UNIT 15 - THERAPY 2.11.13.pptx

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UNIT 15: THERAPY

History of Therapy

• _{General movement from}

brutal to gentler treatments

– _{Philippe Pinel (France)}

– _{Dorthea Dix (U.S., Canada,}

Scotland)

• _{Both were advocates of mental}

hospitals and more humane treatment of those with mental disorders

• Since the mid-1950s therapeutic drugs and

community based treatments emptied mental hospitals

Two categories of Therapies

• _{Psychotherapy – for}

learning-related disorders such as phobias

– Therapy is usually psychological techniques used by therapist

• _{Biomedical Therapy – for}

biologically influenced

disorders such as schizophrenia

– _{Therapy is usually in the form of a}

prescribed medication or medical procedure affecting nervous

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Blending Therapies

• _{Eclectic Approach – an}

approach to psychotherapy that, depending on the

client’s problems, uses techniques from various forms of therapy

– Widely accepted by therapists – It may also be called

psychotherapy integration

Psychological Therapies • _{Built on psychology’s major}

theories:

– Psychoanalytic

– Humanistic

– Behavioral

– Cognitive

• _{Psychotherapy – treatment}

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UNIT 15: THERAPY

Psychoanalysis

• _{Psychoanalysis – Sigmund}

Freud’s therapeutic technique. Freud believed the patient’s free associations, resistances, dreams, and transferences – and the therapist’s

interpretation of them –

released previously repressed feelings, allowing the patient to gain self-insight

Psychoanalysis

• _{Freud sought to bring}

“repressed” feelings into conscious awareness

– Also said energy should focus away from id-ego-superego conflicts

– Through historical

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Psychoanalysis

• _{Free association –}

technique used by Freud where patient says aloud whatever comes to mind

• _{Resistance – in}

psychoanalysis, the blocking from consciousness of

anxiety-laden material

– _{Defending against revelation} of sensitive material

Psychoanalysis

• _{Interpretation – in}

psychoanalysis, the analyst’s noting supposed dream

meanings, resistances, and other significant behaviors and events in order to

promote insight

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Psychoanalysis

• _{Latent content – the}

underlying but censored meaning of a dream

– _{Opposite of manifest content}

• _{Transference – in}

psychoanalysis, the patient’s transfer to the analyst of

emotions linked with other relationships (such as love or hatred for a parent)

Psychoanalysis

• _Criticism:_{interpretations}

cannot be proven or disproven

• _{Psychoanalysis can be very}

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Psychodynamic Therapy

• Psychodynamic Therapy – therapy deriving from the psychoanalytic tradition that

views individuals as

responding to unconscious forces and childhood

experiences, and that seeks to enhance self-insight

– Patient’s conversations and relationship with psychologist may reveal characteristic pattern of behavior

Psychodynamic Therapy • _{Interpersonal therapy –}

helps people gain insight into the roots of their difficulties

– _{Focus is symptom relief, not} personality change

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Humanistic Therapies

• _{Based on people’s inherent}

potential for self-fulfillment

– _{Does this by focusing on}

self-awareness and self-acceptance

– _{Seeks to reduce inner conflicts}

• _{Insight Therapies – a variety of}

therapies which aim to improve psychological functioning by

increasing the client’s awareness of underlying motives and

defenses

– _{Includes psychoanalytic and}

humanistic therapies

• _{Humanistic therapy differs}

from Psychoanalytic by focusing on:

– _{Present more than past} – _{Conscious more that}

unconscious thoughts

– _{Taking immediate responsibility}

for feelings rather than

explaining them by past events

– _{Promoting growth rather than}

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• _{Client-centered therapy – a}

humanistic therapy,

developed by Carl Rogers (1902-1987), in which the therapist uses techniques

such as active listening within a genuine, accepting,

empathetic environment to facilitate client’s growth (also called Person-centered

therapy)

• _{Nondirective therapy}

– Seeks to refrain from

directing the client toward certain insights

– Rogers admits a therapist cannot be totally nondirective

• _{Rogers encouraged}

therapists to focus on: – _Genuineness

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UNIT 15: THERAPY

• Active listening – empathetic listening in which the listener echoes, restates, and clarifies. A feature of Rogers’

client-centered therapy

• _{Unconditional Positive Regard}

– a caring, accepting,

nonjudgmental attitude, which Carl Rogers believed to be

conducive to developing self-awareness and self-acceptance

• _{Keys to Active Listening}

1. Paraphrase

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UNIT 15: THERAPY

Behavior Therapies

• _{Behavior Therapy – therapy}

that applies learning

principles to the elimination of unwanted behaviors

– Doubt the healing power of self-awareness (psychoanalysts and humanists support)

