Chapter 14. Treatment of Psychological Disorders “A Little Help from My Friends”

Introduction

true
true
You must read each slide, and complete any questions on the slide, in sequence.
A Little Help from My Friends
Dr. Julie B. Hanauer, Suffolk County Community College
true
screen1
Your Situation
screen2
Panic attack
Sudden, extreme fear or discomfort that escalates quickly, often with no obvious trigger, and includes symptoms such as increased heart rate, sweating, shortness of breath, chest pain, nausea, lightheadedness, and fear of dying.
Psychoanalysis
Freud’s views regarding personality as well as his system of psychotherapy and tools for the exploration of the unconscious.
Psychodynamic theory
A type of insight therapy that incorporates core psychoanalytic themes, including the importance of unconscious conflicts and experiences from the past.
Consciousness
The state of being aware of oneself, one’s thoughts, and/or the environment; includes various levels of conscious awareness.
Preconsciousness
According to Freud, the mental activity that can be brought easily to awareness.
Unconscious
According to Freud, the level of consciousness outside of awareness, which is difficult to access without effort or therapy.
Dream interpretation
According to Freud, dreams are the “royal road to the unconscious.” Therefore, a basic mechanism of psychoanalysis is attempting to discover the underlying meaning of a client’s dream.
Free association
A psychoanalytic technique in which a patient says anything that comes to mind.
Resistance
A patient’s unwillingness to cooperate in therapy; a sign of unconscious conflict.
Transference
A type of resistance that occurs when a patient reacts to a therapist as if dealing with parents or other caregivers from childhood.
Behavior therapies
A type of therapy that focuses on behavioral change.
Classical conditioning
Learning process in which two stimuli become associated with each other; when an originally neutral stimulus is conditioned to elicit an involuntary response.
Operant conditioning
Learning that occurs when voluntary actions become associated with their consequences.
Negative reinforcement
The removal of an unpleasant stimulus following a target behavior, which increases the likelihood of it occurring again.
Systematic desensitization
A treatment that combines anxiety hierarchies with relaxation techniques.
Flooding
A treatment in which the individual is exposed to the feared stimulus all at once.
Spontaneous recovery
The reappearance of a conditioned response following its extinction.
Cognitive therapy
A type of therapy aimed at addressing the maladaptive thinking that leads to maladaptive behaviors and feelings.
Major depressive disorder
A psychological disorder that includes at least one major depressive episode, with symptoms such as depressed mood, problems with sleep, and loss of energy.
Panic disorder
A psychological disorder that includes recurrent, unexpected panic attacks and fear that can cause significant changes in behavior.
Generalized anxiety disorder
A psychological disorder characterized by an excessive amount of worry and anxiety about activities relating to family, health, school, and other aspects of daily life.
Social anxiety disorder
A psychological disorder characterized by the fear of being criticized and judged by and/or humiliating oneself in front of others.
Obsessive-compulsive disorder (OCD)
A psychological disorder characterized by obsessions and/or compulsions that are time-consuming and cause a great deal of distress.
Eating disorders
A group of psychological disorders, including anorexia nervosa, bulimia nervosa and binge-eating disorder, in which the main focus of psychological distress and dysfunction focuses around food.
Humanistic therapy
A type of insight therapy that emphasizes the positive nature of humankind.
Therapeutic alliance
A warm and accepting client–therapist relationship that serves as a safe place for self-exploration.
Operationalized
Based on the model of operational definition: The precise manner in which a variable of interest is defined and measured. In humanistic therapy, Rogers promotes “unconditional positive regard,” but that is very difficult to measure (e.g., how do we measure the amount of love on an objective scale?) and therefore makes this model of therapy difficult to evaluate scientifically.
Anxiety hierarchy
The ranking of a client’s fears from least fearful to most fearful. This is used within the therapeutic intervention of systematic desensitization.
Blurred university student running in corridor with textbooks
Clerkenwell / Getty Images

Your professor announces that everyone will need to present on a specific topic in class in 3 weeks. The presentation will replace your research paper and will be worth 50% of your final grade. As she finishes the announcement, you begin to experience a panic attack: hyperventilating, sweating, and experiencing incredible chest pain. You think: “I’m going to be sick. I feel like I’m going to die!” You rush out of the classroom, thinking that you’re done with life as a college student. Thankfully, a friend from your class follows you out to make sure that you’re OK. She gets you some water and a wet towel and sits down on the stairs with you. You say, “I can’t do this presentation. I just can’t do it… or I’m going to die.”

