Download Chapter 13: Psychological Therapies File

Psychology
Third Edition
Chapter 13
Psychological
Therapies
Copyright © 2015, 2012, 2009 Pearson Education, Inc. All Rights Reserved
Treatment in the Past
Learning Objective 13.1: Historical and Modern Ways to Treat Psychological Disorders
• Mentally ill people began to be confined to institutions
called asylums in the mid-fifteen hundreds.
• Treatments were harsh and often damaging.
• Philippe Pinel became famous for demanding that the
mentally ill be treated with kindness, personally unlocking
the chains of inmates in France.
• The first truly organized effort to house mentally ill persons
began in England in the 16th century and took place at
Bethlehem Hospital
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Therapy (1 of 3)
Learning Objective 13.1: Historical and Modern Ways to Treat Psychological Disorders
• Therapy: treatment methods aimed at making
people feel better and function more effectively
• Two Broad Categories
– One is based primarily in psychological theory and
techniques.
– The other uses medical intervention to bring symptoms
under control.
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Therapy (2 of 3)
Learning Objective 13.1: Historical and Modern Ways to Treat Psychological Disorders
• Psychotherapy: therapy for mental disorders in
which a person with a problem talks with a
psychological professional
– Insight therapies: psychotherapies in which the main
goal is helping people to gain insight with respect to
their behavior, thoughts, and feelings
– Action therapy: psychotherapy in which the main goal
is to change disordered or inappropriate behavior
directly
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Therapy (3 of 3)
Learning Objective 13.1: Historical and Modern Ways to Treat Psychological Disorders
• Biomedical therapy: therapy for mental disorders
in which a person with a problem is treated with
biological or medical methods to relieve symptoms
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Freud’s Psychoanalysis (1 of 2)
Learning Objective 13.2: Elements of Freud’s Psychoanalysis and Psychoanalysis Today
• Psychoanalysis: insight therapy based on the
theory of Freud, emphasizing the revealing of
unconscious conflicts
– Dream Interpretation
 Manifest content: the actual content of one’s dream
 Latent content: the symbolic or hidden meaning of dreams
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Freud’s Psychoanalysis (2 of 2)
Learning Objective 13.2: Elements of Freud’s Psychoanalysis and Psychoanalysis Today
• Psychoanalysis (continued)
– Free association: Freudian technique in which a patient
is encouraged to talk about anything that comes to
mind without fear of negative evaluations
– Resistance: occurs when a patient becomes reluctant
to talk about a certain topic, either changing the subject
or becoming silent
– Transference: the tendency for a patient or client to
project positive or negative feelings for important
people from the past onto the therapist
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Psychoanalysis Today (1 of 2)
Learning Objective 13.2: Elements of Freud’s Psychoanalysis and Psychoanalysis Today
• Directive: actively giving interpretations of a
client’s statements in therapy, even suggesting
certain behavior or actions
– Psychoanalysis today is generally directive.
• Psychodynamic therapy: a newer and more
general term for therapies based on
psychoanalysis, with an emphasis on
transference, shorter treatment times, and a more
direct therapeutic approach
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Psychoanalysis Today (2 of 2)
Learning Objective 13.2: Elements of Freud’s Psychoanalysis and Psychoanalysis Today
• Interpersonal therapy (IPT): a form of therapy for
depression; it incorporates multiple approaches
and focuses on interpersonal problems
• Good candidates for psychoanalysis are fairly
verbal, are not psychotic, not withdrawn and suffer
from anxiety.
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Rogers’s Person-Centered Therapy (1 of 3)
Learning Objective 13.3: Basic Elements of Humanistic Therapies
• Person-centered therapy: a nondirective insight
therapy in which the client does all the talking and
the therapist listens
– Based on the work of Carl Rogers
– Emphasizes the potential for growth
– Nondirective: therapeutic style in which the therapist
remains relatively neutral and does not interpret or take
direct actions with regard to the client, instead
remaining a calm, nonjudgmental listener while the
client talks
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Rogers’s Person-Centered Therapy (2 of 3)
Learning Objective 13.3: Basic Elements of Humanistic Therapies
• Four Elements
1. Authenticity: the genuine, open, and honest response
of the therapist to the client
2. Unconditional positive regard: the warmth, respect,
and accepting atmosphere created by the therapist for
the client in person-centered therapy
3. Empathy: the ability of the therapist to understand the
feelings of the client
4. Reflection: the therapist restates what the client says
rather than interpreting those statements
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Rogers’s Person-Centered Therapy (3 of 3)
Learning Objective 13.3: Basic Elements of Humanistic Therapies
• Motivational Interviewing (MI)
– In contrast to client-centered therapy, MI has specific
goals: namely, to reduce ambivalence about change
and to increase intrinsic motivation to create change.
