Treatments Of Mental Disorders

Historical Treatments

  • Trepanning is a historic treatment (dating back to BCE times) involving drilling a 'burr' hole into the body (normally the skull, in this case) to 'relieve pressure'. There are some modern applications (corneal transplant surgery, for instance), but in this context we refer to the outdated attempt to treat intracranial problems - survival rate appears to have been quite high, and infection rate quite low.
  • Frontal Lobotomy is a horrific treatment that was prevalent for three decades around the 1940s. It consisted of separating the connections to and from the prefrontal cortex, often leaving the patient completely incapacitated. Not all patients were left unable to resume their former lives, but it was only with the culture of insulin-coma therapy and other dangerous treatments that allowed it to become mainstream.
  • Insulin-Coma Therapy predates lobotomy and is even more shocking; it involved daily insulin injections for 2 months, increasing the dosage until the patients were falling into comas (only relieved by glucose). There were no formal instructions from the procedure, and patients were left obese, suffering hypoglycaemic shock, brain damaged (sometimes seen as good as a 'loss of hostility') or dead.
  • Mosquito Therapy was pioneered by a man named Wagner-Jaureg, who won the nobel prize (1927) for his discovery that a syphilis-caused mental disorder (paresis) could be treated by a high fever induced from malarial blood. He treated patients with malaria, and then cured them of malaria with quinine.

Biological Treatments

Biological treatments target brain abnormalities directly.

Pharmacological Therapies

Most pharmacological therapies act on neurotransmitters.

  • Antidepressants; SSRIs (e.g. Prozac), act on serotonin - increasing levels of serotonin in the brain in the long term.
  • Anxiolytics; Used for anxiety treatments, act on GABA (increase the levels of the inhibitory neurotransmitter).
  • Antipsychotics; Antipsychotics act on dopamine.
  • Mood stabilisers; Mechanism of action unclear

Other Biological Therapies

  • Electro-convulsive Therapy; Passing a current through anaesthetised brain.
    • Effective for severe treatment-resistent depression.
    • Causes retrograde amnesia.
  • Deep Brain Stimulation; electrodes placed in ventral striatum
    • Improves obsessions and compulsions

Psychological Therapies

Psychological therapies target maladaptive behaviour (behavioural therapies) and thoughts (cognitive therapies). They target brain abnormalities indirectly by concentrating on mental processes and making assumptions about causations.

Psychodynamic Therapy

Psychodynamic therapy (psychoanalytic theory) focusses on resolving unconscious conflicts by overcoming defence mechanisms and brining them int consciousness (Theraputic because takes pressure off of the ego).

Criticisms of Psychoanalysis

  • Psychoanalysis is not very reliable; in the case study below, there are many many ways to interpret the phobia.
  • Psychoanalysis is slow; therapy can take up to 5 years.
  • There are probably more obvious interpretations
  • Hard to gather evidence for its correctness

Humanistic Therapy

Humanistic therapy is 'person centred'; the role of the therapist is to create a non-judgemental environment, and patients develop their own solutions to problems.

The therapy is extremely non-directive; techniques include:

  • Listening
  • Reflecting
  • Understanding
  • Sharing
  • Empathy
  • Unconditional Positive regard

Limitations

Humanism has many limitations, and isn't the best approach for any severe mental illness, or anything that's not lifestyle or the person going through a personal crisis.

Behaviour Therapy

Behavioural therapy is a reaction against psychoanalysis, it believes that if you get rid of the symptoms you get rid of the neurosis.

Behavioural Therapy focusses on changing behaviour so as to change thought. This is done through:

  1. Extinguishing maladaptive learned associations
  2. Preventing reinforcement of maladaptive behaviours
  3. Reinforcing adaptive behaviours

Cognitive Therapy

cognitive therapies focus on identifying and changing unrealistic or unhelpful beliefs. Following the ABC model, modified thoughts lead to modified behaviour.

Examples of Therapy

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Cognitive-Behavioural Therapy (CBT)

Cognitive-Behavioural therapy is a broadened group containing both cognitive and behavioural approaches. There's strong evidence for its effectiveness

Example

E.g. It would take a cognitive approach about a belief (e.g. fast heart beat) and perform an experiment to demonstrate it (e.g. running up stairs for a minute to show that nobody died).

Third-Wave Therapies

Third wave therapies focus on mindfulness and acceptance; they tend to treat maladaptive thoughts by disengaging from rumination and essentially adjusting one's meta to not worry about the present thoughts.

Testing Therapy Effectiveness

  • Randomised Control Trials
    • Using a 'placebo' therapy and randomly assigning clients to one of the two groups and later testing their improvement
  • Definitive outcome variables
    • Figuring out how to measure progress is important; e.g. in a spider phobia, can they hold a toy spider?
  • Compare efficacy of therapies
    • Compare the outcomes