Presentation

1. Chapter 15: Psychological Treatments

2. Chapter 15 Overview: Big Questions
• How Are Psychological Disorders Treated?
• What Are the Most Effective Treatments?
• Can Personality Disorders Be Treated?
• How Can Disorders Be Treated in Children and
Adolescents?

3. Chapter 15 Overview: Study Units
• 15.1 Some Types of Psychotherapy Focus on Providing Insight
• 15.2 Behavioral and Cognitive Treatments Aim to Change Behavior, Emotion, and/or
Thought Directly
• 15.3 The Context of Therapy Matters
• 15.4 Biological Therapies Are Effective for Certain Disorders
• 15.5 Scientific Evidence Indicates Which Treatments Are Safe and Effective
• 15.6 Various Providers Assist in Treatments for Psychological Disorders
• 15.7 Anxiety and Obsessive-Compulsive Disorders Are Best Treated with Cognitive-
Behavioral Therapy
• 15.8 Many Effective Treatments Are Available for Depressive Disorders
• 15.9 Psychotropic Medications Are Most Effective for Bipolar Disorders
• 15.10 Atypical Antipsychotic Medications Are the Best Treatment for Schizophrenia
• 15.11 Dialectical Behavior Therapy Is the Best Treatment for Borderline Personality
Disorder
• 15.12 Antisocial Personality Disorder Is Extremely Difficult to Treat
• 15.13 Using Medication to Treat Depressive Disorders in Adolescents Is Controversial
• 15.14 Children with Autism Spectrum Disorder Benefit from Structured Behavior Therapy
• 15.15 Children with ADHD Can Benefit from Various Approaches

4. How Are Psychological Disorders Treated?
15.1 Some Types of Psychotherapy Focus on Providing Insight
15.2 Behavioral and Cognitive Treatments Aim to Change Behavior, Emotion, and/or Thought Directly
15.3 The Context of Therapy Matters
15.4 Biological Therapies Are Effective for Certain Disorders
15.5 Scientific Evidence Indicates Which Treatments Are Safe and Effective
15.6 Various Providers Assist in Treatment for Psychological Disorders

5. The Historical Treatment of Psychological Disorders
During the latter half of the Middle Ages, people
with psychological disorders were placed in
overcrowded institutions called asylums.
• People in asylums were often chained up
and lived in incredibly filthy conditions.
• The “treatments” they received
included starvation, beatings, and isolation.
• In 1793, Philippe Pinel, a French physician,
argued that treatments should be based on
what actually works to
reduce psychopathology.
o Moral treatment involves close contact
with, and careful observation of, patients.

6. 15.1 Some Types of Psychotherapy Focus on Providing Insight (1)
Psychotherapy
• Treatment for psychological disorders in which a
therapist works with clients to help them
understand their problems and work toward
solutions
o Therapists generally use psychotherapy to
change their clients’ patterns of thought or
behavior.

7. 15.1 Some Types of Psychotherapy Focus on Providing Insight (2)

8. 15.1 Some Types of Psychotherapy Focus on Providing Insight (3)
• Along with Josef Breuer, Sigmund Freud pioneered
the method of psychoanalysis.
o Psychoanalytic treatment involved
identifying unconscious conflicts in feelings and
drives.
o Freud’s techniques included free association
and dream analysis.
• Psychodynamic therapy: Treatment for psychological
disorders in which a therapist works with clients to help
them gain insight about how their unconscious
processes may be causing inner conflict and impairing
daily functioning.

9. 15.1 Some Types of Psychotherapy Focus on Providing Insight (4)
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 insight.
• One of the best-known
humanistic therapies is client-
centered therapy, which
includes
o A safe and comforting setting
for clients
o Active listening
o Unconditional positive regard

10. 15.2 Behavioral and Cognitive Treatments Aim to Change
Behavior, Emotion, and/or Thought Directly (1)
Behavior therapy
• Treatment for psychological
disorders in which a
therapist works with clients
to help them
unlearn behaviors that
negatively affect
their functioning.
o Treatment often centers
around the use of
token economies, social skills
training, and modeling.

