Download defining therapy - Northern Highlands

THERAPIES
CHAPTER 14
INTRODUCTION
• The Lobotomist
Not to mention
your unusually
large
head…
DEFINING THERAPY
• Psychotherapy is the treatment
of emotional and behavioral
Dude…Why
are my arms
problems through
so short?
psychological techniques
• Uses psychological rather than
exclusively biological
approaches to treatment
• Involves conversation between
an individual with psychological
issues and someone trained to
help correct the problem known
as a therapist.
HISTORY OF TREATMENT
• In early Stone Age society, trepanning was
used – many did not survive the procedure
• During Middle Ages, supernatural forces
were blamed for mental illness
(demonology) and exorcism was used
• During the French Revolution, more
humane treatment started with the work of
Philippe Pinel
• By the mid-19th century, people began to
connect abnormal behavior to damage
to the brain/central nervous system
• Sigmund Freud helped to popularize the
“talking cure” in the early 20th century
• Since then there has been an explosive
growth in available therapies
 3500 BC
INSIGHT THERAPIES
PSYCHOANALYSIS
• Designed to bring repressed feelings and
thoughts to conscious awareness developed by
Freud
• Techniques
• Therapist must maintain a neutral relationship with
the client so that client may project unresolved
feelings/issues upon him/her
• Dream analysis
• Hypnosis and post-hypnotic suggestions
• Free association
• Transference and resistance
• Analysis of defense mechanisms
• Insight and working through
PERSON-CENTERED
THERAPY
• Developed by Carl Rogers
• Goal is to help clients become fully functioning
• Therapist expresses unconditional positive regard
and empathy
• Therapist strives to be authentic, trying to be
genuine and real rather than formal
• Therapy is nondirective but engages in active
listening
• Therapist reflects or mirrors clients’ statements
GESTALT THERAPY
Ya, you
are in ze
hot seat!
• Outgrowth of the work of Fritz Perls
• Emphasizes the wholeness of personality
• Attempts to reawaken people to their
emotions and sensations in the here-andnow
• Draws attention to what exists rather than
what is absent, and draws attention to
client’s voice, posture, and movements
• Encourages confrontation with issues
• Therapist is active and directive
• “Empty Chair” and “Hot Seat” technique
RECENT DEVELOPMENTS
• Short-term psychodynamic psychotherapy
• Focused on trying to help people correct the
immediate problems in their lives
• Forego long process of completely excavating
childhood
• Virtual therapy
• Therapy delivered via chat room, phone or
video conference
• Client given techniques to use on their own
after session ends
BEHAVIOR THERAPIES
BEHAVIOR THERAPIES
• Based on the belief that all behavior – adaptive
and maladaptive - is learned
• Objective of therapy is to teach people new ways
of behaving
• Focuses on observable, measurable activities
USING CLASSICAL CONDITIONING
TECHNIQUES
Say hello to Mr.
Spider!