Dugas, M. J., Brillon, P., Savard, P., Turcotte, J., Gaudet, A., Ladouceur, R., and Gervais, N. J. (2010). A randomized clinical trial of cognitive-behavioral therapy and applied relaxation for adults with generalized anxiety disorder. Behavioral Therapies, 41, 46–58.

Leichsenring, F., Abbass, A., Gottdiener, W., Hilsenroth, M., Keefe, J. R., Luyten, P., and Steinert, C. (2016). Psychodynamic therapy: A well-defined concept with increasing evidence. Evidence Based Mental Health, 19. doi: 10.1136/eb-2016-102372

14.1

screen2
screen3
What You Need to Know

Part of you realizes that you need to seek out therapy to help you overcome your overwhelming fear of public speaking. College is preparing you for life. You need to give this presentation to pass your class and to prepare you for other presentations in your future. You decide to face your fear and get some help.

Question

true
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

14.2

screen3
screen4

What kind of therapy should you seek? Let’s examine the different types of therapy and then narrow them down to a therapy that might work best for you. For each of the following definitions, use the drop-down menu to select the therapy that best fits the description.

Question

Uses medicine to alter perceptions, moods, and behaviors

4ohfckwqoFCnqoZwUjHlHhpryPfebK8rh9UF/wNa3APSwMje1jOGHICRU1Lp+21vo039GAInzjVLaTryY1NjxA==

Induces seizures in the brain

WnDsuy6DXYMyPqBH1eUjgbDiLR8LvuPf1Rj4NTu5KA/w1TvpU6R4uv9GefXMW2wGBoYSDZ3eaKtR1nrJnULHfXgmSzc=

Destroys some portion of brain or connections between different areas of brain

CeQJy9zxQQBiesNORCs1wHg2gMRk8dRl0RBYrLTEwpo3hUaFkyMoluojm+eCmTFT8z7V2cur5h9/v/AK

Using principles of learning, seeks to replace maladaptive behaviors

BDA85xwvY/PpElc++7U6M2QFYbqNgpcsvhyNOkK3o33wrNObs+ZkdQi/EhrltmrPN/lJbUFervC2u8zKLCcC/w==

Seeks to increase awareness of unconscious conflicts

kwO+uFDsiK4P2ga28p3HMjoBDpaf1Ib+RS9U1yRWNuiPjm4Oyjwy/ukzPfSKXsbB8BHi5/d9OSK+7cXIpOGKwA==

New approach to psychoanalysis

kk/Q3yQdXkibt4ip5ceM4FwehO1I0VMgRnJokYJayzXKtIpQb2h2HvaI8wPB/C6//r9gGSbUT6YttZD2V36fkw==

Emphasizes positive nature

nDbnhY+roTVUfGGpuQeeyavGMdvxy/Ngr7BdDXNHpwM+7sehQtxENYFsf1FpkFAAhDBRwDMU2xrwRyIV5AfCAPNy/UM=

Seeks to change maladaptive thoughts

tBnE5Ic2FVwOd7XZgSVrXhUWv5tZAnSgOULMrwE4u6r1bhF0/gMJwHnFQv+3VYXDayb3L7i+VUpPbPOzWVYDKlv48rw=

14.3

screen4
screen5
 Prozac, Paxil and Zoloft anti-depressant tablets, close-up
Jonathan Nourok/Getty Images

Let’s figure out the best type of therapy for your social anxiety disorder. There are many different types of therapy, but not all of them are best for all disorders. For example, if you were showing signs of schizophrenia, biomedical interventions in the form of antipsychotic medication are most effective at treating symptoms, and psychodynamic therapy by itself would be ineffective. Finding the correct therapy to treat your symptoms is one of the most important and challenging parts of the process.

Mature psychiatrist listening to man sitting in foreground
Zigy Kaluzny/The Image Bank/Getty Images

14.4

screen5
screen6
Sigmund Freud
Sigmund Freud
© Macmillan

We’re going to focus on four main forms of psychological therapy. You will receive information about each type of therapy, and then you will figure out which one is best for your situation. The first therapy is psychoanalysis, or its more modern term, psychodynamic theory. It is based on the Freudian ideas of consciousness, preconscious, and the unconscious. This therapy depends on dream interpretation, free association, resistance, and transference to deal with the effects of our repressed drives of sex and aggression. Psychoanalytic therapy is the oldest form of therapy, but there are criticisms. For example, psychoanalysis deals with unconscious thoughts, feelings, instincts, and desires of which we are largely unaware. This makes it difficult to objectively and scientifically evaluate and interpret these unconscious aspects. Studies have shown psychoanalysis to be effective for some psychological disorders, but a therapeutic relationship involving a lot of verbal expression and insight into one’s self is required (Leichsenring et al., 2016).

