Download Chapter 16: Therapy

Psychological Therapies
Topics:
 Biomedical Therapies:
 Drugs
 ECT
 Psychosurgery
 Psychological Therapies:
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Psychotherapy
Behavioural Therapy
Cognitive Therapy
Humanistic and Existential
 Group Therapy
 Effectiveness of Psychotherapies
 Prevention of mental illness
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Biomedical Therapies: Drugs, ECT, Psychosurgery
 Psychopharmacology (1950’s) revolutionized
treatment of severely disordered people
 Liberated hundreds of thousands from confinement
(now 20% fewer in mental hospitals)
Drugs:
 Antipsychotic
 Antianxiety
 Antidepressant
 Antipsychotic:
Chlorpromazine (first generation) (sold as
Thorazine)
 helps people who are experiencing the
positive symptoms of auditory hallucinations
and paranoia
 dampens responsiveness to irrelevant stimuli
 side effects – tardive dyskinesia (facial
and body twitch)
Clozapine (second generation) (sold as
Clozaril)
 helps reanimate schizophrenia patients with
negative symptoms of apathy and withdrawal
 blocks dopamine and serotonin activity
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 effective and now less expensive (patent
expired 1994)
Other second generation antipsychotics:
Risperdal, Zyprexa
 side effects – increase risk of obesity and
diabetes
 otherwise not much more effective than first
generation
Antianxiety Drugs:
Valium and Librium
 CNS depressants
 reduce tension and anxiety without causing
excessive fatigue or performance effects
 prescribed even for minor emotional stresses
Other Antianxiety drugs: Xanax, Ativan
Note: several antidepressant drugs used to treat
anxiety conditions such as OCD
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Antidepressant Drugs:
 lift people up, typically by increasing the
availability of the neurotransmitters
norepinephrine and serotonin
fluoxetine (Prozac)
 blocks the reabsorption and removal of
serotonin from the synapse
 Selective-serotonin-reuptake-inhibitor (SSRI)
 Other SSRI’s: Zoloft, Paxil
Dual – action antidepressants: work by blocking
the reabsorption and breakdown of norepinephrine
and serotonin
 many side effects of oral ingestion – weight
gain, hypertension, dizzy spells
 avoided by transderm application (patch)
lithium salt
 often an effective mood stabilizer for those
suffering bipolar disorder
 inexpensive
Depakote – used for epilepsy and mania
$19.5 billion in antidepressant sales worldwide in
2002
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Electroconvulsive Therapy (ECT), or Shock
Treatment:
 Used with severely depressed patients
 brief electric current is sent through the brain
of an anesthetized patient
 credited with saving many from suicide
 no one knows for sure how it works – may
stimulate release of norepinephrine (elevates
mood and arousal) or may help to calm overactive
neural centres (reset principle)
Psychosurgery:
 removes or destroys brain tissue in an effort to
change behavior
lobotomy
 once used to calm uncontrollably emotional or
violent patients (Moniz, 1940’s Nobel Prize)
 nerves cut that connect the frontal lobes to the
emotion-controlling centers of the inner brain
 now a rare procedure
 other psychosurgery is used only in extreme
cases (e.g. split brain sugery)
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Psychological Therapies:
 Major psychotherapies derive from personality
theory:
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Psychoanalytic
Humanistic and Existential
Behavioral
Cognitive
 Half of all therapists use a blend of
therapies (eclectic),including biomedical
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Psychoanalysis: (Freud)
Assumption:
 people are affected by repressed childhood
memories (conflicts and impulses)
 People are cured when energy released from idego-superego conflicts
Goal:
 help people gain insight into the unconscious
origins of their disorders
 to work through the accompanying feelings
Techniques:
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hypnosis (ineffective)
free association
interpretation of dreams
examination of resistances
transference to the therapist of long-repressed
feelings
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Criticisms:
 difficult to refute explanations for behaviour
 psychoanalysis is criticized for its after-thefact interpretations
 time-consuming
 costly
 recent challenges about repressed memories, on
which much of psychoanalysis is built
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Psychological Therapies (con’t)
Humanistic Therapy:
Assumptions:
 Behavioural problems represent the history of
ones’ beliefs and actions
 People need to be responsible to themselves,
learn to take control, learn how to make choices
