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Unit 13 Review: Treatment of Psychological Disorders Introduction • History of treatment-reformers: – Philippe Pinel – Dorothea Dix • Psychotherapy-Trained therapist uses psychological techniques to assist someone seeking to overcome or achieve personal growth. Refers to all forms of talk therapy Types of Therapy • 1. individual • 2. group-lets one see others have similar problems, cheaper • 3. family • 4. support group/self help groups (grew out of humanism) The Relative Effectiveness of Different Therapies • Evidence-based practice basing treatment methods (what tx. To use for what) on: Psychotherapy(Talk Therapy) based on the Perspectives: Psychoanalysis-(*insight therapy) Freud: Insight into unconscious motives and feelings 1. Psychodynamic Therapy influenced by Freud: same as above-by identifying themes across important relationships, including childhood and therapist’s 2. Humanistic Therapy insight, self acceptance, self acceptance leads to self fulfillment Both 1 and 2 are Insight Therapy=Helps people reduce inner conflict and increase self-understanding; assume that psychological problems lessen as self-awareness grows 3. Behavior Therapy: uses behavior modification (changing) to change learned behaviors 4. Cognitive Therapy: identifying and changing faulty beliefs that effect our feelings, thoughts and actions 5. Cognitive Behavior Therapy : changing faulty thinking and behaviors since our irrational, negative thinking affects our behavior Eclectic Approach-using a blend of therapies Biological/Biomedical perspective: PERFORMED BY PSYCHIATRIST (MD) The Biomedical Therapies -changing brain’s functioning with: 1.Drugs psychopharmacology 2. Electroconvulsive therapy (ECT-shocking brain-used for SEVERE depression) 3. Psychosurgery (surgery that removes or destroys brain tissue) prefrontal lobotomy-for psychosis, violent; impacts emotions separating corpus callosum-for epilepsy The Psychological Therapies Psychoanalysis Psychoanalysis (Freud) felt aggression is cathartic Aims of therapy: bring repressed feelings to conscious awareness to gain insight into origins of one’s issues/problems Psychoanalysis Methods • Methods-takes several times a week for several years • Currently called Psychodynamic Therapy (1x week-shorter duration, no couch) -- Hypnosis (more current) – Free association – Resistance Lead to • Interpretation Also interpreted are Dreams: – Dream analysis (manifest/latent content) – Transference (strong positive or Negative feelings towards therapist that represents past important relationships) Humanistic Therapies • Client-centered therapy Carl Rogers – Nondirective therapy (listen’s to client’s self-perceptions without judging, interpreting, or directing towards feelings), acceptance (no judging), and empathy (how world appears from clients point of view) HOW: 1. Active-Reflective Listening 2. Unconditional Positive Regard (total acceptance) GOAL=Therapist accepts you; You accept you Behavior Therapies • Behavior Therapy (assumes Abnormal behaviors are learned) – Operant conditioning techniques (changing behaviors through: 1. rewards-positive or negative, 2. punishmentspositive or negative, 3. ignoring behaviors – includes Behavior Modification(reinforce desired behaviors and withholding reinforcement for, or punishing, undesired behaviors) such as Token Economies Joseph Wolpe 1915-1997 Systematic Desensitization (Treatment Choice for Phobia) Behavior Therapies Classical Conditioning Therapies-Classical conditioning Exposure therapies=facing/exposure to fears Counterconditioning Counter-conditioning= pairing the unpleasant event/stimulus (snake, spider, elevator, clown, flying, public speaking, etc…) with something incompatible with fear, such as in the case of 1.Systematic desensitization-Joseph Wolpe 1. Learn series of Relaxation techniques 2. Anxiety Hierarchy (come up with about a 10 item hierarchy) 3. The person thinks about or experiences each step in the hierarchy, from lowest to highest, while relaxation 2. Virtual reality exposure therapy 3. Aversive conditioning (opposite of # 1) Substitute a negative (aversive)response for a positive response to a harmful stimulus EX 1. bitter nail polish for nail biters 2. pill to induce vomiting to