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Therapies
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Terms
symptoms: behavioral signs indicating a disorder is present
diagnosis: a classification of a disorder; typically the DSM-IV is used to determine the diagnosis
etiology: suggestion of a cause of a disorder
prognosis: an estimate as to the length of time or degree of effectiveness in treating a disorder
treatment: a course of action aimed at reducing, controlling or eliminating the symptoms of a
disorder
History
trephining--discovered by archeologists, early process in which holes were drilled into skulls to
let harmful human spirits leave
Hippocrates believed the psychological disorders were a result of biological factors and could be
treated.
during the Middle Ages, disorders were the result of evil sprits and the victims were persecuted
during the Enlightenment, patients with psychological disorders were treated more humanely
– Philippe Pinel (France) and Dorothea Dix (US) helped to develop institutionalization to care
for and help their patients
treatment in the United States:
– 1950s--psychotropic drugs facilitated the release of patients from institutions
– 1960s--in response to released patients’ inability to care for themselves, community-based
mental health centers were set up
– recent trends are aimed at prevention:
• primary prevention--reduce the occurrence of societal problems that can cause mental
illness
• secondary prevention--dealing with people who are undergoing psychological difficulties
• tertiary prevention--working to make sure mental health issues don’t get worse
Models of Treatment
there are six recognized models of treatment:
– psychodynamic: believes the key to successful treatment involves having the patient gain
insight into their unconscious motives, emotions or conflicts
– behavioral: advocates relearning as the preferred method of correcting past maladaptive
behaviors
– humanistic: believes in the inherent goodness of people and strives to make them more fullyfunctioning
– cognitive: attempts to restructure the patient's incorrect thought processes and unrealistic
expectations into more realistic thoughts
– biomedical: advocates the treatment of psychological disorders through chemical or surgical
processes
– group therapy: allows other afflicted with similar disorders to share real-world solutions and
coping mechanisms
Psychodynamic Therapy
Sigmund Freud pioneered this form of treatment with his "talking cure," a derivative of Joseph
Breuer's "chimney sweeping"
both of these involve the cathartic method, or a treatment that results in a cleansing or purging of
emotions
the ultimate goal is to provide the patient insight into past, unresolved conflicts from emotionally
abrasive experiences during childhood
the patients may exhibit resistance, or an unwillingness to discuss their thoughts and behaviors
freely
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Freud's psychoanalysis involves three parts:
– free association: allowing the patient to say whatever is important to them at the time with
minimal prompting from the therapist
– hypnosis: a mild state of relaxation and increased suggestibility that Freud perfected through
his studies with Jean Martin Charcot in Paris
– dream analysis: an investigation into the dream work, the process involved in changing the
latent content of a dream produced by the id into the manifest content designed to preserve
ego integrity
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while undergoing therapy, the patient can experience both positive and negative transference
– positive transference involves projecting the patient's warm feelings for their parents onto the
therapist
– negative transference involves projecting hostile feelings towards authority figures onto the
therapist
the therapist can also suffer from countertransference where they project feelings of affection or
hostility toward significant people in their lives onto the patient.
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neoFreudians or post-Freudians have emphasized different aspects of Freud's theories
they don't believe the libido is the primary motive in our unconscious actions
they believe that current issues the individual is dealing with are sometimes more significant than
experiences in childhood
they include the influence of social and interpersonal relationships in the patient's overall mental
health
they also believe that the patient's self-concept plays a significant role in their emotional wellbeing
Psychodynamic Therapy
psychodynamic therapy—shorter in duration and less frequent than conventional psychotherapy
interpersonal psychotherapy—focuses on the cause of problems but uses current variables to
relieve the current symptoms
Behavioral Therapy
there are a variety of behavioral techniques employed to correct maladaptive learning:
– behavioral contracting:
• also called behavior modification or contingency management
• involves the use of operant conditioning in providing rewards for positive behaviors and
punishment for negative behaviors
• behavioral contracting actually spells out the criteria for receiving rewards and
punishment
– avoidance conditioning:
• also called aversive conditioning
• this technique teaches the patient to avoid negative behaviors because they will result in
punishment
• patients may take medication to make them throw up if they drink any alcohol
– systematic desensitization:
• a step-by-step process in which patients move closer to the objects or situations they fear,
progressing each step only when they feel comfortable enough to proceed
• a person who is afraid of heights will gradually progress from the bottom to the top of a
tall building to combat their acrophobia
– flooding:
• the patient is exposed to the object or situation they most fear or provokes the greatest
emotional reaction in order to extinguish the anxiety associated with the entire class of
stimuli
