5.5 Treatment of Psychological Disorders

A meta-analysis combines the results of many studies to find an overall effect. Meta-analyses of psychotherapy generally conclude that therapy is effective: on average, people who receive therapy improve more than similar people who don't. Many psychologists now use evidence-based interventions, treatments supported by research for a specific problem.

Two relationship factors help therapy work, whatever the approach. The therapeutic alliance is the trusting, collaborative bond between therapist and client. Cultural humility is a therapist's ongoing openness to learning about a client's culture and values rather than assuming they understand them.

In the second half of the 20th century, newer psychotropic medications (drugs that affect mood, thinking or behavior) helped drive deinstitutionalization, the release of large numbers of people from psychiatric hospitals into community-based care. Today, treatment is usually decentralized, delivered in clinics and private offices, and often combines medication with therapy.

Therapists follow ethical principles set by the American Psychological Association (APA), including nonmaleficence (do no harm), fidelity (being trustworthy and keeping commitments to clients), integrity (honesty and accuracy) and respect for people's rights and dignity.

Each approach has its own idea about what causes problems and how to fix them.

Behavioral therapies use conditioning (3.7, 3.8), an approach called applied behavior analysis. Exposure therapies have a person face what they fear in a safe setting until the fear fades. In systematic desensitization, a client builds a fear hierarchy (a ranked list of feared situations), learns relaxation, and then works up the list while staying relaxed. Aversion therapy pairs an unwanted behavior with something unpleasant, such as a medication that causes nausea when combined with alcohol. A token economy rewards target behaviors with tokens that can be traded for privileges. Biofeedback gives a person real-time information about body signals like heart rate or muscle tension so they can learn to control the sympathetic and parasympathetic responses tied to anxiety.

Aaron Beck's cognitive therapy helps clients spot and challenge negative automatic thoughts. Albert Ellis's REBT targets irrational beliefs ('I must be liked by everyone'). DBT, developed by Marsha Linehan, combines cognitive-behavioral skills with mindfulness and emotion regulation. Fear hierarchies cross the line between approaches: the course lists them as a cognitive therapy tool, and they are also the backbone of systematic desensitization and of exposure work in CBT.

Group therapy treats several clients at once with a therapist. Compared with individual therapy, it costs less per person, shows people they aren't alone, and lets them practice social skills and get feedback from peers. The tradeoffs are less individual attention and less privacy. Family therapy treats the family as a system, since one person's problems affect everyone.

Hypnosis can help people manage pain and anxiety. It doesn't help people dig up accurate hidden memories or truly go back to an earlier age, and it can actually make people more confident in false memories (2.7).

Medications, summarized in the table below, are the most common biomedical treatment. When they aren't enough, other options exist. Electroconvulsive therapy (ECT) passes a brief electric current through the brain of an anesthetized patient to cause a controlled seizure; it can help severe depression that hasn't responded to other treatment, with possible short-term memory loss. Transcranial magnetic stimulation (TMS) uses magnetic pulses through the scalp to stimulate brain areas and doesn't require anesthesia. Psychosurgery removes or lesions brain tissue. The lobotomy, which cut connections to the frontal lobes, was widely used in the 1940s and 1950s and has all but disappeared.