Chapter 17

Therapy

The Psychological Therapies

Psychoanalysis Human Therapies Behavior Therapies Cognitive Therapies Group and Family Therapies

Psychoanalysis

a method of investigation of the mind and the way one thinks

a systematized set of theories about human behavior;

a method of treatment of psychological or emotional illness

Humanistic Therapies

Humanistic therapy emerged in the 1950's, and although behavioral therapy and psychoanalytic methods were available, a humanistic approach offered individuals another alternative. This approach focuses on recognizing human capabilities in areas such as creativity, personal growth and choice.

“The good life is a process, not a state of being. It is a direction not a destination”

Carl Rogers

“He that is good with a hammer tends to think everything is a nail”

Abraham Maslow

Behavior Therapies

Behavior therapy is a type of psychotherapy that focuses on changing undesirable behaviors. Behavior therapy involves identifying objectionable, maladaptive behaviors and replacing them with healthier types of behavior. This type of therapy is also referred to a behavior modification therapy

Cognitive Therapies

Cognitive therapy focuses primarily on the thoughts and emotions that lead to certain behaviors, while behavioral therapy deals with changing and eliminating those unwanted behaviors. However, some therapists practice a type of psychotherapy that focuses on both thoughts and behavior.

Group and Family Therapies Family therapy, also referred to as couple

and family therapy and family systems therapy, is a branch of psychotherapy that works with families and couples in intimate relationships to nurture change and development. It tends to view change in terms of the systems of interaction between family members. It emphasizes family relationships as an important factor in psychological health.

Clients Perceptions

Reasons people enter therapy:

*People enter because of crisis -(when the crisis passes they may attribute their improvement to therapy)

*Clients may need to believe the therapy was worth the effort- (self justification is a powerful human motive)

Testimonials can be misleading which is why they aren't used to judge whether psychotherapy is effective.

Clients enter therapy by emphasizing their unhappiness, then justify leaving by emphasizing their well being

EX.

Delinquent boys were put through “Scared Straight” programs(visiting jails being taunted by inmates) said after they were most likely to be law abiding. Compared to boys who weren't in the program the boys in the program became more likely to commit new offenses.

Perceptions

Client and Therapy perceptions come from two phenomena

Placebo Effect- the power of belief in a treatment

Regression toward the mean- the tendency for unusual events to regress or return to their average state

Outcome Research

To better assess psychotherapy psychologists have turned to controlled research studies

The most powerful tool for sorting reality from wishful thinking is the control group.

The results from many studies are digested by a technique called meta analysis- a procedure for statistically combining the conclusions of a large number of different studies as if the results had come from one huge study of participants

Relative Effectiveness of Different Therapies EX:

Cognitive/Interpersonal therapy- For depression Cognitive/Exposure therapy- For stress & anxiety Cognitive behavior therapy - Bulimia

Behavior modification- Bed wetting

Therapy is most effective when the problem is clear cut. Those who experience phobias or panic can only hope for improvement. Those who suffer depression or anxiety usually benefit only for short terms. People with chronic schizophrenia or wish to change their personality are unlikely to benefit. The more specific the problem the greater the hope.

Alternative Therapies

The tendency of states of mind to regress combined with the placebo effect creates a need for pseudo therapies

Ex: Spiritualist, Hypnotherapist, Reflexologist, Aroma therapists, and Colonic Irrigationists

EMDR

Eye Movement Desensitation and Processing Francine Shapiro when one imagines a

traumatic scenes she triggers eye movements by waving her finger enabling them to unlock and reprocess previous frozen trauma memories

84% claim that this has worked

Light Exposure Therapy

Suffered mostly by women and those living far from the equator during the winter time months enter a state of depression from the lack of exposure to light

All Therapies offer hope for demoralized people, a new perspective of ones self and the world; and an empathetic and trusting relationship.

Drug TherapiesAntipsychotic DrugsAntianxiety Drugs

Antidepressant DrugsMood-Stabilizing Medications

Psychosurgery

Drug Therapies

Pschopharmacology: The study of the effects of drugs on mind and behavior.

Some people use double-blind technique which is a experimental procedure.