– Behavior therapists view maladaptive symptoms as learned behaviors that can be replaced by constructive

behaviors

• _{Classical Conditioning:}

• _{O.H. Mowrer – conditioned} children who wet the bed to correct that behavior by waking them with an alarm

• _{Counterconditioning – a behavior} therapy procedure that uses

classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors

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• _{Exposure Therapies –}

behavioral techniques, such as systematic

desensitization, that treat anxieties by exposing

people (in imagination or actuality) to the things they fear and avoid

• _{Systematic Desensitization –}

a type of exposure therapy that associates a pleasant relaxed state with gradually increasing anxiety-triggering stimuli. Commonly used to treat phobias

– Goal is to substitute a positive (relaxed) response for a

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• _{Mary Cover Jones (1924) –}

behaviorist who used exposure therapy

– Worked with 3-year-old Peter and counterconditioned his fear of rabbits

– Introduced rabbit across large room during otherwise

pleasant snack time for Peter – Gradually Peter learns to

enjoy snack time and rabbit

• _{Joseph Wolpe (1958) –}

psychiatrist who refined

Jones’ techniques into what is today called exposure

therapy

– _{The key with exposure}

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UNIT 15: THERAPY

• _{Progressive Relaxation – a}

therapist trains you to relax one muscle group after

another, until you achieve a drowsy state of complete relaxation and comfort

– Part of systematic

desensitization; eventually the professional pairs

somewhat anxious scenes with a state of relaxation

• _{Virtual Reality Exposure} Therapy – an anxiety

treatment that progressively exposes people to

simulations of their greatest fears, such as airplane flying, spiders, or public speaking

– _{Avatar – a computer}

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UNIT 15: THERAPY

• Aversive Conditioning – a type of counterconditioning that associates an unpleasant state (such as nausea) with an

unwanted behavior (such as drinking alcohol).

– _{Goal is to substitute a negative}

(aversive) response for a positive response to a harmful stimulus (such as alcohol)

– _{Reverse of systematic}

desensitization

• _{Works on the same principles}

as taste aversions

• _{Aversive therapy has only}

worked in the short term; since cognition influences conditioning, the subject knows that the aversive

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• _{Operant Conditioning:}

– This is where voluntary behaviors are strongly influenced by their consequences

– Behavior Modification –

reinforcing desired behaviors and withholding

reinforcement for undesired behaviors, or punishing them

– _{Therapists use positive}

reinforcers to shape behavior in step-by-step manner, rewarding closer and closer approximations of the desired behavior

• _{Token Economy – an operant}

conditioning procedure in which people earn a token of some sort for exhibiting a

desired behavior and can later exchange the tokens for

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• _{Criticisms of behavior}

modification:

– How durable are the

behaviors? Will they last? – Is it right for one human to

control another’s behavior?

• _{In a token economy, the}

patient is being deprived of something they really want and don’t get it until a

desired behavior is exhibited

Cognitive Therapies

• _{Cognitive Therapy – therapy}

that teaches people new, more adaptive ways of thinking and acting; based on the

assumption that thoughts

intervene between events and our emotional reactions

– _{These therapies assume that our}

thinking colors our feelings

– _{Therapists try to teach people}

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• _{Aaron Beck – cognitive}

therapist

– Through cognitive therapy, Beck worked to reverse

clients’ catastrophizing beliefs about themselves

– Work to “remove the dark glasses” through which a depressed person views life

• _{Getting people to change}

what they say to themselves (we think in words) is an

effective way to change their thinking.

• _{Stress inoculation training –}

Donald Meichenbaum’s way to change negative self talk

– _{“I realize the test will be hard,}

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Cognitive-Behavior Therapy

• _{Cognitive-Behavior Therapy –}

a popular integrated therapy that combines cognitive

therapy (changing self-defeating thinking) with behavior therapy (changing behavior).

– _{Example: someone fears social}

situations; they learn to think differently about them, and they practice approaching people.

Group & Family Therapies

• _{Group Therapy}

– Not the same amount of involvement from therapist – Saves therapist time

– Saves client money

– Allows client to see that

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• _{Family Therapy – therapy}

that treats the family as a system. Views an

individual’s unwanted

behaviors as influenced by, or directed at, other family members

– Works to heal relationships and mobilize family resources

• Support Groups

– _{Usually focus on stigmatized or} hard-to-discuss illnesses

• AIDS

• Anorexia

• Alcohol Dependency

• Reflect a longing for community and connectedness

– _{Alcoholics Anonymous (AA)} • Considered the largest of all

support groups

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UNIT 15: THERAPY

• _{See Table 15.1 on pg 650 of}

text for Comparison of Major Psychotherapies:

– Psychodynamic – Client-Centered – Behavior

– Cognitive – Family

Evaluating Psychotherapies

• _{During the period from}

1991-2004, there was a 25% increase in Americans

“undergoing counseling for mental or emotional

problems.