• Systematic desensitization
• Gradually associating relaxation with
what was feared
• Extinction through
counterconditioning
• Ending of old fears or reactions through
repeated exposure to new stimulus pairs
• Flooding
• Full-intensity exposure to feared object
• Aversive conditioning
• Eliminate undesirable behavior by
associating it with pain and discomfort
• Virtual reality exposure therapy
• Expose client to fears in safe, virtual
setting
OPERANT CONDITIONING
• Behavior contracting
• Client and therapist set behavioral goals and
agree on reinforcements the person will receive
• Client engages in desired behaviors to attain
reinforcement
• Token economy
• Clients earn tokens for desired behaviors and
exchange them for desired items or privileges
• Often used in schools and hospitals
MODELING
• Person learns new behaviors by watching others
perform those behaviors
• Sometimes used in conjunction with operant
conditioning
• Therapist him/herself may model desirable
behaviors for client
COGNITIVE THERAPIES
MEICHENBAUM’S STRESSINOCULATION THERAPY
• Type of cognitive therapy that trains people
to cope with stressful situations by learning
a more useful patterns of self-talk
• Taught to suppress negative and anxietyprovoking thoughts in times of stress
• Particularly effective for treating anxiety
disorders
ELLIS’ RATIONAL-EMOTIVE
THERAPY (RET)
• A directive, confrontational therapy based on the
idea that psychological distress is caused by
irrational and self-defeating beliefs
• Core problem is belief in “musts” and “shoulds” that
leave no room for making mistakes (no more
“musterbation”)
• Therapist’s job is to challenge client’s irrational
beliefs
BECK’S COGNITIVE THERAPY
• Aimed at identifying and changing
inappropriately negative and self-critical
patterns of thought
• Therapist points out automatic thoughts
(instantaneous, habitual, and unconscious
thoughts that impact mood and action)
and catastrophizing beliefs and forces
client to substantiate them
• Good treatment for depression
COGNITIVE DISTORTIONS LIST
• All or nothing thinking
(“always”, “every”, “never”)
• Mental filter (focus on
negative aspects while
ignoring positive aspects)
• Disqualifying the positive
(shooting down positive
experiences for no reason)
• Jumping to conclusions
(drawing conclusions with
little/no evidence)
• Overgeneralization (isolated
case assumed for all)
• Magnification/minimization
(making mountains out of
molehills, catastrophizing)
• Emotional reasoning (decision
making based on feelings, not
logic)
• Personalization (attributing
personal responsibility when
individual has no control over
event)
• Should statements (emphasizing
what should be rather than
what is; what Ellis called
“musterbation”)
GROUP THERAPIES
FAMILY THERAPY
• Form of group therapy that sees the family as at
least partly responsible for the individual’s problems
• Seeks to change all family members’ behavior to
the benefit of the family and the individual
SELF-HELP GROUPS AND COUPLE
THERAPY
• Self Help Groups
• Small, local gatherings of people
who share common problems and
provide mutual assistance at very
low cost
• Alcoholics Anonymous is an
example
• Good for empathy, but may
trigger temptation to relapse
• Couple Therapy
• A form of group therapy intended
to help troubled partners improve
their communication and
interaction
• Empathy training: partners taught
to share feelings and listen to and
understand partner’s feelings
EVALUATING
PSYCHOTHERAPIES
OVERALL EFFECTIVENESS OF
PSYCHOTHERAPY
• Does Psychotherapy Work?
• Psychotherapy helps about 2/3rd of people
treated
• Approximately 1/3 would improve without
therapy
• Which Type of Therapy is Best for Which
Disorder?
• No one type of therapy is better
• Key is to match the problem with the
appropriate therapy
EFFECTIVENESS OF INSIGHT AND
COGNITIVE THERAPIES
• Difficult to judge as spontaneous remission
may occur
• Who should be asked to judge the
effectiveness of therapy? Therapist or
client?
• Meta-analysis may be the best bet to
evaluate these therapies
• 75-80% result in improvement vs. no therapy
at all
• Only 10% were worse after therapy
• Works best with those who are not
severely disturbed
EFFECTIVENESS OF BEHAVIOR THERAPIES
• Work well for certain problems such as
phobias, compulsive behaviors, impulse
control, and learning new social skills to
displace maladaptive ones
• Criticized for ignoring internal thoughts and
expectations and just treating symptoms
rather than underlying causes
• Not well suited for some types of problems
BIOLOGICAL
TREATMENTS
BIOLOGICAL TREATMENTS:
OVERALL TRENDS
• View abnormal behavior as a symptom of an
underlying physical disorder
• Typically favor biological therapy (drugs,
psychosurgery, ECT, etc.)
