AP Psychology 5.9-5.10: Treatment of Disorders

What proportion of U.S. adults experienced mental illness in 2017, and what proportion received mental health treatment?

In 2017, about 18.9% of U.S. adults experienced mental illness, while approximately 14.8% received treatment through inpatient or outpatient care and/or prescription medication.

How did treatment rates differ among children with different types of mental disorders?

About half of children with a mental disorder received treatment in the previous year. Children with anxiety disorders were least likely to receive treatment, whereas those with ADHD or conduct disorders were more likely to receive it.

What explanations historically dominated beliefs about the causes of mental illness?

Mental illness was often attributed to demonic possession, witchcraft, or punishment by an angry deity rather than to medical or psychological causes.

Term: Exorcism

A historical practice intended to drive supposedly possessing spirits out of a person through prayers, incantations, or medicinal drinks.

Term: Trephining

A historical procedure involving drilling or cutting a small hole in a person's skull, supposedly to release spirits believed to cause abnormal behavior. It was frequently fatal.

How were people with unusual or psychologically disordered behavior commonly treated before humane reforms?

They might be executed, imprisoned, chained, abandoned as homeless beggars, or subjected to religious procedures such as exorcism. These responses reflected misunderstanding and often cruelty.

What were asylums originally designed to do, and what was their major limitation?

Beginning in the eighteenth century, asylums were institutions specifically intended to house people with psychological disorders. Their primary function was often to isolate or ostracize residents rather than treat them.

What conditions characterized many early asylums?

Residents were often confined in filthy, windowless spaces, beaten, chained to beds, and given little meaningful contact or care from staff.

What reform did Philippe Pinel advocate in the late eighteenth century?

Pinel argued that people with mental illness should be treated humanely, including being released from chains and spoken to respectfully. Such reforms allowed some patients to improve and leave the hospital.

What was Dorothea Dix's contribution to mental health care in the United States?

Dix investigated the mistreatment of poor people with mental illness and lobbied state legislatures and Congress for reform. Her efforts helped establish and fund the first American mental asylums.

Why did the creation of mental asylums not solve the problem of mental health care?

Many asylums remained underfunded, poorly regulated, abusive, and focused on confinement rather than effective treatment. Some residents were kept there for decades.

How did historical psychiatric treatments such as cold baths and early electroshock reflect problems in institutional care?

They were sometimes administered for long periods or without adequate safeguards, causing serious suffering and injury. Modern electroconvulsive treatment uses anesthesia and safety procedures, although its benefits and side effects remain debated.

What is psychosis, and why did it commonly lead to hospitalization?

Psychosis is a loss of contact with reality, often involving hallucinations or delusions. Because these symptoms can be severe and disruptive, psychosis was a common diagnosis among institutionalized patients.

How did antipsychotic medications change mental health treatment beginning in the 1950s?

They provided an effective way to reduce symptoms of disorders involving psychosis, such as hallucinations and delusions, and helped make large-scale institutionalization less necessary.

What was the purpose of the 1963 Mental Retardation Facilities and Community Mental Health Centers Construction Act?

It provided federal support for community mental health centers and helped shift care from large institutions toward treatment within local communities.

Term: Deinstitutionalization

The movement to close large psychiatric institutions and provide mental health treatment in community settings instead. In the United States, it produced a major decline in the number of people hospitalized in public psychiatric facilities.

Why did deinstitutionalization sometimes produce homelessness and inadequate care?

Community programs were often underfunded, understaffed, and not prepared to manage severe disorders. Housing, food, employment assistance, and other needed supports were frequently unavailable.

What percentage of adults living in U.S. homeless shelters was estimated to experience mental illness?

Approximately 26% of adults living in shelters were estimated to experience mental illness.

How are people with mental illness represented in the U.S. correctional system?

They are overrepresented in prisons, jails, probation, and parole populations. Rates in probation and parole populations have been estimated at roughly two to four times those in the general population.

How can incarceration affect mental health?

Exposure to violence, sexual assault, isolation, and other trauma can worsen existing symptoms, trigger psychological disturbances, or contribute to PTSD, depression, and other long-term problems.

