Sarah Grison • Todd Heatherton • Michael Gazzaniga Psychology in Your Life FIRST EDITION Chapter 14 Psychological Treatments © 2014 W. W. Norton & Company, Inc. Section 14.1 How Are Psychological Disorders Treated? 14.1 How Are Psychological Disorders Treated? Three main approaches are used to treat disorders: 1. Psychotherapy 2. Psychotropic medications 3. Alternative treatments Psychotherapy Is Based on Psychological Principles Psychotherapy Treatment for psychological disorders in which a therapist works with clients to help them understand their problems and work toward solutions Therapists generally use psychotherapy to change their clients’ patterns of thought or behavior See table 14.1 next slide Psychotherapy Is Based on Psychological Principles Psychodynamic therapy One of the first people to develop treatments for psychological disorders was Sigmund Freud Along with Josef Breuer, Freud pioneered the method of psychoanalysis Psychoanalytic treatment involved identifying unconscious conflicts in feelings and drives Freud’s techniques included free association and dream analysis Psychotherapy Is Based on Psychological Principles Psychodynamic therapy Psychodynamic therapy: Treatment for psychological disorders in which a therapist works with clients to help them become aware of how their unconscious processes may be causing conflict and impairing daily functioning There is only weak evidence, however, for its effectiveness in treating most psychological disorders Psychotherapy Is Based on Psychological Principles Humanistic therapy Humanistic therapy: Treatment for psychological disorders in which a therapist works with clients to help them develop their full potential for personal growth through greater selfunderstanding One of the best-known humanistic therapies is client-centered therapy A safe and comforting setting for clients Active listening Unconditional positive regard Psychotherapy Is Based on Psychological Principles Behavior and cognitive therapies Behavior therapy: Treatment for psychological disorders in which a therapist works with clients to help them unlearn behaviors that negatively affect their functioning Treatment often centers around the use of token economies, social skills training, and modeling Psychotherapy Is Based on Psychological Principles Behavior and cognitive therapies Cognitive therapy: Treatment for psychological disorders in which a therapist works with clients to help them change distorted thought patterns that produce maladaptive behaviors and emotions Aaron Beck has advocated cognitive restructuring Albert Ellis introduced rational-emotive therapy See figure 14.5 next slide Psychotherapy Is Based on Psychological Principles Behavior and cognitive therapies Cognitive-behavioral therapy (CBT): Treatment for psychological disorders in which a therapist incorporates techniques from cognitive therapy and behavior therapy to correct faulty thinking and maladaptive behaviors Psychotherapy Is Based on Psychological Principles Group therapy The most obvious benefit is cost Group therapies vary widely in the types of clients enrolled in the group, the duration of treatment, the theoretical perspective of the therapist running the group, and the group size Many groups are organized around a particular type of problem (e.g., sexual abuse) or a particular type of client (e.g., adolescents) Psychotherapy Is Based on Psychological Principles Family therapy According to a systems approach, an individual is part of a larger context Any change in individual behavior will affect the whole system. This effect is often easiest to see within families Biological Therapies Are Effective for Certain Disorders Biological therapy Treatment for psychological disorders that is based on medical approaches to illness and disease Biological Therapies Are Effective for Certain Disorders Psychotropic medications Psychotropic medications: Drugs that affect mental processes and that can be used to treat psychological disorders Biological Therapies Are Effective for Certain Disorders Psychotropic medications Most psychotropic medications fall into five categories: 1. Anti-anxiety drugs 2. Antidepressants 3. Mood stabilizers 4. Antipsychotics 5. Stimulants See table 14.2 next slide Biological Therapies Are Effective for Certain Disorders Alternative treatments for extreme cases Electroconvulsive therapy (ECT): Treatment for psychological disorders that involves administering a strong electrical current to the client’s brain to produce a seizure; ECT is effective in some cases of severe depression One Flew over the Cuckoo’s Nest See figure 14.7 next slide Biological Therapies Are Effective for Certain Disorders Alternative treatments for extreme cases Transcranial magnetic stimulation (TMS): Treatment for psychological disorders that uses a magnetic field to interrupt function in specific regions of the brain See figure 14.8 next slide Biological Therapies Are Effective for Certain Disorders Alternative treatments for extreme cases Deep brain stimulation (DBS): Treatment for psychological disorders that involves passing electricity through electrodes planted in the client’s brain to stimulate the brain at a certain frequency and intensity See figure 14.9 next slide Scientific Evidence Indicates Which Treatments Are Safe and Effective Some treatments widely believed to be effective not only lack scientific support, but are actually counterproductive It is important to recognize the difference between evidencebased psychotherapies and “fringe” therapies The only way to know whether a treatment is valid