Psychology by P. Gray and D. F., Bjorkland (eight edition) – Summary chapter 16

The caring for people with psychological disorders used to be non-existent. Nowadays, there is more care. Since the 1970s, assertive community treatment has existed, aimed at helping a person with severe psychological problems and preventing hospitalization.

Electroconvulsive therapy is used primarily in cases of severe depression that does not respond to psychotherapy or antidepressant drugs. The treatment consists of people receiving anaesthesia and passing an electric current through a patient’s skull triggering a seizure in the brain that lasts approximately one minute. The shocks and the seizures promote the producing of neurotransmitters and the sensitivity of postsynaptic receptors. It also stimulates the growth of new neurons. The most frequent side effect of the treatment is memory loss, although this mostly clears up within a few months after the treatment.

Psychosurgery is a last-resort treatment, which involves surgically cutting or producing lesions in portions of the brain to relieve a psychological disorder. The consequence of prefrontal lobotomy was that people did not have access to their executive functions anymore and needed constant care. In deep brain stimulation, a thin wire electrode is planted permanently in the brain, usually in the cingulum or in a portion of the basal ganglia for patients with OCD, and this electrode can be activated in order to electrically stimulate, rather than destroy the neurons lying near it.

Psychotherapy aims to treat psychological disorders through talk, reflection, learning and practice. Psychotherapy is any theory-based, systematic procedure, conducted by a trained therapist, for helping people to overcome or cope with mental problems through psychological rather than physiological means. Each major approach in psychotherapy draws on a set of psychological principles and ideas that apply to adaptive as well as maladaptive behaviour:

1. The psychodynamic approach focusses on the idea that unconscious memories and emotions influence our conscious thoughts and actions
2. The humanistic approach focusses on the value of self-esteem and self-direction and that people need psychological support in order to freely pursue their own chosen goals.
3. The behavioural approach focusses on the roles of basic learning processes.
4. The cognitive approach focusses on the idea that people’s ingrained, habitual ways of thinking affect their moods and behaviour.

Psychoanalysis refers to the forms of therapy that are closely tied to Freud’s ideas. Psychodynamic therapy is used to include psychoanalysis and therapies that are more loosely based on Freud’s ideas. Psychodynamic therapy focusses on the fact that mental problems arise from unresolved mental conflicts, which themselves arise from the holding of contradictory motives and beliefs. Symptoms are surface manifestations of the disorder. The disorder itself is buried in the person’s unconscious mind and must be unearthed before it can be treated. The elements of thought that are the least logical give clues to the unconscious motive and psychodynamic therapists use three techniques to find these elements of thought:

1. Free association as clues to the unconscious
2. Dreams as clues to the unconscious
3. Mistakes and slips of the tongue as clues to the unconscious

Patients often resist the therapist’s attempt to bring their unconscious memories or wishes into consciousness. The resistance may manifest itself in for example refusing to talk about a topic, forgetting to come to the sessions. Resistance may give an insight into the unconscious thoughts. To avoid too much resistance, the therapist must present interpretations gradually. Transference also occurs in psychodynamic therapy. This happens when the patient’s unconscious feelings towards someone are projected onto the therapist.

Humanistic therapies are built upon two fundamental psychological ideas:

1. Humans have the capacity to make adaptive choices regarding their own behaviour
2. In order to feel good about themselves, to feel motivated and to move forward in life, people need to feel accepted and approved of by others.

The humanistic views emphasized the inner potential for positive growth, the actualization potential. The goal of humanistic therapy is to help people regain awareness of their own desires and control of their own lives. It is also called person-centred therapy. The relationship between the therapist and the patient is very important. The therapist lets the patient take the lead in therapy, strives to understand and emphasise with the client and endeavours to think positively and genuinely of the patient as a competent, valuable person. Therapists paraphrase what the patient said.

Unconditional positive regard implies a belief on the therapist’s part that the patient is worthy and capable even when the patient may not feel or act that way. By expressing positive feelings about the patient regardless of what the patient says or does, the therapist creates a safe, non-judgemental environment.

Behavioural and cognitive therapies state that the symptoms are the problem. Behaviour therapy is symptom orientated and concerned with immediate, measurable results. The two most common types of treatment in behaviour therapy are contingency management therapy and exposure therapy. Contingency management is a therapy that is focused on altering the contingency between actions and rewards (e.g: people afraid of dogs are rewarded by not seeing dogs by not being afraid, thus they stay afraid of dogs).

If there is an unconditioned fear response to something, then there is habituation, because of exposure therapy. If there is a conditioned fear response to something, then there is extinction, as a result of exposure therapy. There are three different means to present feared stimuli to clients in exposure treatment:

1. Imaginal exposure
2. In vivo exposure (real-life exposure)
3. Virtual reality exposure

Cognitive therapy deals with maladaptive habits of thought. Cognitive therapy starts with the assumption that people disturb themselves through their own, often illogical beliefs and thoughts. There are three general principles in cognitive therapy:

1. Identification and correction of maladaptive beliefs and thoughts
   This is done in several ways, for example, using humour or using Socratic dialogue.
2. Establishment of clear-cut goals and steps for achieving them
   Once the maladaptive belief has been identified, it has to be corrected by a more rational and adaptive way of thinking. This can take long
3. Moving from a teaching role to a consulting role with the patient
   After a while, the therapist becomes less of a teacher and more of a consultant.

In cognitive therapy, there is an ABC theory of emotions. A is the activating event, B is the belief that is triggered in the patient’s mind when the event occurs and C is the emotional consequence of the triggered belief. The therapy changes the belief.

Therapy helps. About 75% - 80% that receive psychotherapy improve upon their condition. There is no therapy superior to another type of therapy, but some types of therapy might work better for some disorders than for other disorders. All therapies include some common factors:

1. Support
   This includes acceptance, empathy and encouragement.
2. Hope
3. Motivation
   The active agent of change is the patient himself and this change requires motivation.