Download Myers3-Ch 14

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Treating Psychological Disorders
The psychological therapies
Evaluating psychotherapies
The biomedical therapies
Preventing psychological disorders
The Granger Collection, NYC — All rights reserved.
THE HISTORY OF TREATMENT
Visitors to eighteenth-century mental hospitals paid to gawk at patients,
as though they were viewing zoo animals. William Hogarth’s (1697–1764)
painting captured one of these visits to London’s St. Mary of Bethlehem hospital
(commonly called Bedlam).
Approach Differences
Psychotherapy
Therapy in which a trained therapist uses
psychological techniques to assist someone seeking
to overcome difficulties or achieve personal growth
Biomedical therapy
Therapy in which a trained therapist, most often a
medical doctor, offers medications and other
biological treatments
Eclectic approach
Uses blend of therapies
The Psychological Therapies
Psychoanalysis and psychodynamic therapy
Humanistic therapies
Behavior therapies
Cognitive therapies
Group and family therapies
The Psychological Therapies
Psychoanalysis
Goals: To bring patients’ repressed feelings into
conscious awareness; to help patients release energy
devoted to id-ego-superego conflicts
Techniques: Historical reconstruction, initially through
hypnosis and later through free association;
Interpretation of resistance, transference
In psychoanalysis, patients may experience strong
feelings for their analyst, which is called ________.
Patients are said to demonstrate anxiety when
they put up mental blocks around sensitive
memories—showing ________.
The analyst will attempt to offer insight into the
underlying anxiety by offering a(n) ________ of the
mental blocks.
Tetra Images / Getty Images
Psychodynamic
Therapy
FACE-TO-FACE THERAPY In this
type of therapy session, the couch has
disappeared. But the influence
of psychoanalytic theory may not
have, especially if the therapist seeks
information from the patient’s
childhood and helps the patient
reclaim unconscious feelings.
Goals: To help people
understand current
symptoms; to explore
and gain perspective
on defended-against
thoughts and feelings
Techniques: Clientcentered face-to-face
meetings; Exploration
of past relationship
troubles to understand
the origins of current
difficulties
Humanistic Therapies
Theme: Emphasis on people’s potential for selffulfillment; to give people new insights
Goals: To reduce inner conflicts that interfere
with natural development and growth
Techniques: Client-centered therapy; focus on
taking responsibility for feelings and actions and
on present and future rather than past
Humanistic
Therapies
Rogers
Time & Life Pictures/Getty Images
Person-centered therapy
focuses on a person’s
conscious selfperceptions; nondirective; active listening;
unconditional positive
regard
ACTIVE LISTENING Carl Rogers (right)
empathized with a client during this
group therapy session.
Most people possess
resources for growth
Therapists foster growth
by exhibiting
genuineness, acceptance,
and empathy
Humanistic Therapies
Strengthening communication: Rogers
Summarize
Invite clarification
Reflect feelings
Behavior Therapies
Classical conditioning techniques
Counterconditioning: Uses classical conditioning to
evoke new responses to stimuli that are triggering
unwanted behaviors
Exposure therapies: Treat anxieties by exposing
people (in imagination or actual situations) to the
things they fear and avoid
Systematic desensitization: Associates a pleasant,
relaxed state with gradually increasing, anxietytriggering stimuli
Treats anxiety by
creative electronic
simulations in which
people can safely face
their greatest fears,
such as airplane
flying, spiders, or
public speaking
Jack Kearse/ Emory University
Virtual Reality
Exposure Therapy
Within the confines of a room,
virtual reality technology exposes
people to vivid simulations of feared
stimuli, such as walking across a
rickety bridge high off the ground.
Aversion Therapy for Alcohol Abuse
Therapists gave people with a history of alcohol abuse a mixed drink containing alcohol
and a drug that produces severe nausea. After repeated treatments, some people
developed at least a temporary conditioned aversion to alcohol. (Classical conditioning
terms: US is unconditioned stimulus, UR is unconditioned response, NS is neutral
stimulus, CS is conditioned stimulus, and CR is conditioned response.)
