3.3. Treatment of Mental Disorders – An Overview

Section Learning Objectives

 Clarify reasons why an individual may need to seek treatment.

 Describe the treatments proposed by the different perspectives of abnormality.

3.3.1. Seeking Treatment

        3.3.1.1. Who seeks treatment? 

Anyone can seek treatment. David Sack, M.D. (2013) writes in an article
entitled, 5 Signs Its Time to Seek Therapy, published in Psychology Today, that
“most people can benefit from therapy at least some point in their lives” and that
though the signs you need to seek help are obvious at times, we often try “to sustain
your busy life until it sets in that life has become unmanageable.” So when should we
seek help? First, if we feel sad, angry, or not like ourselves. We might be withdrawing
from friends and families or sleeping more or less than we usually do. Second, if we
are abusing drugs, alcohol, food, or sex to deal with life’s problems. In this case, our
coping skills may need some work. Third, in instances when we have lost a loved one
or something else important to us, whether due to a death or divorce, the grief may
be too much to process. Fourth, a traumatic event may have occurred such as abuse,
a crime, an accident, chronic illness, or rape. Finally, if you have stopped doing the
things you enjoy the most. Sack (2013) says, “If you decide that therapy is worth a
try, it doesn’t mean you’re in for a lifetime of “head shrinking.” In fact, a 2001 study
in the Journal of Counseling Psychology found that most people feel better within
seven to 10 visits. In another study, published in 2006 in the Journal of Consulting
and Clinical Psychology, 88 percent of therapy-goers reported improvements after
just one session.”

 3.3.2. Treatments

        3.3.2.1 Psychopharmacology and psychotropic drugs. One option to

treat severe mental illness is psychotropic medications. These medications fall under
five major categories:

 The antidepressants are used to treat depression, but also anxiety, insomnia,

or pain.
 Anti-anxiety medications help with the symptoms of anxiety.
  Stimulants increase one’s alertness and attention and are frequently used to
treat ADHD.
 Antipsychotics are used to treat psychosis or, “conditions that affect the mind,
and in which there has been some loss of contact with reality, often including
delusions (false, fixed beliefs) or hallucinations (hearing or seeing things that
are not really there).” They can be used to treat eating disorders, severe
depression, Post Traumatic Stress Disorder, OCD, ADHD, and Generalized
Anxiety Disorder.
 Mood stabilizers are used to treat bipolar disorder and at times depression,
schizoaffective disorder, and disorders of impulse control.

        3.3.2.2. Electroconvulsive therapy. “Electroconvulsive therapy (ECT) is a

procedure in which a brief application of electric stimulus is used to produce a
generalized seizure.” Patients are placed on a padded bed and administered a muscle
relaxant to avoid injury during the seizures. ECT is used for conditions to include
severe depression, acute mania, suicidality, and some forms of schizophrenia.

        3.3.2.3. Psychosurgery. Another option to treat mental disorders is to

perform brain surgeries. Today’s techniques are much more sophisticated and have
been used to treat schizophrenia, depression, and some personality and anxiety
disorders.

        3.3.2.4. Psychodynamic techniques. Freud used three primary assessment

techniques as part of psychoanalysis, or psychoanalytic therapy, to understand the
personalities of his patients and to expose repressed material, which included free
association, transference, and dream analysis.

 First, free association involves the patient describing whatever comes to

mind during the session. The patient continues but always reaches a point
when he/she cannot or will not proceed any further. The patient might change
the subject, stop talking, or lose his/her train of thought. Freud said this
was resistance and revealed where issues were.
 Second, transference is the process through which patients transfer to the
therapist attitudes he/she held during childhood. They may be positive and
include friendly, affectionate feelings, or negative, and include hostile and
angry feelings. The goal of therapy is to wean patients from their childlike
dependency on the therapist.
 Finally, Freud used dream analysis to understand a person’s inner most
wishes. The content of dreams include the person’s actual retelling of the
dreams, called manifest content, and the hidden or symbolic meaning,
called latent content. In terms of the latter, some symbols are linked to the
person specifically while others are common to all people.