• _{Many people trust in}

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UNIT 15: THERAPY

Is Psychotherapy Effective?

• _{Clients’ Perceptions:}

– _{In a 1995 report, 89% of those}

receiving mental health treatment said they were at least “fairly well satisfied”.

• _{Skeptics say:}

– _{People often enter therapy in}

crisis

– _{Clients may need to believe the}

therapy was worth the effort

– _{Clients generally speak kindly of}

their therapists

• _{“We are prone to selective and}

biased recall, many times in an attempt to confirm our beliefs.”

• _{Clinicians’ Perceptions:}

– They hear more feedback after treatment from those for whom the treatment was successful

– _{With any treatment, most clients}

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• _{Outcome Research}

– Hans Eysenck (1952)

questioned the effectiveness of psychotherapy

• _{He found roughly 2/3 of}

those receiving therapy for nonpsychotic disorders improved markedly

• _{He also found roughly 2/3 of}

those receiving NO therapy also improved markedly –

Time was the great healer!

Is Psychotherapy Effective? • _{Meta-Analysis – a procedure}

for statistically combining the results of many different research studies

– _{Includes the bottom line}

results of lots of studies

– _{After meta-analysis, experts}

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UNIT 15: THERAPY

Is Psychotherapy Effective? • _{Final Verdict on}

Effectiveness of

Psychotherapy: Those not undergoing therapy often improve, but those

undergoing therapy are more likely to improve.

– Psychotherapy reduces long-term costs and is a

cost-effective investment

• _{Placebo Effect – illustrates} the healing power of

positive expectations

• _{Regression Toward the Mean} – the tendency for unusual events (or emotions) to “regress” (return) to their average state

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Relative Effectiveness of Therapies

• _{Statistics fail to point to any}

one therapy that is superior

• _{Behavior Therapy}

Successes: – _Bed-Wetting – _Phobias

– _Compulsions

– _{Marital Problems} – _{Sexual Disorders}

• _{Cognitive Therapy}

Successes: – Depression

– Reducing Suicide Risk

• _{“The more specific the}

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• _{Therapies to AVOID:}

– Energy Therapies

• _{Manipulate invisible energy}

fields

– Recovered-Memory Therapies

• _{Unearth repressed}

memories of childhood abuse

– _{Rebirthing Therapies}

• Reenacting the supposed trauma of their birth

• _{Therapies to AVOID:}

– Facilitated Communication

• _{Has an assistant touch the}

typing hand of a child with autism

– _{Crisis Debriefing}

• Forces people to rehearse and “process” their

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• _{Evidence-Based Practice –}

clinical decision-making that integrates the best available research with clinical

expertise and patient characteristics and preferences

– Says that “available therapies should be rigorously

evaluated.”

Evaluating Alternative Therapies

• _{There is no evidence either}

for or against most alternative therapies

• _{Scientific Attitude – being}

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UNIT 15: THERAPY

• _{Eye Movement}

Desensitization and Reprocessing (EMDR)

– _{Many endorse it as effective;}

many dismiss it as a sham

– _{Francine Shapiro observed that}

anxious thoughts vanished as her eyes spontaneously darted about

– Supposedly allows patients to unlock and reprocess

previously “frozen” memories

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UNIT 15: THERAPY

• _{Light Exposure Theapy}

– Seasonal Affective

Disorder(SAD) – a form of depression due to the lack of sunlight

• _{Morning bright light does}

indeed dim SAD symptoms for many people

• Light therapy sparks activity in a brain region that

influences the body’s arousal and hormones

Commonalities Among Psychotherapies

• _{Studies have found little}

correlation between therapists’ training and experience and clients’ outcomes

• _{Commonalities in Therapies:} 1. Hope for demoralized people 2. A new perspective on oneself

and the world

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UNIT 15: THERAPY

Hope for Demoralized People

• _{With any therapy comes an}

expectation that with

commitment from therapy seeker, things can and will get better.