11. 15.2 Behavioral and Cognitive Treatments Aim to Change
Behavior, Emotion, and/or Thought Directly (1)
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.
o Aaron Beck has advocated cognitive
restructuring.
o Albert Ellis introduced rational-emotive therapy.

12. 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.
o CBT is one of the most
effective therapies for many
types of psychological
disorders, especially anxiety
disorders and mood
disorders.
15.2 Behavioral and Cognitive Treatments Aim to Change
Behavior, Emotion, and/or Thought Directly (1)

13. 15.3 The Context of Therapy Matters (1)
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.
o Many groups are organized around a particular
type of problem (e.g., sexual abuse) or a
particular type of client (e.g., adolescents).

14. 15.3 The Context of Therapy Matters (2)
Family therapy
• According to a systems
approach, an individual is
part of a larger context.
o Any change in individual
behavior will affect
the whole system.
o This effect is often
easiest to see within
families.

15. 15.3 The Context of Therapy Matters (3)
Cultural beliefs affect treatment
• Different cultures have
different views on what
psychological disorders are
and how or whether they
should be treated.

16. 15.4 Biological Therapies Are Effective for Certain Disorders (1)
Biological therapy: Treatment for psychological
disorders that is based on medical approaches to
illness and to disease
Psychotropic medications
• Drugs that affect mental processes and that can be
used to treat psychological disorders
o Psychotropic medications act by changing
brain neurochemistry.

17. 15.4 Biological Therapies Are Effective for Certain Disorders (2)

18. 15.4 Biological Therapies Are Effective for Certain Disorders (3)
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.
• The general public has a very
negative view of ECT

19. 15.4 Biological Therapies Are Effective for Certain Disorders (4)
Transcranial magnetic
stimulation (TMS): Treatment for
psychological disorders that uses a
magnetic field to interrupt function
in specific regions of the brain.
• When rapidly switched on and
off, this magnetic field creates
an electrical current in the
brain region directly below the
coil, thereby interrupting the
activity of neurons in that
region.

20. 15.4 Biological Therapies Are Effective for Certain Disorders (5)
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.
• DBS may be especially valuable
for treating severe obsessive-
compulsive disorder (OCD)
and depression.

21. 15.5 Scientific Evidence Indicates Which Treatments Are Safe
and Effective (1)
Some treatments widely believed
to be effective not only lack
scientific support but are actually
counterproductive.
• It is important to recognize the
difference between evidence-
based psychotherapies and
“fringe” therapies.
o The only way to determine
whether a treatment is valid is
to conduct empirical research
using randomized clinical
trials.

22. 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.
3. No overall grand theory guides treatment. Instead,
adoption of a specific treatment is based on the
evidence of its effectiveness.
15.5 Scientific Evidence Indicates Which Treatments Are Safe
and Effective (2)

23. 15.6 Various Providers Assist in Treatment for Psychological
Disorders (1)
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.
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.

24. 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.
15.6 Various Providers Assist in Treatment for Psychological
Disorders (2)

25. 15.6 Various Providers Assist in Treatment for Psychological
Disorders (3)

26. What Are the Most Effective Treatments?
15.7 Anxiety and Obsessive-Compulsive Disorders Are Best Treated with Cognitive-
Behavioral Therapy
15.8 Many Effective Treatments Are Available for Depressive Disorders
15.9 Psychotropic Medications Are Most Effective for Bipolar Disorders
15.10 Atypical Antipsychotic Medications Are the Best Treatment for Schizophrenia

27. 15.7 Anxiety and Obsessive-Compulsive Disorders Are Best
Treated with Cognitive-Behavioral Therapy (1)
There is accumulated evidence that most adult anxiety
disorders are best treated with a combination of cognitive
and behavior therapies.
• Exposure: Therapy technique that involves repeatedly
exposing a client to an anxiety-producing stimulus or
situation and has the goal of reducing the client’s fear.
• Anti-anxiety drugs are also beneficial in some
cases because they have a sedative effect that
makes people feel calmer.
• The effects of cognitive-behavioral therapy
(CBT) persist long after treatment; this remains the
best treatment in general for anxiety disorders.

