1

Therapy Approaches• Biomedical Therapy

• Psychotherapy

• Alternative Therapies

• The Power of Forgiveness

Biomedical Therapies

1. Drug Therapies- Antipsychotic Drugs

- Antianxiety Drugs

- Antidepressant Drugs

- Mood-Stabilizing Medications

2. Brain Stimulation- Electroconvulsive Therapy

- Alternative Neurostimulation Therapy

3. Psychosurgery

2

3

Biomedical Therapies(1) Drug Therapies

• 1-Antipshchotic Drugs

• 2-Antidepressant Drugs

• 3-Tranquilizers

• 4-Mood-Stabilizing Medicines

4

1-Antipsychotic Drugsor Neuroleptics

Good for treating psychosis and schizophreniaExample: ThorazineReduce receptivity to dopamine or increase

serotoninReduce positive symptoms of schizophreniaDo not relieve other negative symptoms

5

Antipsychotic Drugsand Schizophrenia

• Good for reducing:

• Agitation• Delusions• Hallucinations• Can shorten

schizophrenic episodes

• Offers little relief from:

• Jumbled thoughts• Difficulty

concentrating• Inability to interact

with others

After the Introduction of Anti- psychotic Drugs

6

7

2-Antidepressant Drugs• Treat depression, anxiety, phobias, OCD• Example: Prozac, Zoloft, and Paxil• Non addictive but can cause side effects• 1-Monoamine oxidase inhibitors (elevate levels of

ser. & nor. by blocking inhibitors)• 2-Tricyclic antidepressants (boost nor. & ser. by

preventing their reabsorption)• 3-Selective serotonin reuptake inhibitors

(work on serotonin)

Serotonin Reuptake

8

9

3-Tranquilizers

• Prescribed for depressed mood, panic, and anxiety

• Example: Valium

• Increase activity of neurotransmitter GABA

• If overused can result in tolerance and withdrawal

10

4-Mood-Stabilizing MedicationsLithium Carbonate

• Prescribed for bipolar disorder

• Can be dangerous if not given in the right doze

11

Cautions about Drugs

• Placebo effect

• Relapse and drop out rates

• Dosage problems

• Long-term risks

• Overprescription

• Sometimes they have to be with therapy

12

The Placebo EffectKirsch and Sapirstein (1998)

• 7315 participants

• 41% of those receiving antidepressants experienced reduced symptoms.

• 31% of those given placebos also received reduced symptoms.

Biomedical Therapies(2) Brain Stimulation

• Electroconvulsive Therapy

• Alternative Neurostimulation Therapies- Deep-Brain Stimulation- Magnetic Stimulation

13

Biomedical TherapiesElectroconvulsive Therapy ECT

• After three sessions each week for two or four weeks, 80% of people receiving ECT improve markedly, showing no brain damage.

• ECT reduces suicidal thoughts and is credited with saving many from suicide.

14

15

Biomedical TherapiesAlternative Neurostimulation Therapy

1. Deep-Brain Stimulation

• Helen Mayberg and her colleagues have been focusing on a cortex area that bridges the thinking frontal lobes to the limbic system.

• They have discovered that this area, which is overactive in the brain of a depressed or temporarily sad person, becomes calm when treated by ECT and antidepressants.

• Among 12 patients receiving implanted electrodes and a pacemaker stimulator, 8 experienced relief.

16

17

Biomedical TherapiesAlternative Neurostimulation Therapy

2- Magnetic Stimulation• Unlike deep-brain stimulation, the magnetic energy

penetrates only the brain’s surface.• The painless procedure – called repetitive

transcranial magnetic stimulation (rTMS) – is performed on wide-awake patients over several weeks.

• In a study on 67 Israelis with major depression, at the end of two weeks, half the stimulated patients showed at least a 50%improvement in their scores on a depression scale.

18

19

20

Psychosurgery• Egas Moniz who developed the Lobotomy in the

1930s found that cutting the nerves connecting the frontal lobes with the emotion-controlling centers of the inner brain calmed uncontrollably emotional and violent people (disconnecting emotion from thought).

• He was honored with a Nobel Prize for developing this procedure.

• It produced a permanently lethargic, immature, and uncreative people.

21

Psychotherapy

• Psychodynamic

• Behavioral

• Cognitive

• Humanistic

• Family

Three Elements Shares by All Forms of Psychotherapy

• Hope for Demoralized People

• A New Perspective

• An Empathetic, Caring, Trusting Relationship

22

23

Psychodynamic Therapy

• Probes the past

• Doesn’t tackle the immediate problem

• The goal is insight

• Takes a long time

• Explores the unconscious

• Methods: free association, interpretation of dreams, & transference

24

• InterpretationThe analyst noting supposed dream meanings,

resistances, and other significant behaviors in order to promote insight.

• ResistanceIn psychoanalysis, the blocking from

consciousness of anxiety-laden material.• TransferenceThe patient’s transfer to the analyst of

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

25

Behavioral Techniques

Learning

Conditioning

Association between

Environmental Stimuli + ResponseClassical Conditioning Operant Conditioning

Association Reinforcement/

Stimulus-Response Punishment

26

Behavioral Techniques

• There are no mental processes (will, mind)

• Derived from classical and operant conditioning

• The focus is on changing the behavior

• Works on the immediate problem

• Focuses on the present

27

• Ivan Pavlov

• Conditioning

Learning that involves associations between environmental stimuli and the organism’s responses

• Stimulus-response Learning

Classical Conditioning

28

29

Classical Conditioning in Real Life

• Learning to like

• Learning to fear

• Accounting for Taste

• Reacting to Medical Treatment

30

Operant Conditioning

• The behavior is more likely or less likely to occur based on its consequences.

