Chapter 16 Treatment of Psychological Disorders

Answers to Before You Go On Questions

  1. What trends have changed who tends to receive treatment for psychological disorders?The increased availability of third-party coverage for therapy has meant that people of all socio-economic levels (and not just the wealthy) now receive both outpatient and inpatient therapy. Women used to outnumber men in therapy 4 to 1, but now that societal sex-role expectations have changed (men do not have to be tough and self-sufficient) men account for more than 1/3 of therapy patients.
  1. How does in-patient therapy differ from out-patient therapy?People being treated as outpatients live in the community and make regular visits to their therapists’ offices for their treatment. Individuals treated as inpatients typically have severe psychological problems and are treated in the residential psychiatric wards of general hospitals or in psychiatric hospitals.
  1. What are the three key features common to all forms of therapy?All forms of therapy involve three essential features: a sufferer who seeks relief, a trained healer, and a series of contacts between the two in which the healer tries to bring about changes in the sufferer’s emotional state, attitudes, and behaviour.
  1. What are the three main categories of biological treatments? Biological therapies can be divided into treatments using psychotropic drugs, electroconvulsive shock therapy and psychosurgery.
  1. What are some new methods of direct brain stimulation, and how are they used?Vagus nerve stimulation via an implanted pacemaker can influence the mood centres of the brain. Transcranial magnetic stimulation involves placing a magnetic coil on or over a patient’s head. The procedure appears to increase neuron activity in the prefrontal cortex, sometimes helping to alleviate depression. In deep brain stimulation electrodes are implanted deep in the patient’s brain and a pacemaker delivers small electric currents into those brain areas for the treatment of depression, Parkinson’s disease, or seizure disorders.
  1. Contrast three types of psychodynamic therapy.Short-term psychodynamic therapies involve the client working on a single focused problem over a small number of sessions. Relational psychoanalytic therapy involves the therapist playing a more active role in interactions with clients, disclosing personal experiences and feelings. Standard psychodynamic therapy, by contrast, involves a distant, aloof therapist and can go over many, many sessions.
  1. List and describe psychodynamic therapy techniques. Free association requires the client to say whatever thoughts or feelings come to mind. Therapists provide interpretations of the client’s associations looking especially for instances of resistance (the client seems to be avoiding a thought or an idea), transference (the client expresses an emotion toward the therapist that is likely actually aimed at someone in their own life), and dream interpretation. Catharsis occurs when a client is led to see and experience a previously unconscious emotional event or experience, releasing the pent up psychic energy associated with the feeling or event. Working through involves the client going over and over the event or events that arose through catharsis, gaining more and more clarity each time through.
  1. What are systematic desensitization and aversion therapy?Systematic desensitization is used to treat phobias. Individuals construct a fear hierarchy related to their phobic object or situation and then, through training in relaxation, gradually work their way up through their fear hierarchy. Aversion therapy involves using a form of punishment to change maladaptive behaviour. For example, a drug could be administered that makes the client violently ill if they drink alcohol along with the drug as a means of limiting alcohol use.
  1. What principles and procedures are involved in a token economy program?A token economy is a means for using positive reinforcement to support positive behaviour. A child with attention issues in school can be given stars for each hour in which they stay on task and the stars can be turned in at the end of the day or week for more tangible rewards (toys, gaming privileges, etc.).
  1. How does social skills training work?In social skills training a therapist may make use of modelling, rehearsal, feedback, and practice to assist a client in more consistently using effective/adaptive social behaviours.
  1. What do therapists help clients to do in rational-emotive behavioural therapy?Rational-emotive therapists first help clients identify the irrational assumptions that seem to govern their behavioural and emotional responses. Next, they help clients change those assumptions into constructive ways of viewing themselves and the world.
  1. What is cognitive therapy?Beck’s cognitive therapy involves therapists helping clients to identify the negative thoughts and errors in logic that pervade their thinking and that help give rise to feelings of depression.
  1. What are the goals of second-wave cognitive-behavioural therapies? Second-wave cognitive therapy approacheshelp clients to accept many of their problematic thoughts rather than judge them, act on them, or try fruitlessly to change them. The hope is that by recognizing such thoughts for what they are—just thoughts—clients will eventually be able to let them pass through their awareness without being particularly troubled by them.