28. Specific phobias
• 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.
o Systematic desensitization: Therapy technique
that involves exposing a client to increasingly
anxiety-producing stimuli or situations while
having the client relax at the same time.
 Fear hierarchy
15.7 Anxiety and Obsessive-Compulsive Disorders Are Best
Treated with Cognitive-Behavioral Therapy (2)

29. 15.7 Anxiety and Obsessive-Compulsive Disorders Are Best
Treated with Cognitive-Behavioral Therapy (3)

30. 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.
• Psychotropic medication
treatments for phobias often
include anti-anxiety drugs
that are calming.
• CBTs are the treatments of
choice for phobia.
• Antidepressants may be useful
for social phobia (social anxiety
disorder).
15.7 Anxiety and Obsessive-Compulsive Disorders Are Best
Treated with Cognitive-Behavioral Therapy (4)

31. Panic disorder
• Panic disorder has multiple components and
each symptom may require a different treatment.
o Cognitive restructuring is a technique used
in cognitive therapy to address ways of reacting
to the symptoms of a panic attack.
o In the treatment of panic attacks, CBT appears
to be as or more effective than medication.
15.7 Anxiety and Obsessive-Compulsive Disorders Are Best
Treated with Cognitive-Behavioral Therapy (5)

32. Obsessive-compulsive disorder
• Exposure and response
prevention: Exposing a client
to a stimulus that causes
anxiety because it triggers
obsessive thoughts and then
preventing the client from
engaging in compulsive
behavior to reduce that
anxiety
o The goal of treatment is
to reduce fear.
15.7 Anxiety and Obsessive-Compulsive Disorders Are Best
Treated with Cognitive-Behavioral Therapy (6)

33. • Exposure and response
prevention proved superior to
the use of a specific
tricyclic antidepressant, and
both were better than placebos.
• CBT may be more effective at
treating OCD than medication,
especially over the long term.
• Deep brain stimulation (DBS)
may be an effective treatment
for people with OCD.
15.7 Anxiety and Obsessive-Compulsive Disorders Are Best
Treated with Cognitive-Behavioral Therapy (7)

34. 15.8 Many Effective Treatments Are Available for Depressive
Disorders (1)
There is no “best” way to treat
depression.

35. Psychotropic medications for depressive disorders
• Researchers have attempted to determine how particular types of
people will respond to antidepressants.
o Since selective serotonin reuptake inhibitors (SSRIs) have the
fewest serious side effects, they tend to be used as the first-line
medication.
• The use of antidepressants is based on the belief that depression is
caused by an imbalance in neurotransmitters or problems with
neural receptors.
o Approximately 60–70 percent of clients who
take antidepressants experience relief from their symptoms, as
compared with about 30 percent who respond to placebos.
15.8 Many Effective Treatments Are Available for Depressive
Disorders (2)

36. Cognitive-behavioral therapy
• Research has shown that cognitive-
behavioral therapy (CBT) is just as effective
as antidepressants at treating depression.
o The CBT approach helps the client think
more adaptively and eliminate the cognitive
triad of negative thoughts.
o CBT can be effective on its own, but combining
it with antidepressant medication may be
more effective than either approach alone.
15.8 Many Effective Treatments Are Available for Depressive
Disorders (3)

37. Alternative treatments
• Phototherapy: Treatment for seasonal affective disorder (SAD)
through which the client is exposed to high-intensity light each day.
• Treatment that alters the brain’s electrical function, such as
electroconvulsive therapy (ECT), may be very effective for some
people who are severely depressed and do not respond to
conventional treatments.
• A series of studies has demonstrated that changing brain function by
using transcranial magnetic stimulation (TMS) over the left frontal
regions of the brain also reduces depression significantly.
• Deep brain stimulation (DBS) may be valuable for treating
severe depression when all other treatments have failed.
o Several studies have been done using DBS for treatment-resistant
depression, and each time at least half the clients benefited from
the treatment.
15.8 Many Effective Treatments Are Available for Depressive
Disorders (4)

38. 15.9 Psychotropic Medications 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.
o The process by which lithium stabilizes mood is not well understood,
but the drug seems to modulate neurotransmitter levels.
o Lithium has unpleasant side effects, including thirst, hand tremors,
excessive urination, and memory problems.
o The drug quetiapine (better known as Seroquel) is an antipsychotic
and is now the most commonly prescribed drug for bipolar disorders,
as combining lithium with quetiapine improves treatment outcomes.
o As with all psychological disorders, compliance with drug therapy
can be a problem for various reasons.

