5.5 Treatment of Psychological Disorders

Psychological disorders can be treated through various methods, from psychotherapy to medication. These approaches aim to alleviate symptoms and improve overall mental health. Understanding the effectiveness and ethical considerations of different treatments is crucial for both practitioners and patients.

Treatment options have evolved over time, with a shift towards community-based care and combination therapies. Ethical guidelines ensure responsible practice, while different therapeutic techniques address specific mental health issues. Biological interventions and group therapies offer additional avenues for managing psychological disorders.

Research and Trends in Treating Psychological Disorders

Psychotherapy

Meta-analysis studies have revolutionized our understanding of psychotherapy effectiveness by providing comprehensive data analysis across multiple studies. These analyses consistently show that psychotherapy is an effective treatment option for many mental health conditions.

Meta-analytic studies, which combine results from multiple research studies, have found that:

• Most people who receive psychotherapy show significant improvement compared to those who do not receive treatment.
• No single therapy works for everyone; treatment effectiveness depends on the individual and the disorder being treated.
• A combination of therapy and medication is often the most effective approach for conditions like depression, anxiety, and schizophrenia.

Evidence-Based Treatment Approaches

Psychologists increasingly rely on evidence-based interventions, meaning treatments that have been scientifically tested and proven effective. Some widely used approaches include:

• Cognitive-behavioral therapy (CBT) – Helps individuals identify and change negative thought patterns and behaviors.
• Exposure therapy – Gradually reduces fear responses by safely confronting anxiety-provoking situations.
• Dialectical behavior therapy (DBT) – Combines mindfulness and emotional regulation techniques, often used for personality disorders.
• Medication-assisted treatment – Used in combination with therapy for disorders like schizophrenia, bipolar disorder, and severe depression.

Importance of Cultural Humility in Therapy

Therapists must consider cultural and individual differences when treating clients. This involves:

• Cultural humility – Recognizing and respecting a client’s cultural background, values, and experiences.
• Adapting therapy – Modifying treatment methods to align with a client’s personal and cultural identity.
• Reducing stigma – Encouraging open discussions about mental health in diverse communities.

The Role of the Therapeutic Alliance

A strong therapeutic alliance, or the relationship between the therapist and the client, is one of the biggest predictors of successful treatment.

• Trust and collaboration between therapist and client improve therapy outcomes.
• Clients are more likely to stay engaged in treatment when they feel understood and supported.
• Empathy, active listening, and a nonjudgmental approach enhance the effectiveness of therapy.

Deinstitutionalization and Modern Treatment

The late 20th century saw a major shift in how psychological disorders were treated. Deinstitutionalization, or the large-scale release of patients from hospitals and asylums, occurred due to advances in psychotropic medications and a shift toward community-based care.

Reasons for Deinstitutionalization

• Increased use of psychotropic medications – Medications like antipsychotics, antidepressants, and mood stabilizers helped manage symptoms, allowing many individuals to function outside of institutions.
• Concerns about institutional care – Long-term hospitalization often led to poor conditions, mistreatment, and social isolation. Deinstitutionalization aimed to provide more humane and effective care.
• Expansion of outpatient services – Community mental health centers, therapy programs, and outpatient clinics became more common, reducing the need for long-term hospitalization.

Today, treatment for psychological disorders is decentralized, meaning that most care takes place outside of hospitals.

• Combination of medication and therapy – Many therapists use both psychotropic medications and psychological treatments like cognitive-behavioral therapy (CBT) to help clients manage their conditions.
• Community-based care – Mental health services are now provided in outpatient clinics, private therapy practices, and online platforms, making treatment more accessible.
• Emphasis on independent living – Programs such as supported housing and job training help individuals integrate into society while managing their mental health.

Ethical principles in treatment

Psychologists follow ethical guidelines to ensure that therapy and treatment are conducted in a responsible and respectful manner. These principles, established by the American Psychological Association (APA), help protect clients' well-being and maintain professional standards in mental health care.

Nonmaleficence (must avoid causing harm to their clients)

• Providing treatments that are safe, effective, and supported by research.
• Avoiding techniques that could cause emotional or psychological distress.
• Recognizing when a client’s needs are beyond their expertise and referring them to an appropriate professional.

Fidelity and Integrity (focus on trust and honesty in therapy.)

• Therapists must keep their commitments to clients, such as maintaining confidentiality and following treatment plans.
• They must be honest about their qualifications, treatment methods, and potential risks or benefits.
• Avoiding conflicts of interest ensures that clients receive unbiased, professional care.

