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Treatment Modalities for Psychological Disorders “Brutal” to “Gentle” Transition • Dorothea Dix and Philippe Pinel (mid 1800s) – Advocates of mental hospitals to provide more human treatment • Mid 1950s: exodus from mental hospitals: – Introduction of therapeutic drugs – Community-based treatment programs Two Main Treatment Modalities • Psychotherapy • Biomedical therapy • Combination of the two • 50% of psychotherapists say they use an “ecclectic approach,” using a blend of therapies 4 Main Psychological Therapies • 1. Psychoanalysis • Sigmund Freud • 2. Humanistic • Carl Rogers • 3. Behavioral • Pavlov/Skinner • 4. Cognitive • Aaron Beck 1. Psychoanalysis • Psychological problems = • Repressed impulses and conflicts from childhood • Aim: work through ‘buried’ feelings and take responsibility for their own growth • Release energy ‘wasted’ on id-ego-superego conflicts 1. Psychoanalysis • How does it work? • Free association • But watch out for “resistance”… blocks in the flow of free association • Therapist would interpret the ‘meaning’ of your resistance • Interpretation of latent content in dreams 1. Psychoanalysis • One result of therapy: • Transference • Occasionally followed by “Countertransference” • This is why the APA has a “Code of Ethics”! 1. Psychoanalysis • Be ready to open you wallet! • Traditional psychoanalysis is 3-4 visits/week for several years • Conservatively speaking, at $125/hour, this is $68,250 for 3 years • Maybe just take a few nice vacations! 1. Psychoanalysis • Modern “alternative” is: – Psychodynamic Therapy • Goal is to understand current symptoms in terms of childhood and important relationships • Face-to-face; generally once a week for several months 2. Humanistic Therapy • Carl Rogers (1902-1987) • “Client-centered therapy” (Not “patient”) – Aim is to grow in self-awareness and acceptance • Focus is on: – Dealing with present & future – Conscious thoughts rather than unconscious – Taking responsibility for one’s feelings & actions 2. Humanistic Therapy • Therapists strive to exhibit : – Genuineness – Acceptance – Empathy • Which leads to “unconditional positive regard” • Mechanism: “Active Listening” 3. Behavior Therapies • You don’t need “self-awareness” to heal from psychological problems! • A. Classical Conditioning Techniques • B. Operant Conditioning Techniques 3A. Classical Conditioning • “Counter-conditioning”: Pair the trigger stimulus with a new response (relaxation) • Idea: can’t be both fearful AND relaxed • Two techniques: – Exposure therapy – Aversive conditioning 3A. Classical Conditioning • Exposure Therapy/Response Prevention (ERP) 3A. Classical Conditioning • Aversive Conditioning: Substitute an aversive response for a positive response to a harmful stimulus Also, Faradic aversion conditioning! 3B. Operant Conditioning • Behavior Modification • Use positive reinforcers to shape behavior 3B. Operant Conditioning • Token Economies 3B. Operant Conditioning • Concerns with Behavior Modification • How ‘durable’ are the effects? • It is OK for one human to control another’s behavior? 4. Cognitive Therapy • Works with the assumption that our thoughts color our feelings • Aaron Beck: Expose irrational thinking, and then persuade the person to remove the dark glasses through which they view life 4. Cognitive Therapy Therapies to Avoid! • Energy therapy – manipulating invisible energy fields • Recovered-memory therapy • Rebirthing therapy • Facilitated communication • Crisis debriefing Biomedical Therapies: Drugs • • • • Antipsychotic Drugs Antianxiety Drugs Antidepressant Drugs Mood-Stabilizing Drugs Biomedical Therapies: Adjuncts or Alternatives to Drugs • Electroconvulsive Therapy • Magnetic Stimulation • Deep-Brain Stimulation Biomedical Therapies: Drugs • Antipsychotic Drugs • Most common drugs help alleviate “positive” symptoms of schizophrenia • Ex. Chlorpromazine (Thorazine) • Work by blocking activity of dopamine • Major side-effects: tardive dyskinesia, obesity, diabetes Biomedical Therapies: Drugs • “Atypical” Antipsychotic Drugs • Help alleviate ‘negative’ symptoms of schizophrenia • Ex. clozapine (Clozaril) Biomedical Therapies: Drugs • • • • Anti-anxiety Drugs Examples: Xanax, Atavan, Valium ALL depress the central nervous system Anti-anxiety drugs plus ________ make a lethal combination? –ALCOHOL! Biomedical Therapies: Drugs • Anti-anxiety Drugs • Criticisms: – 1. do not treat underlying problem, just symptoms – 2. Psychological dependence: “popping a Xanax” – 3. Physiological dependence: cessation of drug can lead to great anxiety and insomnia –New standard drug treatment for anxiety…. Biomedical Therapies: Drugs • Antidepressant Drugs • Also successfully treat anxiety disorders in addition to depression • Selective-serotonin-reuptake inhibitors (SSRIs) –Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine) Biomedical Therapies: Drugs Biomedical Therapies: Brain Stimulation • Electroconvulsive Therapy • 1938: 100 volts administered to wideawake patient • Today: general anesthesia, muscle relaxant, 30 second electrical stimulation • Refractory Depression: 80% of patients improve with ECT, but 4 in 10 relapse within 6 months Biomedical Therapies: Brain Stimulation • Electroconvulsive Therapy Biomedical Therapies: Brain Stimulation • Alternative Neurostimulation • 1. Magnetic Stimulation: repetitive transcranial megnetic stimulation (rTMS) Biomedical Therapies: Brain Stimulation • Alternative Neurostimulation • 2. Deep-Brain Stimulation Biomedical Therapies: Psychosurgery • Frontal Lobotomy • 1930s, Portuguese physician, Dr. Moniz • In the U.S. during 1950s: 35,000 lobotomies performed • J.F. Kennedy’s sister, Rosemary, received a lobotomy –No longer performed –Nobel Peace Prize awarded to Moniz Therapeutic Life-Style Change • • • • • • Aerobic exercise: 30 min. 3x a week Adequate sleep: 7-8 hours per night Light exposure Social connection Anti-rumination Nutritional supplements: omega-3 fatty acids