Operant Conditioning
Operant conditioning therapy: Consequences
drive behavior
Behavior modification: The desired behavior is
reinforced; undesired behavior is not reinforced
and is sometimes ignored or punished
Token economy: People earn a token for
exhibiting a desired behavior and can later
exchange the tokens for privileges or treats
Quick Comparisons
Insight
therapists
• Assume selfawareness and
psychological
well-being are
complementary
Psychodynamic
therapists
Humanistic
therapists
• Expect people’s
problems lessen
insight into
unresolved and
unconscious
tensions gained
• Expect people’s
problems to
lessen as they
get in touch with
their feelings
Behavior
therapists
• Assume
problem
behaviors are
the problems
How do the insight therapies differ from behavior
therapies?
Some maladaptive behaviors are learned. What
hope does this fact provide?
Exposure therapies and aversive conditioning are
applications of ________ conditioning. Token
economies are an application of ________
conditioning.
Cognitive Therapies
Cognitive Therapies
Cognitive therapies
Teach people new, more adaptive ways of thinking; Based
on the assumption that thoughts intervene between events
and our emotional reactions
Beck’s therapy for depression
Gentle questioning seeks to reveal irrational thinking and
then to persuade people to change their perceptions of
their own and others’ actions as dark, negative, and
pessimistic
People are trained to recognize and modify negative selftalk
Selected Cognitive Therapy Techniques
Cognitive Therapies
Cognitive-behavioral therapy
An integrative therapy that combines cognitive
therapy (changing self-defeating thinking) with
behavior therapy (changing behavior)
Aims to alter the way they act AND they way they
think
Helps people learn to make more realistic appraisals
How do the humanistic and cognitive therapies
differ?
What is cognitive-behavioral therapy, and what
sorts of problems does this therapy address?
Group and Family Therapies
Group therapy
Conducted with groups rather than individuals,
providing benefits from group interaction
Often used when client problems involve interactions
with others
Family therapy
Treats the family as a system
Views an individual’s unwanted behaviors as
influenced by, or directed at, other family members
John Moore/Getty Images News/Getty Images
FAMILY THERAPY This type of
therapy often acts as a preventive
mental health strategy.
• The therapist helps family
members understand how
their ways of relating to one
another create problems
• The treatment’s emphasis
is not on changing the
individuals, but on changing
their relationships and
interactions
Which therapeutic technique has focused more on the
present and future than the past, and has promoted
unconditional positive regard and active listening?
Which of the following is NOT a benefit of group
therapy?
a. more focused attention from the therapist
b. less expensive
c. social feedback
d. reassurance that others share troubles
Evaluating Psychotherapies
Is psychotherapy effective?
Which psychotherapies work best?
How do psychotherapies help people?
How do culture and values influence
psychotherapy?
CLOSE-UP: A consumer’s guide to
psychotherapists
Evaluating Psychotherapies
Clients’ perceptions
Client self-reports indicate that psychotherapy is
effective
Critics of client self-reports
Clients may need to justify their investment of effort
and money
Clients generally speak in positive terms of their
therapists
Clients often enter therapy in crisis
Evaluating Psychotherapies
Clinicians’ perceptions
Therapists are most aware of the failure of other
therapists
Outcome research
With or without psychotherapy: People improved
noticeably over time (Eyenck)
After extensive research review: Those not
undergoing therapy often improve, but those
undergoing therapy are more likely to improve
Evaluating Psychotherapies
Which Psychotherapies Work Best?
Some forms of psychotherapy work best for
particular problems
Behavior therapies: Bed-wetting, phobias,
compulsions, marital problems, and sexual
dysfunctions
Psychodynamic therapy: Depression and anxiety
Cognitive therapies: Anxiety, depression, and
posttraumatic stress disorder
Which Psychotherapies Work Best?
Unsupported approaches
Energy therapies
Recovered memories therapies
Rebirthing therapies
Which Psychotherapies Work Best?
Therapy is more likely to be helpful in those with
the ________ (most/least) clearly defined
problems.
What is evidence-based practice?
STEVE SZYDLOWSKI KRT/Newscom
How Do
Psychotherapies Help
People?
Three basic
benefits for all
psychotherapies
A CARING RELATIONSHIP
Effective counselor aboard a ship,
form a bond of trust with the
people they are serving.
Hope for
demoralized people
A new perspective
for oneself and the
world
An empathic,
trusting, caring
relationship
Those who undergo psychotherapy are ________
(more/less) likely to show improvement than those
who do not undergo psychotherapy.
