UNIT 5.5 · MENTAL AND PHYSICAL HEALTH
Treatment of Psychological Disorders — AP Psychology Notes
Compare psychotherapy, medications and brain stimulation, with examples, evidence and treatment evaluation.
Overview of Treatment Approaches
Compare treatment targets
- Psychodynamic
Patterns, relationships and unconscious processes - Humanistic
Empathy, acceptance and personal meaning - Behavioral
Learning, exposure and reinforcement - Cognitive / CBT
Thought patterns, behavior and practice - Biomedical
Medication or specialized brain interventions
Two Main Categories
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)
Important Note:
Eclectic or integrative practice: Clinicians may draw on more than one approach while considering evidence, goals, culture, preferences and clinical needs. Combining techniques is not evidence that every technique works equally well.
Biomedical Treatments
Psychopharmacology (Medication)
Psychopharmacology is the study and use of drugs to treat psychological disorders. Medications target neurotransmitter systems.
Antidepressants
Used to treat depression, anxiety disorders, OCD. Work by altering neurotransmitter levels.
SSRIs — selective serotonin reuptake inhibitors: A commonly prescribed antidepressant class.
- Block reuptake of serotonin, increasing availability in synapse
- Examples: Prozac, Zoloft, Paxil
- Treat depression, anxiety, OCD
- Fewer side effects than older antidepressants
SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)
- Block reuptake of both serotonin and norepinephrine
- Examples: Effexor, Cymbalta
Older Types (Less Common Now)
- Tricyclics: Increase serotonin/norepinephrine but more side effects
- MAOIs (Monoamine Oxidase Inhibitors): Block enzyme that breaks down neurotransmitters; dangerous interactions
Antianxiety Medications (Anxiolytics)
Used to reduce anxiety quickly. Two main types:
Benzodiazepines — FAST-ACTING
- Enhance GABA (inhibitory neurotransmitter), reducing neural activity
- Examples: Xanax, Valium, Ativan
- Work quickly but can be addictive
- Risk of dependence and tolerance
- Used short-term
SSRIs
SSRIs may also treat several anxiety disorders and OCD. Benefits often take time. They are not considered addictive in the same way as benzodiazepines, but stopping abruptly can cause discontinuation symptoms; medication changes require prescriber guidance.
Antipsychotic Medications
Used primarily for schizophrenia and other psychotic disorders. Reduce psychotic symptoms.
Typical (Traditional) Antipsychotics
- Block dopamine receptors (reduce positive symptoms like hallucinations, delusions)
- Examples: Thorazine, Haldol
- Serious side effects including tardive dyskinesia (involuntary movements)
Atypical (Second-Generation) Antipsychotics
- Many act on dopamine and serotonin systems, but receptor actions differ and some are partial dopamine agonists.
- Examples: Clozapine, Risperdal, Zyprexa
- Can reduce psychotic symptoms; effects on persistent negative symptoms vary and are often limited.
- Fewer movement side effects but other risks (weight gain, diabetes)
Mood Stabilizers
Used primarily for bipolar disorder. Reduce manic episodes and stabilize mood swings.
- Lithium: An established mood stabilizer that can help prevent mood episodes; it requires appropriate blood-level and health monitoring.
- Anticonvulsants: Depakote, Tegretol (also used as mood stabilizers)
- Some treatment plans use additional medications. Antidepressant monotherapy can trigger mania or destabilize mood in susceptible people, so bipolar medication planning needs professional assessment.
Electroconvulsive Therapy (ECT)
ECT involves passing brief electrical current through the brain while patient is under anesthesia, inducing a brief seizure.
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
- Severe depression where a rapid response is clinically important; it is not an instantaneous or guaranteed intervention.
- Catatonic schizophrenia
- Severe mania
Effectiveness and Side Effects:
- ECT can be effective for severe depressive illness; response and remission rates depend on the population, outcome definition and treatment course. There is no universal “success rate.”
