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Treatments for Psychopathology CORNELL NOTES: WHAT IS “THERAPY” AND WHO RECEIVES IT? WHAT IS “INSIGHT THERAPY” AND WHAT ARE ITS CHARACTERISTICS? • Key Points Summary: • Notes Types of Treatment • Psychotherapy – Insight therapies • “talk therapy” Ex. Family and marital therapy – Behavior therapies • Changing overt behavior Ex. Phobias and drug use – Biomedical therapies • Biological functioning interventions Ex. Schizophrenia • Group Question Minute: Out of all of the people who receive psychotherapy, how many of them have mental disorders? • 15% of U.S. population in a given year, almost half of which do not have a psychological disorder (Surgeon General’s report) • Group Question Minute: What are some reasons to receive psychotherapy? Who Seeks Treatment? Common presenting problems Anxiety depression, unsatisfactory interpersonal relations, troublesome habits, poor self0control, low self-esteem, marital conflicts, self-doubt, a sense of emptiness, and feelings of personal stagnation. Most common presenting problems › Anxiety and Depression Women more than men Medical insurance Education level Figure 15.2 Therapy utilization rates Figure 15.3 Psychological disorders and professional treatment Who Provides Treatment? • • • • • • Clinical psychologists Counseling psychologists Psychiatrists Clinical social workers Psychiatric nurses Counselors Therapy Skits instructions 1. 2. 3. 4. 5. Research your subcategory of research focusing on your key words. You may use your text and the other available texts in the classroom. Take notes Write a school-appropriate skit that includes all key words and/or represents the concept communicated by each key word. Each person should have a part. DO NOT JUST IMPROV. Your grade will be based on preparation, accuracy, and creativity. Perform your skit. One group member will remain after the skit to debrief the class on key words and give explanations and/or examples to clarify any questions. All students will have a few minutes to summarize each concept in notes format under the title “Treatment Skits.” Insight Therapies • 1. Insight: Psychoanalysis (key words: psychoanalysis, free association, dream analysis, interpretation, resistance, transference) • 2. Insight: Client-Centered Therapy (key words: ClientCentered Therapy, genuineness, unconditional positive regard, empathy, clarification ) • 3. Insight: Cognitive Therapy (key words: Cognitive Therapy, negative thoughts, maladaptive behaviors, automatic thoughts, unrealistic assumptions, detection, reasonable standards of evaluation, Rational Emotive Behavior Therapy ) • 4. Insight: Group Therapy (key words: Group Therapy, selection of participants, trading view points, sharing experiences, coping strategies, acceptance, emotional support, setting goals, therapist role ) Behavior Therapies • 5. Behavior Therapies: systematic desensitization (key words: systematic desensitization, anxiety hierarchy, deep muscle relaxation, relaxation, working through the hierarchy, imagination, counterconditioning ) • 6. Behavior Therapies: aversion therapy (key words: aversion therapy, aversive stimulus, emetic drug, aversive response, conditioned aversion, troublesome behaviors ) • 7. Behavior Therapies: social skills training (key words: social skills training, social ineptitude, social anxiety, autism, schizophrenia, interpersonal skills, modeling, behavioral rehearsal, shaping, role-playing ) Biomedical Therapies • • • • • 8. Biomedical Therapies: Antianxiety drugs (key words: antianxiety drugs, anxiety, Valium, Xanax, tranquilizers, side effects, drug dependence, overdose, Buspar ) 9. Biomedical Therapies: Antipsychotic drugs (key words: antipsychotic drugs, schizophrenia, mood disorders, psychotic symptoms, dopamine synapses, 70% effective, side effect, tardive dyskinesia, atypical antipsychotics ) 10. Biomedical Therapies: Antidepressant drugs (key words: antidepressant drugs, tricyclins, MAO inhibitors, beneficial for 2/3 of patients and 1/3 have complete resolution of symptoms, complete resolution, selective serotonin reuptake inhibitors, side effects ) 11. Biomedical Therapies: Lithium and Stabilizers (key words: lithium, mood stabilizers, prevention and current treatment of bipolar, side effects, valproic acid, advantages) 12. Biomedical Therapies: Electroconvulsive Therapy (key words: electroconvulsive therapy, severe seizures, electrodes, temporal, electrical current, right hemisphere, controversy, schizophrenia, major depression, risks) Insight Therapies: Psychoanalysis • Sigmund Freud and