1. Biology-based treatment techniques (p. 559) Biological treatment techniques have been used to alter patients psychological states since ancient times. In our time, electroconvulsive therapy (ECT) was first used in the 1930s on the assumption that seizures would eliminate schizophrenic behavior. ECT has been found to be useful in treating severe depression, but the reasons for this are unclear. There is considerable controversy over the use of ECT. Psychosurgery, particularly lesioning the frontal lobes, was once a common treatment for schizophrenia, but now it is used only as a last resort. Videolaserscopy now allows surgeons to make extremely small laser incisions, guided by a video camera.
   Since the 1950s, the most common biology-based treatments are psychopharmacology (drug therapy) approaches. Some researchers are concerned about gender bias in prescribing medications: although women make up only slightly more than half of the patients in psychotherapy, they receive 73 percent of all prescriptions. Antianxiety drugs, including propanediols (meprobamate compounds) and benzodiazepines (Librium and Valium), reduce tension by blocking neural transmission, but they can be addictive and produce withdrawal symptoms. Antipsychotic drugs (the major tranquilizers) are used to treat schizophrenia and other psychotic conditions. The phenothiazines have been more effective than placebos in helping psychotic patients improve social interactions and self-management, and in decreasing agitation and excitement. Side effects include Parkinson-like symptoms, dry mouth, and tardive dyskinesia. Antidepressants include tricyclics, MAO inhibitors, and selective seretonin reuptake inhibitors (SSRIs/Prozac) and are used to treat depression. Recently the Food and Drug Administration issued a Black Box warning on the use of antidepressants with children and adolescents. Lithium, the principal antimanic drug, is effective in the treatment of bipolar disorder, but effective dosage borders on toxicity.
   Psychopharmacological considerations determine which drug in which amount should be prescribed for which condition an patient. Drugs are generally more effective for active symptoms like hallucinations than passive symptoms like social withdrawal, and they do not help patients improve their living skills.
2. Psychotherapy (p. 564) Psychotherapy is defined as the systematic application of techniques derived from psychological theory for the purpose of aiding psychologically troubled people. There are wide differences in strategies, but most psychotherapies agree that treatment is an opportunity for relearning, for developing new emotionally important experiences, for establishing therapeutic relationships, and for achieving hoped-for goals. However, traditional psychotherapy mirrors mainstream Western culture, making it less- effective for those from non-Western cultures and for members of ethnic minority groups. Mental health services need to be adapted for multiethnic populations. Individual psychotherapy is usually subdivided into insight-oriented and action-oriented approaches.
3. Insight-oriented approaches to individual psychotherapy (p. 566) Psychoanalysis, devised by Freud, stresses the resolution of unconscious conflicts through techniques such as free association and dream analysis, analysis of resistance, the transference relationship, and interpretation of events. Post-Freudian psychoanalysis is more flexible than traditional psychoanalysis, but still holds to the idea of symptom substitution if underlying factors are not analyzed and altered. Among the criticisms of psychoanalysis are that clients generally are young, white, and highly educated, so the needs of much of our population are ignored; operational definitions for basic psychoanalytic concepts are problematic, making it difficult to confirm aspects of the theory; and controlled research does not confirm the existence of symptom substitution.
   Humanistic-existential approaches stress the self and personal responsibility. Rogerss person-centered therapy emphasizes the relationship between therapist and client over any techniques. Existential analysis adheres to no single theory but takes a strongly philosophical approach to find meaning in life, and Perlss gestalt therapy uses the persons here-and-now totality of experience to produce change. Because neither existential nor gestalt therapy has generated research, their effectiveness is hard to evaluate.
4. Action-oriented approaches to individual psychotherapy: Classical conditioning techniques, operant conditioning techniques, observational learning techniques, and cognitive-behavioral therapy (p. 569) Classical conditioning principles guide the action-oriented therapies of systematic desensitization, flooding and implosion, aversive conditioning, and covert sensitization. In systematic desensitization, relaxation is paired with anxiety-provoking scenes to reduce anxiety. In flooding, clients confront their fears in real situations, whereas in implosion., the confrontation occurs in imagination. In aversive conditioning, an undesirable behavior such as smoking is paired with a noxious stimulus. This can be done in imagination in a procedure called covert sensitization.
   Operant principles are at work in token economies, where desired behaviors are contingently reinforced with tokens that can be exchanged for privileges or other reinforces. When less drastic methods are ineffective, punishment may be used to suppress self-destructive behaviors, as in autistic or schizophrenic disorders.
   Modeling, based on observational learning theory, is effective in the treatment o phobias, delinquency, and other behavior problems, particularly when models verbalize how to perform a task and make a few mistakes in the process. Cognitive-behavioral therapies focus on clients thoughts as well as on their coping skills. Elliss rational-emotive psychotherapy challenges the clients irrational beliefs; Becks therapy is less confrontational, but uses similar themes to treat depression. Stress inoculation therapy is another form of cognitive-behavioral treatment for learning how to handle life's stresses. For certain depressions, cognitive-behavioral therapy may be at least as effective as drug treatment.