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Gestalt Therapy
Learning Objective 13.3: Basic Elements of Humanistic Therapies
• Gestalt therapy: form of directive insight therapy in
which the therapist helps clients accept all parts of
their feelings and subjective experiences, using
leading questions and planned experiences such
as role playing
• The major goal is to help clients take responsibility
for their choices in the present and the past.
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Today’s View of Humanistic Therapy
Learning Objective 13.3: Basic Elements of Humanistic Therapies
• Humanistic therapies are not based in
experimental research and work best with
intelligent, highly verbal persons.
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Behavioral Therapy and Classical Conditioning (1 of 10)
Learning Objective 13.4: Behavior Therapists’ Use of Classical and Operant Conditioning
• Behavior therapies: action therapies based on the
principles of classical and operant conditioning
and aimed at changing disordered behavior
without concern for the original causes of such
behavior
• Advantage: it can help improve specific symptoms
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Behavioral Therapy and Classical Conditioning (2 of 10)
Learning Objective 13.4: Behavior Therapists’ Use of Classical and Operant Conditioning
• Behavior modification or applied behavior analysis
(ABA): the use of learning techniques to modify or
change undesirable behavior and increase
desirable behavior
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Behavioral Therapy and Classical Conditioning (3 of 10)
Learning Objective 13.4: Behavior Therapists’ Use of Classical and Operant Conditioning
• Systematic desensitization: behavioral
technique used to treat phobias; the client is
asked to make a list of ordered fears and
taught to relax while concentrating on those
fears
– Counterconditioning: replacing an old conditioned
response with a new one by changing the
unconditioned stimulus
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Table 13.1: Fear Hierarchy
SITUATION
Being bitten by a rabbit
FEAR LEVEL
100
Petting a rabbit on the head
90
Petting a rabbit on the back
80
Holding a rabbit
70
Touching a rabbit held by someone else
60
Seeing someone I trust hold a rabbit
50
Being in a room with a rabbit
40
Thinking about petting a rabbit
30
Looking at pictures of rabbits
20
Watching the movie "Hop"
10
Items are ranked by level of fear from most fearful, Fear =100, to least fearful, Fear = 0.
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Behavioral Therapy and Classical Conditioning (4 of 10)
Learning Objective 13.4: Behavior Therapists’ Use of Classical and Operant Conditioning
• Aversion therapy: a form of behavioral therapy in
which an undesirable behavior is paired with an
aversive stimulus to reduce the frequency of the
behavior such as snapping a rubber band (painful)
to stop the desire to smoke.
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Behavioral Therapy and Classical Conditioning (5 of 10)
Learning Objective 13.4: Behavior Therapists’ Use of Classical and Operant Conditioning
• Exposure therapy: behavioral techniques that
introduce the client (under carefully controlled
conditions) to situations related to their anxieties
or fears
– Flooding: technique for treating phobias and other
stress disorders in which the person is rapidly and
intensely exposed to the fear-provoking situation
or object and prevented from making the usual
avoidance or escape response
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Behavioral Therapy and Classical Conditioning (6 of 10)
Learning Objective 13.4: Behavior Therapists’ Use of Classical and Operant Conditioning
• Exposure Therapy (continued)
– Eye-movement desensitization reprocessing (EMDR):
controversial therapy for posttraumatic stress disorder
and similar anxiety problems in which the client is
directed to move the eyes rapidly back and forth while
thinking of a disturbing memory
 Needs more controlled study
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Behavioral Therapy and Classical Conditioning (7 of 10)
Learning Objective 13.4: Behavior Therapists’ Use of Classical and Operant Conditioning
• Modeling: learning through the observation
and imitation of others
– Participant modeling: technique in which a model
demonstrates the desired behavior in a step-bystep, gradual process while the client is
encouraged to imitate the model
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Behavioral Therapy and Classical Conditioning (8 of 10)
Learning Objective 13.4: Behavior Therapists’ Use of Classical and Operant Conditioning
• Reinforcement: the strengthening of a response
by following it with a pleasurable consequence or
the removal of an unpleasant stimulus
– Token economy: the use of objects called tokens to
reinforce behavior in which the tokens can be
accumulated and exchanged for desired items or
privileges
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Behavioral Therapy and Classical Conditioning (9 of 10)
Learning Objective 13.4: Behavior Therapists’ Use of Classical and Operant Conditioning
• Reinforcement (continued)
– Contingency contract: a formal, written agreement
between the therapist and client (or teacher and
student) in which goals for behavioral change,
reinforcements, and penalties are clearly stated
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Behavioral Therapy and Classical Conditioning (10 of 10)
Learning Objective 13.4: Behavior Therapists’ Use of Classical and Operant Conditioning
• Extinction: the removal of a reinforcer to reduce
the frequency of a behavior
– Time-out: an extinction process in which a person
(usually a child) is removed from the situation that
provides reinforcement for undesirable behavior,
usually by being placed in a quiet corner or room away
from possible attention and reinforcement opportunities
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Effectiveness of Behavioral Therapy
Learning Objective 13.4: Behavior Therapists’ Use of Classical and Operant Conditioning
• Behavior therapies can be effective in treating
specific problems, such as bedwetting, drug
addictions, and phobias.
