Psychological Perspectives in the Treatment of Disorders

Perspectives on Psychological Disorders

Teen having a counseling session with a therapist, pexels.com

As experts in psychology learn about psychological disorders, developing one perspective after another gives us a better understanding of how mental illnesses occur, paving the way for more research and identifying the best treatments.

Biological Perspective

From the biological perspective, genetic influence contributes to the development of psychological disorders and chemical imbalances (e.g., neurotransmitters and hormones), and abnormal brain development. Understanding brain structure and function through recent technological advances in brain imaging revealed how abnormalities increase the risk for mental disorders. Regarding OCD, having first-degree relatives with the disorder increases the chance of having it. Other psychological disorders with genetic components include schizophrenia, bipolar disorder, and ADHD.

Psychosocial Perspective

This perspective states that stress, negative thoughts, mental capacity, and other environmental factors are also involved in developing psychological disorders. In determining the likelihood of a mental disorder, the diathesis-stress model is one example that combines both biological and psychosocial perspectives. This model refers to how a diathesis followed by an adverse event increases the risk of developing a disorder. A diathesis is any genetic or situational factor (e.g., childhood trauma) that predisposes a person to mental illness.

Psychological Approaches to Mental Illness

The psychological approach to mental illness sees an interaction between mental health development and the environment. Mental health problems occur when people deal with new situations using maladaptive coping mechanisms. Psychological approaches help provide a holistic perspective on the possible root causes of mental illnesses. There are five psychological approaches to mental illness: biopsychosocial, psychoanalytic, behavioral, humanistic, and cognitive.

Biopsychosocial Approach

Developed by George Engel in 1977, the biopsychosocial approach views a person's mental health as a product of interaction between biological, psychological, and social factors. This approach states that no single factor is attributed to a mental illness; rather, it is the cumulative effects of positive and negative interactions between biological, psychological, and social factors. When negative effects outweigh the positive, mental health problems can occur. Schizophrenia, for example, has been shown to have a genetic component. Add to that adverse experiences in childhood; together, they can trigger the development of schizophrenia.

Psychoanalytic Approach

Sigmund Freud's psychoanalytic approach introduces the concept of the id, the superego, and the ego, which make up our personality.

The id represents our instincts, the superego reflects our conscience, and the ego is what negotiates between the id and superego.

When the id, superego, and ego come into conflict, defense mechanisms evolve in response to anxiety brought about by these conflicts. Psychological problems occur as a result of inner conflicts and overblown defense mechanisms. An example of a defense mechanism is repression, wherein a person pushes his painful memories into his unconscious mind. An individual abused as a child may forget his traumatic experience but show aggression or hostility towards others.

Behavioral Approach

Proponents of the behavioral approach such as John Watson and BF Skinner see behavior as shaped by the environment. Learned normal and abnormal behaviors are due to reinforcement and punishment directly experienced, or seen done to someone else. In this view, environmental stimuli trigger abnormal behavior, followed by negative consequences. An example of this is modeling, where a child who always sees his mother panic over a cockroach may soon develop a fear of cockroaches. Behaviorism sheds light on how people develop fears triggered by situations, and how reinforcement strengthens or weakens abnormal behavior.

Classical Conditioning

In classical conditioning, abnormal behavior is seen as a conditioned response to a stimulus, which gives insight into why people have phobias or anxiety. In general, this approach involves eliminating unwanted behaviors through exposure to triggers of fear or anxiety, and learning by association. Association techniques can be teaching relaxation responses in the face of a feared stimulus, or presenting something unpleasant associated with the targeted negative behaviors or thinking patterns. In this way, both psychologist and patient achieve extinction.

Operant Conditioning

The operant conditioning approach focuses on presenting consequences to change behaviors, such as giving rewards for target behaviors. The goal is to motivate people towards developing socially acceptable behavior, including rewarding small efforts towards achieving a client's goal, such as in-behavior modification, or exchanging tokens for an item, such as in token economies. Psychologists also use techniques that model good behavior, allow clients to practice that behavior, and provide timely and appropriate feedback.

Humanistic Approach

According to the humanistic approach developed by proponents such as Carl Rogers, psychological problems occur when people experience roadblocks in achieving growth and self-actualization. The concept behind the humanistic approach is that people have the free will to act and be the person they want to be, but it can affect their self-image when they try to live up to others' expectations. Insecurities appear, and they lose sight of their capabilities, leading to an abnormality in behavior. An example of this is when a child experiences conditional positive regard from his parents; in this, praise and approval from others are conditional. He may grow up constantly seeking validation from others.