How does modern psychiatric hospitalization differ from traditional asylum care?

Modern psychiatric hospitals generally emphasize short-term stabilization rather than lifelong confinement. Stays often last several days and average less than two weeks, partly because hospitalization is expensive.

Under what circumstances are people usually hospitalized for psychiatric treatment?

Hospitalization is generally reserved for situations in which a person presents an imminent danger to themselves or others or requires intensive short-term stabilization.

Why are psychiatric hospital stays often brief?

Psychiatric hospitalization can cost roughly $800–$1,000 per night, and insurance policies may limit coverage. Consequently, hospitals often focus on short-term crisis care.

What are common pathways through which a person may enter psychological treatment?

A person may seek help independently, be referred by family or a primary care physician, or be directed by child protective services or the criminal justice system.

Term: Voluntary treatment

Mental health treatment that a person chooses to pursue, usually to obtain relief from symptoms or improve functioning.

Term: Involuntary treatment

Mental health treatment that is not freely chosen by the individual, such as counseling required as a condition of parole or mandated by a court.

Where can psychological treatment be delivered?

Services may occur in community mental health centers, private practices, hospitals, schools, prisons, and other community settings.

Which professionals may provide counseling or psychological treatment?

Providers can include psychologists, psychiatrists, clinical social workers, marriage and family therapists, school-based mental health professionals, and appropriately trained religious counselors. Licensing requirements vary by state.

What did the Mental Health Parity and Addiction Equity Act of 2008 require?

For covered group health plans, mental health and substance-use treatment must receive coverage comparable to medical and surgical care. Copayments, deductibles, and visit limits cannot be more restrictive for mental health services.

What major barriers limit access to mental health treatment?

Barriers include shortages of providers, waiting lists, stigma, limited services in rural and low-income areas, poor-quality care, copayments and deductibles, and the need to take time off work.

Why are rural communities especially affected by mental health treatment shortages?

Most federally designated mental health professional shortage areas are rural. Primary care physicians and law enforcement may become first-line providers despite lacking specialized mental health training, and stigma and limited availability further reduce care.

How do psychotherapy and biomedical therapy differ?

Psychotherapy uses psychological methods to help people change thoughts, emotions, behaviors, relationships, or personal patterns. Biomedical therapy uses medication and/or medical procedures to treat psychological disorders.

What is the broad goal of therapy illustrated by the repeated-hole metaphor?

Therapy aims to help people recognize destructive patterns, understand how they repeat them, and develop more adaptive responses or choices rather than continually reenacting the same problems.

What did Freud believe caused many psychological problems, and how did psychoanalysis address them?

Freud attributed many problems to repressed impulses and childhood trauma. Psychoanalysis attempted to uncover these influences through extended talk therapy, including free association and dream analysis.

Term: Free association

A psychoanalytic technique in which a relaxed patient says whatever thoughts come to mind without deliberately censoring them. The therapist looks for patterns and signs of conflict or resistance.

Term: Resistance

The tendency to block or avoid recalling thoughts, memories, or feelings that are threatening or painful, often interpreted in psychoanalytic therapy as evidence of repression.

Term: Dream analysis

A psychoanalytic method in which the therapist interprets dreams to explore possible underlying wishes, conflicts, or emotional concerns.

Term: Transference

The process by which a client redirects feelings and expectations from important relationships onto the therapist. For example, a client may respond to a therapist as if the therapist were a parent.

Term: Psychodynamic psychotherapy

A therapy approach emphasizing how unconscious drives, internal conflicts, and childhood experiences influence current behavior. It is less intensive and less rigid than Freud's original psychoanalysis.

Why is play therapy commonly used with children?

Children may be unable or unwilling to describe their inner experiences through traditional talk therapy. Playing with dolls, animals, or figurines can allow them to express hopes, conflicts, and trauma while giving the therapist information about their behavior.

How do nondirective and directive play therapy differ?

In nondirective play therapy, the child plays freely while the therapist observes. In directive play therapy, the therapist structures the activity by suggesting topics, asking questions, or participating in the play.