• Behavior therapies can also help improve some of
the more troubling behavioral symptoms
associated with severe disorders.
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Cognitive Therapy (1 of 3)
Learning Objective 13.5: Goals and Elements of Cognitive Therapies
• Cognitive therapy: therapy in which the focus is on
helping clients recognize distortions in their
thinking and replace distorted, unrealistic beliefs
with more realistic, helpful thoughts
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Cognitive Therapy (2 of 3)
Learning Objective 13.5: Goals and Elements of Cognitive Therapies
• Cognitive Distortions
– Arbitrary inference: drawing a conclusion without any
evidence
– Selective thinking: focusing on only one aspect of a
situation while ignoring all other relevant aspects
– Overgeneralization: drawing sweeping conclusions
based on only one incident or event and applying
those conclusions to events that are unrelated to
the original
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Cognitive Therapy (3 of 3)
Learning Objective 13.5: Goals and Elements of Cognitive Therapies
• Cognitive Distortions (continued)
– Magnification and minimization: blowing a negative
event out of proportion (magnification) while ignoring
relevant positive events (minimization)
– Personalization: taking responsibility or blame for
events that are unconnected to the person. Your
friend does not pass a test because he did not
study but you assume it is your fault he failed.
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Cognitive-Behavioral Therapies (1 of 2)
Learning Objective 13.5: Goals and Elements of Cognitive Therapies
• Cognitive-behavioral therapy (CBT): action
therapy in which the goal is to help clients
overcome problems by learning to think more
rationally and logically
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Cognitive-Behavioral Therapies (2 of 2)
Learning Objective 13.5: Goals and Elements of Cognitive Therapies
• Three Goals
1. Relieve the symptoms and solve the problems.
2. Help develop strategies for solving future
problems.
3. Help change irrational, distorted thinking.
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Rational Emotive Therapy
Learning Objective 13.5: Goals and Elements of Cognitive Therapies
• Rational emotive behavior therapy (REBT):
cognitive-behavioral therapy in which clients
are directly challenged by the therapist in their
irrational beliefs and helped to restructure
their thinking into more rational belief
statements
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Success of CBT
Learning Objective 13.5: Goals and Elements of Cognitive Therapies
• Cognitive and Cognitive BehavioralTherapy
has seemed successful in treating depression,
stress disorders, eating disorders, anxiety
disorders, and even some of the symptoms of
schizophrenia.
• CBT has been criticized for focusing on the
symptoms, not the causes, of disordered behavior.
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Table 13.2: Characteristics of Psychotherapies
TYPE OF THERAPY
(KEY PEOPLE)
GOAL
METHODS
Psychodynamic therapy (Freud)
Insight
Aims to reveal unconscious conflicts through
dream interpretation, free association,
resistance and transference
Humanistic therapy
Person-centered therapy (Rogers)
Gestalt therapy (Peris)
Insight
Non-directive therapy; client does most of the
talking; key elements are authenticity,
unconditional positive regard, and empathy.
Directive therapy; therapist uses leading
questions and role-playing to help client accept
all parts of their feelings and experiences
Behavior therapy (Watson, Jones, Skinner,
Bandura)
Action
Based on principles of classical and operant
conditioning; aimed at changing behavior
without concern for causes of behavior
Cognitive therapy (Beck)
CBT (various professionals)
REBT (Ellis)
Action
Aims to help clients overcome problems by
learning to think more rationally and logically
Clients are challenged in their irrational beliefs
and helped to restructure their thinking
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Types of Group Therapy (1 of 2)
Learning Objective 13.6: Types of Group Therapy
• Family counseling (family therapy): family
members meet together with a counselor or
therapist to resolve problems that affect the
entire family
• Work with couples on improving the couple's
patterns of communication so they can find
better ways of solving their problems
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Types of Group Therapy (2 of 2)
Learning Objective 13.6: Types of Group Therapy
• Self-help group (support group): a group
composed of people who have similar
problems and who meet together without a
therapist or counselor for the purposes of
discussion, problem solving, and social and
emotional support
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When Is Group Therapy Useful?