followers – Goal: discover unresolved unconscious conflicts • Free association- clients spontaneously express thoughts and feelings without censorship • Dream analysis: discover the unconscious significance of the client’s dreams. Pay attention to symbols and archetypes. • Interpretation: Why is the client saying and thinking what they are? What do these things say about the influence the unconscious is exerting on the person’s behavior? • Common Defense Mechanisms That Turn Up in Therapy: – Resistance- unconscious defensive maneuvers that help people save face and hinder progress in therapy. – Transference- clients unconsciously start relating to their therapist in ways that mimic critical relationships in their lives Figure 15.4 Freud’s view of the roots of disorders Insight Therapies: Client-Centered Therapy Carl Rogers › Goal: restructure self-concept to better correspond to reality › Therapeutic Climate Genuineness: you are sincere and upfront with the client about their problem(s), and they are sincere and upfront with you. No posturing. No acting. No holding back. Unconditional positive regard: make the client understand that you will not judge them and that they’re valuable. Empathy: let the client know that you understand the trouble their problem has caused in their lives. Reflect feelings. Clarification: make the person talk so that you can understand them! Includes paraphrasing. Does insight therapy work? - Homework assignments mimic behavioral therapies o -Depends on goals - Some have doubts, but research shows it’s superior to placebo treatments or no treatments. Figure 15.5 Rogers’s view of the roots of disorders Insight: Cognitive • Cognitive Therapy: change people’s thought patterns • Psychologist will help clients get rid of – negative thoughts: counterproductive – maladaptive behaviors: deterioration of every-day life – automatic thoughts: thoughts you don’t know you’re beginning to have until . . . well . . . you have them! – unrealistic assumptions: automatic catastrophic thinking • Psychologists will help clients develop: – Detection: catch the negative thoughts before they snowball – reasonable standards of evaluation: realistic thinking • Albert Ellis Rational Emotive Behavior Therapy (R.E.B.T.) Also known as “challenge therapy” • A. Something happens. B. You have a belief about the situation. C. You have an emotional reaction to the belief. • If you want to change your emotional reaction, change your belief. Insight: Group Therapy • Also a behavior therapy • Group Therapy is a form of therapy wherein group members serve as pseudo-therapists to each other. The therapist’s role is as a facilitator. • Processes: 1. selection of participants: all have problem in common 2. trading view points and sharing experiences: empathy and learning you’re not alone 3. Sharing coping strategies: What works to combat this problem? 4. setting goals: What are we going to accomplish? • Environment: 1. Acceptance: We all have this problem, so where do we go from here? 2. emotional support: keep commitment to group and self, but also receive help for weaknesses Behavior Therapies: Desensitization • B.F. Skinner and colleagues – Goal: unlearning maladaptive behavior and learning adaptive ones. Counterconditioning. – Systematic Desensitization – Joseph Wolpe • Classical and operant conditioning are involved in (1) “unlearning” associations between fear objects and negative consequences and (2) “relearning” (counterconditioning) those negative associations through the presentation of reinforcing stimuli. • Step #1: Anxiety hierarchy: what are you the most and least afraid of? Which are real and which are perceived (“imaginary”)? • Step #2: the client is trained in deep muscle relaxation (physically relaxing body). Also trained in mental imaging (relaxing mind) • Step #3: the client tries to work through the hierarchy, learning to remain relaxed while imagining each stimulus. • The basic idea: You cannot be anxious and relaxed at the same time. Behavioral Therapies: Aversion – Aversion therapy: based upon operant conditioning (shaping, reinforcement, punishment). Use on troublesome, maladaptive behaviors – Ex. Alcoholism, sexual deviance, smoking, etc. • aversive stimulus: the thing you learn to hate • emetic drug: a drug that makes you vomit. Create a taste aversion on purpose • aversive response: an undesirable response to the stimulus • conditioned aversion: the successful training to hate something that’s not good for you. troublesome behaviors • The process: Pair an aversive stimulus with the problem behavior. Behavior