Treatment of Psychological Disorders

Psych 105
Stephen Paup
Approaches to Therapy
 Movement away from superstition-based treatments of mental illness
 Theoretical orientations begin to arise concerning the best methods to treat
psychological disorders
 Not everyone switched to these therapeutic methods right away
 Permanent institutionalization was still fairly common
What is Done During Therapy?
 Consider psychotherapy, or the treatment of mental disorders through
psychological rather than medical (or other) means
 What comes to mind when you picture “therapy”?
 Couches? Talking? Man with beard nodding slowly? Childhood?
 “How does that make you feel?”
 It looks different depending on the theoretical orientation
 While there are many orientations now, psychotherapy as a concept is still fairly
new
 Sigmund Freud (1856-1939) essentially kicked everything off
 Psychoanalysis, the study of the unconscious mind
Psychoanalysis (Turn of the Century)
 Stereotypically represented by the couch facing away
from the therapist
 Psychanalysis persists to this day (in many forms)
 Significantly fewer couches
 Disorders are symptoms of unconscious and repressed thoughts, feelings, and
motives
 Humans are motivated by aggression and sex
 Sometimes a large focus on dreams – meaning?
 Goal is to increase awareness of unconscious conflicts and work through them
Psychoanalysis Techniques
 Introduced the concept of talk therapy
 Often included free association  Say whatever comes to mind aloud
 Generally non-directive and long-term therapy
 Heavy emphasis on discussing the relationship between client and therapist
 Transference: Redirection of pre-existing feelings toward something new
 Often the therapist
 Exploring influence of childhood on current development
 Criticisms:
 Poor evidence base, highly subjective, long and expensive
Over Freud’s Dead Body: Psychodynamic
Therapy
 Freud had a lot of students
 Most of them didn’t entirely agree with Freud
 Psychodynamic theory is like updated psychoanalysis
 Personality and behaviors can often be traced to past unconscious conflicts and
experiences
 Little bit less of a “puppet show”
 Shorter time in therapy & more goal directed (still very long)
 Face-to-face dialogue, less meandering, more cooperative
 Actually has some empirical support

Welcome to the end

Divergence from the Freudian
 Impossible to completely divorce from Freud, because he started this whole
thing
 However, many heavily altered psychanalysis to something new
 Person-Centered Therapy
 Carl Rogers (1902-1987)
 Based on humanistic psychology—unconditional positive regard
 Nondirective  client leads course of therapy
 Therapeutic alliance, active listening, empathy key elements of treatment
 Roger’s own therapy involved almost no talking on his part that was not
direct repetition
Cognitive Behavioral Revolution
 Cognitive Therapy: Adjustment of beliefs and thought patterns
 Socratic questioning: Questioning complex topics to reveal logical understandings
 Negative thought patterns are challenged and adjusted
 Behavioral Therapy: application of basic behavioral processes to treatment
 Learning through classical and operant conditioning
 Smush  Cognitive Behavioral Therapy
 Mindfulness therapies: Acceptance of negative emotions and commitment to valued actions
 Heavily emphasizes living in the present moment
 Among the descendants from cognitive behavioral therapy
Psychopharmacology & Biomedical
 The use of medications and other medical interventions
 Includes psychotropic medication, electroconvulsive therapy, and various surgeries
 Psychotropic medications vary from antipsychotics, antidepressants, mood stabilizers,
anti-anxiety, etc.
 Maligned/misunderstood by some therapists and general public
 Critical to controlling psychotic states—generally untreatable with therapy
 Variety of drugs and effects, many developed originally for other uses
 Psychotropic medications commonly have significant side effects
 Weight gain, dependency, sexual dysfunction, motor disorders, suicidality, flat affect,
depression, organ damage, etc.
Psychopharmacology & Biomedical
 Not just medications!
 Electroconvulsive Therapy
 In the past: Dangerous shocks to brain multiple times a day while awake
 Modernity: low voltage, under anesthesia, lower frequencies
 Typically used for severe, treatment resistant mood symptoms
 Can result in temporary confusion and memory loss
 Neurosurgery
 Generally a last resort (ex, cases of uncontrollable seizures)
 Destruction of portions of the brain or connective tissues to alleviate symptoms
 Lobotomy, hemispherectomy, controlled lesioning, split-brain procedure
Research findings – does therapy work?

 Most research is conducted on specific disorders

 E.g. is CBT effective for treating panic disorder?
 For many disorders, therapy has been found to be as effective or more effective than
pharmacological treatments
 Therapy treatments tend to be longer-lasting than medications
 Consumer Reports Survey
 People who had undergone therapy reported their results
 Vast majority (87-90%) improved from feeling ”poor” to feeling “very good”, “good”, or at least
“so-so”
 On a 0-300 scale, therapy improved scores between 220-226 points
 Longer treatment was better, and greater choice of therapist and insurance of therapy led to better
outcomes
Medication and Therapy?
 Good idea, but often doesn’t always work well
 For many disorders, medication and therapy are equally effective
 Anxiety & depression especially
 For others, therapy is far superior to medication
 Panic disorder is the most well known example
 Therapy tends to last longer than medication, with fewer side effects
 Medication and therapy together may perform better together
 But some evidence suggests that medication adds little benefit to therapy
 Certain psychological treatments won’t work when clients are medicated
 Can’t face your fears if you can’t really fully feel fear
The Best Therapy?
 Short answer: Probably cognitive behavioral-related therapies (I’m biased)
 Long answer: They might all work at exactly the same level of effectiveness
 Provided the therapist believes what they’re selling
 “Dodo bird verdict” – all “bona fide” therapies appear to result in similar outcomes
 “All have won and all must have prizes”
 Effect sizes of therapies (how much treatment changes outcomes) are fairly uninform when
research is compared
 David Marcus (at WSU!) – treatments have similar effects for ”secondary outcomes,” but
CBT is best for primary outcomes
 Reducing symptoms vs. increasing quality of life