5. Health psychology (p. 574) Health psychology integrates biological and behavioral sciences for the purpose of changing peoples lifestyles to prevent illness or to enhance the quality of their lives. Biofeedback therapy and counseling to reduce Type A behavior patterns have been useful in this effort. Most techniques for changing lifestyles involve establishing priorities, avoiding stressful situations, taking personal time, setting up an exercise schedule, proper diet, developing social supports, and learning to relax.
6. Evaluating individual psychotherapy (p. 575) There are debates over the appropriateness of insight versus action therapies. In 1952, Eysenck created controversy by claiming that psychotherapy was ineffective. More recent studies have been methodologically cleaner, but Persons (1991) points out that therapy outcome studies fail to match the conditions of actual practice of assessment and psychotherapy. Use of meta-analysis to identify treatment effect size shows that those getting therapy show far more improvement than those untreated. Some types of treatment have been rigorously researched and have demonstrated effectiveness in benefiting clients with certain disorders. These treatments have been designated as empirically supported treatments (ESTs) and include cognitive-behavioral therapy for anxiety and depression, interpersonal therapy for depression and bulimia, and behavioral therapy for sexual dysfunction. There is a range of factors including experience, therapeutic. orientation, and demographic characteristics of the therapist that should go into choosing a therapist. Another approach called the common factors approach identifies four common dimensions of curative influence in therapy, Lamber, 1992.
7. Group, family, and couples therapy (p. 578) Group therapy has economic and therapeutic advantages over individual psychotherapy. There are many different forms and structures of group therapy. The purposes and techniques of groups differ widely, but some common features are the experience of feedback on real-life social interactions, the opportunity for modeling, and the reduction of isolation through social support. There are advantages and disadvantages to group treatment. Measuring outcome for group therapy is more difficult than for individual treatment.
   Family therapy is a kind of group therapy seeking to modify family relationships to foster greater harmony. It is based on the assumption that the problems of the identified patient are symptoms of family distress. Two kinds of family therapy are the communications approach and the systems approach.
   Marital therapy also focuses on communications and system roles; it is not designed to save marriages, but to clarify understanding and options. Research on the effectiveness of family and marital therapy have generally not used rigorous designs, so strong conclusions are premature.
   Couples therapy also focuses on communications and system roles; it is not designed to save relationships, but to clarify expectations, needs, and communication. Research on the effectiveness of family and couples therapy have generally not used rigorous designs, so strong conclusions are premature.
8. Systematic integration and eclecticism (p. 582) Most practicing clinicians see themselves as eclectics using divers approaches and techniques. An early technical eclecticism has been refined into a model called multimodal behavior therapy, which incorporates many cognitive and affective concepts into a behavioral basis. Practitioners now prefer the term integrative to eclectic.
9. Culturally diverse populations and psychotherapy (p. 582). Western psychology and mental health concepts make an assumption that they are universal and that healthy clients are individualistic and independent and have control over their lives and the universe, and that self-awareness and personal growth are primary goals of the therapeutic process. However, many racial/minority groups value interdependence and collectivism, the group rather than the individual, and being in harmony with the universe instead of mastering it. Guidelines are suggested for working with particular groups, but they should not be adhered to rigidly.
   With African Americans it is appropriate to bring up the issue of racial differences between the client and the white therapist; to try to understand the African American clients worldview; rather than pathologizing or prejudging the clients suspiciousness or reluctance to self-disclose, see it as a survival mechanism and assess the clients positive assets. Problem-solving approaches are useful for external problems.
   With Asian Americans and Pacific Islanders, therapists should be aware of the potential social stigma of seeing a therapist; understand that these clients are likely to express psychological conflicts via somatic complaints and/or other socially acceptable issues; and reluctance to self-disclose and express feelings may be due to cultural factors, not psychopathology. The therapist should explain the purpose, expectations, and process of therapy, and use an action-oriented, problem-solving approach.
   With Latino or Hispanic American clients, it helps to engage the client in a warm, respectful manner while maintaining a formal persona; be sensitive to linguistic misunderstandings (possibly use a translator); discuss therapy goals with the client; guard against misinterpretations, particularly of differences in body language; and consider the clients positive assets and resources, including the nuclear and extended family.
   With Native Americans, patience is important; basic needs should be addressed first; understand the importance of the clients communal environment; be sensitive to differences in communication styles, especially body language; an consider consulting with indigenous healers.
10. Community psychology (p. 587) Community psychology takes into account the impact of environmental factors on mental health and encourages the use of community resources to eliminate the conditions that cause psychological problems. It seeks to promote well-being and prevent psychopathology.
    Reform in the delivery of mental health services is underway in the form of managed health care. Care is shifting to health maintenance organizations (HMOs), care is increasingly short-term, providers are more often those with masters degrees, and quality assurance is emphasized. Unfortunately, the downside may be reduced quality or extent of services, little effort on persistent problems, and difficulty obtaining long-term care.
    Other changes may allow psychologists with appropriate training to prescribe medications and provide treatment by following treatment manuals.
    Preventing psychopathology is a key feature of community psychology. There are three types. Primary prevention seeks to lower the incidence of new cases. Examples include Project Head Start, Munoz and colleagues attempts to prevent depression community-wide, and early intervention to prevent juvenile delinquency. Secondary prevention attempts to shorten the duration of disorders by detecting them early and providing effective treatment. There are problems in providing both primary and secondary prevention. Tertiary prevention aims to help the readjustment of individuals who have received hospital treatment.