Amelioration of

Psychopathology

Approaches
Two general Approaches
1. Psychotherapies
Emotional Cognitive and Behaviorally
based
2. Somatic Therapies
Biologically based
Early treatments included Trephining,
blood-letting and purges

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Psychoanalysis
Goal: Help clients achieve insight, the
conscious awareness of the
psychodynamics that underlie problems
Techniques:
Free association
Dream interpretation

Psychoanalysis
Resistance
Defensive maneuvers by the client that hinder
the process of therapy

Transference
Positive transference: Client transfers feelings
of affection, dependency, love to the analyst
Negative transference: Expressions of anger,
hatred, or disappointment

Psychoanalysis
Brief Psychodynamic Therapy
Focuses on insight and interpretation, like
regular psychoanalysis
Conversation rather than free association
Focus on current life situation, rather than past
Clients seen once or twice a week

Humanistic Therapies
Focus primarily on the present and future,
rather than the past
Therapy directed at helping clients to discover
true identities and to achieve personal growth

Humanistic Therapies
Three important therapist attributes (Rogers,
1959)
Unconditional positive regard
Empathy
Genuineness

Humanistic Therapies
Rogers viewed this as a self-help approach
Therapists job is to attempt to clarify
clients thought by restating what he client
is trying to say about their feelings
And, to let the client know that he/she is
understood, unconditionally accepted and
esteemed so that the client can come to have
esteem for and accept him/herself

Humanistic Therapies
Five common Themes in Humanistic
Therapy
1. Emotional defusing
2. Interpersonal Learning
3. Insight
4. Therapy is step-by-step process
5. Therapy is a socially acceptable practice

Humanistic Therapies
1. Emotional defusing
Various intense and unrealistic fears to be
evoked in sessions
When this occurs in the presence of an
accepting and non-condemning therapist
the fear is weakened

Humanistic Therapies
Interpersonal Learning
Therapeutic relationship is an important
tool for self learning
Reveals to client how they generally react
to others and provides a vehicle to discover
and rehearse new ways of reacting to others

Humanistic Therapies
Insight
Various kinds of Insight
In Humanistic it is insight into present
feelings
Contrast to Psychoanalytic emotional
insight into past
Contrast to Behavioral insight into S-R
relationship invoking the fear response

Humanistic Therapies
Therapy as a step-by-step process
Gradual process no instant cure
Some flashes of insight
Primarily each new skill discovered must be
practiced in daily life before client can say
it is their own

Humanistic Therapies
Therapy as a socially acceptable practice
Psychotherapists designated role of
emotional healers
Provides a confiding relationship that is
confidential
Individuals who seek therapy do so with the
hope they will improve and have a better
life

Cognitive Therapies
Ellis Rational-Emotive
Therapy

Activating event
Belief
Consequences
Disputing

TheKeyConnection
Toadaptivefunctioning

Cognitive Therapies
Becks Cognitive Therapy
Point out errors of thinking and logic that
underline disturbance
In practice it is to allow client to come to
realize that it is their thoughts which create the
maladaptive emotional reaction and not the
events themselves
Tracing the line from event to thought to emotion
similar to Ellis but less confrontational

Behavioural Therapies
Systematic desensitization (Joesph Wolpe)
Train the client in voluntary muscle relaxation
Client constructs a stimulus hierarchy
Client practices relaxation while moving up the
hierarchy
Problem: transfer to real life situations from therapy
sessions is less successful than Wolpe claimed
Solution: requires some testing in real world situations

Behavioural Therapies
Aversion Therapy
Attach negative feelings to stimulus situations
that are initially attractive to patient
Therapist pairs a stimulus that is attractive to a
person with a noxious UCS (e.g., drinker takes
a sip of favorite alcohol while being on a nausea
producing drug)
Problem: How to create aversion in normal
situation
Solution: To have regularly scheduled reconditioning sessions so that aversion does not
extinguish

Behavioural Therapies
Punishment
In the view of most psychologists, punishment
is the least preferred way to control behaviour
To be effective punishment must be immediate
and severe (the former is not always possible)

Modeling and Social Skills Training

Clients learn new skills by observing and then
imitating models who perform a particular skill

Eclecticism
To an increasing extent, therapists are
combining orientations and therapeutic
techniques for particular clients

Therapy as Social Education

Most therapeutic techniques have the
goal of eliminating unwanted
behaviors.
However simple elimination is not
always sufficient need to replace
the unwanted behavior with positive
healthy behavior

Therapy as Social Education

Three techniques commonly employed are:
1.Graded task assignments progressive
steps in real life situations moving towards
the final desired behavior
2.Modeling therapist demonstrates a healthy
response to a problem situation
3.Role-playing exchange of roles by patient
and therapist in acting out of a problem
situation

