Types of Treatment
Learning Objectives
By the end of this section, you will be able to:
- Distinguish between psychological, biological and integrative approaches to treatment
One of the goals of therapy is to help a person stop repeating and reenacting destructive patterns and to start looking for better solutions to difficult situations. This goal is reflected in the following poem:
Autobiography in Five Short Chapters by Portia Nelson (1993)
Chapter One
I walk down the street.
There is a deep hole in the sidewalk.
I fall in.
I am lost. . . . I am helpless.
It isn’t my fault.
It takes forever to find a way out.
Chapter Two
I walk down the same street.
There is a deep hole in the sidewalk.
I pretend I don’t see it.
I fall in again.
I can’t believe I am in this same place.
But, it isn’t my fault.
It still takes a long time to get out.
Chapter Three
I walk down the same street.
There is a deep hole in the sidewalk.
I see it is there.
I still fall in . . . it’s a habit . . . but,
my eyes are open.
I know where I am.
It is my fault.
I get out immediately.
Chapter Four
I walk down the same street.
There is a deep hole in the sidewalk.
I walk around it.
Chapter Five
I walk down another street.
Two types of therapy are psychotherapy and biomedical therapy. Both types of treatment help people with psychological disorders, such as depression, anxiety, and schizophrenia. Psychotherapy is a psychological treatment that employs various methods to help someone overcome personal problems, or to attain personal growth. In modern practice, it has evolved into what is known as psychodynamic therapy, which will be discussed later. Biomedical therapy involves medication and/or medical procedures to treat psychological disorders. First, we will explore the various psychotherapeutic orientations outlined in Table 15.1 (many of these orientations were discussed in the Introduction chapter).
| Table 15.1 Various Psychotherapy Techniques | ||
|---|---|---|
| Type | Description | Example |
| Psychodynamic psychotherapy | Talk therapy based on belief that the unconscious and childhood conflicts impact behaviour | Patient talks about his past |
| Play therapy | Psychoanalytical therapy wherein interaction with toys is used instead of talk; used in child therapy | Patient (child) acts out family scenes with dolls |
| Behaviour therapy | Principles of learning applied to change undesirable behaviours | Patient learns to overcome fear of elevators through several stages of relaxation techniques |
| Cognitive therapy | Awareness of cognitive process helps patients eliminate thought patterns that lead to distress | Patient learns not to overgeneralize failure based on single failure |
| Cognitive-behavioural therapy | Work to change cognitive distortions and self-defeating behaviours | Patient learns to identify self-defeating behaviours to overcome an eating disorder |
| Humanistic therapy | Increase self-awareness and acceptance through focus on conscious thoughts | Patient learns to articulate thoughts that keep her from achieving her goals |
Biomedical Therapies
Individuals can be prescribed biologically based treatments or psychotropic medications that are used to treat mental disorders. While these are often used in combination with psychotherapy, they also are taken by individuals not in therapy. This is known as biomedical therapy. Medications used to treat psychological disorders are called psychotropic medications and are prescribed by medical doctors, including psychiatrists. In Louisiana and New Mexico, psychologists are able to prescribe some types of these medications (American Psychological Association, 2014).
Different types and classes of medications are prescribed for different disorders. An individual with depression might be given an antidepressant, an individual with bipolar disorder might be given a mood stabilizer, and an individual with schizophrenia might be given an antipsychotic. These medications treat the symptoms of a psychological disorder by altering the levels or effects of neurotransmitters. For example, each type of antidepressant affects a different neurotransmitter, such as SSRI (selective serotonin reuptake inhibitor) antidepressants that increase the level of the neurotransmitter serotonin, and SNRI (serotonin-norepinephrine reuptake inhibitor) antidepressants that increase the levels of both serotonin and norepinephrine. They can help people feel better so that they can function on a daily basis, but they do not cure the disorder. Some people may only need to take a psychotropic medication for a short period of time. Others with severe disorders like bipolar disorder or schizophrenia may need to take psychotropic medication for a long time.
Psychotropic medications are a popular treatment option for many types of disorders, and research suggests that they are most effective when combined with psychotherapy. This is especially true for the most common mental disorders, such as depressive and anxiety disorders (Cuijpers et al, 2014). When considering adding medication as a treatment option, individuals should know that some psychotropic medications have very concerning side effects. Table 15.2 shows the commonly prescribed types of medications, how they are used, and some of the potential side effects that may occur.
| Table 15.2 Some Commonly Prescribed Psychotropic Medications | ||||
|---|---|---|---|---|
| Type of Medication | Used to Treat | Brand Names of Commonly Prescribed Medications | How They Work | Side Effects |
| Antipsychotics (developed in the 1950s) | Schizophrenia and other types of severe thought disorders | Haldol, Mellaril, Prolixin, Thorazine | Treat positive psychotic symptoms such as auditory and visual hallucinations, delusions, and paranoia by blocking the neurotransmitter dopamine | Long-term use can lead to tardive dyskinesia, involuntary movements of the arms, legs, tongue and facial muscles, resulting in Parkinson’s-like tremors |
| Atypical Antipsychotics (developed in the late 1980s) | Schizophrenia and other types of severe thought disorders | Abilify, Risperdal, Clozaril | Treat the negative symptoms of schizophrenia, such as withdrawal and apathy, by targeting both dopamine and serotonin receptors; newer medications may treat both positive and negative symptoms | Can increase the risk of obesity and diabetes as well as elevate cholesterol levels; constipation, dry mouth, blurred vision, drowsiness, and dizziness |
| Anti-depressants | Depression and increasingly for anxiety | Paxil, Prozac, Zoloft (selective serotonin reuptake inhibitors, [SSRIs]); Tofranil and Elavil (tricyclics) | Alter levels of neurotransmitters such as serotonin and norepinephrine | SSRIs: headache, nausea, weight gain, drowsiness, reduced sex drive Tricyclics: dry mouth, constipation, blurred vision, drowsiness, reduced sex drive, increased risk of suicide |
| Anti-anxiety agents | Anxiety and agitation that occur in OCD, PTSD, panic disorder, and social phobia | Xanax, Valium, Ativan (Benzodiazepines) Buspar (non-Benzodiazepine) | Depress central nervous system activity | Drowsiness, dizziness, headache, fatigue, lightheadedness |
| Mood Stabilizers | Bipolar disorder | Lithium, Depakote, Lamictal, Tegretol | Treat episodes of mania as well as depression | Excessive thirst, irregular heartbeat, itching/rash, swelling (face, mouth, and extremities), nausea, loss of appetite |
| Stimulants | ADHD | Adderall, Ritalin | Improve ability to focus on a task and maintain attention | Decreased appetite, difficulty sleeping, stomachache, headache |
Integrative Approach to Treatment
To this point we have considered the different approaches to psychotherapy under the assumption that a therapist will use only one approach with a given patient. But this is not the case; the most commonly practised approach to therapy is an integrative (eclectic) therapy, an approach to treatment in which the therapist uses whichever techniques seem most useful and relevant for a given patient. For bipolar disorder, for instance, the therapist may use both psychological skills training to help the patient cope with the severe highs and lows, but may also suggest that the patient consider biomedical drug therapies (Newman et al., 2002). Treatment for major depressive disorder usually involves antidepressant drugs as well as CBT to help the patient deal with particular problems (McBride et al., 2007).
