Mental Health Therapies: Psychotherapy & Biomedical Interventions
Mental Health Therapies: An Introduction
Therapies Overview
Purpose: To help individuals manage mental health challenges through therapeutic or medical interventions.
Two Main Types:
Psychotherapies (Talk Therapy): Focus on thoughts, emotions, and coping skills.
Biomedical Therapies: Focus on altering brain chemistry or structure.
Psychotherapies Explained
Working with a trained therapist.
Helps in understanding problems, emotions, and relationships.
Useful for stress, anxiety, depression, and trauma.
Biomedical Therapies Explained
Drug Therapy: Medications (e.g., antidepressants, anti-anxiety drugs) alter brain chemistry.
ECT/Brain Stimulation: Electrical or magnetic stimulation used for severe depression.
Psychosurgery (Lobotomy): Rare today; involves cutting brain connections for extreme cases.
Mental Health Treatment Trends & Needs
Prevalence of Mental Disorders
Adults:
In 2017, 18.9% had a mental illness, but only 14.8% received treatment.
Children (Ages 8–15):
13% had mental health issues, with 50.6% of diagnosed children receiving treatment.
Notes:
ADHD and conduct disorders were more likely to be treated.
Anxiety was less likely to be treated.
Shifting Treatment Trends (Past 25+ Years)
Medication-Only Treatment: Increased from 44% to approximately 60%.
Psychotherapy + Medication: Dropped from 40% to just over 30%.
Psychotherapy Alone: Decreased from 16% to approximately 10%.
Reasons for Trend:
Medications are often more convenient, accessible, and cost-effective.
Therapy can be time-consuming and emotionally demanding.
Concern: Medications may relieve symptoms but not address root issues, where therapy can facilitate deeper healing.
Understanding Psychotherapy
What is Psychotherapy?
Talk therapy for emotional, behavioral, and mental health challenges.
Helps with self-understanding, coping skills, and navigating life changes.
Used for: stress, grief, anxiety, depression, trauma, and relationship issues.
Brief History of Psychotherapy
Roots in ancient Greek philosophical dialogue.
Modern psychotherapy began in the late 1800s with Breuer and Freud’s “talking cure” and the development of psychoanalysis.
Uses for Psychotherapy
Most effective for emotional and psychological issues (e.g., anxiety, depression, grief).
Severe mental illnesses (e.g., schizophrenia, bipolar disorder) often require medication.
Who Provides Psychotherapy?
Psychiatrists (MD/DO): Can prescribe medications and provide therapy.
Psychologists (PhD, EdD, PsyD): Doctoral-level therapy providers.
Psychotherapists (MA, MS, MSW, M.Ed + LPC): Master’s degree and licensure are typically required.
Bachelor’s Degree (BA/BS): Not licensed for independent therapy, but can assist in support roles.
Who Benefits Most from Therapy?
A strong therapist-client relationship (built on trust and respect).
Motivation: Clients who are motivated for change tend to benefit more.
Forced therapy (e.g., court-ordered) is often less effective.
Why Some Don’t Seek Therapy
Stigma (fear of judgment or social disapproval).
Cost, lack of insurance coverage, or limited access to qualified therapists.
Is Psychotherapy Effective?
Most individuals report feeling better and coping more effectively.
The placebo effect and regression toward the mean are contributing factors.
Overall: An effective path for healing and personal growth.
The Psychotherapeutic Relationship
Therapy vs. Talking to Friends
Confidentiality: A safe, private space (with exceptions for danger to self or others).
Non-judgmental: Absence of criticism or minimizing of experiences.
One-Way Focus: Full attention is on the client, not mutual venting.
Objectivity: Therapists are trained to identify patterns and offer objective insight.
Expertise: Therapists possess techniques and skills that friends or family may lack.
Major Systems of Psychotherapy
Four Main Forms
Psychoanalytic Therapy (Freud)
Humanistic Therapy
Cognitive Therapy
Behavior Therapy
Psychoanalytic Therapy (Psychoanalysis)
Overview
Developed by Sigmund Freud.
Focus: Gaining insight into unconscious conflicts.
Goal: To uncover hidden thoughts, feelings, and memories.
Core Technique
Free Association: The client relaxes and says whatever comes to mind. Purpose: To allow unconscious thoughts to emerge.
Cognitive Therapy: Rational Emotive Behavior Therapy (REBT)
Overview of Cognitive Therapy
Focus: How thoughts influence emotions and behaviors.
Key Figures: Aaron Beck and Albert Ellis.
Core Idea: Emotional problems are often caused by faulty or irrational thinking.
Goal: To identify and challenge irrational thoughts to change emotions and behaviors.
Albert Ellis and Rational Emotive Behavior Therapy (REBT)
Developed by Albert Ellis.
One of the first cognitive therapy approaches.
Goal: To identify maladaptive (irrational) thinking patterns and replace them with realistic, adaptive beliefs.
Core Belief of REBT
Emotional distress is caused not by events, but by irrational beliefs about those events.
Common Irrational Beliefs
“I must be loved by everyone.”
“I must be perfect.”
“I must always get my way.”
Problem: These beliefs are unrealistic and often lead to chronic emotional distress.
Rational Alternatives
“Some people will like me, some won’t — that’s life.”
“Sometimes I’ll succeed, sometimes I’ll fail — failure is an opportunity to learn.”