39. 15.10 Atypical Antipsychotic Medications Are the Best
Treatment for Schizophrenia (1)
Psychotropic medications for schizophrenia
• Early antipsychotic drugs called
conventional antipsychotics reduced the positive
symptoms of schizophrenia, such as delusions,
hallucinations, and disorganized speech and
behavior.
o These medications have little to no effect on the
negative symptoms.
o Tardive dyskinesia— involuntary movement of body
parts—is another devastating side effect of these
medications and is irreversible once it appears.

40. 15.10 Atypical Antipsychotic Medications Are the Best
Treatment for Schizophrenia (2)

41. • Atypical antipsychotics act on
different neurotransmitters than conventional
antipsychotics do. They are beneficial in treating
both the positive symptoms of schizophrenia and
some of the negative symptoms.
o Atypical antipsychotics can have serious
side effects, including seizures, heart rate
problems, and substantial weight gain.
o Some of these drugs can cause a fatal reduction
in white blood cells.
15.10 Atypical Antipsychotic Medications Are the Best
Treatment for Schizophrenia (3)

42. Behavior therapy
• Behavior therapy can include social skills training to
elicit desired behavior, such as appropriate ways
to act in specific social situations.
o If a client’s self-care skills are poor,
behavioral interventions can focus on areas
such as grooming and bathing, managing
medications, and financial planning.
15.10 Atypical Antipsychotic Medications Are the Best
Treatment for Schizophrenia (4)

43. Prognosis in schizophrenia
• Most clients diagnosed with schizophrenia experience multiple
psychotic episodes over the course of the disorder.
• According to Jääskeläinen et al. (2013), only about 1 in 7
achieved recovery.
• Prognosis: A prediction of the likely course of a psychological
(or physical) disorder.
o People with later onset tend to have a more favorable prognosis.
o Women tend to have a better prognosis than men.
o In developing countries, schizophrenia often is less severe than
in developed countries.
15.10 Atypical Antipsychotic Medications Are the Best
Treatment for Schizophrenia (5)

44. Can Personality Disorders Be Treated?
Most therapists agree that personality disorders are
very difficult to treat.

45. Can Personality Disorders Be Treated?
15.11 Dialectical Behavior Therapy Is the Best Treatment for Borderline
Personality Disorder
15.12 Antisocial Personality Disorder Is Extremely Difficult to Treat

46. 15.11 Dialectical Behavior Therapy Is the Best Treatment for
Borderline Personality Disorder (2)
Traditional psychotherapy
approaches have been largely
unsuccessful for treating
borderline personality disorder.
• Dialectical behavior therapy
(DBT): Form of therapy, used to
treat borderline
personality disorder, that
combines behavior therapy,
cognitive therapy,
psychodynamic therapy, and a
mindfulness approach.

47. 15.12 Antisocial Personality Disorder Is Extremely Difficult to
Treat (1)
Treating people with antisocial
personality disorder (APD) often
seems impossible.
• Individuals with APD
apparently have diminished
cortical arousal, so
stimulants have been
prescribed to normalize
arousal levels.
• Most psychotherapies seem
ineffective in treating APD.

48. Behavior therapy approaches
using operant procedures have
had some success.
Individuals with APD typically
improve after age 40 with or
without treatment.
Criminal acts and imprisonment
decrease among those with APD
after age 40.
15.12 Antisocial Personality Disorder Is Extremely Difficult to
Treat (2)

49. How Can Disorders Be Treated in Children
and Adolescents?
15.13 Using Medication to Treat Depressive Disorders in Adolescents Is Controversial
15.14 Children with Autism Spectrum Disorder Benefit from Structured Behavior Therapy
15.15 Children with ADHD Can Benefit from Various Approaches

50. How Can Disorders Be Treated in Children and Adolescents?
In the United States, an estimated 12–20 percent of children and
adolescents experience psychological disorders.
• Problems not addressed during childhood or adolescence may persist into
adulthood.

