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~Psychosocial Treatments

What are psychosocial treatments?

Psychosocial treatments—including certain forms of psychotherapy (often called “talk-therapy”) and social and vocational training—are helpful in providing support, education, and guidance to people with mental illnesses and their families. Studies tell us that psychosocial treatments for mental illnesses can help individuals decrease the negative effects of their illnesses and increase their functioning (leading to fewer hospitalizations and less difficulties at home, at school, and at work). A licensed psychiatrist (a doctor, who can prescribe medications), psychologist, social worker, psychiatric nurse or counselor typically provides these psychosocial therapies.

In some cases, a therapist and a psychiatrist may work together as many complicated mental illnesses have been found to be treated most effectively with a combination of therapy and medications. Sometimes in these cases, the psychiatrist prescribes medications and the therapist monitors the individual’s progress and can also observe for response to medication treatments. In these cases, a therapist and a prescribing psychiatrist will hopefully be in contact to discuss their thoughts as to how they can work together to support their mutual patients.

The number, frequency, and type of psychotherapy sessions an individual has should be based on his or her individual treatment needs. As with medication, it is important to follow the treatment plan for psychosocial treatments to gain the greatest benefit.

Individual Psychotherapy

Individual psychotherapy involves regularly scheduled sessions between the patient and a mental health professional. The goal of this treatment is to help individuals understand why they are acting and thinking in ways that are troubling or dangerous to themselves (or others). This allows a person to have more control over their behaviors and to change these behaviors when possible.

Talk-therapy sessions may focus on a person's current or past problems, experiences, thoughts, feelings or relationships. By sharing their experiences with a trained, knowledgeable, and understanding person, individuals with mental illnesses may gradually understand more about themselves and the problems they are facing.

Individual psychotherapy is used successfully to treat emotional, behavioral, and social problems in people with schizophrenia, bipolar disorder, attention-deficit/hyperactivity disorder (ADD/ADHD), depression, eating disorders, anxiety disorders and other mental illnesses.

Psychoeducation involves teaching people about their illnesses and how they are treated. This allows people and their families to recognize signs of relapse in order to get necessary treatment before mental illness worsens or occurs again. Family psychoeducation includes teaching coping strategies and problem-solving skills to families (and friends) of people with mental illnesses to help them deal more effectively with their friends and relatives. Family psychoeducation reduces distress, confusion, and anxieties within the family, which may help the individual with mental illness to recover.

Pscyhoeducation in combination with medication has been used successfully to treat people with schizophrenia, bipolar disorder, attention-deficit/hyperactivity disorder (ADHD), depression, and other mental illnesses. Psychoeducation further allows individuals to support their loved ones through the treatment process.

NAMI has developed a program called Family-to-Family, a free, 12-week educational and support program for family members of patients with mental illness. It is available internationally throughout North America (including in Mexico, Puerto Rico and Canada) and is run by people who have family members of their own with mental illnesses. It has been shown in scientific studies to be useful in decreasing the distress of family members and improving outcomes (including less hospitalizations and increased functioning) of patients with mental illness.

Two other programs developed by NAMI are Peer-to-Peer, created to help individuals maintain their wellness and recovery, and NAMI Basics, a program designed to help educate parents and other caregivers of children and adolescents living with mental illness.

Self-help and Support Groups

Self-help and support groups for people and families dealing with mental illnesses are becoming increasingly common. Although not led by a professional therapist, these groups may be therapeutic because members give each other ongoing support. These groups also are comforting because ill people learn that others have problems similar to theirs: they are not alone in this world with their mental illness.

Members of support groups share frustrations and successes, referrals to qualified specialists and community resources, and information about what works best when trying to recover. They also share friendship and hope for themselves, their loved ones, and others in the group.

Groups may also help families work together to advocate for needed research and treatments and for better hospital and community programs. When people act as a group rather than individually, they are often more effective in the fight against stigma and more successful at drawing public attention the discrimination that people living with mental illness often face.

NAMI Connection, a weekly recovery support group for people living with mental illness in which people learn from each other’s experiences, share coping strategies and offer each other encouragement and understanding.

What are examples of specific psychotherapies?

Therapists offer many different types of psychotherapy. In general no one type of therapy is necessarily "better" than another type, although certain mental illnesses have been shown to respond better to specific psychotherapies. When deciding which therapy, or therapies, will likely be the most successful treatment option for an individual, a psychotherapist considers the nature of the problem to be treated and the individual's personality, cultural and family background, and personal experiences. Note that some psychotherapists have specific training in different treatments. Furthermore, a psychiatrist or psychotherapist (or both) may offer each of the following therapies to an individual, family, couple or group.

Interpersonal Therapy

Interpersonal therapy focuses on the relationships a person has with others. The goal of interpersonal therapy is, of course, to improve interpersonal skills. The therapist actively teaches individuals to evaluate their interactions with others and to become aware of self-isolation and difficulties getting along with, relating to, or understanding others. He or she also offers advice and helps individuals make decisions about the best way to deal with other people.