Therapy: Social Skills Training B.F. Skinner and colleagues › Who needs social skills training? › People with social ineptitude (can’t function in social situations) › People lacking interpersonal skills (people skills) for any reason (like inadequate socialization, for example) › People with extreme social anxiety (anxiety around other people). › People who have other disorders like autism, schizophrenia. › Social skills training tools: Modeling and shaping by therapist and other people in client’s life Behavioral rehearsal and role playing: practice a social scenario right there in the office Biomedical therapies: Antianxiety • Assumption: Certain disorders are caused, at least in part, by biological malfunctions. • Psychopharmacotherapy=drug therapy • 3 Categories: – Antianxiety - relieve tension, apprehension, and nervousness. • Mechanism Types Represented by Different Drugs: • Benzodiazapenes: Depress central nervous system by increasing sensitivity to GABA (inhibitory neurotransmitter). FAST ACTING! • Serotonin: increase impact of serotonin by getting rid of inhibition, which calms you down • Barbituates: Depress central nervous system by increasing sensitivity to GABA (inhibitory neurotransmitter), but they also block glutamate (excitatory neurotransmitter) • Tranquilizers: Depress central nervous system – Examples: Valium, Xanax, Buspar Side Effects of Antianxiety Medications •Drowsiness, lack of energy •Clumsiness, slow reflexes •Slurred speech •Confusion and disorientation •Depression •Dizziness, lightheadedness •Impaired thinking and judgment •Memory loss, forgetfulness •Nausea, stomach upset •Blurred or double vision Do you want a more “natural” method of controlling anxiety? Biofeedback A bodily function is monitored, and information about the function is fed back to the person so that they can develop more control over the physiological process. Example: Anxiety attacks Biomedical Therapies: Antipsychotics – Antipsychotic - gradually reduce psychotic symptoms, including hyperactivity, mental confusion, hallucinations, and delusions. – Mechanism: Antipsychotics decrease activity at dopamine synapses by blocking receptors=neurons stop shorting out from overstimulation • Side-effects: symptoms of Parkinson’s disease and tardive dyskinesia, an incurable neurological disorder marked by involuntary writhing and ticklike movements of the mouth, tongue, face, hands, or feet. ALSO Blurred vision, Dry mouth, Drowsiness, Muscle spasms or tremors, Weight gain – Newer drugs, which have a different mechanism of action, such as clozapine, have fewer motor side effects but are not risk free. Atypical antipsycholtics, for example, have fewer side effects than regular antipsychotics and work on patients that have not been receptive to traditional antipsychotics. – Examples: Thorazine, Mellaril, Haldol Biomedical Therapies: Antidepressants Mechanisms: • Tricyclins: like Elavil inhibit reuptake at serotonin and norepinephrine synapses, thus leaving more serotonin (calming neurotransmitter) and norepinephrine (energy/fight-flight chemical) available for cells. Side Effects: dry mouth, drop in blood pressure when getting up quickly, constipation, difficulty urinating, blurred vision, weight gain and drowsiness. • MAO inhibitors: MAO metabolizes serotonin and norepinephrine. MAO inhibitors prevents MAO from breaking down these neurotransmitters thus leaving a higher concentration of them in the body. No major side effects, unless you have high blood pressure. • Selective serotonin reuptake inhibitors (SSRIs) – like Prozac, Paxil, Zoloft slow reuptake at serotonin synapses, thus leaving more serotonin (calming neurotransmitter) floating around available for cells. Side effects: stomach upset, nausea, fatigue, headache, fatigue, tremor, nervousness and dry mouth, sexual dysfunction Instead of being sucked back up into the receiving neuron, “happy” neurotransmitters remain in the synaptic cleft. Higher concentration of “happy” neurotransmitters floating around Biomedical therapies: Mood Disorders › Mood stabilizers Lithium: chemical used to control mood swings in patients with bipolar mood disorders Very successful at preventing future episodes of mania and depression, but it can be toxic and requires careful monitoring. Valproic acid: same result as lithium, but has fewer averse side effects. • Side Effects of Lithium: Nausea, vomiting, and diarrhea, Trembling, Increased thirst and increased need to urinate, Weight gain in the first few months of use, Drowsiness, A metallic taste in the mouth, Abnormalities in kidney function, Abnormalities