Download Behavioral Therapy

Unit 2 Notes: 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
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
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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 well-being
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
– implosion or 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
• 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
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
– rational-emotion therapy (RET):
• irrational beliefs that provoke inappropriate emotional responses are changed into more
productive thinking and behaviors
– 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
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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
– 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
Biomedical Therapies
Psychosurgery (also called lesioning or ablation) involves cutting parts of the brain
– this procedure is irreparable
– psychosurgery is usually used when medication or other forms of therapy prove unsuccessful
• hemispherectomies, which involves severing the corpus callosum 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
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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
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Drug therapy is by far the most commonly used therapy in use today.
– medication is used to control a variety of psychological disorders:
– although they don't cure the disorders, antipsychotic drugs are used to control the symptoms of
use sever disorders as schizophrenia
• clozopine is one of the most widely used medications that helps regulate neurotransmitters in
the brain
– antidepressants are used to combat primarily depression
• Prozac is by far the most commonly prescribed antidepressant because it has fewer side
effects than other medications
– it works by regulating serotonin in the brain
• Effexor is also widely prescribed and regulates both serotonin and norepinephrine in the brain
• Lithium is commonly prescribed for those suffering from bipolar disorder
– antianxiety drugs, commonly called tranquilizers, reduce the symptoms and effects of anxiety
• some, such as Miltown or Equanil, are muscle relaxants
• others such as Librium and Valium affect the central nervous system.
• dependence and addiction can develop with these medications
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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
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
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