• B. F. Skinner modified Pavlov’s concept.

• Skinner used reinforcement and punishment to enhance learning.

31

Skinner’s Box

32

Behavioral Techniques

• Systematic Desensitization/Counter Conditioning

• Aversive Conditioning

• Exposure Treatment (Flooding)

• Behavioral Records & Contracts

• Skills Training

33

Systematic Desensitization

• Fear of Flying– Read about safety– Look at pictures of airplanes– Visit an airport– Take a short flight– Take a long flight

• Fear is extinguished• Counterconditioning

34

Cognitive TherapyAeron Beck

• Aaron Beck and his colleagues (1979) came to believe that cognitive therapy could reverse people’s catastrophizing beliefs about themselves, situations, and their futures

35

Cognitive Distortions

• Labeling

• Mind Reading

• Exaggeration

• Unrealistic Expectations

• Belief in Entitlement

• Belief in Absolute Fairness

36

Fighting Dysfunctional Thought

• Hot Thoughts• He is always mean to

me.• I did a lousy job.• I deserve better.• It’s not fair.• That jerk!• They’re driving me

crazy.

• Cool Thoughts• Maybe he had a bad

day.• It’ll be better next time• But people are people• Life is not fair.• It’s his problem!• Just don’t accept the

ride.

37

Dysfunctional ThoughtSituation Emotion

Rate

1-100%

Automatic Thought

Cognitive Distortion

Rational Response

Outcome

Rate

0-100%

Fight with spouse

Angry, 99%

Sad, 50%

-I’ll never have a normal marriage

-I deserve better

-He’s stubborn

Magnificat-ion

Entitlement

Labeling

-It’s not the end of the world

-That’s normal

-Maybe he had a bad day

Angry,

50%

Sad, 10%

38

Humanistic Therapy

• Works on self-fulfillment and self-actualization

• Does not delve into the past• Helps the client think about the present and

the future• Helps people feel good about themselves• Tackles conscious rather than unconscious

thoughts

39

Carl RogersClient-Centered TherapyPerson-Centered Therapy

• The therapist uses techniques such as active listening within a genuine, accepting, empathetic environment to facilitate clients’ growth.

40

Carl RogersClient-Centered Therapy

• Offers unconditional positive regard

• No specific techniques

• Therapist should be warm, genuine and empathetic

• Client adopts these views and becomes self-accepting

• Promotes growth instead of curing illness.

41

Effective Listening

Client’s Remark

Closed Response

Open Response

I can’t do it. Don’t talk like that.

It seems very difficult to you.

I will never be able to have a good life.

We’ve discussed that before. Stop being negative.

It may look very discouraging now.

42

Active Listening

• Paraphrase.Summarize the speakers words in your own

words.• Invite Clarification.Encourage the speaker to say more.• Reflect Feelings.Reflect what you’re sensing from the speakers

words and body language.

43

Family Therapy

• The therapist helps family members understand how their ways of relating to one another create problems.

• The treatment’s emphasis is not on changing the individuals, but on changing their relationships and interactions.

Relative Effectiveness of Different Therapies

• Behavioral Conditioning Therapies – have achieved favorable results with specific behavior problems, such as bed-wetting, phobias, compulsions, marital problems, and sexual disorders.

• Studies confirm that Cognitive Therapy is effective in coping with depression and reducing suicidal risks

• Biomedical Therapy – is particularly essential for the treatment of the positive symptoms of schizophrenia

44

Alternative Therapy(1) Eye Movement Desensitization and

reprocessing (EMDR)

• Francine Shapiro had people imagine traumatic scenes while she triggered eye movement by waving her finger in front of their eyes, supposedly enabling them to unblock and reprocess previously frozen memories.

• This therapy helps reduce traumatic memories.

45

Alternative Therapy(2) Light Exposure Therapy

• It is used to treat people who suffer from seasonal affecive disorder (SAD).

• After 4 weeks of treatment:

- 61% of those exposed to morning light greatly improved.

- 50% of those exposed to evening light greatly improved.

- 32% of those exposed to the placebo greatly improved.

46

47

When Therapy Helps

• When clients have enough sense of self• When clients have enough distress to

motivate them to change• When therapists are warm and empathetic• When client and therapist establish a good

rapport• Hostile, negative clients are less likely to

benefit

48

When Therapy Harms

• Bias on the therapist’s part because of gender, religion, or race

• Coercion by the therapist to accept his/her advice

• Coercion by the therapist to have sexual intimacy

49

The Power of Forgiveness

• Giving up grudges can reduce chronic back pain• Forgiveness limited the number of relapses among

women battling substance abuse problems.• Using MRI scans to explore how just thinking

about empathy and reconciliation sparks activity in the brains left middle gyrus, suggesting we all have a mental forgiveness center set to be tapped.

50

The Power of Forgiveness

• Cortisol’s depressive effect on the immune system has been linked to serious disorders.

• Forgiveness stops the cortisol and adrenaline from flowing.

51

American Psychosomatic SocietyA Study

• 36 male veterans who had coronary artery disease and who were also burdened by other war-related issues

• Those who received forgiveness training showed greater blood flow to the heart.