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CHAPTER 15 Treatment of Psychological Disorders Introductory Definitions • Psychotherapy: techniques employed to improve psychological functioning & promote adjustment to life • Three major approaches to therapy: – Insight (personal understanding) – Behavior (maladaptive behaviors) – Biomedical (mental illness & medical treatments, such as drugs) Four Major Forms of Insight Therapy • Psychoanalysis/ psychodynamic • Cognitive • Group, Family, & Marital • Humanistic Insight Therapies: Psychoanalysis/Psychodynamic • Psychoanalysis: Freudian therapy designed to bring unconscious conflicts into consciousness Insight Therapies: Psychoanalyis/Psychodynamic • Five major techniques of psychoanalysis: Insight Therapies: Psychoanalysis/Psychodynamic • Evaluation of psychoanalysis: limited applicability & lack of scientific credibility • Psychodynamic Therapy: briefer, more directive, contemporary form of psychoanalysis focusing on conscious processes & current problems Insight Therapies: Cognitive • Cognitive Therapy: focuses on changing faulty thought processes & beliefs – Improvement comes from insight into negative self-talk (internal dialogue) – Cognitive Restructuring: process of challenging & changing destructive thoughts & maladaptive behaviors Insight Therapies: Cognitive (Continued) • Albert Ellis’s RationalEmotive Therapy (RET): eliminates emotional problems through rational examination of irrational beliefs Ellis’s Rational-Emotive Therapy (RET) Beck’s Cognitive-Behavior Therapy • Aaron Beck’s form of CognitiveBehavior Therapy works to change destructive thoughts & behaviors • Depressive thought patterns: – selective perception – overgeneralization – magnification – all-or-nothing thinking Insight Therapies: Cognitive (Continued) • Evaluation of cognitive therapy Pro: Considerable success with a range of problems Con: Criticized for overemphasizing rationality, ignoring unconscious dynamics, minimizing importance of the client’s past, & progress only comes from behavioral change—not thought processes Insight Therapies: Humanistic • Humanistic therapy: seeks to maximize personal growth through affective restructuring (emotional readjustment) • Key assumption: Problems = blockage or disruption of normal growth potential, which leads to a defective selfconcept Insight Therapies: Humanistic (Cont.) • Rogers’s Client-Centered Therapy: provides accepting atmosphere & encourages healthy emotional experiences • Techniques include: – empathy – unconditional positive regard – genuineness – active listening Insight Therapies: Humanistic (Continued) • Evaluation of humanistic therapy Pro: Empirical evidence of efficacy Con: Outcomes such as selfactualization & self-awareness difficult to test scientifically; research on specific techniques has had mixed results Insight Therapies: Group, Family, & Marital Therapies • Group Therapy: a number of people meet together to work toward therapeutic goals • Family & Marital Therapies: work to change maladaptive family patterns Behavior Therapies • Behavior Therapy: group of techniques based on learning principles used to change maladaptive behaviors • Three foundations of behavior therapy: – classical conditioning – operant conditioning – observational learning Behavior Therapies: Classical Conditioning – Aversion Therapy: pairs an aversive (unpleasant) stimulus with a maladaptive behavior Pause & Reflect: Critical Thinking Classical Conditioning: Systematic Desensitization • Systematic Desensitization: gradual process of extinguishing a learned fear (or phobia) by working through a hierarchy of fearful stimuli while remaining relaxed • Virtual reality therapy offers a type of systematic desensitization with “virtual” vs. real-life therapeutic experiences. Behavior Therapies: Classical Conditioning & Driving Phobia Behavior Therapies: Operant Conditioning • Operant conditioning uses techniques to increase ADAPTIVE behaviors: • Shaping: rewards successive approximations of target behavior through role-playing, behavior rehearsal, etc. • Tokens: symbolic rewards used to immediately reinforce desired behavior Behavior Therapies: Observational Learning • Modeling: watching & imitating models that demonstrate desirable behaviors Behavior Therapies (Continued) • Evaluation of behavior therapies: Pro: Strong evidence for success with a wide range of problems Con: Questioned & criticized for generalizability & questionable ethics Biomedical Therapies • Biomedical Therapy: uses physiological interventions, such as drugs, to reduce or alleviate symptoms of psychological disorders • Three forms of biomedical therapy: – Psychopharmacology – Electroconvulsive therapy (ECT) – Psychosurgery Biomedical Therapies: Psychopharmacology • Four major categories of drugs: 1. Antianxiety (increases relaxation; reduces anxiety & muscle tension) 2. Antipsychotic (treats hallucinations & other symptoms of psychosis) 3. Mood Stabilizer (treats manic episodes & depression) 4. Antidepressant (treats symptoms of depression) Biomedical Therapies (Continued) • Electroconvulsive Therapy (ECT): based on passing electrical current through the brain; used almost exclusively when other methods have failed • Psychosurgery: operative procedures on the brain designed to relieve severe mental symptoms that have not responded to other forms of treatment Evaluating Biomedical Therapies • Psychopharmacology: enormously beneficial, but several problems (e.g., side effects, dependency, etc.) • Electroconvulsive Therapy (ECT) & Psychosurgery: controversial & generally used as a last resort Therapy Essentials: Five Common Goals Cultural Issues in Therapy • Cultural similarities in therapy: naming the problem qualities of the therapist establishing credibility familiar framework applying techniques that bring relief special time & place Cultural Issues in Therapy (Cont.) • Cultural differences: – Therapies in individualistic cultures emphasize independence, the self, & control over one’s life. – Therapies in collectivist cultures emphasize interdependence. Cultural Issues in Therapy (Cont.) • Key considerations for women & therapy: 1. higher rates of diagnosis & treatment of mental disorders 2. stresses of poverty 3. stresses of multiple roles 4. stresses of aging 5. violence against women Therapy & Critical Thinking: Institutionalization • Institutionalization—criteria for involuntary commitment: – dangerous to self or others – believed to be in serious need of treatment – no reasonable alternatives Therapy & Critical Thinking: Institutionalization (Continued) • Deinstitutionalization: discharging as many people as possible from state hospitals & discouraging admissions • Community services such as community mental health (CMH) centers work to cope with problems of deinstitutionalization.