is to conduct empirical research Randomized clinical trials Scientific Evidence Indicates Which Treatments Are Safe and Effective Three features characterize evidence-based psychological treatments 1. Treatments vary according to the particular psychological disorder and the client’s specific symptoms 2. The techniques used in these treatments have been developed in the laboratory by psychologists, especially behavioral, cognitive, and social psychologists Scientific Evidence Indicates Which Treatments Are Safe and Effective Three features characterize evidence-based psychological treatments 3. No overall grand theory guides treatment. Instead, treatment is based on evidence of its effectiveness Various Providers Assist in Treatment for Psychological Disorders Nearly half of all Americans meet Diagnostic and Statistical Manual (DSM) criteria for a psychological disorder at some point in their lives. In any given year, 25 percent of the population meets these criteria Various Providers Assist in Treatment for Psychological Disorders Choosing the right treatment provider is extremely important for ensuring successful treatment The professional must have the appropriate training and experience for the specific psychological disorder or life problem, and the person seeking help must believe the therapist is trustworthy and caring Various Providers Assist in Treatment for Psychological Disorders Medication is normally prescribed only by psychiatrists, who hold an MD Efforts are under way to give more practitioners, such as clinical psychologists, the ability to prescribe medications The most important features to look for in a provider are empathy and experience in the methods known to be effective in treating specific psychological disorders See table 14.3 and next slide Section 14.2 What Are Effective Treatments for Common Disorders? 14.2 What Are Effective Treatments for Common Disorders? See table 14.4 next slide Anxiety and Obsessive-Compulsive Disorders Are Best Treated With Cognitive-Behavioral Therapy There is accumulated evidence that most adult anxiety disorders are best treated with a combination of cognitive and behavior therapies Anti-anxiety drugs are also beneficial in some cases because they have a sedative effect that makes people feel calmer The effects of CBT persist long after treatment; this remains the best treatment in general for anxiety disorders Anxiety and Obsessive-Compulsive Disorders Are Best Treated with Cognitive-Behavioral Therapy Specific phobia Learning theory suggests that specific phobias are acquired either by experiencing a trauma or by observing similar fear in others Behavior techniques are the treatment of choice, along with approaches to changing the client’s thoughts about the fearful stimulus Anxiety and Obsessive-Compulsive Disorders Are Best Treated with Cognitive-Behavioral Therapy Specific phobia Exposure: Therapy technique that involves repeatedly exposing a client to an anxiety-producing stimulus or situation, with the goal of reducing the client’s fear Systematic desensitization: Therapy technique that involves exposing a client to increasingly anxiety-producing stimuli or situations while coaching her to relax See figure 14.13 next slide Anxiety and Obsessive-Compulsive Disorders Are Best Treated With Cognitive-Behavioral Therapy Specific phobia A recent alternative is to expose clients to fearful situations without putting them in danger by using computers to simulate the environments and the feared objects See figure 14.14 next slide Anxiety and Obsessive-Compulsive Disorders Are Best Treated With Cognitive-Behavioral Therapy Specific phobia Psychotropic medication treatments for phobias often include anti-anxiety drugs that are calming CBTs are the treatments of choice for phobia Anxiety and Obsessive-Compulsive Disorders Are Best Treated With Cognitive-Behavioral Therapy Panic disorder Panic disorder has multiple components, and each symptom may require a different treatment Cognitive restructuring is a technique used in cognitive therapy to address ways of reacting to the symptoms of a panic attack In the treatment of panic attacks, CBT appears to be as effective as or more effective than medication Anxiety and Obsessive-Compulsive Disorders Are Best Treated With Cognitive-Behavioral Therapy Obsessive-compulsive disorder CBT is effective for OCD Exposure and response prevention: Therapy technique that teaches clients to relax as they are gradually exposed to increasingly fear-inducing stimuli or situations. The goal of treatment is to reduce fear See figures 14.15a, 14.15b next slide Anxiety and Obsessive-Compulsive Disorders Are Best Treated With Cognitive-Behavioral Therapy Obsessive-compulsive disorder Exposure and response prevention proved superior to the use of a specific tricyclic antidepressant, although both were better than placebos CBT may thus be more effective at treating OCD than medication, especially over the long term See figure 14.16 next slide Anxiety and Obsessive-Compulsive Disorders Are Best Treated With Cognitive-Behavioral Therapy Obsessive-compulsive disorder Deep brain stimulation (DBS) may be an effective treatment for those with OCD Many Effective Treatments Are Available for Depressive Disorders There is no “best” way to treat depression Psychotropic drug treatment Researchers have attempted to determine how particular types of people will respond to antidepressants Since SSRIs have the fewest serious side effects, they tend to be the first-line medication Many Effective Treatments Are Available for Depressive Disorders Psychotropic