Term: Behavior therapy

An approach that applies principles of learning, including classical and operant conditioning, to replace undesirable behaviors with more adaptive ones. It focuses on changing behavior rather than uncovering unconscious conflicts.

How can classical conditioning principles be used to treat bedwetting?

A moisture-sensitive alarm wakes the child when urination begins. Repeated pairing of bladder relaxation with waking can condition the child to awaken before wetting the bed.

Term: Counterconditioning

A behavioral process in which a new response is learned to replace an undesirable response to a stimulus. Relaxation can be conditioned to replace fear, for example.

Term: Aversive conditioning

A counterconditioning method that pairs an unwanted behavior with an unpleasant stimulus so that the behavior becomes less appealing. It has been used for behaviors such as smoking, nail biting, and alcohol use.

How can Antabuse reduce alcohol consumption through aversive conditioning?

If a person taking Antabuse consumes alcohol, unpleasant effects such as nausea, headache, increased heart rate, and vomiting may occur. Repeatedly pairing alcohol with these effects can create a conditioned aversion to drinking.

Term: Exposure therapy

A behavioral treatment for fear or anxiety that repeatedly presents the client with the feared object or situation until the fear response decreases. Exposure may occur in real life, through imagination, or with virtual reality.

Why is relaxation useful during exposure therapy?

Relaxation is incompatible with the intense fear response. Pairing gradual exposure with relaxation can help replace the conditioned fear response with a calmer response.

Who pioneered early exposure-based behavior therapy, and what was the basic strategy?

Mary Cover Jones is regarded as an early pioneer of behavior therapy. In treating a boy afraid of rabbits, she gradually exposed him to a rabbit while he engaged in a pleasant activity, aiming to condition relaxation instead of fear.

Term: Cognitive therapy

A psychotherapy approach that helps clients identify and change inaccurate or distress-producing thought patterns, such as overgeneralizing from one failure.

Term: Cognitive-behavioral therapy (CBT)

An approach that combines changing maladaptive thoughts with changing self-defeating behaviors. It targets the interaction between cognition, emotion, and behavior.

Term: Humanistic therapy

A therapy orientation that emphasizes conscious experience, self-awareness, personal growth, and acceptance. Clients are encouraged to articulate thoughts and feelings that interfere with achieving their goals.

What are the core therapist attitudes emphasized in client-centered humanistic therapy?

The therapist provides empathy, genuineness, and unconditional positive regard, creating an accepting environment in which the client can develop self-awareness and personal growth.

Term: Dialectical behavior therapy (DBT)

A form of cognitive-behavioral therapy that combines acceptance and mindfulness with skills for emotional regulation, distress tolerance, and interpersonal effectiveness. It is especially associated with treating borderline personality disorder and suicidal or self-harming behaviors.

How does DBT balance acceptance and change?

DBT helps clients accept their current thoughts and emotions without judgment while also teaching them concrete strategies to change harmful behaviors and regulate intense emotions.

What are the major categories of psychiatric medications?

Major categories include antipsychotics for psychosis, antidepressants for depression and some anxiety disorders, antianxiety medications for anxiety, and mood stabilizers for disorders involving extreme mood changes such as bipolar disorder.

How do antidepressant medications generally work?

They alter neurotransmitter activity involved in mood regulation. Common classes include selective serotonin reuptake inhibitors, or SSRIs, which increase serotonin availability in synapses by reducing its reuptake.

What are important limitations of medication therapy?

Medications may require several weeks to produce benefits, can cause side effects, and do not work equally well for everyone. They are often most effective when combined with monitoring and, when appropriate, psychotherapy.

What is electroconvulsive therapy (ECT), and when is it used?

ECT is a biomedical treatment in which a controlled electrical stimulus produces a brief generalized seizure while the patient is under anesthesia. It is often used for severe or treatment-resistant depression and can provide relatively rapid improvement.

How does modern ECT differ from historical electroshock treatment?

Modern ECT is administered under anesthesia with muscle relaxants and medical monitoring, greatly reducing the physical injuries associated with earlier uncontrolled procedures. Temporary confusion or memory loss can still occur.