Question

true
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

14.5

screen6
screen7

Another form of therapy that might be helpful to you is behavioral therapy. This type of therapy is based on the principles of classical conditioning and operant conditioning. Behavior therapies involve relaxation training, exposure to the anxiety-promoting situation, and replacing the feared outcome with a more positive outcome. Behavioral therapies usually involve relaxation training because you cannot feel anxious and relaxed at the same time. For example, the complete feeling of panic you were experiencing while thinking of doing your presentation does not fit with the feeling of relaxation.

Negative reinforcement also comes into play in behavior therapies. For example, if you avoid speaking to other people, you never have to be afraid of humiliating yourself. The exposure to speaking publicly can be broken down into small increments (systematic desensitization), or it can be delivered all at once (flooding). Behavior therapies have been shown to be helpful in treating many different anxiety disorders and, in many situations, are quicker than many other therapies. However, behavior therapies are based on learned behaviors, so they can’t always change a person’s thinking (“I’m going to die if I have to speak in front of other people.”). Also, unfortunately, spontaneous recovery can cause the old behaviors to come back.

Question

true
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

14.6

screen7
screen8
Aaron Beck drawing
Aaron Beck, the father of cognitive therapy
© Macmillan

Another form of evidence-based therapy is cognitive therapy. Cognitive therapy is based on identifying the client’s (negative) misinterpretations of the world and helping the client to change those misperceptions. For example, the thought “When I get up to speak, everyone is going to make fun of me” may cause you to create a scenario in your head where you can’t possibly speak in front of the class. You may show patterns of automatic thoughts such as: “I just stuttered and everyone is looking at me. I’m an absolute idiot.” You may also exhibit cognitive distortions such as: “I’m going to fail this class because I can’t give the presentation. I might as well just drop out of school.” Cognitive therapy’s goal is to help clients recognize how their thoughts are affecting their beliefs and behaviors and help them change those negative automatic thoughts and cognitive distortions. Thousands of studies have demonstrated that cognitive therapies provide relief from symptoms of major depressive disorder, panic disorder, generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, and eating disorders (Dugas et al., 2010).

Question

true
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

14.7

screen8
screen9
matching_test

Humanistic therapy emphasizes the positive nature of humankind and helps clients reach their full potential and create a life beyond negativity and feelings of emptiness. In order to do this, humanistic therapists believe that a therapeutic alliance must be built between the client and the therapist. Humanistic therapy has proven useful with a variety of psychological disorders and stressful situations. Unfortunately, the methods of humanistic therapy are not “operationalized” so this approach is difficult to study.

Match the terms with the correct description to ensure that a therapeutic alliance can be built between the client and the humanistic therapist. Create matches by selecting the circle next to an option in the left column. Then click on the circle next to the option in the right column where you want to make the match.

Building a Therapeutic Alliance

8 photos left
You correctly matched each personality trait to its characteristics.
Incorrect. Try again.
Empathy
Unconditional positive regard
Genuineness
Active listening
The ability to respond to a client in an authentic way rather than hiding behind a polite or professional mask.
The ability to pick up on the content and emotions behind words in order to understand a client’s perspective, often by echoing the main point of what the client says.
According to Rogers, the total acceptance and valuing of a client regardless of behavior.
The ability to feel what a person is experiencing by attempting to observe the world through the client’s eyes.

14.8

screen9
screen10
Skills You Can Use

Now you need to figure out which type of therapy will work best for you in the shortest period of time (that presentation date is coming up soon!). As you recall from your textbook, problem solving involves working through a variety of approaches to achieve a goal, in this case, giving your presentation to your class. Each type of therapy has demonstrated some effectiveness and helped clients with specific disorders. Which therapy is best for your situation? Let’s go through the steps of problem solving. The first step is understanding the problem.