• a person who is afraid of dogs will encounter a large dog to extinguish their fear of all sizes
of dog
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• the advantages of implosion and flooding are that the therapist can get an accurate
observation of the patient's behaviors and is there to guide the patient through their
anxiety
modeling:
• part of social learning therapy
• patients observe appropriate behaviors in others and then model those behaviors
social skills training:
• attempts to improve social skills by utilizing Skinner’s shaping and Bandura’s modeling
techniques
biofeedback:
• gives the patient information on autonomic functions such as heart rate, muscle tension
and body temperature
• uses behavioral techniques to lessen the anxiety that trigger these biological reaction
token economies:
• using points or tokens (secondary reinforcers) to exchange for rewards (primary
reinforcers)
Cognitive Therapy
cognitive therapies involve getting the patient to think in more rational or realistic terms
there are several cognitive therapies:
– cognitive behavior therapy:
• focuses on changing incorrect or unrealistic attitudes and expectations through
reinforcement contingencies (rewards and punishments)
– Aaron Beck's cognitive therapy:
• focuses on patients suffering from depression
• false assumptions and incorrect thinking are changed into more realistic and productive
thinking by evaluating evidence, situational factors and other possible solutions
• realized that individuals have negative perceptions in how they see themselves, their
world and their future—called the cognitive triad
– Albert Ellis’ rational-emotion therapy (RET):
• irrational beliefs that provoke inappropriate emotional responses are changed into more
productive thinking and behaviors
• the ABCs of RET focus on the patient’s actions, beliefs and consequences of those beliefs
– stress inoculation therapy:
• patients are taught to cope with situations that produce an unreasonable amount of
anxiety reaction through more reasonable thinking, predicting upcoming stress and
techniques to control or reduce the anxiety
Humanistic Therapy
humanistic therapy focuses on our biological actualizing tendency to make ourselves better and
integrate our personality into a more fully functioning person
there are two humanistic therapies:
– client-centered therapy:
• devised by Carl Rogers, this therapy provides unconditional positive regard or total
positive support, to the individual
• employs active listening—clarifying statements and feelings
– Gestalt therapy:
• focuses on the whole person (the whole is greater than the sum of its parts) in integrating
the mind and body
• emphasizes dealing with unresolved issues, expressing repressed feelings and resolving
life tasks
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Biomedical Therapies
psychosurgery (utilizing lesioning or ablation) involves scarring or cutting parts of the brain
– this procedure is irreparable; its use if very limited today
– psychosurgery is usually used when medication or other forms of therapy prove unsuccessful
• hemispherectomies, which involves severing the corpus collosum in the brain, has been
used to reduce the effects of grand mal epileptic seizures
• prefrontal lobotomies involves severing the nerves between the prefrontal lobes of the
brain and the lower brain centers
–this has been used for a variety of disorders but currently is very rarely used if at all
electroconvulsive therapy (ECT) is commonly referred to as "shock therapy"
– this procedure is used for helping cure chronic depression and involves passing an electric
current of 70-150 volts across the patient's head
– the patient is tranquilized and, after the current is administered, has a brief seizure and loses
consciousness
– side effects can include memory loss
– research indicates that ECT is used regularly by some practitioners to alleviate depression
when anti-depressant drugs don't work
repetitive transcranial magnetic stimulation (rTMS) is a newer technique
– magnetic pulses through a coil set above the left eyebrow sends magnetic surges into the left
frontal lobe
psychopharmacotherapy or drug therapy is by far the most commonly used therapy in use today.
– medication is used to control a variety of psychological disorders
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although they don't cure the disorders, antipsychotic drugs are used to control the symptoms of
use sever disorders as schizophrenia
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Thorazine, Haldol and Clozaril are the most widely used medications that helps regulate
neurotransmitters in the brain
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side effects include tardive dynskesia (muscle spasms, drooling, difficulty walking)
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antidepressants are used to combat primarily depression
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Prozac is by far the most commonly prescribed antidepressant because it has fewer side
effects than other medications
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it works by regulating serotonin in the brain
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unipolar depression is treated with tricyclic antidepressants, monoamine oxidase
(MAO) inhibitors or serotonin-reuptake-inhibitors (SSRIs)
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Effexor is also widely prescribed and regulates both serotonin and norepinephrine in the
brain
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Lithium is commonly prescribed for those suffering from bipolar disorder
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anxiolytics or antianxiety drugs, commonly called tranquilizers, reduce the symptoms and effects
of anxiety
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some, such as Miltown or Equanil, are muscle relaxants
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others such as Librium and Valium affect the central nervous system.
