Extraordinary advances have been made in the treatment of mental illness. As a result, many mental health conditions can now be treated nearly as successfully as general medical disorders.
Most treatment methods for mental health conditions can be categorized as either
Somatic (physical)
Psychotherapeutic
Somatic treatments include medications, electroconvulsive therapy, and other therapies that stimulate the brain (such as transcranial magnetic stimulation and vagus nerve stimulation).
Psychotherapeutic treatments include psychotherapy (individual, group, or family and marital), behavior therapy techniques (such as relaxation training or exposure therapy), and hypnotherapy.
Most studies suggest that for major mental health conditions, a treatment approach involving both medications and psychotherapy is often more effective than either treatment method used alone.
Psychiatrists are not the only mental health care professionals trained to treat mental illness. Others include clinical psychologists, psychiatric nurse practitioners, and social workers. However, in the United States, psychiatrists (and psychiatric nurse practitioners in some states) are the only mental health care professionals licensed to prescribe medications. Other mental health care professionals practice psychotherapy primarily. Many primary care doctors and other types of doctors also prescribe medications to treat mental health conditions.
Types of Mental Health Care Professionals
Health Care Professional | Training | Expertise |
|---|---|---|
Psychiatrist | Medical doctor with 4 or more years of medical and psychiatric training after graduation from medical school | Can prescribe medications, administer electroconvulsive therapy, and admit people to the hospital May only practice psychotherapy, only prescribe medications, or do both |
Psychologist | Health care professional who has a master’s or doctoral degree but not a medical degree Often has postdoctoral training and usually has been trained to administer psychological tests that are helpful in diagnosis | May practice psychotherapy but cannot do physical examinations, prescribe medications (in most states), or admit people to the hospital |
Psychiatric social worker | A health care professional with specialized training in certain aspects of psychotherapy, such as family and marital therapy or individual psychotherapy Often trained to interface with the social service systems in the state May have a master's degree and sometimes a doctorate as well | Cannot do physical examinations or prescribe medications |
Advanced practice psychiatric nurse | Registered nurse with a master’s degree or higher and training in behavioral health | May practice psychotherapy independently in some states and may prescribe medications under the supervision of a doctor |
Psychoanalyst | May be a psychiatrist, psychologist, or social worker who has many years of training in the practice of psychoanalysis (a type of intensive psychotherapy involving several sessions a week and designed to explore unconscious patterns of thought, feeling, and behavior) | Practices psychoanalysis and, if also a psychiatrist, may prescribe medications and admit people to hospitals |
(See also Overview of Mental Illness.)
Medication Therapy
A number of psychoactive medications are highly effective and widely used by psychiatrists and other medical doctors. These medications are often categorized according to the disorder for which they are primarily prescribed, although they may be effective for a variety of different psychiatric disorders. For example, most of the medications used to treat schizophrenia are also effective for bipolar disorder and most antidepressants are used to treat depression as well as anxiety disorders.
The most widely used class of antidepressants is
Other classes of antidepressants include
Older antipsychotics
SSRIs and antianxiety medications
Psychotherapy
In recent years, significant advances have been made in the field of psychotherapy, which is sometimes referred to as talk therapy. By creating an empathetic and accepting atmosphere, the therapist often is able to help the person identify the source of the problems and consider alternatives for dealing with them. The emotional awareness and insight that the person gains through psychotherapy often results in a change in attitude and behavior that allows the person to live a fuller and more satisfying life.
Psychotherapy is appropriate and effective in a wide range of conditions. Even people who do not have a mental health condition may find psychotherapy helpful in coping with such problems as employment difficulties, bereavement, or chronic illness in the family. Group psychotherapy, couples therapy, and family therapy are also widely used.
Most mental health professionals practice 1 of 6 types of psychotherapy:
Behavioral therapy
Cognitive therapy
Interpersonal therapy
Psychoanalysis
Psychodynamic psychotherapy
Supportive psychotherapy
Behavioral therapy
Behavioral therapy involves a number of interventions that are designed to help the person unlearn maladaptive behaviors (for example, dependency and inability to tolerate frustration) while learning adaptive behaviors (openness to experience and conscientiousness). Exposure therapy, often used to treat phobias, is 1 example of a behavioral therapy. In exposure therapy, people are exposed to feared objects, activities, or situations in a safe environment. The purpose is to reduce fear and help people stop avoiding the things they fear.
Behavioral therapy is related to cognitive therapy. Sometimes a combination of the 2, known as cognitive-behavioral therapy, is used. The theoretical basis of behavioral therapy is learning theory, which says that abnormal behaviors are due to faulty learning.
Cognitive therapy
Cognitive therapy helps people identify distortions in thinking and understand how these distortions lead to problems in their lives. For example, people may think in an all-or-nothing way ("if I am not a total success, I am a complete failure"). The premise is that how people feel and behave is determined by how they interpret experiences. Through the identification of core beliefs and assumptions, people learn to think in different ways about their experiences, reducing symptoms and resulting in improvement in behavior and feelings.
Interpersonal therapy
Interpersonal therapy was initially conceived as a brief psychological treatment for depression and is designed to improve the quality of a depressed person’s relationships. It focuses on the following:
Unresolved grief
Conflicts that arise when people have to fill roles that differ from their expectations (such as when a woman enters a relationship expecting to be a stay-at-home mother and finds that she must also be the major provider for the family)
Transitions in social roles (such as going from being an active worker to being retired)
Difficulty communicating with others
The therapist teaches the person to improve aspects of interpersonal relationships, such as overcoming social isolation and responding in a less habitual way to others.
Psychoanalysis
Psychoanalysis is the oldest form of psychotherapy and was developed by Sigmund Freud in the first part of the 20th century. The person typically lies on a couch in the therapist’s office 4 or 5 times a week and attempts to say whatever comes to mind—a practice called free association. Much of the focus is on helping the person understand how past patterns of relationships repeat themselves in the present. The relationship between the person and the therapist is a key part of this focus. An understanding of how the past affects the present helps the person develop new and more adaptive ways of functioning in relationships and in work settings.
Psychodynamic psychotherapy
Psychodynamic psychotherapy, like psychoanalysis, emphasizes the identification of unconscious patterns in current thoughts, feelings, and behaviors. However, the person is usually sitting instead of lying on a couch and attends only 1 to 3 sessions per week. In addition, less emphasis is placed on the relationship between the person and therapist.
Supportive psychotherapy
Supportive psychotherapy, which is most commonly used, relies on the empathetic and supportive relationship between the person and the therapist. It encourages expression of feelings, and the therapist provides help with problem solving. Problem-focused psychotherapy, a form of supportive therapy, may be used successfully by primary care doctors.
Electroconvulsive Therapy
For electroconvulsive therapy, electrodes are placed on the head, and while the person is under anesthesia, a series of electrical shocks are delivered to the brain to induce a brief seizure. This therapy has consistently been shown to be the most effective treatment for severe depression. Many people treated with electroconvulsive therapy experience temporary memory loss. However, contrary to its portrayal in the media, electroconvulsive therapy is safe and rarely causes any other complications. The modern use of anesthetics and muscle relaxants has greatly reduced any risk of injury during the procedure.
Other brain stimulation therapies
Other therapies that stimulate the brain, such as repetitive transcranial magnetic stimulation and vagus nerve stimulation, may be beneficial for people with depression that does not respond to medications or psychotherapy. These therapies involve activating or stimulating the brain directly with magnetic fields or implants that stimulate the vagus nerve. The stimulated cells are thought to release chemical messengers (neurotransmitters), which help regulate mood and may thus relieve symptoms of depression.
