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Psychology:
From Inquiry to Understanding 2/e
Scott O. Lilienfeld
Steven Jay Lynn
Laura Namy
Nancy J. Woolf
Prepared by Caleb W. Lack
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Chapter Sixteen
Psychological & Biological Treatments:
Helping People Change
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Lecture Preview
• Psychotherapy
• Insight therapies
• Behavioral approaches
• Is psychotherapy effective?
• Biomedical treatments
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Psychotherapy
• A psychological intervention designed to help
people resolve emotional, behavioral, and
interpersonal problems and improve the
quality of their lives
• Over 500 “brands” of psychotherapy
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Who Seeks and Benefits?
• 20% of Americans have received psychotherapy
at some point in their lives
• Females go more than males, Caucasians more
than minority groups
• True despite research that shows therapy can
benefit all these groups equally
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Who Practices Psychotherapy?
• Clinical psychologists, psychiatrists,
counselors, and social workers are the
mainstays of the mental health profession
• But people with non-advanced degrees also
often offer psychological services
– Social services agencies, crisis intervention centers
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Paraprofessionals
• Often obtain agency-specific training and attend
workshops that enhance their education
• Little to no difference in effectiveness between
experienced and novice therapists
• But, professionals know how to operate within
system and choose more effective treatments
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Effective Therapists
• Warm and direct
• Establish a positive working relationship
• Tend not to contradict clients
• Select important topics to focus on in session
• Match treatments to needs of clients
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Insight Therapies
• Psychotherapies where the goal is to expand
awareness or insight
• Encompasses psychodynamic, humanistic, and
group approaches
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Psychodynamic Therapy
• Share the following approaches and beliefs
1. Causes of abnormal behaviors stem from
traumatic or adverse childhood experiences
2. Analyze certain things, including avoided
thoughts and feelings, wishes and fantasies,
and significant past events
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Psychodynamic Therapy
3. When clients achieve insight into unconscious
material, the causes and significance of
symptoms become evident
•
This insight then often causes symptoms to
disappear
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Psychoanalysis
• Developed by Freud, one of the first forms of
therapy
• Goal is to decrease guilt and frustration and
make the unconscious conscious
• Try to bring to awareness previously repressed
impulses, conflicts, and memories
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Psychoanalytic Approaches
1. Free association
2. Interpretation
3. Dream analysis
4. Resistance
5. Transference
6. Working through
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Neo-Freudian Tradition
• More concerned with conscious aspects of the
client’s functioning
• Emphasize the impact of cultural and
interpersonal influences on behavior
• More optimistic, emphasize needs for power,
love, status (not just sex and aggression)
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Neo-Freudian Tradition
• Sullivan’s influence on interpersonal therapy
• Short term treatment (12-18 sessions)
originally developed for depression
• Also effective at treatment of substance abuse
and eating disorders
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Psychodynamic Therapies
• Research, however, shows that insight is not
necessary to relieve distress
• In addition, many concepts are difficult to
falsify (non-scientific)
• Research shows no evidence for repressing
hurtful memories either
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Psychodynamic Therapies
• Many are questionable from a scientific
standpoint, difficult to research
• Still, brief PD is better than no treatment, but
less effective than cognitive-behavioral ones
• Not effective for psychotic disorders
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Humanistic Psychotherapy
• Therapies that share an emphasis on the
– Development of human potential
– Belief that human nature is basically positive
• Stress importance of assuming responsibility
for our lives and living in the present
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Person-Centered Therapy
• Developed by Carl Rogers, centers on the
client’s goals and ways of solving problems
• To ensure positive outcome, therapist must
– Be authentic and genuine
– Express unconditional positive regard
– Show emphatic understanding
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Person-Centered Therapy
• Tries to increase awareness and heightened
self-acceptance
• This hopefully causes people to
– Think more realistically
– Become more tolerant of others
– Engage in more adaptive behaviors
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Gestalt Therapy
• Aim to integrate differing and sometimes
opposing aspects of clients’ personalities into
a unified sense of self
• Recognizes the importance of awareness,
acceptance, and expression of feelings
• Utilizes empty-chair technique
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Humanistic Therapies Evaluated