Learning Objective 13.6: Types of Group Therapy
• Group therapy is most useful to persons who:
– Cannot afford individual therapy
– May obtain a great deal of social and emotional
support from other group members
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Group Therapy (1 of 2)
Learning Objective 13.7: Advantages and Disadvantages of Group Therapy
• Advantages
– Low cost
– Exposure to other people with similar problems; social
interaction with others
– Social and emotional support from people with similar
disorders or problems
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Group Therapy (2 of 2)
Learning Objective 13.7: Advantages and Disadvantages of Group Therapy
• Disadvantages
– Need to share the therapist’s time with others in the
group
– Lack of a private setting in which to reveal concerns
– Inability of people with severe disorders to tolerate
being in a group
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Effectiveness of Psychotherapy (1 of 5)
Learning Objective 13.8: The Effectiveness of Psychotherapy
• Psychotherapy is more effective than no
treatment at all.
• Between 75 and 90 percent of people who receive
therapy feel that it has helped them.
– The longer a person stays in therapy, the greater the
improvement.
– Psychotherapy works as well alone as with drugs.
– College or university counseling centers find that
symptoms of anxiety disorders are one of the top
four complaints from students.
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Effectiveness of Psychotherapy (2 of 5)
Learning Objective 13.8: The Effectiveness of Psychotherapy
• Some types of psychotherapy are more
effective for certain types of problems, and no
one psychotherapy method is effective for all
problems.
– Effective therapy should be matched to the particular
client and the particular problem.
– Eclectic approach: combining elements of several
different therapy techniques. Most professionals
have this view.
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Effectiveness of Psychotherapy (3 of 5)
Learning Objective 13.8: The Effectiveness of Psychotherapy
• Cybertherapy: therapy offered via the Internet
• Advantages
–
–
–
–
Low or no cost
Availability of therapy opportunities
Access to support groups
Relative anonymity
• Disadvantages
– Lack of body language
– Lack of vocal tones
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Effectiveness of Psychotherapy (4 of 5)
Learning Objective 13.8: The Effectiveness of Psychotherapy
• Common Factors Approach
– Therapeutic alliance: the relationship between
therapist and client that develops as a warm,
caring, accepting relationship characterized by
empathy, mutual respect, and understanding is the
most important aspect for success.
– Protected setting
– Opportunity for catharsis
– Learning and practice of new behaviors
– Positive experiences for the client
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Effectiveness of Psychotherapy (5 of 5)
Learning Objective 13.8: The Effectiveness of Psychotherapy
• Evidence-based treatment (EBT): refers to
techniques or interventions that have produced
desired outcomes or therapeutic change in
controlled studies
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Culture and Psychotherapy
Learning Objective 13.9: Factors that Influence the Effectiveness of Psychotherapy
• When the cultures, ethnic groups, or genders of the
therapist and the client differ, misunderstandings
and misinterpretations can occur.
• Four barriers to effective psychotherapy exist when
the cultural backgrounds of client and therapist
differ.
1.
2.
3.
4.
Culture-bound values
Class-bound values
Language
Nonverbal communication
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Drug Treatments (1 of 3)
Learning Objective 13.10: Types of Drugs Used to Treat Psychological Disorders
• Biomedical therapies: therapies that directly affect
the biological functioning of the body and brain
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Drug Treatments (2 of 3)
Learning Objective 13.10: Types of Drugs Used to Treat Psychological Disorders
• Psychopharmacology: the use of drugs to control
or relieve the symptoms of psychological disorders
– Antipsychotic drugs: used to treat psychotic
symptoms such as delusions, hallucinations, and
other bizarre behavior and work by blocking the
dopamine receptors in the brain.
– After taking for some time may begin exhibiting
tardive dyskinesia (repetitive, involuntary jerks and
movements of his face, lips, and legs).