Antipsychotic Drugs

An antipsychotic (or neuroleptic) is a transquilizing psychiatric medication primarily used to manage psychosis(including delusions or hallucinations , as well as disordered thought), particularly in schizophrenia and bipolar disorder

Antipsychotic drugs, such chlorpromazine(Sold as Thorazine). A number of harmful effects have been observed, including

lowered life expectancy, weight gain, enlarged breasts and milk discharge in men and women hyperprolactinaemia lowered white blood cell count, invlountary repetitive body movements ,diabetes, an inability to sit still or remain motionless sexual dysfunction, a return of psychosis requiring increasing the dosage due to cells producing more neurochemicals to compensate for the drugs

Tardive dyskienisa: Involuntary movement of the facial muscles, tongue, and limbs; a possible neurotoxic side effect of long-term use of antipsychotic drugs that target D2 dopamine receptors.

Antidepressant Drugs An antidepressant is a psychiatric medication used to alleviate

mood disorders, such as major depression and dysthymia and anxiety disorders such as social anxiety disorder.

Opioids were used to treat major depression until the late 1950s. Amphetamines were used until the mid 1960s.

Major antidepressant drugs, except trimipramine, mirtazapine and nefazodone suppress REM sleep, and it has been proposed that the clinical efficacy of these drugs largely derives from their suppressant effects on REM sleep. The three major classes of antidepressant drugs, monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs), profoundly suppress REM sleep.[Mirtazapine either has no effect on REM sleep or increases it slightly.The MAOIs almost completely suppress REM sleep, while the TCAs and SSRIs have been shown to produce immediate (40-85%) and sustained (30-50%) reductions in REM sleep. This effect often causes increased fatigue in patients who take large doses of antidepressants for extended periods of time. Such fatigue can occasionally interfere with a patient's everyday activities. Abrupt discontinuation of MAOIs can cause a temporary phenomenon known as "REM rebound" in which the patient experiences extremely vivid dreams and nightmares.

Mood-Stabilizing Medications Lithium is usually one of the first medicines

prescribed for bipolar disorder to treat mania and to prevent the return of both manic and depressive episodes.

How Well It Works Lithium carbonate may provide relief from acute

episodes of mania or depression and can help prevent them from recurring.

Lithium is often helpful in treating manic episodes that are not mixed with any depressive mood. Long-term use of lithium has been shown to reduce the risk of suicide related to bipolar disorder.

Divalproex has been shown to help reduce rapid cycling between moods and is effective in those with bipolar disorder who also have substance abuse or anxiety problems.

Brain Stimulation Electroconvulsive Therapy

Brain stimulation therapies involve activating or touching the brain directly with electricity, magnets, or implants to treat depression and other disorders. Electroconvulsive therapy is the most researched stimulation therapy and has the longest history of use.

Electroconvulsive therapy

First developed in 1938, electroconvulsive therapy (ECT) for years had a poor reputation with many negative depictions in popular culture. However, the procedure has improved significantly since its initial use and is safe and effective. People who undergo ECT do not feel any pain or discomfort during the procedure.

ECT is usually considered only after a patient's illness has not improved after other treatment options, such as antidepressant medication or psychotherapy, are tried. It is most often used to treat severe, treatment-resistant depression, but occasionally it is used to treat other mental disorders, such as bipolar disorder or schizophrenia.

How it Works Before ECT is administered, a person is sedated with general

anesthesia and given a medication called a muscle relaxant to prevent movement during the procedure. An anesthesiologist monitors breathing, heart rate and blood pressure during the entire procedure, which is conducted by a trained physician. Electrodes are placed at precise locations on the head. Through the electrodes, an electric current passes through the brain, causing a seizure that lasts generally less than one minute.

Psychosurgery

Psychosurgery, also called neurosurgery for mental disorder (NMD), is the neurosurgical treatment of mental disorder

Psychosurgery is a collaboration between psychiatrists and neurosurgeons. During the operation, which is carried out under a general anaesthetic and using stereotactic methods, a small piece of brain is destroyed or removed. The most common types of psychosurgery in current or recent use are capsulotomy, cingulotomy, subcaudate tractotomy and limbic leucotomy.

Key Terms

Psychopharmacology: The study of the effects of drugs on mind and behavior

Tardive Dyskinesia: Involuntary movements of the facial muscles, tongue, and limbs; a possible neurotoxic side effect of long-term use of antipsychotic drugs that target D2 dopamine receptors