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Treatment of Psychological Disorders
- Early treatment (10,000 B.C – 3,000 BC) involved Trepanning: cutting holes in the skull to let out harmful spirits.
（曹操与华佗.txt）
- Hippocrates (Greece) and Galen (Rome) suggested that psychological illness resulted from biological factors.
- During Dark Ages, long after these men, Europeans thought evil spirits were the cause of psychological illness.
- During the 1950s, research and development into antipsychotic drugs led the U.S. to get rid of large mental institutions which housed lots of mentally ill patients.
- The thinking was that the drugs would help people recover, but most mentally ill patients did not recover and became homeless, delusional, and unable to take care of themselves.
- Preventative efforts are methods used to prevent or diminish the onset of psychological illness.
- Primary prevention efforts attempt to reduce the incidences of problems that can later lead to psychological problems (joblessness, homelessness, etc.).
- Secondary preventioninvolves working with people who are at risk for developing psychological problems (identify people who've experienced trauma or exhibit early symptoms).
- Tertiary prevention efforts aim to keep people's mental health issues from becoming more severe through whatever methods are available (drugs, behavioral therapy, etc.).
- Treatment styles discussed: Psychoanalytic, Humanistic, Behavioral, Biomedical, Cognitive.
- Two broad types of therapy:
- Psychotherapy, involves talking extensively to a psychologist; all of the above use this except behavioral and biomedical.
- Somatic treatments, relating to the body, involve treatment with drugs.
- Psychologists with a biomedical orientation and psychoanalysts refer to people who come for help as patients.
- Humanistic therapies prefer the term clients, believing that this is a more positive term.
- sychoanalytic theorists view the cause of psychological disorders as unconscious conflicts.
- Psychoanalysts focus on identifying the underlying cause of the problem.
- Psychoanalysis and humanistic therapy are referred to as insight therapies because they help patients/clients gain an understanding of their problems.
- Psychoanalytic therapists believe that a person's symptoms are the outward manifestation of deeper problems that can be cured only through analysis.
Techniques involved
- Hypnosis: After being hypnotized by a therapist, patients are less likely to repress thoughts.
- Free association: A psychoanalyst asks the patient to speak about whatever comes to mind without censorship, hoping the problem surfaces naturally.
- Dream analysis: Asking a patient about their dreams and interpreting them.
- Psychoanalysts believe that, because the ego’s defenses are relaxed during sleep, unconscious conflicts will more easily reveal themselves during dreams.
- Dreams: Manifest content & Latent content
- All of the techniques above rely on interpretations of the therapist.
- The therapist's interpretations can be criticized for being subjective.
- When a patient disagrees with their therapist's interpretations, a psychoanalyst views these objections as resistance.
- Since the interpretations can be painful, patients are thought to try to protect themselves by "resisting the interpretation."
- Transference is when patients begin to have strong feelings toward their therapist.
- Patients may think they love their therapist, may view their therapist as a parental figure, or may hate them.
- Humanistic therapies focus on helping people understand and accept themselves.
- Humanistic therapies strive to help people self-actualize.
- Humanistic therapies come out of Abraham Maslow’s work.
- Self-actualization means to reach one's highest potential.
- (其他引用了此图片的章节：Chapter 1, Chapter 10.)
- Carl Rogers created client-centered therapy which provides the client with unintentional positive regard.
- Unconditional Positive Regard is when the therapist accepts and supports a person regardless of what they say.
- Roger believes that this is essential to healthy development.
- Humanistic Therapists claim that people are innately good and have free will (ability to control their own destiny).
- Other therapists, such as biomedical, behavioral, and psychoanalysts argue that behavior is determined, and not free.
- Humanistic approaches and client-centered therapy are non-directive.
- Rogers and others do not tell their clients what to do; they seek to help clients choose a course of action for themselves.
- Therapists encourage the clients to talk a lot about how they feel and the therapist sometimes mirror back those feelings; this is called active listening.
- Another type of humanistic therapy is Gestalt therapy developed by Fritz Perls.
- Gestalt therapists emphasize the importance of the whole rather than just the parts.
- Gestalt therapists encourage their clients to explore feelings of which they may not be aware and emphasize the importance of body position and minute actions.
- Gestalt therapists want their clients to integrate all of their actions, feelings, and thoughts into a harmonious whole.
- Gestalt psychologists also emphasize the present.
- Existential therapies have a humanistic focus on helping clients achieve a subjectively meaningful perception of their lives.
- Therapists view their clients' problems as caused by not having a sense of purpose.
- Therapists seek to help a client develop their sense of purpose.
- Behavioral therapies are based around using classical conditioning, operant conditioning, and modeling.
- Counterconditioning: developed by Mary Cover Jones, is when you repair two stimuli.
- For example, present candy at the doctor's office, if the child usually cries at the doctors.