• Core concepts are difficult to falsify
• But, the conditions for effective therapists
have been found to be related to outcome
• More effective than no treatment, but mixed
results compared to other therapies
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Group Therapies
• Refers to therapies that treat more than one
person at a time
• Range from 3-20 people, can be efficient,
time-saving, and less costly than individual
• Effective for a wide range of problems and
about as helpful as individual treatments
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Alcoholics Anonymous
• Self-help groups like AA have become very
popular and widespread
• Composed of peers with similar problems,
often no professional therapists
• Based on “12 Steps” method, but little
research demonstrating its effectiveness
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AA Alternatives
• Controlled drinking programs encourage
people to set limits and drink moderately
– Can be effective for many people
• Relapse prevention treatment assumes people
will “slip up” and plans accordingly
– Lapse does not equal relapse
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Family Therapies
• See most psychological problems as rooted in
a dysfunctional family system
• The “patient” is the whole family system, not
one individual
• Focus on interactions among family members
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Family Therapies
• Strategic family interventions are designed to
remove barriers to effective communication
• Structural family therapy has the therapist
immerse herself in the family to make changes
• Both are more effective than no treatment and
at least as effective as individual therapy
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Behavioral Approaches
• Behavior therapists focus on specific problem
behaviors and variable that maintain them
• Assume that behavior change results from the
operation of basic principles of learning
• Use a wide variety of behavioral assessment
techniques
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Exposure Therapies
• Confronts clients with what they fear with the
goal of reducing the fear
• Earliest was systematic desensitization,
developed by Joseph Wolpe in 1958
• SD gradually exposes clients to anxiety producing
situations through the use of imagined scenes
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Systematic Desensitization
• Based on principle of reciprocal inhibition - we
can’t be anxious and relaxed at the same time
• Uses counterconditioning by repeatedly pairing
an incompatible relaxation response with anxiety
• Can use imaginal and in vivo exposure to the fear
situations listed on the created hierarchy
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Systematic Desensitization
• Dismantling research showed that no single
component was essential
• Led to development of exposure with
response prevention therapies like flooding
• Very effective for many anxiety disorders, like
phobias, OCD, and PTSD
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Modeling in Therapy
• Participant modeling has the therapist
– Model a calm encounter with the client’s feared
object or situation
– Guide the client through the steps of the
encounter until she can cope unassisted
• Used in assertion and social skills training,
along with behavioral rehearsal
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Operant Procedures
• Applied behavior analysis procedures to treat
autistic children
• Token economies reward clients for desirable
behaviors with tokens to exchange for items
• Mixed support for the use of aversion
therapies (e.g., Antabuse and alcohol)
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Cognitive-Behavioral Therapies
•
All share three core assumptions
1. Cognitions are identifiable and measurable
2. Cognitions are key in both healthy and
unhealthy psychological functioning
3. Irrational beliefs or thinking can be replaced by
more rational and adaptive cognitions
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Rational Emotive Behavior Therapy
• Developed by Albert Ellis starting in 1950s
• Emphasizes changing how we think, but also
how we act
• How we feel about the consequences of an
event is determined by our beliefs or opinions
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Rational Emotive Behavior Therapy
• Our vulnerability to psychological disturbance
is a product of the frequency and strength of
our irrational beliefs
• To the ABC, Ellis added D (dispute the beliefs)
and E (adopt more effective ones)
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Other CBT Approaches
• Aaron Beck developed cognitive therapy around
the same time as Ellis’ REBT
• Focuses on identifying and then modifying
distorted thoughts and long-held core beliefs
• Works very well with depression, some evidence
for bipolar disorder and schizophrenia
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Third Wave of CBT
• After behavioral (first) and cognitive (second),
these therapies focus on acceptance
• Includes Acceptance and Commitment
Therapy and Dialectical Behavior Therapy
• Highly eclectic, remains to be seen if these are
superior to accepted CBT methods
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CBT Evaluated Scientifically
• More effective than no or placebo treatment
• At least or more effective than psychodynamic
and humanistic therapies
• At least as effective as drug therapies for
depression
• In general, CBT and BT are about as effective
for most problems
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Is Psychotherapy Effective?