Cognitive Approach

In the cognitive approach, our thoughts and perception may cause psychological disorders. For example, all of us experience cognitive distortions, which is an inaccurate and faulty thinking pattern, but the perpetuation of this type of thinking contributes to anxiety and depression. Over-generalizing is an example of cognitive distortion. When a person over-generalizes, he applies a standard from one situation to other unrelated ones. For instance, a person who fails at a job interview might think that he is not capable enough, and will most likely fail in whatever he does.

Psychological Approaches to Treatment

Psychological perspectives in the treatment of disorders provide guidelines on the appropriate treatment, but they are not the only factor that determines effectiveness. In supporting a client's mental health, his working relationship with the treatment provider is equally important. The major psychological approaches to treating disorders include psychodynamic, humanistic, behavioral, and cognitive perspectives.

Psychodynamic Therapies

The psychodynamic approach, introduced by Sigmund Freud, involves a deep understanding of the unconscious mind and emotions of the patient. The therapist plays an active role in identifying the patient's mental health concerns through one-on-one sessions, where the patient sits on a chair facing the therapist. This approach also includes interpretation of the concerns causing the mental health problem. Through these sessions, the patient can also understand the causes of the disorder rooted in his unconscious mind.

Humanistic Therapies

The humanistic approach emphasizes the importance of a therapeutic relationship built on empathy and focuses on what happens during sessions, not past events. The therapist helps the patient discover his true self, motivations, and desires. Sessions encourage openness, where the patient is the expert, and the therapist facilitates growth, allowing the patient to gain his sense of worth and be emotionally understood. With these sessions, the therapist gets an insight into the patient's perspective.

Behavioral Therapies

The primary focus of the behavioral approach is to eliminate unwanted behaviors and encourage positive behaviors by using techniques built upon the principles of operant and classic conditioning of Pavlov, Skinner, and Watson. Phobia and anxiety disorders are some examples of applications of this approach. Therapists help develop good behavior by utilizing positive reinforcement such as token economies. In token economies, a token such as a sticker acts as a reinforcer, received for good behavior, and exchanged for a reward. On the other hand, negative punishment and extinction reduce undesirable behaviors such as a child's tantrums, by removing a reinforcer (e.g., attention).

Cognitive Therapies

The cognitive approach to treatment involves changing faulty thinking patterns that produce behavioral problems leading to mental health concerns. Therapists using this approach help patients recognize their distorted perceptions about their problems and then guide them into changing their beliefs and learning to think more rationally. One of the ways patients gain insight into their faulty reasoning is by writing down their thoughts following their negative emotions. Common applications include anxiety disorders, OCD, and depression.

Advances in evidence-based approaches greatly support mental health, not just for those afflicted with disorders, but also for the mental health community.

Psychological Treatment Examples

Psychological treatment stems from the psychological perspectives in the treatment of disorders. The main treatment types are psychotherapy (psychological) and biomedical treatment (biological).

Psychotherapy

Psychotherapy is a type of treatment mainly focusing on methods in psychology, involving counseling or sessions between a trained professional and a patient to address mental health problems. Psychotherapy addresses the psychological nature of disorders concerning their factors, causes, and remedies. To improve a patient's mental health, trained professionals examine the underlying causes of the disorder and employ strategies to promote the patient's sense of well-being. This treatment is designed to reduce unwanted symptoms and help the patient develop skills to respond to roadblocks in life. Examples of psychotherapy include psychoanalysis, exposure therapy, and cognitive-behavioral therapy.

Psychoanalysis

In psychoanalysis, key terms need to be remembered: free association, resistance, transference, and dream analysis. During sessions, free association is when the psychoanalyst asks the patient to express whatever emotions or ideas arise in their minds. Resistance is when the patient unconsciously blocks the expression of those thoughts and feelings. Transference is when the patient transfers ill feelings, such as hostile feelings toward a parent, to the psychoanalyst, when conflicts arise between the psychoanalyst and the patient. Dream analysis involves a detailed description of dreams, which Freud believed represent unmet needs, and then analyzing them.

Cognitive-Behavioral Therapy

This therapy combines two psychological perspectives in the treatment of disorders: cognitive and behavioral. Therapists focus on helping patients change their thinking and behavior by exploring cognitive distortions and problematic perceptions. The cognitive aspect involves creating awareness of unhealthy thinking patterns and developing how to think in a more positive light. The behavioral aspect involves teaching healthy coping behaviors and responses to challenges. Applications of cognitive-behavioral therapy include drug addiction, bipolar disorder, PTSD, and eating disorders.

