S-Cool Revision Summary

S-Cool Revision Summary

Self-treatment and medication can be very dangerous.

Not all mental disorders are serious or long lasting - many are mild and short-term.

Most mental disorders can be treated effectively.

Therapy - a course of treatment aimed at changing the way a person thinks, feels or behaves. It is used to try to reduce mental distress or make their behaviour more socially acceptable.

Psychologists have developed many different therapies depending on what they believe to be the causes of various disorders.

It is difficult to identify causes of mental illnesses - there are no simple answers, often there are complex interactions between different factors - the search for the most appropriate and effective treatments goes on.

Appropriate means which therapies are suitable for various different types of disorder.

Effectiveness means how well a therapy works.

There are four psychological approaches used in treating illnesses:

  1. Biological: therapies of this type include psychosurgery, ECT and drug therapy.
  2. Behavioural: therapies of this type include token economy, flooding and aversion therapy.
  3. Cognitive-behavioural (CBT): therapies of this type include rational emotive therapy.
  4. Psychodynamic therapy: therapies of this type include psychodrama and psychoanalysis.

If a mental disorder has a biological cause (for example, chemical imbalance in the brain) it may be possible to treat it by changing the way the body functions. Such methods are also known as physiological treatments or somatic treatments ('soma' means 'body').

Biological treatments interfere with, and change, the body's physiology (biological processes) and, because of this, they can be described as invasive treatments. Such treatments include drug therapies (chemotherapy), electro-convulsive therapy (ECT) and psychosurgery (surgical procedures).

Drug treatments are known as chemotherapy - using chemicals to change the way the brain or body works.

Drug treatments for mental disorders were first introduced in the 1950s - reducing by thousands the number of people permanently in hospitals.

Drugs that change the way a person thinks or behaves are called psychoactive drugs.

Drugs used to treat mental disorders - psychotherapeutic drugs - alter the chemical functioning of the brain by affecting the action of neurotransmitters.

Neurotransmitters: Chemicals that transmit impulses across the microscopic gaps between nerve cells called synapses. Changes in the brain's neurotransmitter systems lead to changes in moods, feelings, perception and behaviour.

How do psychotherapeutic drugs affect neurotransmitters?

A drug might be so similar to a neurotransmitter that it can imitate it and interfere with its activity by moving into the receptor sites.

Other drugs might block receptor sites so that the effects of a neurotransmitter are dampened down. Some neuroleptic (or 'antipsychotic') drugs, used to treat schizophrenia work in this way.

Other drugs work by slowing down the re-uptake of neurotransmitters so they hang around in synapses affecting receptor sites for longer. Antidepressant drugs called SSRI's work in this way (selective serotonin re-uptake inhibitors).

What are the main types of drugs used to treat mental disorders?

Anti-psychotic drugs (neuroleptics) Used to treat schizophrenia. These dampen down 'psychotic' symptoms such as delusions and hallucinations - for example, chlorpromazine and clozapine.
Anti-depressants Used mainly for depression, sometimes used for panic disorder, some phobias and obsessive-compulsive disorder. For example: tricyclic drugs, MAOI's and SSRI's (for example, Prozac).
Anti-anxiety drugs (anxiolytic drugs) Help reduce the disabling symptoms of anxiety disorders - for example, Valium.
Anti-manic drugs Used to treat states of mania. Also used for 'bipolar disorder' ('manic-depression') involving extreme mood cycles from highs (mania) to deep lows (depression) - for example, lithium.

In the 1950s the anti-psychotic drug chlorpromazine heralded dramatic changes in the treatment of mental disorders.

Do you remember the names of some anxiety disorders?

  1. Generalised anxiety disorder (GAD)

  2. Panic disorder (PD)

  3. Obsessive-compulsive disorder (OCD)

  4. Post-traumatic stress disorder (PTSD)

  5. Phobias

Do drug treatments work?

Yes. Most drug treatments are very effective in relieving frightening and distressing symptoms for many people, enabling them to manage day-to-day life more easily. Drug treatments do not work for everybody though, and individuals can respond differently to the same drug treatments.

What about side effects?

Unfortunately, most psychotherapeutic drugs have some unwanted side effects.

Side effects vary between individuals and dosages taken.

A drug treatment is still effective if the improvements to an individual's life outweigh the side effects.

Medication: Some possible side effects:
Anti-psychotic medication Can be fairly mild (tiredness, sleepiness) or more serious spasms, shuffling gait, slow speech and tardive dyskinesia. More severe side effects are associated with long-term, high dose medication.
Tricylic drugs
(Anti-depressant medication)
Common side effects are blurred vision, dry mouth, weight gain, constipation and decreased interest in sex.
SSRIs (selective serotonin re-uptake inhibitors)
(Anti-depressant medication)
Digestive problems, headaches, insomnia and vivid dreams.
MAOIs (monamine oxidase inhibitors)
(Anti-depressant medication)
React very badly with some other drugs and foods - for example, cold remedies, cheese, 'Marmite' and red wine. This reaction can be life-threatening - special dietary rules have to be followed.
Anti-anxiety medications Serious and possibly life-threatening reactions if mixing benzodiazepines with alcohol or some other medicines. Possible dependence if used long-term and withdrawal reactions if stopped suddenly.

