Treatment of Psychological Disorders

When psychological disorders get so serious that they interfere in everyday functioning, treatment may become necessary.

People can be treated as in-patients (24 hour a day care in a hospital-like setting) or as outpatients (periodic appointments in a clinic-like setting).

There are four general types of professionals that provide therapy. See the chart on the next page the professionals, their functions, and the educational requirements.

  • Psychologist
    • Help treat disorders but usually not able to prescribe drugs.
    • Doctoral degrees -- PhD and an internship. Licensed
  • Psychiatrist
    • M.D. doctor who treats disorders. They can prescribe drugs and perform surgery.
    • Medical school degree and specialization in mental disorders. Licensed.
  • Counselors
    • In schools and businesses they help people by listening and assisting with everyday problems, refers more serious situations to a psychologist or psychiatrist.
    • Master's degree and possibly a PhD in psychology or counseling. Licensed.
  • Psychiatric Social Workers or Psychiatric Nurse
    • Help people with everyday family problems, refer more serious situations to a psychologist or psychiatrist.
    • Master's degree and possibly a PhD in social work. Licensed.'

Make sure that if you ever need a professional they are licensed. That means they meet rigorous standards.

To refresh your memory, historically treatments for mental illnesses ranged from lack of care to extreme cruelty. Early treatment, (1300-1900), consisted primarily of imprisonment and removal of the person from society.

Asylums were built to house the mentally ill and treatment, if any, was barbaric at best. People like Philippe Pinel and Dorthea Dix initiated reforms to treat the mentally ill with dignity and respect.

In the early 1900's, harsh medical treatments were still employed to deal with mental disorders, prefrontal lobotomies and electroconvulsive therapy being two of the most common.

Biological/Medical Model

In the biological or medical model abnormal behavior is often talked about as mental illness.

The medical model looks at abnormal behavior as a disease. It attributes disorders to organic, internal causes like the brain and genetic factors.

The American Psychiatric Association used a medical model for the Diagnostic and Statistical Manual (DSM-IV) that classifies psychological disorders by their symptoms.

Biological therapies rely on methods such as drugs, electric shock and surgery.

Drug therapy is the most used biological treatment for disorders. There are four major types of drugs: antianxiety drugs, antidepressant drugs, lithium and the antipsychotic drugs.

Antianxiety drugs work by depressing the activity of the nervous system. They reduce the symptoms of anxiety but they do not cure anxiety.

Antidepressant drugs are used to treat depression and also in some types of eating and panic disorders. Antidepressant drugs work by increasing the production of the neurotransmitters, serotonin and norepinephrine. The drug must build up to a specific level in the body to be effective. This can take several days to weeks. Depressed people have to be watched so that they do not overdose.

Lithium carbonate helps to flatten out the cycle of depression and mania. Lithium has side effects of shakiness, memory impairment and excessive thirst.

The antipsychotic drugs, also called major tranquilizers are effective in reducing agitation, delusions and hallucinations. Some of the antipsychotic drugs block the activity of dopamine and reduce schizophrenic symptoms.

Electroconvulsive therapy (ECT) also called shock therapy has proved extremely effective in the treatment of severe depression, acute mania, and some types of schizophrenia.

No one understands exactly how it works, but it involves administering, a series of brief electric shocks.

Many people consider ECT a controversial treatment but today it entails very little discomfort for the patient since sedatives and muscle relaxers are given before treatment. The use of ECT has declined somewhat, but it remains a highly effective treatment for depression.

And the last biological therapy is psychosurgery.

The most common operation is the prefrontal lobotomy which involves the destruction of the frontal lobe.

The frontal lobe contains most of the nerve connections that control emotions.

This treatment was performed on people who were extremely violent, or diagnosed with schizophrenia, depression, bipolar disorder, and obsessive-compulsive disorder.

Because of the development of new drugs which offer an alternative treatment, this surgery is rarely performed today.

The Cognitive Approach

In previous units, you learned about the cognitive approach and how the focus is on changing the way people think (Beck 1991). The same holds true for many mental illnesses.

The basic assumptions that cognitive therapists share are that faulty cognitions- our irrational or uninformed beliefs, expectations, and ways of thinking- distort our behaviors, attitudes, and emotions. So to improve ourselves, we must work to change our patterns of thinking.

The cognitive approach helps people change their thoughts about their problems.

The two most used cognitive methods are Rational Emotive Therapy as proposed by Albert Ellis and Cognitive Restructuring Therapy as proposed by Aaron Beck.

Rational Emotive Therapy is based on Ellis's belief that people engage in self-talk that is false.

Since most of the false concepts are learned, Ellis believes that clients need to be confronted with their irrational beliefs so that they can be changed.

The therapist acts like a teacher to help the client develop skills that will allow the client to think more rationally.

Beck's Cognitive Restructuring Therapy does not use the technique of challenging the client's thoughts but guides clients in testing the logic of their thoughts and developing more logical ways of thinking. Clients have homework to do as in filling out forms about their responses to everyday life events.

Cognitive therapy tends to respond well with depression, anxiety and some personality disorders. People have to be involved and want to do the work required to get better.

Sociocultural Model

The sociocultural model looks at the social and cultural causes of mental disorders.

Remember the 20th century deinstitutionalization movement? Well, social psychologists found that they must view the patient in context of society and what could be done to help them become more productive citizens. These patients are no longer kept in an institution where they are seen by doctors or therapists daily. Now they are seen one or twice a week, and the rest of the time they are out in the world working and learning to adjust within society.

Sociocultural psychologists see mental disorders from larger social contexts: ineffective functioning of family, neighborhood, socioeconomic status, ethnicity, gender & culture.

Therefore, instead of focusing on the internal malfunctioning of the individual, the sociocultural approach focuses mainly on the larger institutions and communities involved in a person's life.

Due to its large and diversified approaches, it also uses different frameworks utilized by anthropologists, social workers, political scientists, economists etc.

Therapy usually involves group therapy, family and couple's therapy, support groups, and community modification.

Summary

As you can see from these three approaches, they each have a different views on mental illness and therefore a different way of treating disorders. Keep in mind that not all disorders are addressed by these three or the many other approaches in psychology.

The biological/medical model looks at the disorder as a disease and therefore treats the disease with medication most often and in rare cases with electric shock or surgery. The Cognitive approach helps clients develop new ways of thinking and behaving. And last, the Sociocultural approach views disorders from a social context and offers a variety of therapies that involves the individual and the group in which the individual belongs.

Read "Approaches in Practice" to learn more about contemporary techniques for treating mental illness.