Chapter Introduction

“TODAY WE’RE GOING TO BE TOUCHING A DEAD MOUSE I saw in the alley outside my office building,” Dr. Jenkins said. “OK, let’s do it, I’m ready,” Christine responded. The pair walked down to the alley and spent the next 50 minutes touching, then stroking, the dead mouse. They then went back upstairs to plan out what other disgusting things Christine was going to touch over the next 7 days before coming back for her next therapy session. Yes, this is all part of the psychological treatment of Christine’s obsessive-compulsive disorder (OCD). It is an approach called exposure and response prevention (ERP), in which people are gradually exposed to the content of their obsessions and prevented from engaging in their compulsions. Christine’s obsession is that she is going to be contaminated by germs and die of cancer; her compulsive behavior involves several hours per day of washing her body and scrubbing everything around her with alcohol wipes. After dozens and dozens of exposures, without performing the behaviors that they believe have been keeping them safe, people eventually learn that their obsessive thoughts are not accurate and that they don’t have to act out their compulsions. ERP can be a very scary treatment, but it has proven amazingly effective at decreasing obsessions and compulsions and helping people with OCD return to a high level of daily functioning. OCD was widely considered untreatable until the development of ERP, which is now considered to be the most effective way to treat OCD (Foa, 2010). ERP is just one of many approaches currently being used to help people to overcome the mental disorders you learned about in the last chapter.

Exposure-based treatments, in which a person learns to face the source of their fear and anxiety, have proven to be an effective way to treat anxiety disorders.

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THERE ARE MANY DIFFERENT WAYS TO TREAT PSYCHOLOGICAL DISORDERS and to change the thoughts, behaviors, and emotions associated with them. In this chapter, we will explore the most common approaches to psychological treatment. We will examine why people need to seek psychological help in the first place, and then explore how psychotherapy for individuals is built on the major theories of the causes and cures of disorders, including psychoanalytic, humanistic, existential, behavioral, and cognitive theories. We also will look into biological approaches to treatment that focus on directly modifying brain structure and function. We’ll discuss whether treatment works, as well as how we know that treatment works. We’ll also look to the future by exploring some exciting new directions in the assessment and treatment of disorders using innovative technologies.