Unit 5.5: Treatment of Psychological Disorders

1. Biomedical Treatments

Physical interventions that directly affect the body and brain

• Psychopharmacology (medications)
• Electroconvulsive therapy (ECT)
• Brain stimulation techniques
• Based on medical model

2. Psychotherapy (Talk Therapy)

Psychological interventions through conversation and relationship with therapist

• Psychoanalytic/Psychodynamic
• Humanistic (Client-centered)
• Behavioral
• Cognitive
• Cognitive-Behavioral (CBT)

Antidepressants

Used to treat depression, anxiety disorders, OCD. Work by altering neurotransmitter levels.

Antianxiety Medications (Anxiolytics)

Used to reduce anxiety quickly. Two main types:

Antipsychotic Medications

Used primarily for schizophrenia and other psychotic disorders. Reduce psychotic symptoms.

Mood Stabilizers

Used primarily for bipolar disorder. Reduce manic episodes and stabilize mood swings.

• Lithium: Most common mood stabilizer; prevents manic episodes; requires blood monitoring
• Anticonvulsants: Depakote, Tegretol (also used as mood stabilizers)
• Often combined with antidepressants (but antidepressants alone can trigger mania)

How It Works:

• Patient under general anesthesia and muscle relaxant
• Electrodes placed on head
• Brief electrical pulse triggers controlled seizure
• Seizure lasts less than one minute
• Typically 6-12 treatments over several weeks
• Exact mechanism unknown but alters brain chemistry

Used For:

• Severe depression that hasn't responded to medication
• Suicidal patients who need immediate relief
• Catatonic schizophrenia
• Severe mania

Effectiveness and Side Effects:

• Very effective for severe depression (60-90% success rate)
• Works faster than medication (relief in days/weeks vs. weeks/months)
• Side effects: Memory loss (usually temporary), confusion, headaches
• Memory loss is main concern — especially for events around treatment period
• Modern ECT is safe and humane (not like historical depictions)

Transcranial Magnetic Stimulation (TMS)

• Uses magnetic fields to stimulate nerve cells in brain
• Non-invasive (no surgery, no anesthesia)
• Used for depression
• Fewer side effects than ECT but less effective for severe cases

Deep Brain Stimulation (DBS)

• Surgically implanted electrodes deliver electrical stimulation to specific brain areas
• Used for severe OCD, depression
• Also used for Parkinson's disease
• Invasive but can be effective for treatment-resistant cases

Key Techniques:

Modern Psychodynamic Therapy:

• Shorter-term than traditional psychoanalysis (months vs. years)
• Less emphasis on sexuality, more on relationships
• Focus on present relationships as well as past
• Face-to-face instead of couch

⭐ CRITICAL: Three Core Conditions

Rogers identified three essential therapist attitudes for effective therapy. Know these — frequently tested!

The Three Core Conditions:

Key Features:

• Non-directive: Client leads the therapy, chooses topics
• Active listening: Therapist reflects and clarifies feelings
• Focus on present: Here and now, not past
• Trust in client: Client has capacity to solve own problems
• Goal: Self-actualization, personal growth, congruence (alignment between real and ideal self)

Systematic Desensitization (Wolpe) — VERY IMPORTANT

Systematic desensitization treats phobias and anxiety by gradually exposing person to feared stimulus while in relaxed state. Based on counterconditioning — can't be anxious and relaxed simultaneously.

Result: Fear response weakened through repeated pairing of relaxation with feared stimulus. New association: relaxation instead of anxiety.

Exposure Therapy

Expose person to feared stimulus until anxiety naturally decreases through habituation.

• Flooding: Immediate, intense exposure to most feared stimulus (vs. gradual). Quick but more distressing.
• Virtual reality exposure: Use VR to simulate feared situations (useful for PTSD, phobias)

Used for: Phobias, PTSD, OCD

Aversion Therapy

Pairs unpleasant stimulus with undesired behavior to create negative association. Based on classical conditioning.

• Example: Medication that causes nausea when drinking alcohol (Antabuse)
• Limited effectiveness; behavior may return when aversive stimulus removed
• Ethical concerns

Token Economy

Uses operant conditioning (reinforcement) to increase desired behaviors. Give tokens (secondary reinforcers) for appropriate behaviors that can be exchanged for rewards (primary reinforcers).

• Used in institutional settings (psychiatric hospitals, schools, prisons)
• Example: Patient earns tokens for making bed, attending groups, socializing. Trade tokens for privileges, snacks, activities.
• Effective for increasing adaptive behaviors

Aaron Beck's Cognitive Therapy

Developed specifically for depression. Focuses on identifying and changing negative automatic thoughts and cognitive distortions.

Albert Ellis: Rational Emotive Behavior Therapy (REBT)

Identifies and disputes irrational beliefs that cause emotional disturbance.

Key Principles:

• Thoughts, feelings, and behaviors are interconnected
• Changing thoughts AND behaviors leads to change in emotions
• Present-focused and problem-oriented
• Structured, goal-directed, time-limited
• Collaborative relationship between therapist and client
• Homework assignments between sessions

Effectiveness:

• Most evidence-based therapy — extensive research support
• Effective for depression, anxiety disorders, PTSD, OCD, eating disorders
• Benefits often maintained long-term
• Can be delivered individually or in groups
• Can be combined with medication

Benefits:

• Cost-effective: Less expensive than individual therapy
• Social support: Connect with others facing similar issues
• Universality: Realize you're not alone
• Practice social skills: Safe environment to try new behaviors
• Learn from others: Observe how others cope
• Altruism: Helping others boosts self-esteem
• Examples: Support groups (AA, grief groups), therapy groups

Key Concepts:

• Family as system — change in one member affects all
• Identified patient may be symptom of family dysfunction
• Focus on communication patterns, boundaries, roles
• Improve family functioning, not just individual symptoms
• Helpful for relationship problems, parenting issues, family conflicts

Does Therapy Work?

• Yes! Meta-analyses show therapy is effective
• People in therapy improve more than 80% of those not in therapy
• Most improvement occurs in first few months
• Benefits often maintained long-term

Common Factors Across Therapies:

• Therapeutic alliance: Trust and rapport between therapist and client (most important)
• Hope and expectation: Belief that therapy will help
• New perspective: Different way of understanding problems
• Emotional release: Expressing feelings
• Specific technique matters less than relationship and common factors

Evidence-Based Treatments:

• CBT: Most research support; effective for many disorders
• Exposure therapy: Highly effective for phobias, PTSD, OCD
• Behavioral activation: Effective for depression
• Medication + therapy: Often more effective than either alone for many disorders