“Sometimes things go my way, sometimes they don’t — that’s normal.”
Core Techniques in REBT
Identify irrational beliefs.
Challenge those beliefs logically.
Replace them with rational, balanced thinking.
Focus on reducing catastrophizing (blowing things out of proportion).
Emphasis on Personal Responsibility
Events or people don’t “make” you feel something.
Your interpretation causes your emotional reaction.
Shift from “She made me angry” to “I interpreted her actions and felt angry.”
Therapist’s Role in REBT
Highly directive: The therapist plays an active, structured role.
The therapist confronts and guides the client toward rational thinking.
Duration of REBT
Often short-term therapy.
Clients are given homework to practice new thinking patterns between sessions.
Behavior Therapies
Rooted in the belief that emotional and psychological problems stem from learned behaviors.
Focus: Changing actions, not unconscious processes or distorted thinking.
Goal: To stop self-defeating or harmful behaviors and replace them with constructive ones.
Target behaviors include: compulsive gambling, shopping, gaming, substance abuse, phobias, and aggression.
Core Techniques
Retraining Techniques (behavior modification):
Reinforcement: Strengthen good behaviors via rewards.
Punishment: Introduce negative consequences to reduce unwanted behaviors (used cautiously).
Extinction: Remove reinforcement maintaining bad behaviors.
Classical Conditioning: Form new associations to change emotional/behavioral responses.
Aversive Conditioning (Aversion Therapy):
Pairs a harmful behavior with something unpleasant.
Example: Penile plethysmograph + ammonia for deviant sexual arousal (controversial and rarely used today).
Systematic Desensitization (SD):
Developed by Joseph Wolpe.
Used mainly for phobias and intense fears.
Based on counterconditioning (the principle that one cannot be simultaneously relaxed and anxious).
Steps:
Teach relaxation techniques (e.g., deep breathing, muscle relaxation).
Create a fear hierarchy (listing situations from least to most anxiety-provoking).
Gradual exposure to the hierarchy while practicing relaxation.
Goal: To remain calm at each level, thereby reducing the fear response.
Structure of Behavior Therapy
Directive: The therapist plays an active, structured role.
Short-term: Focuses on observable actions and practical techniques.
A Frequent Question
Do Therapists Stick to One Therapy Style?
Answer: No, most therapists are eclectic.
They combine methods based on the client’s needs (e.g., cognitive-behavioral therapy with person-centered approaches).
Goal: To provide flexible, personalized treatment.
Biomedical Therapies
Drug Therapies
Psychotropic medications manage symptoms.
They don’t cure disorders but make symptoms manageable.
They have dramatically changed the mental health field (previous treatments were often harsh or institutional).
What Drug Therapies Do:
Relieve symptoms.
Enable other therapies to be more effective.
Have side effects (which vary in severity).
Some are addictive (especially anti-anxiety drugs).
Main Categories:
Anti-Anxiety Drugs: (e.g., Xanax, Ativan) — reduce tension and panic. Carry a risk of addiction.
Anti-Psychotic Drugs: (for schizophrenia, bipolar psychosis) — stabilize thought processes but can have serious side effects.
Anti-Depressant Drugs: (e.g., SSRIs like Prozac, Zoloft; SNRIs like Effexor) — help with depression, anxiety, and PTSD. They are generally not addictive but can be slow to take effect.
Anti-Manic Drugs (Mood Stabilizers): (e.g., Lithium) — treat bipolar disorder by leveling mood swings.
Stimulants: (e.g., Ritalin, Adderall) — treat ADHD by increasing focus and reducing impulsivity.
Electroconvulsive Therapy (ECT)
Developed in the 1930s by Ugo Cerletti.
Induces controlled seizures to “reset” the brain.
Today: Used mainly for severe, treatment-resistant depression (and sometimes mania).
Procedure:
General anesthesia and muscle relaxants are administered.
Electrical shocks (approximately 150 volts) are applied to trigger a controlled seizure.
Several treatments are typically administered over 1–2 weeks.
Effectiveness:
Remission rates range from 60%–85%.
Effects are often temporary, requiring maintenance treatments.
Side Effects:
Memory loss (can be temporary or permanent).
Short-term confusion.
The exact mechanism of action is still not fully understood.
Psychosurgery: Lobotomy
Surgical removal or disruption of brain parts (especially pathways from the frontal lobes to deeper structures).
Developed in the 1930s.
Goal: To reduce severe mental illness symptoms (e.g., agitation, delusions).
Technique:
Early methods involved drilling skull holes and cutting pathways.
Later methods (e.g., transorbital lobotomy by Walter Freeman) used an ice-pick-like instrument through the eye socket.
Effects: While symptoms were reduced, it often caused:
Personality changes
Emotional blunting
Severe cognitive impairments
Transcranial Magnetic Stimulation (TMS)
Noninvasive, uses magnetic pulses.
FDA-approved for depression, especially when medications have failed.
Procedure:
A coil is placed near the scalp.
The patient remains awake and seated.
Minimal pain is experienced (a mild tapping sensation is possible).
Also being explored for: PTSD, Parkinson’s disease, multiple sclerosis, fibromyalgia, tinnitus, hallucinations, and schizophrenia.
Shows promise but is not a cure.
Further research includes rTMS and SAINT therapies.