DRUG THERAPIES
• Psychopharmacotherapy is the treatment
of mental disorders with medication – also
known as drug therapy
• Major reasons for widespread use of drugs
• Drugs are effective at treating disorders –
especially serious disorders
• Drug therapies are often less expensive that
psychotherapy
ANTIPSYCHOTIC DRUGS
(NEUROLEPTICS)
• Used for schizophrenia or psychosis (hallucinations,
delusions, paranoia, disordered thinking,
incoherence)
• All antipsychotics block dopamine receptors in the
brain
• Side effects include drowsiness, dry mouth,
muscular rigidity, and Tardive Dyskinesia
• Examples include Thorazine, Haldol, Mellaril,
Clozapine, and Risperidone
• 60-70% show improvement in symptoms when these
drugs are used
ANTIDEPRESSANT DRUGS
(THYMOLEPTICS)
• Tricyclics and MAO (monoamine oxidase)
inhibitors
• Most common antidepressants prior to late 1980s
• Work by increasing amount of the neurotransmitters
serotonin and norepinephrine
• Effective, but have serious side effects such as heart
complications and weight gain
• Examples: Tofranil, Elevil (Tricyclics), Nardil (MAOi)
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Work by blocking the reuptake of serotonin
• Examples: Prozac, Paxil, Zoloft, Effexor
• Side effects: sleepiness, reduced sex drive
• 60-70% show improvement though it may take
two weeks for changes to take effect
ACTION OF SSRIS
ANTIMANIA DRUGS:
LITHIUM
• A naturally occurring salt (lithium
carbonate) that is used to treat bipolar
disorder (manic depression) with 80%
effectiveness
• Nobody knows how lithium works to
alleviate symptoms
• Problem with establishing proper dosage
and with people stopping medication
when symptoms ease
• Examples: lithium carbonate, Eskalith
ANTIANXIETY DRUGS (ANXIOLYTICS)
• Use to treat anxiety disorders and are often
referred to as tranquilizers
• Most widely prescribed of all legal drugs
• Produce a feeling of calm and mild
euphoria
• Side effects include physical dependence
and withdrawal symptoms is abruptly
discontinued
• Examples: Valium, Librium, Xanax, Equanil
PSYCHOSTIMULANTS
• Used to treat disorders such as AD/HD
• Concern that psychostimulants are being
overused
• Side effects: lethargy, depression,
aggression
ELECTROCONVULSIVE THERAPY
• Commonly known as “shock therapy”
• 1938 Italian physicians Ugo Cerletti and Lucio
Bini created seizures in patients by passing an
electric current through their brains
• During 1940s and 50s, used as a treatment for
depression, schizophrenia and sometimes
mania; now used only for severe depression
• Causes brief convulsions and temporary loss of
consciousness
• Side effects include memory loss and difficulty
learning following the procedure
• Up to 100,000 people receive ECT each year
PSYCHOSURGERY
• Brain surgery performed to change a
person’s behavior or emotional state
• History of Lobotomy: Egas Moniz and Walter
Freeman
• Prefrontal lobotomy (EM)
• Transorbital lobotomy (WF)
• Tragedies
• Psychosurgery is rarely used today and
removes far less brain tissue
ALTERNATIVES TO
INSTITUTIONALIZATION
DEINSTITUTIONALIZATION
• Releasing people with severe psychological
disorders into the community
• Can cause problems
• Some people are ill-prepared to deal with life outside of
a hospital
• Up to 40% of homeless are mentally ill
• Alternative forms of treatment (many)
• Half-way houses
• Family-crisis interventions
• Day-care
PREVENTION
• Primary prevention
• Improve the social environment so that new cases
of mental disorders do not develop
• e.g. Family planning, Genetic counseling
• Secondary prevention
• Interventions with high risk groups
• e.g., suicide hot-lines, job training in economically
depressed areas
• Tertiary prevention
• Help people adjust after they are released from
the hospital in order to help prevent a relapse
• e.g. halfway houses, long-term outpatient care
• Community psychology attempts to minimize
or prevent mental disorders – not just treat
them