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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 This multimedia product and its contents are protected under copyright law. The following are prohibited by law: any public performance or display, including transmission of any image over a network; preparation of any derivative work, including the extraction, in whole or part, of any images; any rental, lease, or lending of the program. Copyright © 2011 Pearson Education, Inc. All rights reserved. Chapter Sixteen Psychological & Biological Treatments: Helping People Change Copyright © 2011 Pearson Education, Inc. All rights reserved. Lecture Preview • Psychotherapy • Insight therapies • Behavioral approaches • Is psychotherapy effective? • Biomedical treatments Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. Insight Therapies • Psychotherapies where the goal is to expand awareness or insight • Encompasses psychodynamic, humanistic, and group approaches Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. Psychoanalytic Approaches 1. Free association 2. Interpretation 3. Dream analysis 4. Resistance 5. Transference 6. Working through Copyright © 2011 Pearson Education, Inc. All rights reserved. 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) Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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) Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. Copyright © 2011 Pearson Education, Inc. All rights reserved. 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) Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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? Copyright © 2011 Pearson Education, Inc. All rights reserved. Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. Some Potentially Harmful Therapies • Facilitated communication • Scared Straight Programs • Crisis debriefing • DARE programs • Coercive restraint therapies Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved. 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 Copyright © 2011 Pearson Education, Inc. All rights reserved.