- Works faster than medication (relief in days/weeks vs. weeks/months)
- Possible adverse effects: Confusion, headache and memory problems. Some memory difficulties resolve, while some autobiographical memory gaps can persist; risk varies with the procedure and individual.
- Memory effects are an important concern; medical and cognitive monitoring both matter
- Modern ECT uses anesthesia, muscle relaxation, monitoring and consent procedures; potential benefits and adverse effects still require individual assessment.
Other Brain Stimulation Techniques
Transcranial Magnetic Stimulation (TMS)
- Uses magnetic fields to stimulate nerve cells in brain
- Non-invasive (no surgery, no anesthesia)
- Used for depression
- Different adverse-effect profile from ECT; effectiveness comparisons depend on the condition, protocol and outcome rather than a universal ranking.
Deep Brain Stimulation (DBS)
- Surgically implanted electrodes deliver electrical stimulation to specific brain areas
- DBS for psychiatric conditions is highly specialized. Depression applications remain investigational; selected severe OCD use is limited and depends on regulatory and clinical context.
- Also used for Parkinson's disease
- Invasive but can be effective for treatment-resistant cases
Psychotherapy Approaches
Additional techniques and ethical practice
DBT: Dialectical behavior therapy integrates acceptance and change, including mindfulness, emotion regulation, distress tolerance and interpersonal skills. It was developed for borderline personality disorder and requires a structured treatment context.
Biofeedback: Instrument feedback on physiological activity can help a person practise regulation. It is distinct from a therapist simply giving encouragement.
Hypnosis: It may be used for some pain or anxiety problems; it does not reliably recover accurate hidden memories or provide literal age regression.
Ethics and access: Consent, confidentiality and its limits, competence, cultural humility, respect and avoiding harm apply across approaches. Community-based care after deinstitutionalization needs adequate housing, support and follow-up; leaving a hospital alone is not a complete treatment plan.
Psychoanalytic/Psychodynamic Therapy (Freud)
Psychoanalysis aims to bring unconscious conflicts into conscious awareness. Based on Freud's theory that psychological problems stem from repressed childhood experiences and unconscious conflicts.
Key Techniques:
Free Association
Patient says whatever comes to mind without censoring. Reveals unconscious thoughts and feelings.
Dream Analysis
Interpreting dreams to uncover unconscious wishes and conflicts. Dreams are "royal road to unconscious."
Interpretation
Therapist suggests meanings of patient's thoughts, feelings, dreams, behaviors.
Resistance
Patient's unconscious blocking of painful material. Sign that therapy is approaching important issues.
Transference
Patient transfers feelings about important people (parents) onto therapist. Provides insight into relationships.
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
Humanistic Therapy: Client-Centered Therapy (Rogers)
Carl Rogers' client-centered (also called person-centered) therapy emphasizes personal growth and self-actualization. Assumes people have innate drive toward growth and that problems arise from conditions of worth.
Three Core Conditions
Rogers identified three essential therapist attitudes for effective therapy. Know these — frequently tested!
The Three Core Conditions:
1. Unconditional Positive Regard
Unconditional positive regard: Respect and acceptance of the person, with empathy and warmth. This does not require approving every behavior or removing boundaries.
2. Empathy (Empathic Understanding)
Understanding client's feelings from their perspective. Therapist reflects feelings back to client, showing deep understanding. "I sense that you feel..." Active listening and reflection.
3. Genuineness (Congruence)
Genuineness: The therapist is authentic and consistent while maintaining appropriate professional boundaries. It does not mean unrestricted self-disclosure or abandoning professional responsibilities.
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)
Behavioral Therapies
Behavioral therapy applies learning principles (classical and operant conditioning) to change maladaptive behaviors. Focus on observable behaviors, not thoughts or unconscious.