Question

true
AvOVyAl5ubGOvNHIm+fls6GOXFDTMqa9A58M4pWXovG2I9WBhq0efbsz5vjEapFt8Z9qf4/WFKilMfManDOSBaGFJH9oviJ5MH9M0IwgsgBWT3bUzkD6N0rjD8KjqXKnnMkeuaEa9G3ADEXPlcfT6guWhN3GeIZ5Hls6J2p3uMg49am2SyfsuTG6VS16DJp4qLFzC02ka83D+whLAdcL8jEPL4uUy5y6mV4E+BVrMw7LNm6zy/c1MO/1FKRPF3S+YNfXjh6FC221sJufaIUyxabx5BQvywt9nQ+lhyLCgFuAOaE8ZeOOCyx7nLkjT4HK5xrJh6uo/TE3JHfye43lf5ThB3TzFoRO+z/qixXilJxcEQDy/3pXDl0XjQJAxxYz/AR6xq+rUEaETjXnMmoVnvVFZK+rJzs2pyX48Fd2FYJygQveLawuuMXyjl6widEQJLM75K0YgvyvdYpeEy5HDtkC8omGs6E7OrjtdwVpMP9FDC4Gx3qluJ+wEhLeJu1RvAOpNcaJZRgiC/sz55r4A5EFOWI2tX/myialjHScUR9vKG8AD9M9qlcSFyHQmOR4FGcKyYVDGa49SMdY59fvydFEmNYSfNPgrXsnhSAM+3mVe0Qo122BqQQutfYA9YyWH0eqgzBzBHEyw1PqNJFns8qbvrkhnUjgfovGMNQvJtGFr09/ElbyYEapQyRcdbXrBrCUtlpK10lFrpaFQ01R4jvtXdhRLLi0YXWSDFPZy7bYwIlz54VunlnQZm25bnOE60IWkjOdVe1jyvzki/At3ITP/n1qHG5OBXQeRDok866I3vXsYKNr5Tketh7quQ+hgL1ffoWBS5CgkVFz/f1Zb+JjWKvJlouIWH5D1zp+DOfkwc7G8VVsrAWJvEmqEyaKjDn6StM3qMFX2N0DXJh0TMtj+XokoJPeQ7SEsBhX/gc=

14.9

screen10
screen11

Question

true

Now you know that your primary problem involves a specific fear, public speaking. The second step in problem solving is choosing an approach. You have learned about four different types of therapy.

For your situation, which of these are the most important issues? Check all that apply:
Correct! Your therapy will need to work quickly because the due date for your presentation is fast approaching, your problem involves high anxiety levels, and you fear experiencing another panic attack because of public speaking. In addition, you are afraid that your fear of giving the presentation will generalize to other social situations.
Actually, your therapy will need to work quickly because the due date for your presentation is fast approaching, your problem involves high anxiety levels, and you fear experiencing another panic attack because of public speaking. In addition, you are afraid that your fear of giving the presentation will generalize to other social situations.

Question

qRP/fEq9JNQqk/98255amwHKVny9qf8WQ/Xk3FaXpo+ek2eJLakO+ihKLPD8rPUuDkJZUAEYY5ZIhzHSI3nnJ1JGXnnyow//Otaq7LZ6Wdq84DJWRFW2P+0J9KMQRg3zmpFHwYvQNsaurdcLqf/XKKlhr+d6hgdlqu/Gxp7iJ6/pBWKxpZeIkgaxy6VQbMpvC0UwjoCnfsccyZbMlvFUtF9qzxvT4bghhpIiVdfpThvk5Nm//GYVJY6W3m36dHwRmoImZwtJAzAkWUq3VZ/VnZyUL6ZJWjqHK6oiZVku6NMlsXqjjaAB7J2DLFsvPWm7QuGKH1X2sVRLOF1QW9TIQDeJkbTszcLR6DFMleQ8hCRsv4GAST6Ngy8dz15tDAmBfg5ytJ6itwRXBOPeDt1lz45Afz2kxu36NqC/2lNp4OlzXZKcqbfg7w==
Answers will vary, but should break down the reasons why the student has chosen the particular therapeutic intervention. The best answer choice is behavioral therapy. Reasons should include relaxation training, exposure to feared stimuli in a gradual or extreme manner, and learning to overcome the feared stimuli in a time sensitive manner. Cognitive, humanistic, and psychoanalytic therapies are somewhat effective, but they are not likely to be successful for quickly overcoming the social anxiety. For overcoming the fear of public speaking, learning to relax while gradually being exposed to the stimuli might be the best intervention.

14.10

screen11
screen12
dnd_test

You choose behavioral therapy because it best meets your needs. You make an appointment with a therapist who teaches you relaxation techniques such as deep breathing, visualization, and muscle relaxation. You also go through the process of systematic desensitization.

