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Therapies Chapter 14 Not to mention your unusually large head… Defining Therapy Psychotherapy is the treatment of Dude…Why are my arms so short? emotional and behavioral problems through 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 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-and-now 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 anxiety-provoking 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 selfdefeating 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