drug treatment The use of antidepressants is based on the belief that depression (like other psychological disorders) is caused by an imbalance in neurotransmitters or problems with neural receptors Many Effective Treatments Are Available for Depressive Disorders Psychotropic drug treatment Approximately 60 percent to 70 percent of clients who take antidepressants experience relief from their symptoms, as compared with about 30 percent who respond to placebos Many Effective Treatments Are Available for Depressive Disorders Cognitive-behavioral treatment Research has shown that cognitive-behavioral therapy (CBT) is just as effective as antidepressants at treating depression The CBT approach helps the client think more adaptively and eliminate the cognitive triad of negative thoughts CBT can be effective on its own, but combining it with antidepressant medication can be more effective than either approach alone Many Effective Treatments Are Available for Depressive Disorders Alternative treatments Phototherapy: Treatment for seasonal affective disorder (SAD) through which the client is exposed to high-intensity light each day An alternative treatment that alters the brain’s electrical function, such as electroconvulsive therapy (ECT), is very effective for those who are severely depressed and do not respond to conventional treatments Many Effective Treatments Are Available for Depressive Disorders Alternative treatments A series of studies have demonstrated that changing brain function by using transcranial magnetic stimulation (TMS) over the left frontal regions of the brain also reduces depression significantly Many Effective Treatments Are Available for Depressive Disorders Deep brain stimulation DBS might be valuable for treating severe depression when all other treatments have failed Several studies have been done using DBS for treatmentresistant depression, and each time at least half the clients benefited from the treatment Mood Stabilizers Are Most Effective for Bipolar Disorders Bipolar disorders are one of the few psychological disorders for which there is a clear optimal treatment The best practice is to use psychotropic medications, especially the mood stabilizer lithium The process by which lithium stabilizes mood is not well understood, but the drug seems to modulate neurotransmitter levels Mood Stabilizers Are Most Effective for Bipolar Disorders Bipolar disorders are one of the few psychological disorders for which there is a clear optimal treatment Lithium has unpleasant side effects, including thirst, hand tremors, excessive urination, and memory problems Drug Treatments Are Superior for Schizophrenia Psychotropic drug treatments Early antipsychotic drugs called conventional antipsychotics reduced the positive symptoms of schizophrenia, such as delusions, hallucinations, and disorganized speech and behavior. These medications have little to no effect on the negative symptoms Tardive dyskinesia— involuntary movement of body parts—is another devastating side effect of these medications and is irreversible once it appears Drug Treatments Are Superior for Schizophrenia Psychotropic drug treatments Atypical antipsychotics act on different neurotransmitters. They are beneficial in treating both the positive symptoms of schizophrenia and some of the negative symptoms Drug Treatments Are Superior for Schizophrenia Psychotropic drug treatments Atypical antipsychotics can have serious side effects including seizures, heart rate problems, and substantial weight gain. Some of these drugs can cause a fatal reduction in white blood cells See figure 14.21 next slide Drug Treatments Are Superior for Schizophrenia Behavior therapy Behavior therapy can include social skills training to elicit desired behavior, such as appropriate ways to act in specific social situations When a client’s self-care skills are poor, behavioral interventions can focus on areas such as grooming and bathing, managing medications, and financial planning Drug Treatments Are Superior for Schizophrenia Prognosis in schizophrenia Most clients diagnosed with schizophrenia experience multiple psychotic episodes over the course of the disorder Most clients with schizophrenia also experience a reduction in symptoms as they get older Drug Treatments Are Superior for Schizophrenia Prognosis in schizophrenia Prognosis: A prediction of the likely course of a psychological (or physical) disorder People with later onset tend to have a more favorable prognosis Women tend to have better prognoses than men In developing countries, schizophrenia often is less severe than in developed countries Section 14.3 Can Personality Disorders Be Treated? 14.3 Can Personality Disorders Be Treated? Most therapists agree that personality disorders are very difficult to treat See table 14.5 next slide Dialectical Behavior Therapy Is Most Successful for Borderline Personality Disorder Traditional psychotherapy approaches have been largely unsuccessful Dialectical behavior therapy (DBT): Form of therapy used to treat borderline personality disorder DBT combines elements of behavior, cognitive, and psychodynamic therapies with a mindfulness approach based on Eastern meditative practices See figure 14.23b next slide Antisocial Personality Disorder Is Extremely Difficult to Treat Treating those with antisocial personality disorder (APD) often seems impossible Individuals with APD apparently have diminished cortical arousal. For this reason, stimulants have been prescribed to normalize arousal levels Most psychotherapies seem of little use in treating APD Behavior therapy approaches have had some success when they use operant procedures See figures 14.24a, 14.24b next slide Antisocial Personality Disorder Is Extremely Difficult to Treat Treating those with antisocial personality disorder (APD) often seems impossible Individuals with APD typically improve after age 40 with or without treatment Criminal acts and imprisonment decrease among those with APD after age 40 See figure 14.25 next slide Section 14.4 How Can Disorders Be Treated in Children and Adolescents? 