AP Psychology · Lesson 3

Treating psychological disorders

Know Know it

Psychodynamic therapy, rooted in Freud's psychoanalysis, aims to bring unconscious conflicts into awareness. Techniques include free association (saying whatever comes to mind), dream analysis and interpretation. The therapist watches for resistance (blocking painful material) and transference (directing feelings about important people onto the therapist). Modern versions are usually shorter and more focused on current relationships.

Humanistic therapy centers on growth. In Carl Rogers's person-centered therapy, the therapist offers genuineness, empathy and unconditional positive regard, and uses active listening: restating and clarifying what the client says rather than directing the session.

Behavioral therapy applies learning principles to change behavior. Exposure therapies have clients face feared situations: systematic desensitization pairs relaxation with a ranked list of fears, worked through step by step, while flooding brings intense exposure at once. Aversive conditioning pairs an unwanted behavior with an unpleasant experience. A token economy rewards target behaviors with tokens that can be traded for privileges.

Cognitive therapies target how people interpret events. Albert Ellis's rational emotive behavior therapy directly challenges irrational beliefs. Aaron Beck's cognitive therapy helps clients spot automatic, distorted interpretations and test them against evidence. Cognitive-behavioral therapy (CBT) combines this work with changes in behavior and is effective for many people with anxiety and depressive disorders. Dialectical behavior therapy, developed by Marsha Linehan, adds mindfulness and emotion-regulation skills and is often used with borderline personality disorder. Group and family therapy treat people in a social setting.

Biomedical treatments act on the body. Antidepressants such as SSRIs slow the reuptake of serotonin, and their effects on mood usually take several weeks. Antianxiety drugs such as benzodiazepines boost GABA's calming effect but can lead to dependence. Lithium and other mood stabilizers are often used for bipolar disorder. Antipsychotics reduce positive symptoms by blocking dopamine receptors, and long-term use of older ones can cause tardive dyskinesia, involuntary movements. Electroconvulsive therapy (ECT) and transcranial magnetic stimulation are options for severe depression that has not responded to other treatment.

Does treatment work? Researchers test it with randomized controlled trials that compare a treatment group with a control group, such as a waitlist or a placebo, and drug trials are often double-blind. Meta-analyses, which combine many studies, show that many people improve more with therapy than without it, though no single approach helps everyone. A strong therapeutic alliance between client and therapist is linked to better outcomes, and many therapists take an eclectic approach, drawing on several methods.

Therapy approaches at a glance
ApproachWhat it tries to changeSample technique
PsychodynamicUnconscious conflictsFree association, interpreting transference
HumanisticSelf-understanding and growthActive listening with unconditional positive regard
BehavioralLearned behaviorsSystematic desensitization, token economy
CognitiveDistorted beliefs and interpretationsTesting beliefs against evidence
BiomedicalBrain chemistry or activityAntidepressants, lithium, ECT

Trap Gradual is not the same as all at once

Systematic desensitization and flooding are both exposure therapies, but they differ in pace. Systematic desensitization climbs a ranked list one step at a time while the client stays relaxed. Flooding starts with intense exposure right away.

Worked example Easy

In each session, Dr. Okafor lets her client choose what to talk about. She restates what the client says, asks what it felt like, and accepts whatever the client shares without judging it.

Which kind of therapy is Dr. Okafor using?

  1. Psychoanalysis
  2. Aversive conditioning
  3. A token economy
  4. Person-centered therapyAnswer

How to solve it

  1. The client leads, so the therapy is nondirective.
  2. Restating feelings is active listening; accepting without judging is unconditional positive regard.
  3. Both are features of person-centered therapy.

Why each choice is right or wrong

  • A. Incorrect. Psychoanalysis has the therapist interpret unconscious meaning, while Dr. Okafor restates and accepts without interpreting.
  • B. Incorrect. Aversive conditioning pairs a behavior with something unpleasant, and nothing unpleasant appears in these sessions.
  • C. Incorrect. A token economy rewards target behaviors with tokens, and Dr. Okafor gives no rewards.
  • D. Correct. Letting the client lead, active listening and nonjudging acceptance mark Rogers's person-centered therapy.

Explain Explain it

Task verbs: explain, compare

To explain a treatment, say what it changes and how. A behavioral therapy changes learned responses, a cognitive therapy changes interpretations, and a drug changes activity at the synapse. Then tie that mechanism to the client's symptoms.

Worked example Medium

Omar and his therapist list ten dog-related situations, from a photo of a puppy up to petting a large dog. Omar learns deep muscle relaxation. Then he works up the list one step at a time, moving on only when he can stay calm.

Which therapy is Omar receiving, and which kind of learning is it based on?

  1. Flooding, based on observational learning
  2. Systematic desensitization, based on classical conditioningAnswer
  3. A token economy, based on operant conditioning
  4. Aversive conditioning, based on classical conditioning

How to solve it

  1. A ranked list plus relaxation, one step at a time, is systematic desensitization.
  2. It links the feared stimulus to a calm response instead of fear.
  3. Linking a stimulus to a new response is classical conditioning.

Why each choice is right or wrong

  • A. Incorrect. Flooding means intense exposure all at once, and Omar works up slowly, with no model to watch.
  • B. Correct. A ranked list worked through while relaxed replaces fear with calm, a form of classical counterconditioning.
  • C. Incorrect. A token economy rewards behavior with tokens, and Omar receives no tokens or rewards.
  • D. Incorrect. Aversive conditioning pairs an unwanted behavior with something unpleasant, but Omar pairs dogs with relaxation.

Explain Your turn

A client with major depressive disorder starts taking an SSRI. Explain what the drug does at the synapse, and say about how long such drugs usually take to improve mood.

Write it, then compare. Nothing you type here is saved or graded.

Compare with a model answer

A full answer does this

  • Says the drug slows the reuptake of serotonin, so more serotonin stays in the synapse
  • Says mood usually takes several weeks to improve

Model answer

An SSRI slows the reuptake of serotonin by the sending neuron, so more serotonin stays in the synapse and keeps acting on the receiving neuron. Its effects on mood usually take several weeks to appear, so the client may not notice a change at first.

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