Create your anxiety hierarchy by ranking your fear about public speaking from the least anxiety-provoking situation to the most. Move items by dragging them to the correct location or by selecting an item and then selecting the location where it should move.

8 photos left
Making a Speech
DGLimages/Getty Images
First you practice relaxation techniques to attain a relaxed physiological state, and then you are presented with the situations on your anxiety hierarchy, moving gradually from the least to each slightly more anxiety-provoking situation. You first read your presentation to yourself, then out loud. Then you give your presentation while looking in the mirror and you record yourself speaking. To further help, your therapist allows you to use her virtual reality device in which you are, virtually, giving a presentation in front of a large class. You hear the applause from the audience without feeling overwhelmed. You have attained virtual success! Eventually, after giving your presentation to your roommate, followed by a small group of friends, you can give a full speech in front of a real live audience without feeling anxious.
First you practice relaxation techniques to attain a relaxed physiological state, and then you are presented with the situations on your anxiety hierarchy, moving gradually from the least to each slightly more anxiety-provoking situation. You first read your presentation to yourself, then out loud. Then you give your presentation while looking in the mirror and you record yourself speaking. To further help, your therapist allows you to use her virtual reality device in which you are, virtually, giving a presentation in front of a large class. You hear the applause from the audience without feeling overwhelmed. You have attained virtual success! Eventually, after giving your presentation to your roommate, followed by a small group of friends, you can give a full speech in front of a real live audience without feeling anxious.
Giving a presentation in front of your class
Giving a presentation to a small group of friends
Giving a presentation to your best friend or roommate
Giving a presentation to a virtual “large audience” using a virtual reality device
Recording yourself giving a presentation
Giving a presentation to yourself in the mirror
Reading your presentation out loud
Reading your presentation to yourself

14.11

screen12
screen13
Think It Through!

Question

ZtlghDi3xiBDDI4OeoWhYTteRpOc0K231GbjdxqLRV6kPOFSnyq/uUWlDRvVlB1+/sTtY2NH+V5srUWE60+F93AssH5FS+FpG1dZ7L8T8SCtpX08clRj2AoH7euCt2HHKctFF/58YHJP7Pky2zu0c/ojpL9l/1qNunAhhfxWely6+Gn6gP8ZCdlVZcfBbLb9IVMH1Gv2jkD2MXAKmp1yH6JPTzlMHQgjfZv3pryLcDxOJxra0BuHbEb2zIfDAcgJbgyknbQH17OgIixu2WvuPnIf8jPDg8wO
Answers will vary, but should include the gradual presentation of the feared stimuli as one of the keys to success. Systematic desensitization is successful in many cases because of this gradual exposure of the paired stimuli being paired with relaxation. Remember that one cannot be both amped up by an anxiety-provoking situation and calm at the same time. Relaxation training will, hopefully, make the conditioned response of fear become extinct.

14.12

screen13
screen14

As you have now seen with the example of systematic desensitization, gradual exposure to the feared stimulus along with relaxation training can help individuals to overcome their phobias. We are now going to watch a video of Mike, who had an extreme fear of going to a dentist. Pay close attention to how psychological techniques helped Mike overcome his fears and get the dental treatment that he needed.

Video transcript

MIKE: 12 months ago I needed to go and see a dentist, because I had tooth ache-- severe tooth ache. And I finally plucked up the courage to go and visit the dental surgery. I stood outside, could feel my heart pumping in my chest. A little bit like a panic attack, I suppose.

MAN: Right.

MIKE: Just couldn't walk over the threshold.

MAN: Mike has a dental phobia. To overcome his phobia, we're going to rewire his brain using a process called gradual exposure. It's a specialized treatment, and Tim Newton at Guy's Hospital in London is one of the world's leading experts.

TIM NEWTON: So what happens when you think about going to the dentist? What's going through your mind.

MIKE: Teeth being extracted, blood, pain.

TIM NEWTON: And instantly thinking it's going to be very, very unpleasant?

MIKE: Yeah.

TIM NEWTON: And so, one of the things, which we'll want to do, is sort of test the reality of that. And look to see whether that is what will really happen, so that we can change the way you think about the dentist situation. We're going to start today a sort of new approach, which we're developing here, which is using video. The idea is that we show you this and we ask you to practice relaxing yourself, calming yourself. Keep doing that until you can watch that bit of video without being too anxious. And then we'll start doing it in real life, and gradually, gradually build up until we've reached your goal, which is to be able to walk into surgery, sit in the chair, and have some treatment.