How Do Culture and Values Influence
Psychotherapy?
Psychotherapists’ personal beliefs and values
influence their practice
Differences in cultural and moral diversity and
religious values can create a mismatch
The Biomedical Therapies
Drug therapies
Brain stimulation
Psychosurgery
Therapeutic lifestyle change
The Biomedical Therapies
Drug therapies
Are the most widely used biomedical
treatments
Include prescribed antidepressants for 27
million Americans
Involve placebo and double-blind techniques
to evaluate drug effectiveness
The Biomedical Therapies
Most common drug treatments for
psychological disorders
Antipsychotic drugs
Antianxiety drugs
Antidepressant drugs
Mood-stabilizing medications
Let’s take a closer look at each of these.
Drug Therapies
Antipsychotic drugs
Mimic certain neurotransmitters (e.g., block or increase activity of
dopamine); reduce overreaction to irrelevant stimuli
May produce sluggishness, tremors, twitches, and tardive
dyskinesia; Thorazine
Successfully used with life-skills programs and family support to
treat schizophrenia
Antianxiety drugs
Depress CNS activity; Xanax or Ativan
Used in combination with psychological therapy
May reduce symptoms without resolving underlying problems;
withdrawal linked to increased anxiety and insomnia
Drug Therapies
Antidepressant drugs
Increase availability of norepinephrine or serotonin;
promote birth of new brain cells
Slow synaptic vacuuming up of serotonin (SSRIs)
Effectiveness sometimes questioned due to spontaneous
recovery and placebo effect
Mood-stabilizing medications
Depakote: Controlling manic episodes
Lithium: Levels emotional highs and lows of bipolar
disorder
How do researchers evaluate the effectiveness of
particular drug therapies?
The drugs given most often to treat depression are
called ________. The drugs that are now often
given to treat anxiety disorders are called
________. Schizophrenia is often treated with
________ drugs.
Brain Stimulation
Electroconvulsive therapy
Manipulates the brain by shocking it
Involves the administration of a general anesthetic
and muscle relaxation to prevent convulsions
Causes less memory disruption than earlier versions
AMA concluded that ECT methods among most
positive treatment effects; reduces suicidal thoughts
Involves several theories about the reason for
effectiveness
Brain Stimulation
Brain Stimulation
Alternative neurostimulation therapies
Vagus nerve stimulation: Stimulates neck nerve that
sends signals to limbic system; increases available
serotonin by increasing firing rate of some neurons
Deep brain stimulation: Manipulates depressed brain
via pacemaker; stimulates inhibition activity related to
negative emotions and thoughts
Repetitive transcranial magnetic stimulation (rTMS):
Sends magnetic energy to brain surface through
coiled wire held close to brain; fewer side effects;
modest effectiveness
Severe depression that has not responded to other
therapy may be treated with ________, which can
cause memory loss. More moderate neural
stimulation techniques designed to help alleviate
depression include ________ stimulation,
________ stimulation, and ________ magnetic
stimulation.
Brain Stimulation
Psychosurgery
Involves surgery that removes or destroys brain tissue in
an effort to change behavior
Is irreversible; is the least used biomedical therapy
Lobotomy
Psychosurgical procedure once used to calm
uncontrollably emotional or violent patients
Procedure cut the nerves connecting the frontal lobes to
the emotion-controlling centers of the inner brain (Moniz)
Today less invasive techniques are used; MRI-guided
surgery in severe disorders
Therapeutic Lifestyle Change
Training seminars
Human brains and bodies were designed for physical
activity and social engagement
Our ancestors hunted, gathered, and built in groups
with little evidence of disabling depression
12-week training with the following goals
Aerobic exercise, adequate sleep, light exposure,
social connection, antirumination, nutritional
supplements
Comparing Therapies
What are some examples of lifestyle changes we
can make to enhance our mental health?
Preventing Psychological Disorders
Resilience
Involves personal strength that helps most people cope
with stress and recover from adversity and trauma
Can be seen in New Yorkers after 9/11, spinal cord injury
patients, Holocaust survivors, and others
Prevention
Through identification and elimination of conditions that
cause psychological casualties
Through support of programs and providers that control or
eliminate stress
What is the difference between preventive mental
health and psychological or biomedical therapy?