Interpersonal therapy is a psychosocial treatment used most frequently to help people with bipolar disorder, ADHD, depression, eating disorders and generalized anxiety disorder. It is often expected to last for approximately 3-4 months and to target specific symptoms over this time period.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a treatment that focuses on the relationship between an individual’s thoughts, feelings, and behaviors. A CBT therapist will try to explore the links between the thoughts and emotions that occur prior to disruptive behaviors in people with mental illness. By establishing these connections, individuals learn to identify and change inappropriate or negative thought patterns and as a consequence, can address the behaviors associated with their illness.

A common goal is to recognize negative thoughts or mind-sets (mental processes such as perceiving, remembering, reasoning, decision making, and problem solving) and to replace them with positive thoughts, which will lead to more appropriate and beneficial behavior. For instance, CBT tries to replace thoughts that lead to low self-esteem ("I can't do anything right") with positive expectations ("I can do this correctly"). This can often times involve “homework” to help an individual “practice their skills” in between treatment sessions.

CBT is often thought of as a “first-line treatment” in many anxiety disorders (including OCD, Panic Disorder, and PTSD). Along with medication treatment, CBT can successfully help people with schizophrenia, bipolar disorder, ADHD, depression, eating disorders, generalized anxiety disorder, panic disorder, OCD, substance abuse problems and other mental illnesses.

Exposure Therapy

A type of behavioral therapy known as exposure therapy (or exposure and response prevention) is specifically useful for treating obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). During exposure therapy, an individual is deliberately exposed to whatever triggers the obsessive thoughts or reaction to a previous traumatic experience under controlled conditions. The individual is then taught techniques to avoid performing the compulsive rituals or to work through the trauma. This is helpful in decreasing the urges following a stimulus (thought or situation) that previously resulted in the individual being paralyzed by the thoughts and behaviors associated with their mental illness. ERP (Exposure and Response Prevention) is thought of as a “first-line treatment” for PTSD and OCD in certain situations. In many cases, exposure therapy is used along with medications due to the severity of symptoms.

Dialectical Behavior Therapy (DBT)

Dialectical behavior therapy (DBT) was initially developed to treat chronically suicidal individuals with Borderline Personality Disorder (BPD). Over time, DBT has evolved into a treatment for individuals with multiple different disorders, although many people who are treated with DBT have borderline personality disorder (BPD) as a primary diagnosis. DBT has also been adapted for behavioral disorders involving emotional dysregulation (such as substance dependence in individuals with BPD and binge eating disorder) and for treating people with severe depression and associated suicidal thoughts. DBT combines the basic strategies of behavior therapy with a philosophy that focuses on the idea that ‘opposites may really not be opposite when looked at differently.’

As a comprehensive treatment, DBT can:

Decrease the frequency and severity self-destructive behaviors,
Increase the motivation to change (by providing positive reinforcement),
Teach new “coping skills” that generalize to a person’s natural environment
Provide a treatment environment that emphasizes the strengths of both individuals and their treatments
Enhance the therapist's motivation and ability to treat their clients effectively
In standard DBT, different types of psychosocial therapies—including individual psychotherapy, group skills training, and even phone consultations—may be used as part of treatment.

Psychodynamic Psychotherapy

Psychodynamic Psychotherapy has its fundamental roots in the teachings of Sigmund Freud, Carl Jung, and other psychiatrists who practiced in the early twentieth century. Yet most therapists who offer this treatment are no longer driven by the rigid rules of traditional “psychoanalysis.” Psychodynamic psychotherapy is practiced differently by different therapists and will likely vary depending on the needs of their client. There is not as much scientific data supporting the effectiveness of psychodynamic psychotherapy in some illnesses (such as schizophrenia) as opposed to other treatments (including CBT). Therefore it is no longer considered a “first-line treatment” in many mental illnesses. In spite of this, psychodynamic psychotherapy can be useful for some patients with depression, anxiety disorders, borderline personality disorder, and other mental illnesses. In many cases, psychodynamic psychotherapy occurs along with medication therapy.

Assertive Community Treatment (ACT)

ACT is a highly effective team-based model of providing comprehensive and flexible treatment and support to individuals who live with serious mental illness. Teams can include peer support specialists and practitioners with expertise in psychiatry, nursing, social work, substance abuse treatment, and employment who work closely together to provide integrated and outreach‐oriented services.

Dual Diagnosis and Integrated Treatment of Mental Illness and Substance Abuse Disorder

Dual diagnosis services are treatments for people who live with co-occurring disorders—mental illness and substance abuse. Research has strongly indicated that to recover fully, a consumer with co-occurring disorder needs treatment for both problems—focusing on one does not ensure the other will go away. Dual diagnosis services integrate assistance for each condition, helping people recover from both in one setting, at the same time.

Reviewed by Ken Duckworth, M.D. and Jacob Freedman, M.D., July 2012

The authors would like to thank Rex Cowdry, M.D. who was responsible for writing a previous draft of this article.