• Prior to 1970s, considerable controversy on it
• Meta-analysis studies proved that therapy
does work in alleviating human suffering
• But which therapy? And for whom?
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Is Psychotherapy Effective?
• Some researchers claim the dodo bird verdict
– “All have won, and all must have prizes”
• But there are clear cut exceptions, like
– Use of BT and CBT for behavior problems in youth
– BT and CBT for anxiety disorders
• Some therapies may actually be harmful
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Some Potentially Harmful Therapies
• Facilitated communication
• Scared Straight Programs
• Crisis debriefing
• DARE programs
• Coercive restraint therapies
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Common Factors
• Many therapies may be comparable due to
common factors that cut across therapies
LO 16.9 that characterize
• Specific factors are those
only certain therapies
• Most agree that both matter, but are divided
over the degree of each
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Empirically Support Therapies
• Name for interventions for specific disorders
supported by high-quality scientific evidence
• Most therapists do not use ESTs in practice
• Many BT, CBT, acceptance, and interpersonal
therapies have been found to be useful
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Fooled by Ineffective Therapies
• Five reasons can help explain why bogus
therapies can gain a dedicated public following
– Spontaneous remission
– Placebo effect
– Self-serving biases
– Regression to the mean
– Retrospective rewriting of the past
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Biomedical Treatments
• Attempt to directly alter the brain’s chemistry or
physiology to treat psychological disorders
• Psychopharmacotherapy – use of medications –
is the most widespread
• Began with use of Thorazine in 1954; today
almost 15% of Americans are on antidepressants
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Psychopharmacology
• Today, medications are available to treat most
psychological disorders
• Antianxiety, antidepressants, mood stabilizers,
antipsychotics, psychostimulants
• Unfortunately, we don’t know exactly why
most of these work
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Cautions to Consider
• Not a cure-all, as most meds have numerous
side effects that need to be weighed
• Most dissipate after discontinuing the drug,
but not all (tardive dyskinesia)
• Weight, age, and even racial differences often
affect drug response
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Cautions to Consider
• Questions about efficacy and safety of SSRIs in
children and adolescents
• Overprescription is also a concern for many,
especially of psychostimulants for ADHD
• Polypharmacy is prescribing many
medications at the same can be hazardous
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Evaluating Psychopharmacotherapy
• In many cases, therapy alone can produce as
great or better benefits for many disorders
• Clear advantages to combining meds and
therapy when
– Symptoms interfere greatly with functioning
– Therapy alone hasn’t worked for a 2 month period
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Electrical Stimulation
• Electroconvulsive therapy (ECT) involves
patients receiving brief electrical pulses to the
brain that produce a seizure
• Used to treat severe problems (intractable
depression, schizophrenia) as a last resort
• 6-10 treatments given three times a week
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Electrical Stimulation
• Most who undergo ECT would do so again,
and report improvements
• Must weigh benefits against problems
– Over 50% relapse in six months
– Short-term confusion and clouded memory
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Electrical Stimulation
• Vagus nerve and transcranial magnetic
stimulation are both FDA approved for
treatment-resistant depression
• No large-scale studies on effectiveness, side
effects similar to or greater than ECT
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Psychosurgery
• Brain surgery to treat psychological disorders,
like prefrontal lobotomies
• Used today as an absolute last resort with a
handful of conditions
– Severe OCD, depression, bipolar disorders
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