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Drug Treatments (3 of 3)
Learning Objective 13.10: Types of Drugs Used to Treat Psychological Disorders
• Psychopharmacology (continued)
– Atypical neuroleptics are prescribed to treat the
negative symptoms of schizophrenia, including
withdrawal, apathy, and reduced communication
– Antianxiety drugs: used to treat and calm anxiety
reactions
 Typically treated with benzodiazepines (minor
tranquilizers): such as Valium and Xanax
– Mood-stabilizing drugs: used to treat bipolar
disorder
 include lithium and certain anticonvulsant (for mania)
drugs
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Drug Treatments
Learning Objective 13.10: Types of Drugs Used to Treat Psychological Disorders
• Antidepressant drugs: such as Prozac are
used to treat depression and anxiety
• Two of the major classes of antidepressant
drugs are MAO inhibitors (MAOIs) and
tricyclics
• MAOI use requires: a severely restricted diet
being careful about eating certain smoked,
fermented, or pickled foods, and drinking
certain beverages. In addition, being careful
about taking other medications due to a risk of
severe high blood pressure
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Drug Treatments
Learning Objective 13.10: Types of Drugs Used to Treat Psychological Disorders
• Some drugs that combat depression work by
increasing the amount of serotonin in the
brain.
• One of the main advantages of selective serotonin
reuptake inhibitors (SSRIs) as compared to similar
drugs is they have fewer side effects
• A new class of antipsychotic medications,
called partial dopamine agonists, influences
the release of neurotransmitters rather than
blocking their receptors in the brain.
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Table 13.3: Types of Drugs Used in
Psychopharmacology
CLASSIFICATION
TREATMENT
AREAS
SIDE EFFECTS
EXAMPLES
Antipsychotic: Typical
antipsychotic
Positive (excessive)
symptoms such as
delusions or
hallucinations
Motor problems, tardive
dyskinesia
chlorpromazine, droperidol,
haloperidol
Antipsychotic: Atypical
antipsychotic
Positive and some
negative symptoms of
psychoses
Fewer than typical
antipsychotic; clozapine may
cause serious blood disorder
risperidone, clozapine,
aripiprazole
Antianxiety: Minor
Tranquilizers
Symptoms of anxiety
and phobic reactions
Slight sedative effect; potential alprazolam, lorazepam,
for physical dependence
diazepam
Antimanic
Manic behavior
Potential for toxic buildup
lithium, anticonvulsant drugs
Antidepressants: MAO Is
Depression
iproniazid, isocarboxazid,
phenelzine sulfite,
tranylcypromine sulfate
Antidepressants: Tricyclics
Depression
Antidepressants: SSRIs
Depression
Weight gain, constipation, dry
mouth, dizziness, headache,
drowsiness, insomnia, some
sexual arousal disorders
Skin rashes, blurred vision,
lowered blood pressure,
weight loss
Nausea, nervousness,
insomnia, diarrhea, rash,
agitation, some sexual arousal
problems
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imipramine, desipramine,
amitriptyline, doxepin
fluoxetine, sertraline,
paroxetine
Electroconvulsive Therapy
Learning Objective 13.11: Electroconvulsive Therapy and Psychosurgery
• Electroconvulsive therapy (ECT): biomedical
treatment in which electrodes are placed on either
one or both sides of a person’s head and an
electric current strong enough to cause a seizure
or convulsion is passed through the electrodes
– Still used to treat severe depression
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Psychosurgery (1 of 3)
Learning Objective 13.11: Electroconvulsive Therapy and Psychosurgery
• Psychosurgery: surgery performed on brain tissue
to relieve or control severe psychological disorders
– Prefrontal lobotomy: the connections of the prefrontal
lobes of the brain to the rear portions are severed
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Psychosurgery (2 of 3)
Learning Objective 13.11: Electroconvulsive Therapy and Psychosurgery
• Psychosurgery (continued)
– Bilateral anterior cingulotomy: an electrode wire is
inserted into the anterior cingulated gyrus area of
the brain for the purpose of destroying that area of
brain tissue with an electric current
 An electrode is inserted with the guidance of a magnetic
resonance imaging (MRI) machine.
 Used to treat Major Depression
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Psychosurgery (3 of 3)
Learning Objective 13.11: Electroconvulsive Therapy and Psychosurgery
• Emerging Techniques
– Repetitive transcranial magnetic stimulation (rTMS):
magnetic pulses are applied to the cortex
– Transcranial direct current stimulation (tDCS): uses
scalp electrodes to pass very-low-amplitude direct
currents to the brain
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Virtual Reality
Learning Objective 13.12: Applications of Virtual Reality for Treating Psychological
Disorders
• Virtual reality is a software-generated, threedimensional, simulated environment with can
be used in the treatment of PTSD.
– Like playing a video game
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