MAN: Under Professor Newton's instructions, Mike's been working hard on a number of techniques. As well as watching videos, he's written about his fears, he's listened to the sound of dental drills, handled dentist instruments, and developed a series of flashcards to highlight his key fears and ways to cope with them.

MIKE: To begin with, I must confess, I couldn't really see the point in some of this. But bit by bit, the building blocks have come together, and it's a bit like a snowball rolling downhill. The new experiences, and the desensitization, and the logic behind some of the way I feel and how I feel it has come together, it's actually been very, very good. And a lot of the historic experiences that were very poor have now been replaced by new ones, and the demons don't seem to be there.

Question

true
What was Mike experiencing as he approached the dentist? Check all that apply.
Correct! Mike expressed feeling increased heart rate, a feeling of a panic attack, great anxiety, anticipation of blood, anticipation of pain and anticipation of teeth extraction.
Actually, Mike expressed feeling increased heart rate, a feeling of a panic attack, great anxiety, anticipation of blood, anticipation of pain and anticipation of teeth extraction.

14.13

screen14
screen15

Question

true
According to the video, along with relaxation training, what exposure therapy techniques did Mike undertake so that he was gradually able to successfully overcome his dental phobia? Check all that apply.
Correct! Along with relaxation training, Mike used the following techniques so that he was gradually able to successfully overcome his dental phobia: watching videos, writing about his feelings and fears, developing flash cards on how to handle specific situations, listening to the sounds of the dental drill, and handling the dental instruments.
Actually, along with relaxation training, Mike used the following techniques so that he was gradually able to successfully overcome his dental phobia: watching videos, writing about his feelings and fears, developing flash cards on how to handle specific situations, listening to the sounds of the dental drill, and handling the dental instruments.

Question

RwnP4o3eftr6GjeyBLoP6GGQxGfWKD+pMvUuSJ2RDTaF8CkT1NXPaE5Qsl0wUHhnOo/HFPaKp3RDJhkmWDlEMLpiGpq5+hSK3W/0MbsqRadyFdFUYM1xW9Mi5WpK6OTiO/+Q4yJuI8QSfEhY9PTufq8hvKsX/k7XuFOYoFT0AOptDQz74WlWJQohGSdjm/lvs6LMYE4A6pnN68F5qW29NbUfcUAR3Zzqn0BUpkVrjE0z+hOmcp+kSpuFmSiF1Kmcdj3Cnp7YRNYV55J0f2OUQk8HpB4i3kZweV3tCZRlTQPgzP7f0VVs2BCc0tTVmDJfqUiBGzfag90Lx8w5Gtty89KO+HQ/1ILKZY21MVJ8w6nr0QU+3R2uJ3w1e2RxsUF5RSsm80OxsKo+QOn2NUCuoexFP+QHS8EMmTi4nEO1S2w=
Answers will vary, but may include isolation from others because of tooth issues becoming more apparent, missed work due to pain and discomfort, danger of infections in his mouth spreading, distress about feeling isolated from others because of bad breath, pain, appearance, missed socialization and loneliness.

14.14

screen15
screen16
In Your Own Words

Mental illness is real, but there are many therapeutic approaches to help people. Other options go beyond what has been discussed here. Some people benefit from biomedical interventions such as antidepressants. Some individuals learn to cope in a group setting. Most important is to get help if you need it; seeking out the best fit is key to success. The problem-solving strategies discussed in this activity should help you find the resources you need.

Question

ZhR3tM+4KyGzubJZBS7zr58A+eczAt+oYe/KRAdK3gWD3t+NyLPyqVtAM4mJo1IqIeAInPM7A9Cm6sJ88IwhOluSr0ADmt0vFrJeoS8/i8PAQ9K8tnSvj3pHbB4gENo26bhgMj9L/28mv3AcawfonmpwwsH9T4wwsKCW3Ku5E7meBYDxTY8W3W2v3U1EEuJBslWyFULNQ6qGNOoaEwBcvbug6E5iJ+sY4MRsK8QZfmLDU7oEp4Jp0dVFS1U=
Answers will vary, but should include the discovery of multiple approaches to therapy such as psychodynamic, cognitive, behavioral, and humanistic. In addition, individual and group therapy can be mentioned, as well as biomedical treatments. Therapies should be differentiated based on effectiveness and usefulness, as well as practicality for the person seeking therapy.

14.15

screen16
Show What You Know

Question

true
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

Question

true
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

Question

true
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

Question

true
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

Question

true
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