- Systematic desensitization, developed by Joseph Wolpe, involves teaching the patient to replace feelings of anxiety with relaxation to reduce phobias.
- Thinking about a spider.（恐惧程度=1）
- Looking at a photo of a spider.（恐惧程度=13）
- Looking at a spider in a box.（恐惧程度=135）
- Holding the box.（恐惧程度=1356）
- Letting spider crawl on desk.（恐惧程度=13567）
- Letting spider crawl on pants.（恐惧程度=135678）
- Letting spider crawl on sleeve.（恐惧程度=1356789）
- Letting spider crawl on arm.（恐惧程度=9876531）
- In vivo desensitization: The patient confronts the actual feared objects or situation.
- Covert desensitization: The patient imagines the feared objects or situation.
- Flooding can be in vivo (actual) or covert (imagined).
- During flooding, the patient faces the most frightening situation first; and if the patient does not back down, they begin to realize their fears are often irrational.
- Aversive conditioning: Pairing a habit someone wishes to remove, such as nail biting , with an electric shock or with a substance that induces nausea.
- Rational Emotive Behavior Therapy (REBT) focuses on both how clients think and how they behave.
- One may be embarrassed of public speaking, and the therapist would identify the irrationality of the thoughts of the patient, as well as get the patient to engage in public speaking to demonstrate the irrationality of the thoughts.
- Cognitive Therapies: The therapist challenges the irrational thinking patterns of their clients.
- Aaron Beck, a cognitive theorist, views depression as the result of unreasonably negative ideas that people have about themselves, the world, and their future.
- This is called the Cognitive Triad.
Recall attribution styles
- Albert Ellis and Cognitive-Behavioral Therapy
- Cognitive-behavioral therapy (CBT) is an action-oriented form of psychotherapy that assumes that maladaptive thinking patterns cause maladaptive behavior and emotions.
- Modifying dysfunctional thinking and behavior leads to improved symptoms.
- Thought: What we think affects how we act and feel.
- Emotion: What we feel affects how we think and do.
- Behavior: What we do affects how we think and feel.
Group Therapies
- Since a patient's problems do not occur in vacuum devoid of other people, many therapists find meeting with the whole family (family therapy) helpful in revealing patterns of dysfunctional behavior between them.
- Self-help groups are another form of group therapy: Alcoholics Anonymous, Narcotics Anonymous, Gamblers Anonymous.
Somatic therapies (relating to the body)
- Psychologists with a biomedical, biological, orientation view the cause of disorders as relating to the body and brain.
- Psychologists with this approach view disorders arising from imbalances in neurotransmitters, structural abnormalities in the brain, and genetic predispositions.
- Somatic Therapy: Anxiety Disorders
- Drugs: Barbiturates, benzodiazepines.
- These drugs are classified as depressants because they depress (slow) the central nervous system down and alleviate anxiety.
- Commonly prescribed benzodiazepines: Ativan, Halcion, Klonopin, Rohypnol, Valium, Xanax.
- Somatic Therapy: Schizophrenia
- Drugs used to treat Schizophrenia:
- Treated with antipsychotic drugs like Thorazine and Haldol.
- These drugs block a receptor for the neurotransmitter dopamine.
- Somatic Therapy: Mood Disorders
- Drugs used to treat Mood Disorders: Tricyclic antidepressants, monoamine oxidase inhibitors (MOIs), and serotonin-reuptake-inhibitor drugs (SSRIs).
- These drugs increase the activity of the serotonin neurotransmitter.
- Bipolar disorder is treated with Lithium.
- Electroconvulsive Therapy uses electric current, passed through both hemispheres of the brain.
- The electric shock causes patients to experience a brief seizure.
- How ECT works is not certain, shock of electricity probably changes blood flow paths in the brain.
- It is uncommon, and used mostly in cases of severe depression.
- Psychosurgery involves the purposeful destruction of part of the brain to alter behavior. This is a last resort.
- Prior to a good understanding, prefrontal lobotomy (removal o the prefrontal lobe) was regularly performed for severe mental illness; it may alleviate some symptoms, but the patient is severely affected in other ways.
- Eclectic means a broad range of sources or approaches.
- Eclectic therapies take advantage of the different forms of therapies and combine them.
- Drugs may be used alongside behavioral therapies, and CBT to treat mood disorders, depression, anxiety, and other mental disorders.
Types of Therapists
- Psychiatrists are medical doctors, and are able to prescribe prescriptions.
- Clinical psychologists earn PhDs, and usually deal with people who are experiencing severe mental disorders.
- Counseling therapists have either a Masters or PhD and deal with less severe cases of mental disorders – family therapy, school counsellors.
- Psychoanalysts are trained in Freudian methods, and may or may not have medical degrees/Masters/PhDs.