Always Remember:Never take prescription drugs that have not been prescribed for you!

A very controversial treatment, first used in 1938 to treat schizophrenia and widespread during the 1940s.

Psychiatrists used ECT for all sorts of disorders including alcoholism, personality disorders, and eating disorders. It is now considered inappropriate for these disorders and schizophrenia.

ECT is used very rarely now. Successful drug treatments have emerged since the 1950s.

What happens in ECT?

A weak current is passed across the temples for 0.5 - 4 seconds. The patient's body goes into convulsions that are reduced by muscle relaxants and anaesthetic (a mouth gag prevents the tongue being bitten). Oxygen is given before and after treatment to aid recovery. Therapy usually consists of a series of shock treatments over several weeks.

Does ECT work?

ECT may seem brutal but it seems to benefit some people with acute depression when other treatments have not worked.

No one really knows what ECT does to the brain or why it sometimes has a positive effect on severely depressed people.

ECT might work by altering the person's memory or by chemically changing their brain's functioning.

The side effects of ECT are not fully understood. Not surprisingly, the patient suffers confusion and muscular aches afterwards. Memory can also be affected.

When it was first used, some patients died in ECT due to undetected heart defects - patients are now screened carefully before the treatment is allowed.

Many people have objected to the use of ECT because we do not fully understand the effects of it. Critics have said it's a bit like kicking a television, or hitting a computer, to make it work.

What is Psychosurgery?

Psychosurgery is another very controversial type of treatment.

Psychosurgery has been used since prehistoric times and means surgical procedures carried out on the brain to treat mental disorders.

What were the effects of the pre-frontal lobotomy?

Here are some of them:

  1. Calmer, apathetic patients.

  2. Partial paralysis.

  3. Reduced intellectual functioning and inability to learn.

  4. Loss of emotional response to others.

  5. Loss of memory.

  6. Childlike and slovenly behaviour.

  7. The procedures often destroyed individual personalities and, in some cases, caused death.

Why was it used?

The pre-frontal lobotomy became a common surgical procedure - psychiatrists used it in desperate attempts to find treatments for people. Tens of thousands of people had these operations for many different mental disorders.

Does psychosurgery work?

Moniz claimed that he had a 70% success rate in curing schizophrenia, compulsions and anxiety disorders.

Many people have expressed grave doubts about these claims. The techniques might have reduced 'psychotic' symptoms, but the after effects could be so severe that they probably did more harm than good. The techniques did not have a thorough scientific basis - no one really knew what they were doing. Surgery was often forced upon people and the results - all irreversible - varied tremendously, from mild changes in memory or intellectual ability to fatalities.

In 1949, Moniz won a Nobel Prize for his contribution to medicine. (Unfortunately, he was later paralysed when he was shot by one of his former patients!)

Are these techniques still used?

The techniques described above are no longer in use. In the 1950s, drug therapies meant that such desperate remedies no longer needed to be attempted.

Is Psychosurgery still used?

Yes, but the techniques are different. It is sometimes used to alleviate extreme depression or obsessive-compulsive disorder, when other treatments have failed to help. In today's methods, only very small amounts of brain tissue are destroyed by heat or radioactivity. The risks of side effects are lower, and the person appears normal after the surgery. Patients must give fully informed consent for treatment.

Do today's techniques work?

Today's techniques seem to be successful for some people. Psychiatrists have said that if the risk of suicide is reduced and some lives are saved in this way, then that is enough to justify the treatment.

How does psychosurgery work?

The short answer to that is that no one really knows. Further research might tell us more about it in the future. In spite of all our sophisticated technology, we still don't know much about our own brains - probably the most complicated things in the universe!

Behavioural therapies are based on the idea that abnormal behaviour can be learned.

According to this approach, successful training can alter a person's behaviour by teaching new responses. Unwanted or distressing behaviour can be 'extinguished'.

Changing behaviour through a training programme is called conditioning. Classical conditioning means learning by direct association.

Remember Pavlov's classic experiments with dogs?

Pavlov noticed that his laboratory dogs salivated before their food arrived - he devised an experiment to see if he could make them salivate to different stimuli. He called his training method 'conditioning'. Pavlov started with the natural, unconditioned response of salivating to the natural, unconditioned stimulus of food. Salivation is a reflex response - it happens automatically without the need for thought. The light bulb is at first a meaningless, unconditioned stimulus to the dog. After repeated trials, the dog learns by association that the light means food. Eventually, the light is flashed without food, and the dog salivates; the light became a conditioned stimulus. Salivating at the flashing light was a conditioned response.

Operant conditioning means learning to perform certain actions to receive rewards or avoid punishment.

The principles of classical and operant conditioning theory have been applied to humans in various types of behavioural therapy for mental disorders.

