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Geri Lavrov / Photographer's Choice / Getty Images 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?