Download 13 Treatment of Abnormal Behavior

Treatment of Abnormal
Behavior
Unit 13
Treatments
• Treatment history
• From very harsh/jail, to asylum/hospitals (Philippe Pinel & Dorothea Dix)
• Since 1950s…return them home & use medication
• 2 ½ types of treatment…
• Psychotherapy—to fix disorders, like phobias. Approaches…
• …psychoanalysis, behaviorism, humanism, cognitive
• Biomedical therapy—medication, like schizophrenia.
• Eclectic approach—a mix of both
• Psychoanalysis – “insight therapy” you look inside for problems
• Unconscious drives, childhood matters, struggles (iceberg)
• Psychodynamic – childhood & unconscious matter
• Interpersonal psychotherapy – digs for the cause, but with a more
specific goalimprove relationships (12 – 16 weeks)
Cont.
• Humanism – also is “insight therapy”
• Carl Rogers & Abraham Maslow
• G.A.E. (genuine, accepting, empathy); unconditional positive regard
• Maslow’s triangle/hierarchy of needs/“self actualize”
• “Client-centered” therapy and “active listening”
• Self-help and/or group therapy
• Behaviorism – respond to reinforcements
• Pavlov – classical conditioning – your body reacts
• Watson – Baby Albert – generalization of stimulus
• Skinner – operant conditioning – reinforcements & shaping behavior
• We’ve learned the things we do, we can UNlearn them too
Behaviorism cont.
• Counterconditioning – put a trigger to stimulus with new response (we
unlearn something, like not being afraid of heights). 2 ½ types…
1. exposure therapy – slowly face your fear  associate it with
something good (chocolate!)
2. systematic desensitization – you can’t be worried and relaxed at same
time. So, face your fear, relax, go further, relax, repeat.
2 ½ virtual reality exposure – uses computers to face fears (social fear)
• Aversive conditioning – associate a negative result with unwanted stimulus
(classical cond.). Ex.: alcoholics and drug that causes nausea
• Token economy – getting points/tokens for desired behavior (operant
cond.). Ex.: drug rehab, start with 0 pts/privileges, must earn them
Treatments cont.
• Quick review…1. psychoanalysis/psychodynamic, 2. humanist, 3. behaviorist
4. Cognitive treatments – trying to solve things via thinking, logical thought
• Aaron Beck tries to…
• (a) change people’s thinking from negative to positive
• (b) point out illogic
• Donald Meichenbaum…
• Focused on the words used—change their words, change their feelings
• Cognitive-behavioral therapy – mix of thinking and acting (widely used)…
• (a) change labeling
• (b) do something about it. (PET scans support this.)
• “Dead-end job”, or “Building experience and working the plan.”
Cont.
5. Group therapy – most common therapy
• Shows we’re not alone, it’s cheaper
• Family therapy – shows you’re both an individual AND family member;
focus on relationships
• Support group – usually deals with hard-to-discuss topics
• A.A. – Alcoholics Anonymous – 12-step program
Does psychotherapy work?
• Three ways to assess it…
1. Ask client
• Usually say, “Yes.” Confirmation bias here?
2. Ask therapist
• Usually say, “Yes.”
3. Objectively
• Look at people’s behavior
• Exper.: group A gets treatment, group B none, later…
• …BOTH were healed (time heals)
• Meta-analysis (study of studies) – psychotherapy group got better than
80% of control group
Cont.
• Quick review of therapies…1. psychoanalysis/psychodynamic, 2.
humanist, 3. behaviorist, 4. cognitive
• Each “flavor” seems to work. The more specific the problem, the
more effective the remedy
• Behavioral – good for phobias
• Cognitive – good for depression
Alternative therapies
• “Voodoo” therapies…
• Energy therapy, recovered memory, rebirthing, facilitated communication,
crisis debriefing. Remember…
• …placebo effect, time heals.
• Evidence-based alternative therapies (recommended by APA):
1. EMDR – Eye Movement Desensitization and Reprocessing – Francisco Shapiro
• Eyes dart to-and-fro to relieve anxiety; 84% to 100% success?; placebo?
2. Light Exposure Therapy – winter months are dark  people get S.A.D.
(seasonal affective disorder)
• So…get in the light! Exp.A – light in AM  50%+; PM  33%+
• Control  30%+; Conclusion: light as effective as drugs, brain scan
supports it
Themes
1.
2.
3.
4.
Hope matters – even if treatment is poor, things improve (placebo?)
New outlook – chance for an explanation and a new start
Relationship with therapist – “therapeutic alliance” matters
Culture matters
• East – values the group
• West – values the individual…therapy should be tailored as such
• Religion – therapist of same religion gives better results
Drug treatments
• #1 treatment today
• 1950s – psychopharmachology – study of how drugs affect the mind and
behavior
• Positive…got many people out of mental hospitals
• Negative…many can’t make it on their own, wind up homeless
1. Anti-psychotic drugs
• Thorazine (Chlorpromazine) – for psychosis (hallucinations, delusions)
• Acts like dopamine & blocks receptors
• Side effects – sluggish motor function, shakes, tardive dyskinesia –
involuntary facial movements
• Thorazine ineffective for apathy & withdrawal cases, instead, clozapine
(blocks dopamine AND serotonin)
Cont.
2. Anti-anxiety drugs
• Depress the central nervous system (Xanax)
• To treat PTSD, OCD. A negative…dependence
3. Anti-depressants
• Boost mood via neurotransmitters serotonin or norepinephrine
• Prozac, Paxil, Zoloft…block reuptake
• Side effects: dry mouth, weight gain, dizzy, hypertension
• Takes about a month to kick in…75% placebo effect here?
• Mix with cognitive therapy & exercise
4. Mood stabilizers – usually with bipolar disorder
• Lithium is effective (7/10 people)
Brain therapy
• ECT – Electroconvulsive therapy – “shock therapy”
• Electricity through the brain, for deep depression
• 80% had + results (4/10 return to depression)
• Psychosurgery – destroying/removing part of brain
• Lobotomy – cutting nerve connection between frontal lobe &
emotional areas of brain
• Negatives: lethargic, immature, uncreative
• 1950s – drugs replaced this
• Alternative therapies
• Magnetic stimulation – magnet impulses
• Deep brain stimulation – electrode in brain
Wrap-up
• Better than drugs…
• …if you want to change how you feel, change how you live.
1. Exercise
2. Sleep
3. Light exposure
4. Social interaction
5. Don’t dwell on it
6. Nutritional supplements (esp. fish oil)
• Compare Amish folks vs. gamer geeks above.
• Best…don’t get disorder in 1st place. Find ways to deal with stress. “I’m OK.”