in thyroid function. • Side Effects of Valporic Acid: weight gain, drowsiness, low energy, stomach upset, changes in liver function, and problems with platelet functioning . Uncommon side effects can include temporary hair loss, headaches, and confusion Biomedical therapies: ECT Electroconvulsive therapy (ECT) Electroconvulsive therapy (ECT) is a biomedical treatment in which electric shock channeled through the temporal lobes is used to produce a cortical seizure accompanied by convulsions. While the use of ECT peaked in the 40s and 50s to treat schizophrenia, there has been a recent resurgence in this therapy as applied to depressive disorders. Traumatic. Can be emotionally scarring. Example: In A Beautiful Mind a version of ECT is used on a schizophrenic patient. Therapy Analysis Activity Ctd. • Reflection Paragraph: What is the origin of the increase for the need for mental health professionals in the late 20th Century? In other words, why do so many people need therapy in our day? According to your personal view and your knowledge of the world, write a RACE paragraph naming one or a few reasons for this increase. Please explain your reasons and cite evidence. Example: Joe Jensen is currently a happy husband and a flight attendant. He loves his family and his work, and has now been married and flying for 25 years. However, earlier on in his adult life, he almost lost his wings and his new family. Joe was diagnosed with histrionic personality disorder at the age of 23. He found himself overreacting to small events in order to get attention. No matter how juvenile he knew this behavior to be, he couldn’t stop himself from laughing hysterically, throwing tantrums, and staging accidents to draw the attention of his wife and the plane passengers. Finally, passengers began complaining to the company about Joe’s behavior on flights. A pilot with whom Joe worked pulled him aside and gave him the card of a competent psychiatrist. Joe saw this doctor for several years, and he was finally able to master his impulsiveness through a combination of behavioral and cognitive treatments. His wife came near to leaving him, but decided to hang in there when she saw Joe’s determination to control his problem. Joe still visits the psychiatrist, but much less frequently than at the beginning. With the help of caring coworkers and an understanding wife, and with his determination to control his behavior, Joe was able to keep his family and job. Cornell Notes: What are the current trends and issues in psychological treatment? • Key Points Summary: • Notes Current Trends and Issues in Treatment • Managed care through Health Insurance: • Are HMOs negatively impacting psychological care? Many say “yes.” • + Consumers pay lower prices (copays) • - Consumers give up freedom to choose providers and obtain whatever treatments they believe necessary. • - In the mental health domain, the question of what is “medically necessary” is more ambiguous. Current Trends and Issues in Treatment • Empirically validated treatments • Psychologists have increased research efforts to validate the efficacy of specific treatments for specific problems. • + Insurance companies will pay for “research based” treatments. • - Concerns about the inability of empirical studies to capture the complexity of the real world or the flexibility with which therapists must practice their craft. • - Some argue that the movement toward empirically supported treatment runs counter to the eclectic blending of therapeutic approaches, which current studies suggest has merit. Current Trends and Issues in Treatment • Blending approaches to treatment • Most mental health professionals use a mixture of treatments • Multicultural sensitivity • Western cultures view “the self” as independent, reflective, rational, and capable of self-improvements. Not all cultures hold these beliefs. • Ethnic minorities are undertreated. Current Trends and Issues in Treatment • Deinstitutionalization – Definition: the movement away from inpatient treatment in mental hospitals to more community based treatment. – The negative effects of mental hospitals have fueled this movement, as has the ability to treat serious mental problems with effective drug therapy. Long-term hospitalization for mental disorders is almost non-existent. – + Fewer people are being hospitalized long-term, because other treatments are available. – - Revolving door problem: people who really do need longterm treatment spend their lives coming and going from the psych. ward. – - Homelessness: 1/3 of homeless people are mentally ill.