Goals:
 focus on clients' current conscious feelings
 teach individuals to take responsibility for
their own growth
Techniques:
Person-centered Therapy (Rogers):
 Therapist engages in active listening to express
genuineness, acceptance, and empathy
 increases self-understanding and self-acceptance
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Gestalt Therapy (Fritz Perls):
Combines:
 psychoanalytic emphasis(bringing unconscious
feelings and conflicts into awareness) and;
 humanistic emphasis (getting in touch with
oneself and assuming personal responsibility in
the present)
 aim is to make people whole by breaking through
defenses and helping them to sense and express
moment-to-moment feelings
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Behavioural Therapy:
Assumption:
 disorders are the result of inappropriate
learned beahavious
 not aimed at resolving cause of underlying
disorder but simply at treating problem
behaviours
Goals:
 eliminate unwanted behaviour by application of
well-established learning principles
 replace problem thoughts and maladaptive
behaviors with more constructive ways of
thinking and acting
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Techniques:
Counterconditioning:
 condition new responses to stimuli that trigger
unwanted behavior
systematic desensitization:
 a pleasant, relaxed state is associated
with gradually increasing anxietytriggering stimuli
 commonly used to treat phobias
aversive conditioning:
 an unpleasant state (such as nausea) is
associated with an unwanted behavior (such
as drinking alcohol)
operant conditioning:
 reinforcing desired behaviours while withholding
reinforcement for undesired behaviours
 rewards used to modify behavior vary, from
attention or praise to more concrete rewards
such as food
 in institutional settings, therapists may create
a token economy in which a patient exchanges an
earned token of some sort for exhibiting the
desired behavior, for various privileges or
treats e.g. some behavioural treatments for
anorexia
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Criticisms:
 what happens when the reinforcers stop?
 is it ethical for one person to control
another's behavior?
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Cognitive Therapy:
Assumption:
 how we think affects how we feel and how we
perceive the world
Goals:
 make people aware of their irrational negative
thinking
 teach people new, more constructive ways of
thinking
 teach people to practice a more positive
approach in everyday settings
Technique:
Rational-emotive Therapy (Albert Ellis):
 rigorously challenge clients' self-defeating
attitudes and assumptions
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Group Therapy
(all but Psychoanalysis):
 people discover that others have problems
similar to their own
 allows people test new ways of behaving
 members try to relate to one another more
sensitively and openly
 leaders encourage the members to "talk straight"
and listen empathetically
Family Therapy:
 family therapy assumes that we live and grow in
association with our family relations
 therapists help family members discover the role
they play within the family's social system.
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Effectiveness of Psychotherapies:
 people who remain untreated often improve
 those who receive psychotherapy are more likely
to improve, regardless of what kind of therapy
they receive and for how long
 mature, articulate people with specific
behaviour problems often receive the greatest
benefits from therapy
 placebo treatments or the friendly counsel of
paraprofessionals also tend to produce more
improvement than occurs with untreated people
 no one therapy has been shown to be best in all
cases
Some therapies are well suited to particular
disorders:
 behavioral conditioning for phobias,
compulsions, and sexual dysfunctions
 cognitive therapies for depression
General benefits of psychotherapies
 with commitment from the patient, things can and
will get better
 therapy offers people a plausible explanation of
their symptoms and an alternative way of looking
at themselves and responding to their worlds
 all therapies offer hope for demoralized people,
a new perspective on oneself and the world, and
an empathic, trusting, caring relationship.
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Prevention of mental illness:
 many psychological disorders are an
understandable response to a disturbed and
stressful society
 not just the person needs treatment, but also
the person's social context
 change oppressive, esteem-destroying
environments into more benevolent, nurturing
environments that foster individual growth and
self-confidence
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