Behavioural Therapy: What happens? Disorders treated: Ethical issues and effectiveness:
Flooding Maximum Exposure to most feared situation until fear subsides. Some types of specific phobia, for example, fear of heights. Successful for many phobias. If not completed, anxiety may be made worse!
Systematic Desensitisation Gradual exposure to feared situation or object while relaxed. Specific phobias and anxieties such as unrealistic fear of criticism or failure. 'Homework' tasks, in situations person feels anxious in, essential if situation cannot be recreated.
Aversion Therapy Unwanted behaviour is associated with unpleasant stimulus - feeling sick or electric shock. Some types of addiction, for example, smoking, overeating, alcoholism.
Small pic of alcohol bottle?
Deliberate pain and discomfort inflicted. Most notoriously, used in past to try to change sexuality of homosexuals and transvestites.
Token Economy Tokens given for 'good' behaviour. Tokens saved up and exchanged for reward later. Used to shape behaviour of patients in mental hospitals. Successful in socialising disturbed patients. Can break down outside institutional setting.
Modelling Person gradually learns from others who are relaxed in situations that normally make them feel anxious. Some phobias, for example, of snakes or dogs, and some other anxieties, for example, used in sex therapy. Successful in treating phobias and socialising disturbed patients both inside and outside hospital environments - therapists modelling behaviour.

Psychodynamic therapies are 'talking therapies' derived from the work of Sigmund Freud in the early 20th Century.

Freud developed a therapy called psychoanalysis.

Freud's original ideas have since been modified to produce many related but different therapies, collectively known as 'psychodynamic' therapies.

Here is an outline of the basics of psychoanalysis:

Freud compared the mind to an iceberg. Most of the things going on in our minds are in our 'unconscious' so we are not aware of them. Conflicts going on in the unconscious mind can cause disorders of thought and behaviour.

To treat someone for disturbed behaviour it is necessary to try to find out what unconscious conflicts they may have.

Traumatic events in our childhood are highly likely to cause unconscious conflicts and 'repression' of unpleasant memories that create anxiety disorders later in life.

In psychoanalysis, Freud would have a patient lie on a couch to relax, and he would sit behind them taking notes while they told him about their dreams and childhood memories.

Sometimes Freud used 'free association' - a technique in which the patient would respond to prompts by saying whatever came into their minds. Patients would be encouraged to say anything no matter how bizarre or embarrassing it might seem. Freud would analyse what they said for clues to unconscious conflicts.

Once a traumatic event in the past, or source of conflict had been brought to the surface in this way the patient might feel very emotional. Transference might occur - in which the patient would transfer emotional feelings onto the therapist.

The next stage was 'working through' the previously unconscious source of conflict to come to terms with it and find ways of dealing with it.

Psychoanalysis would be a lengthy process, involving many sessions with the psychoanalyst. For Freud, just trying to cure a phobia of horses by gradual exposure to horses would not be a 'cure'. The underlying unconscious conflicts would need to be resolved.

In the case of 'little Hans', Freud's only child patient, a phobia of horses was related to Hans' fear of castration - in spite of the fact that Hans had seen an accident involving a horse and been afraid.

Freud's ideas have been very fiercely criticised but he did introduce a new way of dealing with psychological problems - just talking about them!

CBT is based on cognitive theories that some mental disorders may involve 'faulty' or irrational thinking or perception. For example, someone suffering from anorexia nervosa nay not be able to see himself or herself as too thin, even when they are extremely underweight. A person suffering from depression may blame themselves unnecessarily for things that have gone wrong.

Treatment, known as cognitive restructuring aims to train a person to think differently and, by doing this, to change their behaviour for the better.

The focus is on how the person thinks rather than acting directly on their behaviour (as with behavioural therapies).

There are several types of CBT:

The two most important ones to know about are:

  1. Rational emotive therapy.

  2. Stress inoculation therapy.

Ellis developed RET in the 1950s.

It is assumed that the person has persistent self-defeating thoughts that are unrealistic.

RET aims to challenge these thoughts by helping the client to recognise them and discuss them.

Clients are then taught to replace their 'irrational' thoughts with new, more constructive and realistic ones.

RET can involve very tough and challenging conversations between client and therapist.

'Homework' assignments for the clients to test themselves out between sessions are part of this approach.

RET seems to be successful in treating some types of social anxiety. Research suggests that it could be used for the management of anger and depression. It might even be useful in helping 'normal' people manage stress.

A major difficulty with evaluating RET is that it is difficult to define 'irrational thinking'. Psychologists cannot agree on this and RET therapists and their clients decide which thought patterns should be changed.

Meichenbaum developed SIT in the 1970s.

Like RET, this therapy aims to teach clients to replace self-defeating thoughts with more positive ones, and to practice this until it becomes a habit.

As it is called stress inoculation therapy you can see that it is intended as a way of training people to be able to cope with stress before it has become a serious problem.

SIT is used in many workplace situations to help people manage their jobs better.

In SIT clients are encouraged to think differently and taught new skills for dealing with various situations that they might find stressful. Clients then practice those skills to be prepared for them when a real situation arises in the future.

SIT is a sort of preventative treatment for stress-related mental disorders that have seriously damaging effects on people's lives. In this way it is an unusual therapy.