Respect for People’s Rights (recognizing patient rights to privacy, autonomy, and dignity)

• Clients should be able to make informed decisions about their treatment.
• Therapists must respect cultural differences, personal values, and beliefs in therapy.
• Clients should feel safe and supported, free from discrimination or bias.

Techniques in Psychological Therapies

Psychodynamic Therapies

Psychodynamic therapy focuses on uncovering unconscious thoughts, emotions, and past experiences that influence present behavior. This approach helps individuals gain insight into unresolved conflicts and emotional struggles.

Techniques Used in Psychodynamic Therapy

• Free Association – Clients are encouraged to speak freely about whatever comes to mind without censorship. This helps uncover hidden thoughts, memories, and emotions that may be influencing behavior.
• Dream Interpretation – Dreams are analyzed to reveal unconscious desires, fears, and conflicts. Therapists look for symbolic meanings to help clients understand deeper emotional issues.

Goals of Psychodynamic Therapy

• Identifying unresolved conflicts from childhood or past experiences.
• Understanding patterns in thoughts and behaviors that may be causing distress.
• Bringing unconscious emotions into awareness to promote healing and self-growth.

Cognitive Therapies

Cognitive therapy focuses on identifying and changing maladaptive thought patterns that contribute to emotional distress and unhealthy behaviors. This approach helps individuals develop more balanced and constructive ways of thinking.

Techniques Used in Cognitive Therapy

• Cognitive Restructuring – Identifying and challenging negative or irrational thoughts and replacing them with more realistic and positive beliefs.
• Fear Hierarchies – Gradually exposing individuals to feared situations in a structured way, helping them reduce anxiety through controlled exposure.

The Cognitive Triad Cognitive therapy suggests that negative thinking patterns contribute to mental health issues. These negative thoughts often focus on:

• Oneself – Viewing oneself as inadequate, unworthy, or incapable.
• The World – Believing that life is unfair or that external events are overwhelmingly negative.
• The Future – Expecting failure, disappointment, or continued suffering.

Applied Behavior Analysis and Conditioning-Based Therapies

Applied behavior analysis (ABA) uses principles of conditioning and reinforcement to modify behavior. This approach is often used to treat mental disorders, anxiety, and developmental disabilities, including autism spectrum disorder (ASD).

Behavioral Therapies Based on Conditioning

• Exposure Therapies – Help individuals confront fears gradually in a controlled environment.
• Systematic Desensitization – A step-by-step method where a person is gradually exposed to their fear while practicing relaxation techniques.
• Aversion Therapy – Pairs unwanted behaviors with unpleasant stimuli to discourage those behaviors, such as using a bitter substance to stop nail-biting.
• Token Economies – Uses a reward system where individuals earn tokens for desired behaviors, which can later be exchanged for privileges or rewards.

Biofeedback and Self-Regulation Biofeedback helps individuals gain control over involuntary body functions to manage stress and anxiety.

• Sensors track heart rate, muscle tension, or breathing, providing real-time feedback.
• Clients learn relaxation techniques to regulate the sympathetic and parasympathetic nervous systems, reducing symptoms of anxiety or depression.

Cognitive-Behavioral Therapies

Cognitive-behavioral therapies (CBT) combine cognitive techniques (changing thought patterns) with behavioral techniques (modifying actions) to treat mental and behavioral disorders. This approach helps individuals recognize and change negative thinking while developing healthier coping strategies. CBT and its variations are widely used for anxiety, depression, personality disorders, and impulse-control issues, offering structured and practical strategies for improving mental health.

There are two types:

Dialectical Behavior Therapy (DBT)

• Originally developed to treat borderline personality disorder, now used for various emotional and behavioral challenges.
• Focuses on mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness.
• Teaches clients how to accept their emotions while working on changing harmful behaviors.

Rational-Emotive Behavior Therapy (REBT)

• Developed by Albert Ellis, REBT challenges irrational and self-defeating beliefs that contribute to emotional distress.
• Helps clients recognize and replace exaggerated or unrealistic thoughts with more logical and constructive ones.
• Emphasizes that emotions are influenced by how we interpret events rather than the events themselves.

How Cognitive-Behavioral Therapies Work

• Help individuals identify negative thoughts and replace them with healthier ones.
• Use behavioral techniques like exposure therapy and reinforcement to modify actions.
• Encourage practicing coping skills in real-life situations to build long-term resilience.