• _{Harnesses the clients’ own}

healing powers

– Helps to explain why so many varying treatments help

produce cures

A New Perspective

• _{Every therapy offers a}

plausible explanation of symptoms, and an

alternative way of

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UNIT 15: THERAPY

Empathy, Trust, Care • _{Effective therapists:}

– Are empathetic people who seek to understand another’s experience

– Communicate care and concern to the client

– Earn client’s trust and respect through respectful listening, reassurance, and advice

Empathy, Trust, Care

• _{Therapeutic Alliance – the}

emotional bond between therapist and client

• _{People with clear-cut,}

specific problems tend to improve the most

• _{Healers everywhere tend to}

empathize, reassure, advise, console, interpret, and

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UNIT 15: THERAPY

Culture and Values in Psychotherapy

• There is sometimes a

reluctance by some minority populations to use mental health services

– Most American mental health services are based on ideals of individualism; some minority cultures give more priority to group expectations

• _{“Psychotherapists personal}

beliefs influence their practice.”

Culture and Values in Psychotherapy

• _{Religions can be a conflict}

when it comes to therapy

– Clients may have a difficult time developing a trust with

therapists who don’t share their values

• _{Albert Ellis and Allen Bergin –}

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Biomedical Therapies

• _{Biomedical Therapy –}

prescribed medications or medical procedures that act directly on the patient’s

nervous system

– _{Alters the brain’s chemistry} with drugs, or affecting its circuitry with

electroconvulsive shock, magnetic impulses, or psychosurgery.

Biomedical Therapies

• _{Usually only psychiatrists}

can offer biomedical therapies, as they are certified medical doctors.

Drug Therapies

• _{Psychopharmacology – the}

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UNIT 15: THERAPY

Drug Therapies

• _{Drug therapies are the most}

widely used therapies today

• _{The use of antipsychotic}

drugs in the 1950s served to empty many of the mental hospital in the nation.

– Release from mental hospitals has meant homelessness for some who are not able to care for themselves

Drug Therapies

• _{In double-blind studies,}

several types of drugs have proven useful in treating psychological disorders

– _{Antipsychotic Drugs} – _{Antianxiety Drugs} – _{Antidepressant Drugs}

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UNIT 15: THERAPY

Drug Therapies

• _{Antipsychotic Drugs – drugs}

used to treat schizophrenia and other forms of severe thought disorder

– _{Psychoses – disorders in} which hallucinations or

delusions indicate some loss of contact with reality

Drug Therapies

• _{Examples of Antipsychotic}

Drugs:

– Chlorpromazine (sold as Thorazine) – dampen

responsiveness to irrelevant stimuli

– Clozapine (sold as Clozaril) – targets dopamine and

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UNIT 15: THERAPY

Drug Therapies

• _{Tardive Dyskinesia –}

involuntary movements of facial muscles, tongue, and limbs; a possible neurotic side effect of long-term use of antipsychotic drugs that target certain dopamine receptors.

Drug Therapies

• _{An overactive dopamine}

system contributes to schizophrenia

• _{Antipsychotic drugs reduce}

dopamine levels

– Too little dopamine

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UNIT 15: THERAPY

Drug Therapies

• _{Antianxiety Drugs – drugs used}

to control anxiety and agitation

• _Examples:

– _{Xanax or Activan}

• _{Both depress central nervous}

system activity

• _{Should not be used with alcohol}

– D-cycloserine

• _{Acts upon receptors that}

facilitate the extinction of learned fears

• _{Used to treat PTSD and OCD}

Drug Therapies

• _{Criticisms include:}

– Removal of symptoms without resolving the underlying problems

– Antianxiety drugs can cause physiological dependence – The new standard drug

treatment for anxiety

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UNIT 15: THERAPY

Drug Therapies

• _{Antidepressant Drugs –}

drugs used to treat depression; also

increasingly prescribed for anxiety. Different types work by altering the

availability of various neurotransmitters.

– Increasingly used to treat anxiety disorders such as OCD

Drug Therapies

– _{Work by increasing}

availability of norepinephrine or serotonin, which elevate arousal and mood

– Prozac (Fluoxetine) – partially blocks the reabsorption and removal of serotonin from synapses

–

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UNIT 15: THERAPY

Drug Therapies

• _{Side Effects of Dual-Action}

Antidepressants: – Dry mouth

– Weight gain – Hypertension – Dizzy Spells

• _{Fewer side effects when}

administered by a patch; they bypass intestines and liver

Drug Therapies

• _{In U.S. today, 11% of}

women and 5% of men are on antidepressants (2008)

• _{Full effect of antidepressant}

drugs takes about 4 weeks to make a difference

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UNIT 15: THERAPY

Drug Therapies

Alternative Approaches:

