Abnormal Psychology

Foundations of Treatment 117

When older people actually are depressed, electroconvulsive therapy is

often markedly more effective than it is for younger people. In addition, older

depressed patients may be more likely to receive ECT because they may experi-

ence more side effects of antidepressant medication and so not be able to stay on

the medication long enough—and at a high enough dosage—for their depression

to lift (Rabheru, 2001).

Of all the biomedical treatments presented in this section, the most appro-

priate treatment for Leon’s depression and anxiety would be medication. ECT or

TMS would not be considered appropriate because Leon’s depressive symptoms

don’t seem severe enough. Biofeedback is not a treatment for depression. Surgery

is much too drastic for Leon’s problems, even if it were certain that surgery could

cure depression or anxiety (which it cannot, at least not at present). However, some

of the treatments that target psychological and social factors (discussed in subse-

quent sections) are likely to be as effective as medication for treating depression

and anxiety—if not more so. Further, the positive effects of treatments that target

psychological and social factors often continue after the treatment ends. In contrast,

even if medication were effective for Leon’s depression and anxiety, his symptoms

would probably return after he stopped taking the medication.

Key Concepts and Facts About 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 substances are used to treat psychological disorders.


• Treatments that target neurological factors, sometimes
  referred to as biomedical treatments, include medications,
  brain stimulation (electroconvulsive therapy and transcra-
  nial magnetic stimulation), biofeedback, and, in rare cases,
  neurosurgery.


• Medications can alter synaptic activity by:
  
  
  • mimicking the effects of a neurotransmitter or a neuromodula-
    tor (agonists);
  
  
  • binding to a receptor site, which prevents the neurotransmitter
    in the synapse from binding to the receptor or causes less of it
    to bind (antagonists);
  
  
  • causing the release of extra amounts of a neurotransmitter
    from the terminal button into the synapse;
  
  
  • increasing or decreasing the level or activity of other sub-
    stances that activate or inactivate a neurotransmitter; or
  
  
  • partially blocking reuptake of a neurotransmitter from the
    synapse.
    
    
    • Electroconvulsive therapy (ECT) induces a controlled brain sei-
      zure by passing current through electrodes on the scalp; this
      treatment is performed in a hospital, under anesthesia, and
      usually involves up to a dozen sessions over several weeks. ECT
      is most effective for treating severe depression.
    
    
    • Transcranial magnetic stimulation (TMS) delivers very brief
      magnetic pulses into the cerebral cortex. TMS is approved as
      a treatment for depression when other treatments have failed.
      Unlike ECT, TMS does not require anesthesia (and so need not
      be administered in a hospital), and it has fewer side effects.
    
    
    • Biofeedback is a technique by which patients can bring invol-
      untary bodily activity, such as heart rate or muscle tension, un-
      der voluntary control. Biofeedback training sessions require the
      patient to monitor the targeted bodily activity and, through trial
      and error, discover how to modify this activity.
    
    
    • 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
      effective.
    
    
    • Biomedical treatments used with adults may need to be modi-
      fi ed for use with children or elderly patients.
    
    
    
    
  
  
  
  

Treatments That Target Psychological Factors

Many of the types of treatments that might be most appropriate for Leon’s

depression and anxiety are psychosocial therapies or treatments—treatments

Treatments That Target Social Factors

chological factors specifi cally focus on mental processes, mental contents, affect,

and behaviors (see Table 4.1). A variety of treatments directly target psychological