Group vs Individual Therapy

Group therapy and individual therapy are both effective forms of psychological treatment, but they differ in structure, approach, and benefits. While individual therapy focuses on personalized support, group therapy provides shared experiences and peer encouragement. Many therapists recommend a combination of both approaches depending on a client's needs.

Group Therapy

• Involves multiple participants led by one or more therapists.
• Provides a supportive environment where individuals can share experiences and learn from others.
• Encourages social interaction and helps clients develop communication skills.
• Can be more affordable than individual therapy.
• Often used for addiction recovery, anxiety, depression, and social skill-building.

Individual Therapy

• One-on-one setting between a client and therapist.
• Allows for personalized treatment tailored to the client’s specific needs.
• Provides a private and confidential space for discussing sensitive issues.
• Often used for deep self-exploration, trauma recovery, and personal development.

Hypnosis

Hypnosis is a therapeutic technique that involves focused attention, deep relaxation, and heightened suggestibility. While hypnosis can be useful for pain relief, anxiety reduction, and habit control, it is not reliable for memory recovery or age regression. It is most effective when used alongside other therapeutic approaches.

Proven Uses of Hypnosis

• Pain Management – Hypnosis has been effective in reducing chronic pain, surgical pain, and pain from medical conditions like migraines or arthritis.
• Anxiety Reduction – Used to help individuals with generalized anxiety, phobias, and stress-related conditions by promoting relaxation and altering negative thought patterns.
• Behavioral Change – Can assist with overcoming habits like smoking, nail-biting, or overeating by reinforcing positive behaviors.

Limitations of Hypnosis

• Memory Retrieval – Research does not support the use of hypnosis for recovering forgotten or repressed memories, as it can create false memories.
• Age Regression – The idea that hypnosis can take someone back to past life stages or reveal childhood memories accurately is not scientifically supported.

Biological Interventions

The biological perspective in psychology focuses on how brain function, neurotransmitters, and genetics influence mental health. Treatments based on this approach aim to correct biological imbalances and improve neurological functioning.

Medications

Psychoactive medications are used to treat mental disorders by modifying neurotransmitter activity in the central nervous system. These drugs help regulate mood, anxiety, and thought processes by targeting specific brain chemicals. These medications are often used alongside therapy for a more comprehensive treatment plan. Regular monitoring by healthcare providers helps manage side effects and adjust dosages for the best therapeutic outcome.

Types of Psychoactive Medications

• Antidepressants – Increase neurotransmitters like serotonin and norepinephrine to treat depression and anxiety disorders.
• Antianxiety Drugs – Enhance GABA activity, which helps reduce excessive nervous system activity and promotes relaxation.
• Mood Stabilizers (such as Lithium) – Regulate glutamate and serotonin levels to manage mood swings, particularly in bipolar disorder.
• Antipsychotic Medications – Block dopamine receptors to reduce symptoms of schizophrenia and other psychotic disorders.

Potential Side Effects

• Weight gain, drowsiness, and dizziness with antidepressants and antianxiety drugs.
• Nausea, tremors, and kidney issues in long-term lithium use.
• Tardive dyskinesia, a movement disorder caused by long-term antipsychotic use, which affects involuntary muscle movements due to dopamine regulation issues.

Surgical and Invasive Interventions

Some severe mental disorders that do not respond to medication or therapy may require surgical or invasive interventions. These treatments directly alter brain activity to help manage symptoms. While psychosurgery is rare, techniques like ECT and TMS continue to be refined and are used for individuals with severe, treatment-resistant mental disorders. These interventions are carefully considered only when other treatments have not been successful.

Psychosurgery

• Involves lesioning or altering specific brain areas to reduce severe symptoms.
• Lobotomy was a common psychosurgical procedure in the mid-20th century, but it is now almost entirely abandoned due to its severe side effects.
• Modern targeted brain surgeries are sometimes used for extreme cases of obsessive-compulsive disorder (OCD) or epilepsy.

Electroconvulsive Therapy (ECT)

• Uses controlled electrical currents to trigger seizures in the brain, which can help relieve severe depression, bipolar disorder, and psychosis.
• Typically used when medication and therapy have not been effective.
• Modern ECT is much safer than in the past and is done under anesthesia.

Transcranial Magnetic Stimulation (TMS)

• Uses magnetic pulses to stimulate nerve cells in the brain, helping to regulate mood.
• Primarily used for depression, anxiety, and OCD, especially when medication does not work.
• A non-invasive alternative to ECT with fewer side effects.