• _{Aerobic exercise is just as}

good as antidepressant drugs for many people

• _{Cognitive therapy – helping}

people reverse negative thinking

• _{A combined approach is}

good

Drug Therapies

• _{There is increasing evidence}

that antidepressants should be used only in extreme

cases

– _{Those cases of people taking}

the drugs in less extreme

conditions see a large placebo effect

– _{In the long run,}_patients

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UNIT 15: THERAPY

Drug Therapies

• _{Mood-Stabilizing} Medications

– _{Lithium – a simple salt that}

can stabilize an individual with bipolar disorder; discovered by John Cade in Australia

– _{Depakote – drug originally}

used to treat epilepsy; now helps control manic episodes associated with bipolar

disorder

Brain Stimulation

• _{Electroconvulsive Therapy}

(ECT) – a biomedical therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized patient

(See Figure 15.7, p. 665)

– _{First introduced in 1938, patient}

was strapped to table and shock produced convulsions and

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UNIT 15: THERAPY

– _{Today, ECT is done in a more} moderate manner

• No brain damage

• Brief memory loss of preceding hours and no memory of treatment

– ECT is an effective treatment for severe depression patients who have NOT responded to drug therapy

• _{How does ECT relieve}

depression?

– No one knows for sure – May calm neural centers

where overactivity produces depression

– ECT boosts production of new brain cells

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UNIT 15: THERAPY

Brain Stimulation • _Alternative

Neurostimulation Therapies – Chest implant that stimulates

the vagus nerve, which sends signals to brain’s

mood-related limbic system – Magnetic Stimulation – Deep-Brain Stimulation

• _{Repetitive Transcranial}

Magnetic Stimulation (rTMS) – the application of

repeated pulses of magnetic energy to the brain; used to stimulate or suppress brain activity

– _{See Figure 15.8, p. 666}

– _{Unlike ECT, rTMS produces no}

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UNIT 15: THERAPY

• _{rTMS stimulation energizes}

depressed patients’ relatively inactive left hemisphere

– _{Nerve cells can form}

functioning circuits through the process of long-term potentiation (LTP) (See CH 8)

Deep Brain Stimulation

• _{Helen Mayberg – a}

neuroscientist who has

focused on a cortex area that bridges the thinking frontal lobes to the limbic system

– _{This area of brain is overactive}

in the brain of depressed/sad people; becomes calm when treated with ECT or

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UNIT 15: THERAPY

Psychosurgery

• _{Psychosurgery – surgery that}

removes or destroys brain tissue in an effort to change behavior

• _{Lobotomy – a now-rare}

psychosurgical procedure once used to calm uncontrollably emotional or violent patients. The procedure cut the nerves connecting the frontal lobes to the emotion-controlling centers of the inner brain.

Psychosurgery

– Effects are irreversible

– Least used/most drastic

– Lobotomy was developed by Egas Moniz in the 1930s

• _{Lobotomy procedure:} – Shock patient into coma

– Hammer icepicklike instrument through each eye socket into brain

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UNIT 15: THERAPY

Psychosurgery

• _{Attempted to disconnect}

emotion from thought

• _{Side Effects:}

– _{Permanently lethargic} – _{Immature person}

– _{Uncreative person}

• _{Prime era for this procedure}

was from 1936-1954

• Lobotomy is NOT used today – _{More precise surgeries have}

taken its place

Therapeutic Life-Style Change • _{Reminder: Everything}

psychological is also biological

• _{“Humans were never meant}

for sedentary, disengaged, socially isolated, poorly nourished, sleep deprived pace of 21st_century

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UNIT 15: THERAPY

Therapeutic Life-Style Change

Helpful for those Depressed:

• _{Aerobic Exercise}

– 30 min/day; 3x/week

– _{Increases fitness/stimulates} endorphins

• Adequate Sleep

– _{7-8 hrs/night}

– Increases energy, alertness; boosts immunity

• Light Exposure

– _{30 min/morning}

– _{Amplifies arousal/hormones}

Therapeutic Life-Style Change

• _{Social Connection}

– Human need to belong

• _{Anti-Rumination}

– _{Redirecting negative thoughts}

• _{Nutritional Supplements}

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UNIT 15: THERAPY

Preventing Psychological Disorders

• _{Alternative viewpoint: we}

could interpret many

psychological disorders as understandable responses to a disturbing and stressful society.

– This view states that its not just the person who needs treatment, but also the person’s social context

• _{“Preventive mental health is}

upstream work.”

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UNIT 15: THERAPY

• Factors that increase risk of

depression, alcohol dependency, and suicide:

– _Poverty

– Meaningless work – _{Constant criticism} – Unemployment – _Racism

– Sexism

• All these undermine a person’s sense of competence, personal control, and self-esteem.

• _{“Everything aimed at}

improving the human condition, at making life more fulfilling and

meaningful, may be

considered part of primary prevention of mental or emotional disturbance.”