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Chapter 14Treating Psychological Disorders
Christina Graham, Ph.D.
Outline: Therapy Does Therapy Work? Approaches Psychoanalytic Therapy Humanistic Therapy Cognitive-Behavioral Therapy
Treatment for Mood Disorders Treatment for Anxiety Disorders
Outline: Therapy Does Therapy Work? Approaches Psychoanalytic Therapy Humanistic Therapy Cognitive-Behavioral Therapy
Treatment for Mood Disorders Treatment for Anxiety Disorders
Psychotherapy Effectiveness
Q: Does psychotherapy work?
A: Yes.*
*Need to think critically about why studies say it works, and how effectiveness is measured
Effectiveness: Key Points
Most problems usually get better on their own…but they’re likely to improve faster with psychotherapy.
Two key ingredients of successful psychotherapy are: Quality of relationship with the therapist The client’s belief that s/he will improve
In general, no particular therapeutic approach is superior
However, certain therapies work much better for specific problems
Outline: Therapy Does Therapy Work? Approaches Psychoanalytic Therapy Humanistic Therapy Cognitive-Behavioral Therapy
Treatment for Mood Disorders Treatment for Anxiety Disorders
Approaches Q: How should we treat psychological
disorders? A: Depends on our assumptions about
etiology (what causes the disorders)
Approaches: Theoretical Perspectives What causes psychological disorders? Is it…
…unconscious conflicts stemming from childhood relationships with parents (psychodynamic perspective)?
…not living to one’s full potential (humanistic)? …learned behaviors and responses
(behavioral)? …thinking a certain way (cognitive)? …neurochemistry and biology (biological)?
Outline: Therapy Does Therapy Work? Approaches Psychoanalytic Therapy Humanistic Therapy Cognitive-Behavioral Therapy
Treatment for Mood Disorders Treatment for Anxiety Disorders
Psychoanalytic therapy (psychoanalysis)
Assumes conflicts are unconscious
Free association = allowing the client to verbalize everything that comes to mind without censoring anything
Sessions are often frequent over a long period of time Expensive!
Psychoanalytic therapy (psychoanalysis) cont’d
Therapist looks for signs of transference (client acts toward the therapist in ways suggestive of unconscious conflicts)
http://www.youtube.com/watch?v=yTHM2o3dvao
Countertransference is also an issue A therapist’s own conflicts can
change how s/he acts toward the client
Outline: Therapy Does Therapy Work? Approaches Psychoanalytic Therapy Humanistic Therapy Cognitive-Behavioral Therapy
Treatment for Mood Disorders Treatment for Anxiety Disorders
Humanistic Therapy Sometimes called client-
centered therapy Therapist provides
unconditional positive regard
Therapist is empathic Encourages client to be
genuine Most therapists –
regardless of orientation – employ these humanistic principles
Carl Rogers (1902-1987)
Outline: Therapy Does Therapy Work? Approaches Psychoanalytic Therapy Humanistic Therapy Cognitive-Behavioral Therapy
Treatment for Mood Disorders Treatment for Anxiety Disorders
Cognitive-Behavioral Therapy (CBT) Integrates assumptions from both the
behavioral and cognitive perspectives Basic model:
Cognitions
EmotionsBehaviors
Using a CBT model, how might a therapist treat depression?
CBT model of depression
Cognitions
EmotionsBehaviors
“I’m no fun…nobody wants to hang out
with me.”
Avoiding friends, avoiding
social events, staying home
alone
Feeling lonely, depressed
“If I go out I won’t have a good
time...people will think I’m such a
jerk”
Treatment for depression: Changing attribution styles
Depressed people tend to attribute events in ways that are inaccurate and maladaptive (Beck’s Cognitive Triad of Depression) Beliefs about the self – negative events are
attributed to internal causes Beliefs about the world – negative events
are seen as having global effects Beliefs about the future – negative events
are seen as stable and unchanging
Treatment for depression: Changing attribution styles
Depressive Non-Depressive
Internal“It’s all my fault”
Global“Everything is going
wrong”
Stable“Things will always
be lousy”
External“That was just bad
luck”
Specific“This is just one lousy
situation”
Unstable“This won’t last
forever”
Some Maladaptive Cognitions Overgeneralization = arbitrarily concluding
that an event will happen to you over and over again
All-or-nothing thinking = tendency to evaluate personal qualities in black/white categories
Mind-reading = assuming you know what others are thinking of you (inaccurately)
Mental filter = dwelling on the negative and ignoring the positive
Magnification = exaggerating the importance of a negative action
Using a CBT model, how might a therapist treat a Specific Phobia?
Treatment of phobias: Systematic Desensitization Feeling relaxed is incompatible with
feeling anxious The therapist helps the client construct a
‘fear hierarchy’ The client is asked to practice coping by
using relaxation strategies in the presence of fearful stimuli
Exposure to the feared stimulus lasts until the fear level drops to a very low level
Sample fear hierarchy Sitting on Santa’s lap – 10 Touching Santa’s beard – 9 Talking to Santa 5 ft away – 8 Hearing Santa say “Ho Ho Ho!” – 6 Seeing a red Santa suit on a hanger – 4 Touching a toy Santa - 4 Seeing a chubby man with a bushy
white beard – 3 Hearing “Jingle Bells” - 2
Using a CBT model, how might a therapist treat OCD?
Treatment of OCD:Exposure and Response Prevention
Compulsions (behaviors) are negatively reinforcing because they decrease anxiety
Client with OCD is exposed to a situation that triggers obsessions (thoughts) and is prevented from performing compulsions
Client learns that anxiety will eventually decrease over time without performing the compulsion Client is negatively reinforced for doing other
things, like distracting self or relaxing)
Stress Inoculation Combination of systematic desensitization
(classically conditioning relaxation response with anxiety-provoking stimuli) with cognitive responses
Use of self-talk to facilitate relaxation and coping (“I can get through this OK”, “Just one step at a time”, “Fear is natural, it won’t always be this bad and I can get through this.”)
Coping skills (self-talk and relaxation) are practiced prior to encountering the stressors
Questions?