Abnormal Psychology

150 CHAPTER 4

SUMMING UP

Summary of Treatments

That Target Neurological

Factors

The goal of treatment is to reduce or eliminate

problems or symptoms and/or to improve

quality of life. Various procedures and sub-

stances are used to treat psychological disor-

ders. Treatments that target neurological factors,

sometimes referred to as biomedical treatments,

include medications, brain stimulation, biofeed-

back, and, in rare cases, neurosurgery. Medica-

tions can alter synaptic activity in various ways.

Electroconvulsive therapy (ECT) induces

a controlled brain seizure by passing current

through electrodes on the scalp. ECT is most

effective for treating severe depression. Trans-

cranial magnetic stimulation (TMS) delivers

very brief magnetic pulses into the cerebral

cortex. Unlike ECT, TMS does not require

anesthesia and it has fewer side effects.

Biofeedback is a technique by which

patients can bring involuntary bodily activity,

such as heart rate or muscle tension, under vol-

untary control. Neurosurgery, usually considered

a treatment of last resort, is sometimes used to

modify brain structures that contribute to severe

disorders in cases where other treatments have

not been suffi ciently effective. Biomedical treat-

ments used with adults may need to be modifi ed

for use with children or elderly patients.

Thinking like a clinician

Nita has been depressed for several weeks;

although she’s often teary and feels hopeless,

she’s able to function well enough at her job.

She doesn’t want to talk to a therapist about

it (“I don’t want any counseling or therapy”),

but she’s willing to see a psychiatrist for one

visit (“Just to see whether there’s anything

that can help”). If the psychiatrist recommends

a treatment that targets neurological factors,

what is it likely to be and why? What would be

the goal—in terms of neurological factors—of

that particular type of treatment? Why would

other treatments targeting neurological fac-

tors not be appropriate? What, in particular,

should the psychiatrist want to know about

Nita before making a recommendation?

Summary of Treatments

That Target Psychological

Factors

Psychodynamic therapy and psychoanaly-

sis are intended to help each patient more

adaptively manage unconscious confl icts that

arise in large part from id-driven impulses and

urges. They are supposed to do so by helping

the patient develop insight into events in his

or her past and how these events and uncon-

scious forces infl uence current diffi culties.

Client-centered therapy is designed to

integrate the sense of self by decreasing the

incongruence between a patient’s real and ideal

selves. According to the theory of client-centered

therapy, with an integrated sense of self comes

reduced emotional pain.

Behavioral treatments use both classical

and operant conditioning techniques (includ-

ing habituation and extinction) to change

behavior. Behavioral methods often focus

attention on the antecedents and conse-

quences of a maladaptive behavior, as well as

the behavior itself.

Cognitive methods based on Ellis’s rational

emotive behavior therapy (REBT) are designed

to dispute beliefs that lead to maladaptive

consequences. Methods based on Beck’s cog-

nitive restructuring challenge patients’ mal-

adaptive automatic negative thoughts, and

encourage patients to test the accuracy of

their beliefs through real-life experiments.

The behavioral aspects of cognitive-

behavior therapy (CBT) are intended to trans-

form maladaptive behaviors that stem from

previous learning, whereas the cognitive

aspects of CBT are intended to modify irratio-

nal thoughts and incorrect beliefs that influ-

ence feelings and behavior in a maladaptive

way. Changing behaviors and thoughts in turn

alters feelings as well.

Technology is being incorporated into

treatment through the use of electronic

methods for self-monitoring, cognitive restruc-

turing, virtual exposure, and cybertherapy.

However, cybertherapy has drawbacks: The

therapist could be an imposter, confidential

information may not remain private, and the

lack of nonverbal cues for the therapist may

skew the treatment in a less helpful direction.

Thinking like a clinician

After seeing the psychiatrist, Nita decides

that she definitely doesn’t want anyone

“messing with my brain” and will try psycho-

therapy instead of a neurological interven-

tion. List the types of questions a therapist

with each theoretical orientation that targets

psychological factors—psychodynamic, hu-

manist, behavioral, and cognitive—might

ask of Nita. What specifi c types of informa-

tion would each therapist want, based on his

or her orientation? What techniques might

each type of therapist use in treating Nita’s

depression?

Summary of Treatments

That Target Social Factors

Treatments that target social factors are designed

to reduce symptoms and/or improve quality of

life by changing a person’s relationships for the

better and by creating, expanding, or improving

a person’s sense of community. Interpersonal

therapy (IPT) is intended to address a patient’s

problematic relationships and improve his or

her interpersonal skills so that relationships

become more satisfying; the theory is that as

relationships improve, the symptoms of psycho-

logical disorders will lessen.

Family therapy can be conducted using

most theoretical approaches; depending on the

specifi c approach, the focus of family therapy

may be an individual patient in the context of

his or her family, or the family itself. In contrast,

systems therapy views the entire family as the

unit of change and is designed to improve com-

munication or behavior patterns among family

members and in doing so change the system.

Group therapy, in which patients with

similar needs meet together with one or two

therapists, can be based on various theoreti-

cal approaches, such as psychodynamic ther-

apy or CBT.

Treatment can occur in different settings and

with differing levels of intensity, ranging from

once-a-week outpatient treatment to partial

hospitalization, residential treatment, and in-

patient treatment. People can also receive help

for psychological disorders in self-help groups

and through bibliotherapy. Prevention programs

target those at risk for a variety of psychological

disorders. Treatments for children and elderly

patients that target social factors may need to

be modifi ed for those specifi c populations.

Therapists should try to be aware of—

and discuss with patients—any cultural,

demographic, or other significant difference

between themselves and their patients that

could affect the goals and expectations of

treatment or create miscommunication and

misunderstanding. Mental health services that

are tailored to the needs of a specifi c cultural

or ethnic group are more likely to be used by

members of that group.

Thinking like a clinician

Community Psychiatric Hospital has had

its budget slashed dramatically and thus is

trying to help its highest functioning inpa-

tients move into supervised housing in the

community. What are the different types of

living situations that might be available?

Why might the hospital want to offer group

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