Cultural Factors in Therapy

Barriers to treatment (Sue
& Sue, 1990)
Cultural norms
Access problems
Lack of skilled counselors
to provide culturally
responsible forms of
treatment
CAUT Bulletin (2005/03)
CMHA survey 34% believe
people will think less of
them if it is known they
suffer from depression
and/or anxiety. 49% with
symptoms have not sought
help

Culturally competent
therapists (Sue, 1998)
Able to use knowledge
of clients culture to
understand the client
Able to introduce
culture-specific
elements into therapy

Factors Affecting Therapy

Outcome
Openness and
willingness to invest in
therapy
Self-relatedness
Ability to understand
internal states and relate
to therapist

Nature of the problem

and its fit with therapy

Common factors
Faith in the therapist
Alternative and
plausible way of
looking at problems
Protective setting
Opportunity to practice
new behaviours
Increased optimism and
self-efficacy

Therapist-Client Relationship
The most important factor in therapy
outcome
Therapists who produce the best results:
Are empathic
Are genuine
Unconditionally accept clients

Evaluating Psychotherapy
Specificity question
Which types of
therapy, adminstered
by which kinds of
therapists, to which
kinds of clients,
produce which kinds of
effects?

Measurement of
outcomes
Emotions, thoughts, or
behaviours?
Who determines
outcomes?
Client
Therapist
Others

Evaluating Psychotherapy
Desirable standards for designing psychotherapy
research studies:
Randomized clinical trials
Placebo control groups
Standardization of treatment

A Study of Therapeutic Outcome

Paul (1966)
96 undergraduates severely anxious about
public speaking
Were randomly placed into 1 of 4 therapy
groups
Each experimental group received 5 therapy
sessions

A Study of Therapeutic Outcome

Therapy Groups
1. Insight Therapy
2. Desensitization Therapy
3. Placebo Contol
4. No-treatment group

A Study of Therapeutic Outcome

Insight Therapy
Subjects received 5 sessions during which
the therapist established unconditional
positive regard for the students and
attempted to help them understand their
fears and present feelings

A Study of Therapeutic Outcome

Desensitization Therapy
Subjects received 5 sessions in which they
worked through hierarchically arranged
speech-related anxiety situations

A Study of Therapeutic Outcome

Placebo Control
Subjects in this condition were also given 5
sessions
In each session they were given a simple
bicarbonate of soda capsule which they were led
to believe was a potent tranquilizer
They then performed a very boring discrimination
task which they were told was, under normal
conditions, very stressful
They were also told that after repeated sessions
they would be able to be free of anxiety

A Study of Therapeutic Outcome

No-treatment group
This group received no treatment and were
only measured at the outset of the study and
again after all other subjects had completed
their 5 sessions
Were measured for trembling hands,
quivering voices, sweating, pulse rate and
self-evaluation

A Study of Therapeutic Outcome

Results

Therapy Outcome for Serious

Conditions
Sloan, et.al., (1975)
Insight therapy most effective for younger, better
educated and wealthier patients
Behavior therapies appear to be helpful across
more diverse backgrounds
Refutation of symptom substitution argument as
when one area of a patients life improved they
noted improvements in other areas as well

Effectiveness of Psychotherapy
Freudian

Humanistic

Behavioral

Effectiveness of Psychotherapy
Approximately 60% of neurotic patients who
receive psychotherapy recover or show
improvement
About 40% of untreated neurotics improve
spontaneously
Some patients actually get worse after
psychotherapy May be caused by the
disturbance of an unstable neurotics equilibrium
without supplying an appropriate substitute

Somatic Approaches
Three major categories
1. Drug Therapies
2. ECT (Electro-convulsive therapy)
3. Psychosurgery

Drug Therapies
Originated when a drug (reserpine- an
alkoliod extracted from juices of rauwolfia
plant) was discovered in the early 1900s
that prevented paresis (the effect of
advanced syphilis on the central nervous
system which leads to general paralysis and
death).