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dependence and addiction can develop with these medications
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stimulants activate motivational centers and hinder inhibitory centers in the central nervous
system
they work by increasing neurotransmitter activity, specifically serotonin, norepinephrine and
dopamine
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Reuptake Diagram p. 713
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Group Therapies
family therapy—aimed at articulating issues among family members
marriage therapy—aimed at articulating issues among spouses
self-help groups—meeting a various individuals all experiencing similar issues
Therapists
psychiatrists—medical doctors who can prescribe medication; favor the medical model of
treatment
clinical psychologists—hold Ph.D.s in psychology
counseling psychologists—hold graduate degrees in psychology and deal with less severe
problems like marriage and family counseling
psychoanalysts—specialize in Freudian or psychodynamic methods but may not hold medial
degrees
clinical/psychiatric social workers—hold a Masters of PhD in social work
meta-analysis—a statistical system for combining and contrasting the results of numerous
research studies to determine the effectiveness of therapy or one therapy over another
Effectiveness of Therapy
Eysenck (1952), through a series of studies, concluded that therapy significantly helped about 2
out of 3 people
– two-thirds of neurotic patients, however, would recover or improve within two years without
treatment
– therefore, therapy was no more effective than no therapy
Bergin and Lambert (1978) found that 1 out of 3 people improves without treatment but
conceded that they do get therapeutic help from friends, clergy, physicians and teachers
the general consensus now is that therapy is effective but works best for mild disorders and for
people who want to change
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Seligman and Consumer Reports (1995) concluded the following:
– 90% of patients feel better after therapy
– medication with therapy did not improve people’s scores than simple therapy
– there are no differences in the form of therapy
– there are no differences in effectiveness between psychologists, psychiatrists and social
workers
– marriage counselors were seen as less effective
– patients with long-term therapy had more improvement than those with short-term therapy
Tailoring Therapies
insight therapy is effective for people seeking:
– self-understanding
– relief of inner conflicts and anxiety
– better relationships with others
behavior therapy works best for people with specific anxieties
cognitive therapy is used for treating:
– depression
– anxiety disorders
neuroleptics are used for schizophrenia
antidepressants are used to treat depression
– they have also been effectively used for treating OCD and PTSD
anxiolytics are effective for anxiety disorders
– PTSD, panic attacks, GAD and certain phobias
stimulants have been used to treat ADHD and narcolepsy
currently the trend is toward eclecticism, an approach that recognizes the value of a broad
treatment package over a rigid commitment to one particular form of therapy
Prevention
large mental hospitals offer people with severe mental disorders shelter and a degree of care, but
a number of problems are linked with institutionalization, including
– inadequate care
– the tendency of patients to become lethargic and accept a permanent "sick role."
Deinstitutionalization
with the advent of antipsychotic drugs in the 1950s, many patients were released from large
public hospitals to be cared for in a community setting, in the policy of deinstitutionalization
community mental-health centers and other support services proved inadequate to the task
as a result, many former patients stopped taking their medication, became homeless, and ended
up suffering from psychosis and living on the street
alternatives to hospitalization range from
– living in the family home, with training to cope with daily activities for the mentally ill
individual and crisis therapy for the family
– small homelike facilities in which residents and staff share responsibilities
most alternative treatments involve
– some medication of the troubled individual
– skillful preparation of the family/community
the majority of studies have found more positive outcomes for alternative treatments than for
hospitalization.
AP Check
AP students in psychology should be able to do the following:
• Describe the central characteristics of psychotherapeutic intervention.
• Describe major treatment orientations used in therapy (e.g. behavioral, cognitive, humanistic) and
how those orientations influence therapeutic planning.
• Compare and contrast different treatment forms (e.g. individual, group).
• Summarize effectiveness of specific treatments used to address specific problems.
• Discuss how cultural and ethnic context influence choice and success of treatment (e.g. factors that
lead to premature termination of treatment) (pp. 708-710).
• Describe prevention strategies that build resilience and promote competence.
• Identify major figures in psychological treatment (e.g. Aaron Beck, Albert Ellis, Sigmund Freud,
Mary Cover Jones (p. 691), Carl Rogers, BF Skinner, Joseph Wolpe).