3.3.2.5. Behavioral modification strategies. These strategies arise from

the different learning models postulated by Pavlov, Skinner, Bandura and other
learning theoriests. Behavior modification is the process of changing behavior. To
begin, an applied behavior analyst will identify a target behavior, or behavior to be
changed, define it, work with the client to develop goals, conduct a functional
assessment to understand what the undesirable behavior is, what causes it, and what
maintains it. Armed with this knowledge, a plan is developed and consists of
numerous strategies to act on one or all of these elements – antecedent, behavior,
and/or consequence.

 Modeling techniques are used to change behavior by having subjects observe

a model in a situation that usually causes them some anxiety.  By seeing the
model interact nicely with the fear evoking stimulus, their fear should subside.
This form of behavior therapy is widely used in clinical, business, and
classroom situations.
 In terms of operant conditioning, strategies include antecedent
manipulations, prompts, punishment procedures, differential
reinforcement, habit reversal, shaping, and programming.
 Flooding and desensitization are typical respondent conditioning
procedures used with phobias.

3.3.2.6. Cognitive therapies. Cognitive behavioral therapy focuses on

exploring relationships among a person’s thoughts, feelings and behaviors. During
CBT a therapist will actively work with a person to uncover unhealthy patterns of
thought and how they may be causing self-destructive behaviors and beliefs. CBT
attempts to identify negative or false beliefs and restructure them. Oftentimes
someone being treated with CBT will have homework in between sessions where they
practice replacing negative thoughts with more realistic thoughts based on prior
experiences or record their negative thoughts in a journal. Some commonly used
strategies include cognitive restructuring, cognitive coping skills training, and
acceptance techniques.

 First, you can use cognitive restructuring, also called rational

restructuring, in which maladaptive cognitions are replaced with more
adaptive ones. To do this, the client must be aware of the distressing thoughts,
when they occur, and their effect on them. Next, help the client stop thinking
these thoughts and replace them with more rational ones.
 A second major strategy is to use what is called cognitive coping skills
training. This strategy teaches social skills, communication, and
assertiveness through direct instruction, role playing, and modeling. For
social skills, identify appropriate social behavior such as making eye contact,
saying no to a request, or starting up a conversation with a stranger and
whether the client is inhibited from making this behavior due to anxiety. For
communication, determine if the problem is with speaking, listening, or
both and then develop a plan for use in various interpersonal situations.
Finally, assertiveness training aids the client protect their rights and
obtain what they want from others. Those who are not assertive are often
overly passive and never get what they want, or are overly aggressive and only
get what they want. Treatment starts with determining situations in which
assertiveness is lacking and coming up with a hierarchy of assertiveness
opportunities. Least difficult situations are handled first, followed by more
difficult situations, all while rehearsing and mastering all the situations
present in the hierarchy.
 Finally, acceptance techniques can be used to reduce a client’s worry and
anxiety. Life involves a degree of uncertainty and at times we need to just
 accept this. Techniques might include weighing the pros of fighting
uncertainty against the cons of doing so. The cons should outweigh the pros
and help you to end the struggle and accept what is unknown. Chances are you
are already accepting the unknown in some areas of life and identifying these
can help you to see why it is helpful in these areas, and how you can also think
like this in more difficult areas.

3.3.2.7. Humanistic perspective (Carl Rogers) states that the humanistic

therapist should be warm, understanding, supportive, respectful, and accepting of
his/her clients. This approach came to be called client-centered therapy.

3.3.2.8. Existential therapy is used to treat substance abuse, “excessive

anxiety, apathy, alienation, nihilism, avoidance, shame, addiction, despair,
depression, guilt, anger, rage, resentment, embitterment, purposelessness, psychosis,
and violence. They also focus on life-enhancing experiences like relationships, love,
caring, commitment, courage, creativity, power, will, presence, spirituality,
individuation, self-actualization, authenticity, acceptance, transcendence, and awe”

3.3.2.9. Culture-sensitive therapies have been developed and include

increasing the therapist’s awareness of cultural values, hardships, stressors, and/or
prejudices faced by their client; the identification of suppressed anger and pain; and
raising the client’s self-worth. These therapies have proven efficacy for the treatment
of depression and schizophrenia.