  1. What are the key characteristics therapists should display in client-centred therapy? (1) Unconditional positive regard—full and warm acceptance for the client. (2) Accurate empathy—skillful listening, including restatements of the client’s own comments. (3) Genuineness—realness, sincere communication, no professional front or facade.
  1. What techniques are used in Gestalt therapy? (1) Skillful frustration—the therapist consistently refuses to meet their clients’ expectations or demands. The aim here is to help the clients see how often they try to manipulate others into meeting their needs. (2) Role-playing—the client may be instructed to be another person, an object, an alternate self, or even a part of the body. Through this experience, clients are eventually expected to “own,” or accept, feelings that previously made them uncomfortable. (3) Rules—the therapist insists that the client use the word “I,” as in “I am sad” rather than “the situation is depressing.”
  1. What are the main goals of existential therapy?Existential therapists encourage clients to accept responsibility for their lives and their problems. They help clients recognize their freedom so that they may choose different paths and live more meaningful lives. Existential therapists also place great emphasis on the relationship between therapist and client and try to create an atmosphere of honesty, shared learning, and growth.
  1. What are self-help groups?Self-help groups are made up of people who have similar problems or who may be at different places in a life process (e.g., supporting a loved one with Alzheimer’s) and come together to help and support one another without the direct leadership of a professional clinician.
  1. What is the main assumption of family systems therapy?Family systems therapy holds that each family has its own implicit rules, relationship structure, and communication patterns that shape the behaviour of the individual members, including dysfunctional behaviour. For one family member to change, the family system must be changed (for therapy to succeed).
  1. Describe primary, secondary, and tertiary prevention.Primary prevention consists of efforts to improve community functioning and policies. Secondary prevention consists of detecting and treating psychological disorders in the early stages, before they reach serious levels. Tertiary prevention aims to provide effective treatment immediately so that moderate or severe disorders do not become chronic problems.
  1. What does research show about whether or not therapy is generally effective?Studies reveal that therapy is often more helpful than no treatment or placebo treatments. A large-scale meta-analytic study showed that the average person who received treatment was better off than 75 percent of the untreated control clients.
  1. What do effective therapists have in common?Successful therapists tend to do similar things: (1) They provide feedback to clients; (2) they help clients focus on their own thoughts and behaviour; (3) they pay careful attention to the way they and their clients interact; (4) they try to build a sense of self-mastery in their clients.
  1. What does research show about the effectiveness of particular therapies for certain problems?Research has indicated that particular therapies are particularly effective in treating certain disorders. For example, behavioural therapies seem to be the most effective of all treatments for phobias. Cognitive-behavioural therapies are particularly helpful in cases of social anxiety disorder, generalized anxiety disorder, panic disorder, and depression. And drug therapy is the single most helpful treatment for schizophrenia and bipolar disorder.
  1. Is therapy equally effective across race and gender? Members of ethnic and racial minority groups typically show less improvement in clinical treatment, make less use of mental health services, and stop therapy sooner than members of majority groups. Culturally sensitive therapies seek to address the unique issues faced by members of cultural minority groups. Therapies geared to the pressures of being female, called gender-sensitive or feminist therapies,follow similar principles.

Answers to Your Brain and Behaviour Questions

  1. Which area of the cerebral cortex often shows reduced activity in people who are depressed?The prefrontal cortex often shows reduced activity in people with depression.
  1. What does it mean to say that a particular drug is a “serotonin reuptake inhibitor”?Reuptake is the process by which excess neurotransmitter molecules are absorbed by the sending neuron. Serotonin reuptake inhibitors slow down reuptake, leaving more serotonin molecules in the synapse to activate particular brain regions, such as the hippocampus and prefrontal cortex.
  1. What is the role of the hippocampus in the recovery of someone taking antidepressant medication to relieve depression?The use of antidepressants stimulates the hippocampus, which may be one mechanism by which antidepressant medications reduce anxiety and improve cognitive function in a person with depression.

Comer/Psychology Around Us, Second Canadian Edition