51. 15.13 Using Medication to Treat Depressive Disorders in
Adolescents Is Controversial (1)
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.

52. Risks 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.
o Many questions about the effects of SSRIs on young
people need to be answered.
15.13 Using Medication to Treat Depressive Disorders in
Adolescents Is Controversial (2)

53. The treatment for Adolescents with
Depression Study (TADS) provided
clear evidence that SSRIs are effective
in treating adolescent depression
• 61 percent participants
showed improvement in
symptoms, compared with 43
percent receiving cognitive-
behavioral therapy (CBT) and
35 percent taking a placebo.
• The group that received both an
SSRI antidepressant and therapy
did best (71 percent improved).
15.13 Using Medication to Treat Depressive Disorders in
Adolescents Is Controversial (3)

54. Further thoughts on treatment approaches
• It is relatively easy for pediatricians and
family physicians to prescribe drugs.
• In the TADS report, suicide attempts were quite
uncommon.
o Among adolescents, higher doses of SSRIs
are more likely to trigger suicide attempts.
o According to some researchers, the
relative success of psychotherapy for teenage
depression makes it a better treatment choice.
15.13 Using Medication to Treat Depressive Disorders in
Adolescents Is Controversial (4)

55. 15.14 Children with Autism Spectrum Disorder Benefit From
Structured Behavior Therapy (1)
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.

56. Behavior therapy for autism spectrum disorder
• Applied behavioral analysis: An intensive behavior therapy used to
treat autism; this treatment is based on operant conditioning.
o There is evidence that this method can be used successfully to treat
autism spectrum disorder.
o This intensive approach requires a minimum of 40 hours of
treatment per week.
o Lovaas’s applied behavioral analysis program has some drawbacks,
particularly time commitment.
• Parents of children with autism essentially become full-time teachers
for years.
o The financial and emotional drains on the family can be substantial.
15.14 Children with Autism Spectrum Disorder Benefit From
Structured Behavior Therapy (2)

57. Biological treatments for autism spectrum disorder
• There is good evidence that autism
spectrum disorder is caused by brain dysfunction.
o The neurobiology of autism spectrum disorder
is not well understood.
15.14 Children with Autism Spectrum Disorder Benefit From
Structured Behavior Therapy (3)

58. Prognosis in autism spectrum disorder
• 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 a
better outcome.
• Higher IQ is also associated with a better outcome.
15.14 Children with Autism Spectrum Disorder Benefit From
Structured Behavior Therapy (4)

59. 15.15 Children with ADHD Can Benefit from Various
Approaches (1)
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, but many more continue to
experience the disorder throughout adolescence
and adulthood.

60. Psychotropic medications for ADHD
• The most common treatment for ADHD is a central nervous
system stimulant, such as methylphenidate (Ritalin) or Adderall.
o The actions of these drugs are not fully understood, but they
may affect multiple neurotransmitters, particularly
dopamine.
o Side effects include sleep problems, reduced appetite, body
twitches, and temporary slowing of growth.
o Some children on medication may see their problems as
beyond their control.
o Most therapists believe medication should be supplemented
by psychological therapies, such as behavior modification.
15.15 Children with ADHD Can Benefit from Various
Approaches (2)

61. 15.15 Children with ADHD Can Benefit from Various
Approaches (3)

62. Behavior Therapy for ADHD
Behavior therapy for ADHD
• Behavior therapy for ADHD applies operant procedures
to reinforce positive behaviors and ignore or punish
problem behaviors.
• An analysis of 174 studies found clear support for the
effectiveness of behavior therapy (Fabiano et al., 2009).
• Many therapists advocate combining behavioral
approaches with medication.
o Some suggest that medication should be used only if
behavioral techniques fail to reduce inappropriate
behaviors.