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Chapter 13 Therapies © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 1 Chapter Preview • Biological Therapies • Psychotherapy • Sociocultural Approaches and Issues in Treatment • The Effectiveness of Psychotherapy © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 2 Biological Therapies • Also called biomedical therapies • Treatments that reduce symptoms of psychological disorders by altering aspects of body functioning • Drug therapy • Electroconvulsive therapy • Psychosurgery © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 3 Drug Therapy • Revolutionized mental health care in the 20th century • Psychotherapeutic drugs used mainly in: • Anxiety disorders Antianxiety drugs • Mood disorders Antidepressant drugs • Schizophrenia Antipsychotic drugs © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 4 Antianxiety Drugs • Commonly known as tranquilizers • Bind to receptor sites of neurotransmitters that become overactive during anxiety • Benzodiazepines • Relatively fast acting • Side effects include drowsiness, loss of coordination, fatigue, and mental slowing • Can become addictive • Nonbenzodiazepines • Generalized anxiety disorder © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 5 Antidepressant Drugs • Regulate mood through effects on neurotransmitters • Tricyclics • Increase norepinephrine and serotonin levels • Monoamine oxidase (MAO) inhibitors • Block enzyme that breaks down serotonin and norepinephrine © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 6 Antidepressant Drugs • Selective serotonin reuptake inhibitors (SSRI) and serotonin and norepinephrine reuptake inhibitors. • Interfere with reabsorption of serotonin and/or norepinephrine in brain • Lithium • Solid element used to treat bipolar disorder © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 7 Antipsychotic Drugs • Neuroleptics • Block dopamine’s action in brain • Side effects include: • Dysphoria • Tardive Dyskinesia Lack of pleasure Movement disorder • Atypical antipsychotic medications • Lower risk of side effects • Block reuptake of serotonin © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 8 Electroconvulsive Therapy • • • • Commonly called shock therapy Goal is to set off seizure in brain Used primarily to treat severe depression Patient receives anesthesia and muscle relaxants • Controversial © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 9 Psychosurgery • Irreversible removal or destruction of brain tissue to improve adjustment • Prefrontal lobotomy • Severing of fibers connecting frontal lobe with thalamus • Actual effectiveness questioned • Ethical concerns © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 10 Psychotherapy • Nonmedical process that helps individuals with psychological disorders recognize and overcome their problems • Approaches include: • • • • Psychodynamic Humanistic Behavioral Cognitive © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 11 Mental Health Professionals © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 12 Psychodynamic Therapies • Stress importance of: • Unconscious mind • Extensive interpretation by therapist • Role of early childhood experiences • Psychoanalysis (Freud) • Contemporary psychodynamic therapies © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 13 Psychoanalysis • Freud’s therapeutic technique for analyzing unconscious thoughts • Goal is to bring unconscious conflicts into conscious awareness • Free association • Interpretation • Dream Analysis © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 14 Psychoanalysis • Free association • Encouraging individuals to say aloud whatever comes to mind • Catharsis • Release of emotional tension when reliving emotionally-charged or conflicting experiences • Interpretation • Search for symbolic, hidden meaning © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 15 Dream Analysis • Interpreting dreams that contain information about unconscious thoughts, wishes, and conflicts • Manifest content • Conscious, remembered aspects of dream • Latent content • Unconscious, hidden aspects symbolized by manifest content © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 16 Psychonanalysis • Transference • Inevitable – and essential – aspect of therapeutic relationship • Relating to analyst in ways that reproduce or relive important relationships • Resistance • Unconscious defense strategies © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 17 Humanistic Therapies • Encourage people to understand themselves and to grow personally • Emphasis on self-healing capacities • Client-centered therapy (Rogers) • Warm, supportive atmosphere to improve selfconcept and to encourage insight • Reflective speech used to mirror feelings • Therapist must enter into an authentic relationship with the client © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 18 Behavior Therapies • Use principles of learning to reduce or eliminate maladaptive behavior • Classical conditioning techniques • Systematic desensitization • Flooding • Aversive conditioning • Operant conditioning techniques • Applied behavior analysis © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 19 Cognitive Therapies • Emphasize thoughts as main source of psychological problems • Attempt to change feelings and behaviors by changing cognitions • Cognitive restructuring • Changing pattern of thought presumed to be causing maladaptive behavior or emotion © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 20 Cognitive Therapies • Albert Ellis’s rational-emotive behavior therapy • Aaron Beck’s cognitive therapy • Cognitive-behavior therapy © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 21 Rational-Emotive Behavior Therapy • Emotional reactions to life events as product of irrational beliefs and expectations • Central false belief that feelings cannot be controlled • Demands (“musterbating”) create dysfunctional, exaggerated