Abnormal Psychology

CHAPTER 4 Foundations of Treatment

P S

N

P S

N

Although a given treatment targets a particular factor or set of factors, the

treatment also creates feedback loops among factors: As some symptoms are

reduced or quality of life improves, these changes in turn affect additional factors,

other than those directly targeted. A rising tide raises all boats. Throughout this

book, we highlight sections that discuss these treatment-initiated feedback loops

by placing in the margin our feedback loop icon, along with an arrow pointing

to the type of factor that is being directly targeted by the treatment. For instance,

suppose that medication (which directly targets a neurological factor) success-

fully treated Leon’s social phobia so that he was able to interact with people more

freely (social factor) and not be anxious beforehand or ruminate about it after-

ward (psychological factor). Because social situations would no longer fi ll him with

dread, he would in turn be less aroused in such situations (neurological factor).

Let’s review the most common methods of treatment, considering them in terms

of the type of factor that is each treatment’s primary target.

Treatments That Target Neurological Factors

One way to treat Leon’s depression and anxiety would be to make neuro-

logical factors the direct target of treatment. Biomedical treatments reduce

target symptoms and/or improve quality of life by changing brain function-

ing, hormonal activity (which is regulated by the brain), or another aspect

of bodily functioning (which typically is also regulated by the brain; see

Table 4.1). Thus, the general goal of these treatments is to change neuro-

logical functioning directly in some way; as we shall discuss, several differ-

ent methods can achieve this goal.

Medications that Change Brain Functioning

Throughout the ages and across cultures, healers have treated abnormal

thoughts (mental processes and mental contents), feelings (affect), and be-

haviors by dispensing medicines to sufferers. Using medication to reduce

or eradicate symptoms of psychological disorders, and the study of such

treatment, is termed psychopharmacology. Medications that affect mental process or

mental contents, affect, or behavior are called psychotropic medications. Psychotropic

medication is most frequently administered as pills, but can also be administered via

skin patches (which allow it to be absorbed through the skin), or by injection.

Goals of Medication

Medications generally are intended to affect neurological factors (such as over-

arousal in anxiety disorders) or psychological factors (such as thoughts, feelings,

and behaviors related to depression) by increasing or decreasing specifi c types of

brain activity; that is, medications cause particular sets of neurons to fi re more or

less than they otherwise would.

The key point about successful treatment with medication is that the benefi cial

effects go beyond altering brain activity—the changes in brain activity, in turn, infl uence

psychological factors (mental processes, mental contents, affect, and behavior) and so-

cial factors (interactions with family members, friends, and coworkers). These positive

psychosocial changes in turn infl uence neurological and other biological processes.

Methods of Medication

Medication can alter neural activity in several ways. Figure 4.1 on the next page

shows a synapse—the space between the sending neuron’s terminal button and the

receiving neuron’s dendrite—and the various methods by which medications can

alter neuronal activity. Medications can alter activity in the synapse by:

• mimicking the effects of a neurotransmitter or a neuromodulator, thereby activat-

ing a particular type of receptor; such medications are called agonists.

Keith Philpott/Time Life Pictures/Getty Images

By defi nition, biomedical treatments target neu-

rological factors, but such treatments also affect

other sorts of factors. In particular, the relationship

between the patient and the person providing the

treatment is itself an intervention that addresses

social factors: The patient receives support, advice,

and, at least some of the time, the feeling that

someone cares. Biomedical treatments—like any

type of treatment—also address psychological

factors by giving the patient hope and a frame-

work for understanding his or her symptoms and

problems.