discourage alchohol 4. Flooding (extreme exposure, all at once, to demonstrate nothing bad will occur) Mary Carver Jones First to use Classical Conditioning in a positive way (after Watson-FATHER OF BEHAVIORISM) to alleviate a child’s fear of rabbits: Used favorite food to desensitize- by pairing food with the rabbit Cognitive Therapy The Goal: Using Thoughts to Change Emotions and behaviors by teaching clients new ways of thinking Premise is: We have Faulty Cognitions (thinking) We have irrational beliefs and expectations that distort our behaviors, attitudes and emotions If I leave the house Change thinking=Changed Behaviors Aaron Beck- Cognitive Therapy Mostly for depression-Goal Is to change Catastrophizing (Illogical, Maladaptive) beliefs: •Client’s told to test their thoughts for accuracy •Example: I never have a good time •Client may come up with times that were actually good. --An unassertive person may be asked to cut in line or ask someone for a favor Cognitive Behavioral Therapy • Goal=alter the way we think and act since our irrational, negative thinking affects our behavior (ex. “I will not die if I leave the house; it is only fear I feel and no real harm awaits me.”) • Rational Emotive Therapy or Rational Emotive Behavioral Therapy(RET or REBT)-Developed by Albert Ellis His ABCs: Activating Event (say being criticized) Belief (I must be loved by everyone to be happy) Consequent Emotions (unhappiness) The goal of RET is to change B=FALSE, SELF-DEFEATING BELIEFS Comparison of Psychotherapies Is Psychotherapy Effective? • Regression toward the mean • Client’s perceptions (very positive) • Therapist’s perspective: Very positive Why Clients Remain Positive • 1. enter tx. In crisis and may mis-attribute improvement to tx. • Clients have a “stake” in believing the therapy was worth it (similar to belief perseverence) • Clients generally speak highly of their therapist even if symptoms remain Is Psychotherapy Effective? • Outcome research-2/3 of those treated for non-psychotic disorders improved markedly – Meta-analysis-putting a bunch of studies together and evaluating Placebo treatments Placebo Effect=I get better with therapy b/c I think it will help (not due to therapy itself) Evaluating Alternative Therapies • light exposure therapy helps with –Seasonal affective disorder (SAD) Types of Therapists Biological / Biomedical Therapies Drug Therapies (Agonists or Antagonists) Drug Therapies Antipsychotic Drugs • Antipsychotic drugs (neuroleptics) – Psychoses (some loss of reality contact with delusions and hallucinations) – Chlorpromazine (sold as Thorazine or Haldol)- Antipsychotic drugs similar to molecules in neurotransmitter Dopamine –they block receptor sites for dopamine – Tardive dyskinesia (involuntary movements of facial muscles, tongue, and limbs from antipsychotic medications) Drug Therapies Antipsychotic Drugs – Atypical antipsychotics –Clozaril- are best to alleviate negative symptoms of schizophrenia and cause “awakenings” in these individuals Overall, antipsychotic drugs are effective Drug Therapies Antianxiety Drugs • Antianxiety drugs – Xanax, Ativan, – Draw back: 1.Physiological Dependence 2. Worsening symptoms When stopped Drug Therapies Antidepressant Drugs • Antidepressant drugs-increase activity of serotonin – Use with mood and anxiety disorders increase levels of norepinephrine or serotonin, neurotransmitters that elevate mood – Fluoxetine (common name Prozac), Zoloft and Paxil block removal of serotonin from synapses and are called: Selective-serotonin-reuptake Inhibitors (SSRIs) Serotonin promotes Neurogenesis (birth of new brain cells) May be why the drugs take up to 4 week to work Drug Therapies Mood-Stabilizing Medications • Mood-stabilizing medications – Lithium Carbonate for the highs and lows of bipolar – unsure why these drugs Are effective Psychosurgery • Psychosurgery (surgery that removes or destroys brain tissue) – Lobotomy (not used after introduction of antipsychotic meds in 1950s) • Procedure-cut nerves connecting frontal lobe with emotion centers-used for uncontrollably emotional and violent patients • Side effects: lethargic, immature, uncreative-Permanent Lobotomy abandoned when drugs available Psychosurgery used in rare instances with epilepsy by cutting corpus coliseum