Drug Therapies
Anti-anxiety drugs
E.g. Valium, Xanax, BuSpar
Psychological and physical dependence can
occur

http://www.libfind.unl.edu/tcweb/pharm/drugs/a
ntianxiety/antianxiety
.html

Drug Therapies
Antidepressant Drugs
Tricyclics most commonly used due to fewer
side effects.
MAO (Monoamine oxidase inhibitors)
SSRIs (Selective Serotonin Reuptake
Inhibitors)
http://www.apa.org/monitor/sep99/nl11.html

Drug Therapies
How do antidepressants work?
Tricyclics prevent the reuptake of excitatory
neurotransmitters into the presynaptic neurons
MAO inhibitors reduce the activity of MAO, an
enzyme that breaks down neurotransmitters in
the synapse
SSRIs increase the activity of serotonin in the
synapse by preventing its reuptake by the
presynaptic neuron

Anti-depressant Drugs
Actual amounts of these drugs must be
patient specific since biology differs from
patient to patient
Important to note these drugs are not simply
stimulants
They do not produce euphoria in normal
non-depressed individuals

Anti-depressant Drugs
Lithium
Lithium salts or carbonates are used to treat
bipolar manic-depressive persons
Most manic cases show improvement in 5
to 10 days
Reduces the frequency of depressive
episodes but does not entirely eliminate
them

Anti-depressant Drugs
Lithium, cont
It is believed that lithium limits the
availability of norepinephrine
This explains the counter action of mania,
but not depression

Anti-psychotic drugs
Class of Phenothiazines
These drugs are targeted at the receptors sensitive
to dopamine
Thus are primarily used in treatment of
schizophrenia
Chlorpromazine is the most commonly used
Introduced in the 1950s
Is not merely a sedative as it reduces symptoms of
schizophrenia (a specific effect)

Anti-psychotic drugs
Chlorpromazine cont
Reduces though disorders, withdrawal
behavior, and hallucinations
Not merely a depressant as this drug does
not calm down individuals with anxiety
disorders and not schizophrenia

Anti-psychotic drugs
Chlorpromazine cont
Major drawback Tardive Dyskinesia (loss of
control of voluntary muscles) shown to affect
approx 19% of young patients and over 30% of
those over 55 years of age.
New drug clozapine seems effective in reducing
schizophrenic behaviors while not creating
Tardive Dyskinesia
However requires constant blood monitoring as it
has caused fatal blood disorders in 2% of
individuals prescribed the drug

Evaluating A Drug
Three major considerations
A. Controlling for spontaneous
improvement
B. Controlling for Placebo effect
C. Controlling for Doctors expectations

Evaluating A Drug
A. Controlling for spontaneous
improvement
Use 2 groups of patients drawn from the
same psychopathological population
After six weeks of one group on drug and
one group not assess each group for
improvement Is there a difference?

Evaluating A Drug
B. Controlling for Placebo effects
Administer Placebo to control group
Administer drug to experimental group
After six weeks assess are there differences?
If difference in favour of E group then can be
attributed to drug
Problem Placebo effect can in some cases be as
great as drug so drug actually works but hidden by
placebo effect

Evaluating A Drug
C. Controlling for Doctors expectations
Use Double Blind procedure
ALL participants are unaware of who is
receiving drug and who is not (done
according to a code which is not made
available until end of test period)
Ensures reliability of the test

Limitations of Drug Therapy

Side-effects (e.g., Tardive Dyskinesia, chronic dry
mouth, blurred vision, heart irregularities,
shuffling gait, blank stare, blood disorders)
In schizophrenics failure to continue medication
results in rapid relapse
Life external to institution may be impossible as
they generally have not acquired the necessary life
skills and some symptoms may make it impossible
to hold employment

Electroconvulsive Therapy
(ECT)
Deliberate production of massive convulsive
seizures
Derived from belief that since epileptics rarely
experience schizophrenia the seizures counteract
the psychotic process
Originally seizures were produced by large doses
of Insulin Now electric current
ECT is also used in treating severe depression
response is quicker than drugs
Controlled studies indicate that 60-70% of people
given ECT improve (Rey & Waller, 1997)

ECT: Problems
Risk of contusions and fractures during
seizures (generally countered with muscle
relaxants)
Can cause permanent nervous tissue
damage
Can cause amnesia
Not clearly understood how procedure
works

Psychosurgery
Surgical procedures that remove or destroy brain
tissue to change disordered behaviour
Lobotomies nervous connections between
Thalmus and frontal lobes are severed
generally done by inserting a leucotome
through the eye socket and swishing it from
side to side
Cingulotomies more precise only a small
bundle of nervous tract near the corpus
callosum that connects frontal lobes with limbic
system is severed.

Psychosurgery
PROBLEMS
Often results in damage to higher
intellectual functioning such as foresight
Ability to pay attention is often impaired
Now rarely used except as a treatment of
last resort after psychotherapies and/or drug
treatments have proven useless.

Preventive Mental Health

Situation-focused
intervention
Directed at reducing
or eliminating
environmental causes
of behaviour disorders
and enhancing
situational factors
preventing disorders

Competency-focused
prevention
Designed to increase
personal resources and
coping skills