Systematic Desensitization (Wolpe) —
Systematic desensitization traditionally pairs a graded fear hierarchy with relaxation and exposure. Counterconditioning is its historical rationale; exposure also involves learning about safety and feared predictions, rather than a literal impossibility of feeling anxious while relaxed.
Three Steps:
Step 1: Relaxation Training
Teach client deep relaxation techniques (progressive muscle relaxation, deep breathing). Must master this before proceeding.
Step 2: Create Anxiety Hierarchy
List feared situations from least to most anxiety-provoking. For snake phobia: see photo of snake (least) → see snake in cage → touch snake → hold snake (most).
Step 3: Gradual Exposure
While deeply relaxed, gradually expose client to feared stimulus starting at bottom of hierarchy. Progress to next level only when client comfortable. Can use imagination (virtual) or real exposure (in vivo).
Result: Fear response weakened through repeated pairing of relaxation with feared stimulus. New association: relaxation instead of anxiety.
Exposure Therapy
Exposure therapy involves planned, supported contact with feared cues and learning that changes avoidance and feared expectations. Habituation may occur, but anxiety falling within every session is not a requirement for learning.
- Flooding: A high-intensity form of exposure. It is not automatically quicker or appropriate for everyone; consent, planning and individual suitability matter.
- 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
A token economy uses operant reinforcement: tokens function as learned, often generalized conditioned reinforcers and can be exchanged for valued activities, goods or privileges. Backup rewards are not all 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
Cognitive Therapies
Cognitive therapy focuses on changing distorted, irrational thoughts that lead to psychological problems. Based on idea that thoughts influence emotions and behaviors.
Aaron Beck's Cognitive Therapy
Developed specifically for depression. Focuses on identifying and changing negative automatic thoughts and cognitive distortions.
Cognitive Distortions (Thinking Errors):
- All-or-nothing thinking: See things in black-and-white categories
- Overgeneralization: One negative event means pattern of defeat
- Mental filter: Focus only on negatives, ignore positives
- Catastrophizing: Expect disaster, blow things out of proportion
- Personalization: Blame yourself for things not your fault
- Should statements: Rigid rules create guilt and frustration
Technique:
Identify negative automatic thoughts → examine evidence for/against → develop more balanced, realistic thoughts. Homework assignments to practice new thinking patterns.
Albert Ellis: Rational Emotive Behavior Therapy (REBT)
Identifies and disputes irrational beliefs that cause emotional disturbance.
ABC Model:
- A = Activating event (something happens)
- B = Beliefs about event (rational or irrational)
- C = Consequences (emotional and behavioral)
Key insight: Beliefs influence emotional and behavioral consequences. Events, bodily responses and social conditions also matter; the model does not imply thoughts alone cause every outcome.
Irrational Beliefs:
- "I must be perfect"
- "Everyone must like me"
- "Things should always go my way"
Technique: Actively dispute and challenge irrational beliefs, replace with rational ones. More directive/confrontational than Beck.
Cognitive-Behavioral Therapy (CBT)
CBT integrates cognitive therapy (changing thoughts) with behavioral techniques (changing behaviors). Most widely used and researched therapy approach today.
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:
- Many CBT protocols have substantial research support for particular conditions. There is no single “most evidence-based” therapy for all people and disorders.
- 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
Group and Family Therapy
Group Therapy
One therapist works with multiple clients (typically 6-10) simultaneously. Can use various theoretical approaches.
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
- Distinguish formats: Professionally led group psychotherapy is different from peer-led mutual-help groups, although both can offer support.
Family Therapy
Treats family as a system. Problems exist not just in individuals but in family dynamics and communication patterns.
Key Concepts:
- Family as system — change in one member affects all
- Family interaction patterns may affect coping and symptoms, without implying that a family caused a person’s disorder or should be blamed.