Biomedical Therapy

This therapy uses medicines, as well as healthcare procedures, in the treatment of mental disorders. Biomedical therapy attributes biological factors to mental disorders as physical and mental health are connected. This therapy also addresses symptoms brought about by psychological disorders such as hallucinations from schizophrenia. Medications help the hallucinations subside. The treatment plan often involves a combination of biomedical therapy and psychotherapy, but not all would need biomedical treatment. Examples of biomedical treatment are pharmacotherapy, electroconvulsive therapy (ECT), and psychosurgery.

Pharmacotherapy

Pharmacotherapy involves medications used to treat psychological symptoms. These include antipsychotics, antidepressants, mood stabilizers, and anxiolytics.

Antipsychotics have two categories: first-generation or typical antipsychotics, and second-generation or atypical antipsychotics. These medications help deal with symptoms of schizophrenia, such as hallucinations and paranoia. The drug's effect is that it blocks dopamine, which is a type of neurotransmitter associated with schizophrenia, where a lack or excess of it causes hallucinations.

Antidepressants treat depressive and anxiety symptoms. There are three types of antidepressants: monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCA), and selective serotonin reuptake inhibitors (SSRIs).

MAOIs are used to treat the major depressive disorder and atypical depression. They block the action of monoamine oxidase enzymes, responsible for breaking down dopamine, norepinephrine, and serotonin.

On the other hand, TCAs help treat disorders such as bipolar disorder, generalized anxiety disorder, and obsessive-compulsive disorder. These medications work by maintaining healthy levels of serotonin and norepinephrine; too much or too little may result in anxiety or depressive symptoms.

SSRIs are the most often used and have the least side effects among the three classes. These drugs only deal with serotonin and help increase its levels in the brain in moderate to severe depression.

Mood stabilizers such as lithium help deal with extreme mood swings in bipolar disorder. Still, the effects of the drug may take a while to work, requiring careful monitoring to prevent any side effects. These drugs work by calming areas of the brain and decreasing the abnormal activity of neurotransmitters, which can cause mood problems.

Anxiolytics, also known as anti-anxiety drugs, treat anxiety disorders. Its action involves increasing the activity of gamma-aminobutyric acid, a neurotransmitter that lowers brain activity. Too much brain activity can cause symptoms of anxiety and other mental health problems.

Electroconvulsive Therapy (ECT)

Electroconvulsive therapy deal with symptoms related to conditions like severe depression or bipolar disorder by delivering an electrical current to the brain. Patients receive an anesthetic before the treatment to help them relax. Side effects from this treatment include temporary memory loss associated with repeated administrations. This treatment is a last resort, only used if other treatments don't work. A similar treatment to ECT is transcranial magnetic stimulation (TMS), which involves stimulating electrical activity in the brain to improve symptoms of severe depression. Like ECT, TMS is also used as a last resort.

Psychosurgery

Psychosurgery is a surgical procedure of removing or destroying a small part of the brain to improve symptoms of mental disorders. Psychiatrists and neurosurgeons work together in carrying out this operation. One example of the most often used type of psychosurgery is capsulotomy. Like ECT, capsulotomy is a last resort in treating severe OCD. In this procedure, neurosurgeons create lesions on a small area of the anterior capsule, the brain region near the thalamus, using heat. There have been reports of adverse damage and even death from this treatment, with risks including cognitive problems, seizures, and weight problems.

Methods of Treatment

The method of treatments includes group therapy, family and couples therapy and self-help groups.

Group Therapy

Group therapy uses similar approaches to individual counseling. It may prove to be more helpful for people who struggle to share their problems in one-on-one sessions. This method allows patients to learn about others who have similar problems and better understand their problems through peer feedback. Patients also benefit from the lower cost of group therapy over individual sessions.

Family and Couples Therapy

Family and couples therapy involves open discussions between spouses and family members. The concerned parties discover each others' points of view, while the therapist remains neutral. Individuals become more aware of each other's concerns and feelings, training them to improve their communication and relationship.

Self-Help Groups

Self-help groups are a collaboration of individuals who have the same problem with no involvement of a trained professional. This method serves as an avenue for individuals to share their insights and receive assistance and support from each other. Group members are responsible for conducting their meetings.