14.4 How Can Disorders Be Treated in Children and Adolescents? In the United States, an estimated 12 percent to 20 percent of children and adolescents experience psychological disorders See table 14.6 next slide Using Medication to Treat Depression in Adolescents Is Controversial Approximately 8 percent of 12- to 17-year-olds in the United States have reported experiencing a major depressive episode Untreated adolescent depression is associated with drug abuse, dropping out of school, and suicide Using Medication to Treat Depression in Adolescents Is Controversial Risk of antidepressants for adolescents Shortly after SSRIs were introduced as treatments for adolescent depression, some mental health researchers raised concerns that the drugs might cause some adolescents to become suicidal Many questions about SSRIs and young people remain to be answered TADS study See figure 14.27 next slide Using Medication to Treat Depression in Adolescents Is Controversial Further thoughts on treatment approaches According to some researchers, however, the relative success of psychotherapy for teenage depression makes it a better treatment choice It is relatively easy for pediatricians and family physicians to prescribe drugs See figure 14.28 next slide Children With ADHD Can Benefit From Various Approaches Is attention-deficit/hyperactivity disorder (ADHD) a psychological disorder that should be treated, or is it simply a troublesome behavior pattern that children eventually outgrow? Some individuals diagnosed with ADHD as children do grow out of it. Many more continue to experience the disorder throughout adolescence and adulthood Children With ADHD Can Benefit From Various Approaches Psychotropic medication treatment of ADHD The most common treatment for ADHD is a central nervous system stimulant, such as methylphenidate (Ritalin) The drug’s actions are not fully understood, but it may affect multiple neurotransmitters, particularly dopamine See figures 14.29a, 14.29b next slide Children With ADHD Can Benefit From Various Approaches Psychotropic medication treatment of ADHD Side effects include sleep problems, reduced appetite, body twitches, and temporary slowing of growth Some children on medication may see their problems as beyond their control Children With ADHD Can Benefit From Various Approaches Behavior therapy for ADHD Many therapists advocate combining behavioral approaches with medication Some suggest that medication should be used only if behavioral techniques do not reduce inappropriate behaviors Children With Autism Spectrum Disorder Benefit From Structured Behavior Therapy The core symptoms of autism spectrum disorder are impaired communication, restricted interests, and deficits in social interaction Changing these behaviors is difficult to do because effective reinforcers are hard to find The tendency to focus on specific details while ignoring others interferes with generalizing learned behavior to other stimuli and situations Children With Autism Spectrum Disorder Benefit From Structured Behavior Therapy Behavior therapy for autism Applied behavioral analysis: An intensive behavior therapy for autism, this treatment is based on operant conditioning There is evidence that this method can be used successfully to treat autism spectrum disorder This intensive approach requires a minimum of 40 hours of treatment per week Children With Autism Spectrum Disorder Benefit From Structured Behavior Therapy Behavior therapy for autism Lovaas’s applied behavioral analysis program has some drawbacks The most obvious is the time commitment. Parents of children with autism essentially become full-time teachers for years The financial and emotional drains on the family can be substantial Children With Autism Spectrum Disorder Benefit From Structured Behavior Therapy Biological treatments for autism spectrum disorder There is good evidence that autism spectrum disorder is caused by brain dysfunction The neurobiology of autism spectrum disorder is not well understood Children With Autism Spectrum Disorder Benefit From Structured Behavior Therapy Prognosis Despite a few reports of remarkable recovery from autism spectrum disorder, the long-term prognosis is poor Early diagnosis clearly allows for more effective treatments Early language ability is associated with better outcomes Higher IQ is also associated with better outcomes Children With Autism Spectrum Disorder Benefit From Structured Behavior Therapy Case study of childhood autism spectrum disorder John O’Neil, a deputy editor at the New York Times O’Neil’s son James had been an easy baby James’s behavior really started to deteriorate when he was 2½ He started school with the assistance of one of his full-time instructors, who attended class with him Children With Autism Spectrum Disorder Benefit From Structured Behavior Therapy Case study of childhood autism spectrum disorder This success story and others like it show that psychological research can help us discover effective treatments for many psychological disorders
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