Topic 5.5 Notes – Treatment of Psychological Disorders

How Psychological Disorders Are Treated

Treatment tries to reduce distressing thoughts, emotions, behaviors, and relationship problems. In AP Psych, there are three broad approaches:

• Psychotherapy means talking with a trained therapist to change thoughts, feelings, or behavior.
• Biological treatments act more directly on the nervous system through medication, brain stimulation, or rare surgery.
• Combined treatment uses both, which is common because disorders usually have biological, psychological, and sociocultural causes all interacting.

A lot of modern treatment is eclectic or integrative. That means the therapist does not stick to one school of thought if a mix works better. A common example is medication plus therapy. Medication may lower symptoms enough for someone to function, and therapy can build longer-lasting changes in thinking and behavior.

Late in the 20th century, deinstitutionalization shifted care away from long-term hospitals and asylums toward outpatient and community care. Psychotropic meds helped make this possible. The problem was that many communities did not have strong enough support systems, so some people ended up homeless, relapsed, or were hospitalized again.

Why Some Treatments Work Better Than Others

Research does not just ask whether people improved. It asks why they improved.

• Meta-analyses combine results from many studies. They generally show that psychotherapy is effective.
• Evidence-based interventions are treatments backed by systematic research.
• Evidence-based practice combines three things:
  • research evidence
  • clinician expertise
  • the client’s needs, values, and culture

Treatment studies often use random assignment and comparison groups like:

• wait-list groups
• placebo groups
• alternative-treatment groups

That helps separate true treatment effects from:

• placebo effects
• simple attention from a caring adult
• spontaneous remission (getting better on its own)
• regression toward the mean (extreme symptoms often move closer to average later)
• outside life changes

A key research distinction:

Therapeutic alliance

The therapeutic alliance is the working bond between therapist and client. It includes:

• trust
• agreement on goals
• agreement on tasks

This is one of the best predictors of success across many therapy types.

Cultural humility

Cultural humility means the therapist recognizes the limits of their own assumptions and learns from the client’s lived experience. That includes attention to language, religion, race and ethnicity, gender, sexual orientation, disability, SES, discrimination, and family expectations. This strengthens the alliance and reduces stereotyping.

Major Types of Therapy

Psychodynamic therapy

Based on Freud’s influence, this therapy looks at unconscious conflicts.

• Free association means saying whatever comes to mind.
• Dream interpretation looks for unconscious meanings in dreams.

Cognitive therapy

This therapy targets maladaptive thoughts and beliefs.

• Cognitive restructuring helps replace distorted thoughts with more realistic ones.
• Aaron Beck is strongly tied to cognitive therapy for depression.
• The cognitive triad in depression is negative views of:
  • self
  • world
  • future
• Fear hierarchies rank feared situations from least scary to most scary.

Behavioral therapy and applied behavior analysis

This uses conditioning principles to change behavior.

• Exposure therapy reduces fear by preventing avoidance.
• Systematic desensitization works in steps
  1. learn relaxation
  2. build a fear hierarchy
  3. face low-level fears while relaxed
  4. move upward gradually
• Aversion therapy pairs an unwanted behavior with something unpleasant.
• Token economies give conditioned reinforcers for desired behaviors.
• Biofeedback helps people gain control over body responses like muscle tension, heart rate, and arousal.

Cognitive-behavioral therapy

CBT combines changing thoughts with changing behavior.

• REBT, developed by Albert Ellis, challenges irrational beliefs.
• DBT combines acceptance, mindfulness, and change. It was first developed for borderline personality disorder.

Humanistic therapy

Person-centered therapy, developed by Carl Rogers, emphasizes growth and support.

• Active listening means carefully reflecting what the client says and feels.
• Unconditional positive regard means accepting the client as a person.

Treatment Formats and Other Techniques

• Individual therapy has one therapist and one client. It gives more privacy and personalized attention.
• Group therapy has several clients with one or more therapists. It offers peer support, lower cost, interpersonal practice, and the realization that other people struggle too. It gives less individual attention and confidentiality is harder to control.

Hypnosis involves focused attention and greater responsiveness to suggestion. It can help with pain and anxiety. AP Psych does not support it for accurate memory recovery or age regression.

Biological Treatments and Ethics

Psychoactive medications

• Antidepressants often affect serotonin and/or norepinephrine. SSRIs are a key example.
• Antianxiety drugs often enhance GABA.
• Lithium stabilizes mood in bipolar disorders.
• Antipsychotics often reduce dopamine activity to treat hallucinations and delusions.
• Tardive dyskinesia is an involuntary movement side effect linked to long-term antipsychotic use.

Brain stimulation and surgery

• ECT uses controlled electrical current and is especially used for severe depression.
• TMS uses magnetic pulses, often for depression.
• Psychosurgery, which may involve lesioning brain tissue, is rare and used only in severe cases.
• Lobotomy is the classic historical example and is now rarely, if ever, used.

Ethical principles

• Nonmaleficence means do no harm.
• Fidelity means trust, confidentiality, and professional responsibility.
• Integrity means honesty about methods, risks, and qualifications.
• Respect for people’s rights and dignity includes informed consent, privacy, autonomy, and freedom from discrimination.