Chapter 14. Treating Psychological Disorders
Psychological disorders create a tremendous individual, social, and economic drain on society. Psychologists work to reduce this burden by preventing and treating disorder. Psychologists base this treatment and prevention of disorder on the bio-psycho-social model, which proposes that disorder has biological, psychological, and social causes, and that each of these aspects can be the focus of reducing disorder.
Treatment for psychological disorder begins with a formal psychological assessment. In addition to the psychological assessment, the patient is usually seen by a physician to gain information about potential Axis III (physical) problems.
One approach to treatment is psychotherapy. The fundamental aspect of psychotherapy is that the patient directly confronts the disorder and works with the therapist to help reduce it.
Psychodynamic therapy (also known as psychoanalysis) is a psychological treatment based on Freudian and neo-Freudian personality theories. The analyst engages with the patient in one-on-one sessions during which the patient verbalizes his or her thoughts through free associations and by reporting on his or her dreams. The goal of the therapy is to help the patient develop insight — that is, an understanding of the unconscious causes of the disorder.
Humanistic therapy is a psychological treatment based on the personality theories of Carl Rogers and other humanistic psychologists. Humanistic therapies attempt to promote growth and responsibility by helping clients consider their own situations and the world around them and how they can work to achieve their life goals.
The humanistic therapy promotes the ideas of genuineness, empathy, and unconditional positive regard in a nurturing relationship in which the therapist actively listens to and reflects the feelings of the client; this relationship is probably the most fundamental part of contemporary psychotherapy
Cognitive behavioural therapy (CBT) is a structured approach to treatment that attempts to reduce psychological disorder through systematic procedures based on cognitive and behavioural principles. CBT is a very broad approach used for the treatment of a variety of problems.
Behavioural aspects of CBT may include operant conditioning using reward or punishment. When the disorder is anxiety or phobia, the goal of the CBT is to reduce the negative affective responses to the feared stimulus through exposure therapy, flooding, or systematic desensitization. Aversion therapy is a type of behaviour therapy in which positive punishment is used to reduce the frequency of an undesirable behaviour.
Cognitive aspects of CBT include treatment that helps clients identify incorrect or distorted beliefs that are contributing to disorder.
The most commonly used approaches to therapy are eclectic, such that the therapist uses whichever techniques seem most useful and relevant for a given patient.
Biomedical therapies are treatments designed to reduce psychological disorder by influencing the action of the central nervous system. These therapies primarily involve the use of medications but also include direct methods of brain intervention, including electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and psychosurgery.
Attention-deficit/hyperactivity disorder (ADHD) is treated using low doses of psychostimulants, including Ritalin, Adderall, and Dexedrine.
Mood disorders are most commonly treated with the antidepressant medications known as selective serotonin reuptake inhibitors (SSRIs), including Prozac, Paxil, and Zoloft. The SSRIs selectively block the reuptake of serotonin at the synapse. Bipolar disorder is treated with mood stabilizing medications.
Antianxiety medications, including the tranquilizers Ativan, Valium, and Xanax, are used to treat anxiety disorders.
Schizophrenia is treated with antipsychotic drugs, including Thorazine, Haldol, Clozaril, Risperdal, and Zyprexa. Some of these drugs treat the positive symptoms of schizophrenia, and some treat the positive, negative, and cognitive symptoms.
Practitioners frequently incorporate the social setting in which disorder occurs by conducting therapy in groups, with couples, or with families. One way for people to gain social support is by joining a self-help group.
Community mental health services refer to psychological treatments and interventions that are distributed at the community level. These centres provide primary, secondary, and tertiary prevention.
Psychologists use outcome research to determine the effectiveness of different therapies. These studies help determine if improvement is due to natural improvement, nonspecific treatment effects, or placebo effects. Research finds that psychotherapy and biomedical therapies are both effective in treating disorder, but there is not much evidence that any one type of therapy is more effective than any other type. What all good therapies have in common is that they give people hope; help them think more carefully about themselves and about their relationships with others; and provide a positive, empathic, and trusting relationship with the therapist — the therapeutic alliance.
One problem with drug therapies is that although they provide temporary relief, they don’t treat the underlying cause of the disorder. Once the patient stops taking the drug, the symptoms often return in full force.
Data suggest that although some community prevention programs are successful, the changes brought about by even the best of these programs are, on average, modest.