beliefs © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 22 Rational-Emotive Behavior Therapy • Goal of eliminating self-defeating beliefs by rationally examining them • Directive, persuasive, confrontational © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 23 Beck’s Cognitive Therapy • Problems, such as depression, as result of illogical thoughts about self, world, future • Emotions as product of cognitions • Goal of bringing automatic thoughts to awareness so they can be changed • Challenging accuracy of automatic thoughts • Logical errors Erroneous beliefs • More open-ended dialogue with therapist © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 24 Cognitive-Behavior Therapy • Combination of: • Cognitive therapy Reducing self-defeating thoughts • Behavior therapy Changing behavior • Self-efficacy (Bandura) • Mastering situation and producing positive outcomes © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 25 Cognitive-Behavior Therapy • Self-instructional methods • Teaching to modify own behavior • Using reinforcing self-statements to take positive steps © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 26 Use of Cognitive Therapy • Anxiety disorders • Panic disorder • Post-traumatic stress disorder • Generalized anxiety disorder, phobias, OCD • Mood disorders • Depression • Schizophrenia • Personality disorders © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 27 Therapy Comparisons © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 28 Therapy Integrations • Integrative therapy • Combination of techniques from different therapies based on therapist’s judgment • Dialectical behavior therapy • Used for borderline personality disorder • Includes variety of techniques • Also, treated with psychotherapy and drug therapy • Conceptually compatible with biopsychosocial model © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 29 Sociocultural Approaches & Issues • Individual as part of social system of relationships, influenced by social and cultural factors • Group therapy • Family and couples therapy © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 30 Sociocultural Approaches & Issues • Self-help support groups • Community mental health • Cultural perspectives on therapy © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 31 Group Therapy • Individuals sharing psychological disorder brought together in sessions • Relationships as key to successful therapy © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 32 Group Therapy • Features • • • • • • Information Universality Altruism Experiencing a positive family group Development of social skills Interpersonal learning © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 33 Family and Couples Therapy • Family therapy • Group therapy among family members • Couples therapy • Group therapy with married or unmarried couples with relationship problems • Symptoms as function of relationships © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 34 Family Therapy Techniques • Validation • Understanding and acceptance of each family member’s feelings and beliefs • Reframing • Problems as family (not individual) problems • Structural change • Restructuring coalitions in family • Detriangulation • Disentangle situations where scapegoating occurs © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 35 Couples Therapy • Conflict frequently involves poor communication • Attempt to improve communication • Focus on roles partners play • Addresses diverse problems © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 36 Self-Help Support Groups • Voluntary organizations of individuals who get together to discuss topics • Conducted by paraprofessionals • Sympathetic audience for confession, sharing, and emotional release • Social support, role modeling, and sharing of concrete problem-solving strategies © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 37 Self-Help Support Groups • Alcoholics anonymous (AA) • Compeer • Reduce stress and promote adjustment © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 38 Community Mental Health • Movement born in 1960s • Individuals with disorders ought to remain in society • Deinstitutionalization • Success depends on resources and commitment of community © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 39 Community Mental Health • Training those who directly interact with community members to offer services • Explicit goal of helping people who are disenfranchised from society © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 40 Cultural Perspectives • Collectivistic cultures • More importance on group, rather than individual • Individual psychotherapies may not be as effective • Ethnicity • Ethnic match between therapist and client • Cultural sensitivity and skill • Gender • Changing roles affect therapy goals © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 41 Effectiveness of Psychotherapy • Research Psychotherapy works • Meta-analysis • Statistical combination of results of different studies • No therapy is significantly better than the other • Therapy benefits during first 6 months © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 42 Health & Wellness Benefits • Positive effect of therapy on: • Ability to cope with disease, such as cancer • Physical health as a result of relieving psychological disorders such as depression • Health behavior and physical illness • May also prevent psychological and physical problems © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 43 Health & Wellness Benefits • May enhance positive psychological wellbeing • Well-being therapy (WBT) © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 44 Common Themes • Effective psychotherapies have common elements of: • Expectations • Mastery • Emotional arousal • Therapeutic alliance • Relationship between therapist and client • Client factors • Quality of participation © 2013 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 45