- Focus on communication patterns, boundaries, roles
- Improve family functioning, not just individual symptoms
- Helpful for relationship problems, parenting issues, family conflicts
Evaluating Treatment Effectiveness
Evaluate a study: Specify the outcome (symptom change, remission, functioning or relapse), comparison group, assignment method, follow-up, attrition and adverse effects. An average effect does not guarantee an individual result. Statistical significance, practical importance and causation are separate questions.
Key Findings
Does Therapy Work?
- Yes! Meta-analyses show therapy is effective
- Average psychotherapy outcomes in research are generally better than comparison conditions, but effect size, comparison group and disorder matter. A percentile comparison is not the percentage of clients cured.
- Most improvement occurs in first few months
- Benefits often maintained long-term
Common Factors Across Therapies:
- Therapeutic alliance: A collaborative relationship, shared goals and trust are important; neither alliance nor technique alone guarantees improvement.
- Hope and expectation: Belief that therapy will help
- New perspective: Different way of understanding problems
- Emotional release: Expressing feelings
- Both common factors and condition-specific techniques can matter. Research on their relative contributions does not justify treating all methods as interchangeable.
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
AP Exam Strategy
Multiple Choice Tips
- Know medication types: SSRIs (depression/anxiety), benzodiazepines (anxiety), antipsychotics (schizophrenia, block dopamine), lithium (bipolar)
- Understand ECT: For severe depression; electrical current causes seizure; memory loss side effect
- Master systematic desensitization: Three steps (relaxation, hierarchy, gradual exposure)
- Know Rogers' three conditions: Unconditional positive regard, empathy, genuineness
- Distinguish cognitive therapies: Beck (identify cognitive distortions) vs. Ellis (dispute irrational beliefs - REBT)
- Understand CBT: structured cognitive and behavioral approaches have evidence for specific conditions; match the protocol and outcome to the evidence.
- Match treatments to disorders: Exposure therapy for phobias, SSRIs for depression, antipsychotics for schizophrenia
Free Response Question (FRQ) Tips
- Describe systematic desensitization fully: All three steps with specific example for phobia given
- Apply Rogers' conditions: Show how therapist would use unconditional positive regard, empathy, genuineness
- Explain treatment mechanisms: Not just "CBT works" — explain how changing thoughts changes emotions/behaviors
- Match treatment to disorder: Justify why specific treatment appropriate for given disorder
- Compare approaches: Psychoanalytic (unconscious) vs. behavioral (learning) vs. cognitive (thoughts)
- Use proper terminology: "Unconditional positive regard" not "acceptance," "systematic desensitization" not "gradual exposure"
- Distinguish medication classes: Explain what neurotransmitters affected and why that helps disorder
Quick Review Summary
The Big Picture
Biomedical approaches include medications and selected brain-stimulation procedures; benefits and risks vary and require clinical monitoring. Psychodynamic, humanistic, behavioral, cognitive and CBT approaches use different techniques. DBT combines acceptance and change; exposure is planned learning rather than a requirement for immediate comfort. Token economies use learned reinforcement. Group psychotherapy differs from mutual help. Treatment evaluation considers condition-specific evidence, functioning, adverse effects and follow-up alongside alliance, preferences, culture and ethics. No method guarantees success for every person.
Essential Treatments to Know
- SSRIs
- Benzodiazepines
- Antipsychotics
- Lithium
- ECT
- Psychoanalysis
- Free association
- Dream analysis
- Client-centered therapy (Rogers)
- Unconditional positive regard
- Empathy
- Genuineness
- Systematic desensitization
- Exposure therapy
- Token economy
- Cognitive therapy (Beck)
- REBT (Ellis)
- CBT
- Group therapy
- Family therapy
Quick FAQs
Is there one best treatment for every disorder?
No. Evidence varies by condition, protocol and outcome, and treatment planning also considers preferences, context, risks and professional assessment.
Are support groups the same as group psychotherapy?
No. Group psychotherapy is professionally delivered treatment; peer-led mutual-help groups have a different role, although they can provide support.