial personality disorder (APD) often seems very difficult Individuals with have diminished cortical arousal, so stimulants may normalize arousal levels Most therapies seem ineffective because clients have trouble developing therapeutic relationships Behavior therapy approaches using operant procedures have had some success Individuals with APD typically improve after age 40 with or without treatment Criminal acts and imprisonment decrease too. 47

48 15.4 How Can Disorders Be Treated in Children and Adolescents? (1) In the United States, an estimated 12 to 20 percent of children and adolescents experience psychological disorders Problems not addressed during childhood or adolescence may persist into adulthood 48

49 Using Medication to Treat Depression in Adolescents Is Controversial (2) Approximately 8 percent of 12- to 17-yearolds in the United States have reported experiencing a major depressive episode Untreated adolescent depression is associated with drug abuse, dropping out of school, and suicide 49

50 Using Medication to Treat Depression in Adolescents Is Controversial (4) Risk of antidepressants for adolescents Shortly after SSRIs were introduced as treatments for adolescent depression, some mental health researchers raised concerns that the drugs might cause some adolescents to become suicidal Many questions about the effects of SSRIs on young people remain to be answered 50

51 Using Medication to Treat Depression in Adolescents Is Controversial (5) Treatment for Adolescents with Depression Study (TADS) Provided clear evidence that SSRIs are effective in treating adolescent depression Of participants taking an SSRI, 61 percent showed improvement in symptoms, compared with 43 percent receiving cognitive-behavioral therapy (CBT) and 35 percent taking a placebo The group that received both an SSRI antidepressant and therapy did best (71 percent improved) 51

52 Using Medication to Treat Depression in Adolescents Is Controversial (6) Further thoughts on treatment approaches It is relatively easy for pediatricians and family physicians to prescribe drugs In the TADS report, suicidal thoughts among adolescents increased, but overall suicide rates decreased when using SSRIs. Among adolescents, higher doses of SSRIs are more likely to trigger suicide attempts According to some researchers the relative success of psychotherapy for teenage depression makes it a better treatment choice 52

53 Children With ADHD Can Benefit From Various Approaches (1) Is attention-deficit/hyperactivity disorder (ADHD) a psychological disorder that should be treated, or is it simply a troublesome behavior pattern that children eventually outgrow? Some individuals diagnosed with ADHD as children do grow out of it, but many more continue to experience the disorder throughout adolescence and adulthood 53

54 Children With ADHD Can Benefit From Various Approaches (2) Psychotropic medication treatment of ADHD The most common treatment for ADHD is a CNS stimulant, such as Ritalin or Adderall The actions of these drugs are not fully understood, but they may affect multiple neurotransmitters, particularly dopamine Side effects include sleep problems, reduced appetite, body twitches, and temporary slowing of growth Some children on medication may see their problems as beyond their control Most therapists believe medication should be supplemented by psychological therapies, such as 54 behavior modification

55 Children With ADHD Can Benefit From Various Approaches (5) Behavior therapy for ADHD Many therapists advocate combining behavioral approaches with medication Some suggest that medication should be used only if behavioral techniques fail to reduce inappropriate behaviors 55

56 Children With Autism Spectrum Disorder Benefit From Structured Behavior Therapy (1) The core symptoms of autism spectrum disorder are impaired communication, restricted interests, and deficits in social interaction Changing these behaviors is difficult to do because effective reinforcers are hard to find The tendency to focus on specific details while ignoring others interferes with generalizing learned behavior to other stimuli and situations 56

57 Children With Autism Spectrum Disorder Benefit From Structured Behavior Therapy (2) Behavior therapy for autism Applied behavioral analysis: An intensive behavior therapy for autism, this treatment is based on operant conditioning There is evidence that this method can be used successfully to treat autism spectrum disorder This intensive approach requires a minimum of 40 hours of treatment per week 57

58 Children With Autism Spectrum Disorder Benefit From Structured Behavior Therapy (4) Lovaas s applied behavioral analysis program has some drawbacks The most obvious is the time commitment Parents of children with autism essentially become full-time teachers for years The financial and emotional drains on the family can be substantial Biological treatments for autism spectrum disorder There is good evidence that autism spectrum disorder is caused by brain dysfunction The neurobiology of autism spectrum disorder is not well understood 58

59 Children With Autism Spectrum Disorder Benefit From Structured Behavior Therapy (6) Prognosis Despite a few reports of remarkable recovery from autism spectrum disorder, the long-term prognosis is poor Early diagnosis clearly allows for more effective treatments Early language ability is associated with a better outcome Higher IQ is also associated with a better outcome 59

60 Children With Autism Spectrum Disorder Benefit From Structured Behavior Therapy (7) Case study of childhood autism spectrum disorder John O Neil, a deputy editor at the New York Times O Neil s son James had been an easy baby James s behavior started to deteriorate when he was a toddler and really started to deteriorate at age 2½ Treatment is expensive, difficult, and time consuming James started school with the assistance of one of his full-time instructors, who attended class with him With support, James was able to start talking, attend school, and make a friend This success story and many others show that psychological research can help us discover effective treatments for many psychological disorders 60