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History of Treatment In early Stone Age society, trepanning was used – many did not survive the procedure During Middle Ages, supernatural forces were blamed for mental illness (demonology) and exorcism was used During the French Revolution, more humane treatment started with the work of Philippe Pinel By the mid-19 th century, people began to connect abnormal behavior to damage to the brain/central nervous system Sigmund Freud helped to popularize the “talking cure” in the early 20 th century Since then there has been an explosive growth in available therapies
Citation preview
Therapies
Chapter 14
Defining Therapy Psychotherapy is the treatment of
emotional and behavioral problems through psychological techniques Uses psychological rather than
exclusively biological approaches to treatment
Involves conversation between an individual with psychological issues and someone trained to help correct the problem known as a therapist.
Dude…Why are my arms
so short?
Not to mention
your unusually
large head…
History of Treatment In early Stone Age society, trepanning was
used – many did not survive the procedure During Middle Ages, supernatural forces
were blamed for mental illness (demonology) and exorcism was used
During the French Revolution, more humane treatment started with the work of Philippe Pinel
By the mid-19th century, people began to connect abnormal behavior to damage to the brain/central nervous system
Sigmund Freud helped to popularize the “talking cure” in the early 20th century
Since then there has been an explosive growth in available therapies
Insight Therapies
Psychoanalysis
Designed to bring repressed feelings and thoughts to conscious awareness developed by Freud
Techniques Therapist must maintain a neutral relationship with the
client so that client may project unresolved feelings/issues upon him/her
Dream analysis Hypnosis and post-hypnotic suggestions Free association Transference and resistance Analysis of defense mechanisms Insight and working through
Person-Centered Therapy Developed by Carl Rogers Goal is to help clients become fully
functioning Therapist expresses unconditional positive
regard and empathy Therapist strives to be authentic, trying to be
genuine and real rather than formal Therapy is nondirective but engages in active
listening Therapist reflects or mirrors clients’
statements
Gestalt Therapy
Outgrowth of the work of Fritz Perls Emphasizes the wholeness of personality Attempts to reawaken people to their emotions
and sensations in the here-and-now Draws attention to what exists rather than what
is absent, and draws attention to client’s voice, posture, and movements
Encourages confrontation with issues Therapist is active and directive “Empty Chair” and “Hot Seat” technique
Ya, you are in ze hot seat!
Recent Developments Short-term psychodynamic
psychotherapy Focused on trying to help people correct the
immediate problems in their lives Forego long process of completely excavating
childhood Virtual therapy
Therapy delivered via chat room, phone or video conference
Client given techniques to use on their own after session ends
Behavior Therapies
Behavior Therapies
Based on the belief that all behavior – adaptive and maladaptive - is learned
Objective of therapy is to teach people new ways of behaving
Focuses on observable, measurable activities
Using Classical Conditioning Techniques
Systematic desensitization Gradually associating relaxation with what
was feared Extinction through counterconditioning
Ending of old fears or reactions through repeated exposure to new stimulus pairs
Flooding Full-intensity exposure to feared object
Aversive conditioning Eliminate undesirable behavior by
associating it with pain and discomfort Virtual reality exposure therapy
Expose client to fears in safe, virtual setting
Say hello to Mr. Spider!
Operant Conditioning Behavior contracting
Client and therapist set behavioral goals and agree on reinforcements the person will receive
Client engages in desired behaviors to attain reinforcement
Token economy Clients earn tokens for desired behaviors
and exchange them for desired items or privileges
Often used in schools and hospitals
Modeling
Person learns new behaviors by watching others perform those behaviors
Sometimes used in conjunction with operant conditioning
Therapist him/herself may model desirable behaviors for client
Cognitive Therapies
Meichenbaum’s Stress-Inoculation Therapy Type of cognitive therapy that trains
people to cope with stressful situations by learning a more useful patterns of self-talk
Taught to suppress negative and anxiety-provoking thoughts in times of stress
Particularly effective for treating anxiety disorders
Ellis’ Rational-Emotive Therapy (RET) A directive, confrontational therapy
based on the idea that psychological distress is caused by irrational and self-defeating beliefs
Core problem is belief in “musts” and “shoulds” that leave no room for making mistakes (no more “musterbation”)
Therapist’s job is to challenge client’s irrational beliefs
Beck’s Cognitive Therapy
Aimed at identifying and changing inappropriately negative and self-critical patterns of thought
Therapist points out automatic thoughts (instantaneous, habitual, and unconscious thoughts that impact mood and action) and catastrophizing beliefs and forces client to substantiate them
Good treatment for depression
Cognitive Distortions List All or nothing thinking (“always”,
“every”, “never” Mental filter (focus on negative
aspects while ignoring positive aspects)
Disqualifying the positive (shooting down positive experiences for no reason)
Jumping to conclusions (drawing conclusions with little/no evidence)
Overgeneralization (isolated case assumed for all)
Magnification/minimization (making mountains out of molehills, catastrophizing)
Emotional reasoning (decision making based on feelings, not logic)
Personalization (attributing personal responsibility when individual has no control over event) Should statements (emphasizing what should be rather than what is; what Ellis called “musterbation”)
Group Therapies
Family Therapy
Form of group therapy that sees the family as at least partly responsible for the individual’s problems
Seeks to change all family members’ behavior to the benefit of the family and the individual
Self-Help Groups and Couple Therapy
Self Help Groups Small, local gatherings of people who
share common problems and provide mutual assistance at very low cost
Alcoholics Anonymous is an example Good for empathy, but may trigger
temptation to relapse Couple Therapy
A form of group therapy intended to help troubled partners improve their communication and interaction
Empathy training: partners taught to share feelings and listen to and understand partner’s feelings
Evaluating Psychotherapies
Overall Effectiveness of Psychotherapy
Does Psychotherapy Work? Psychotherapy helps about 2/3rd of people
treated Approximately 1/3 would improve without therapy
Which Type of Therapy is Best for Which Disorder? No one type of therapy is better Key is to match the problem with the appropriate
therapy
Effectiveness of Insight and Cognitive Therapies Difficult to judge as spontaneous remission
may occur Who should be asked to judge the effectiveness
of therapy? Therapist or client? Meta-analysis may be the best bet to evaluate
these therapies 75-80% result in improvement vs. no therapy at
all Only 10% were worse after therapy
Works best with those who are not severely disturbed
Effectiveness of Behavior Therapies Work well for certain problems such as phobias,
compulsive behaviors, impulse control, and learning new social skills to displace maladaptive ones
Criticized for ignoring internal thoughts and expectations and just treating symptoms rather than underlying causes
Not well suited for some types of problems
Biological Treatments
Biological Treatments:Overall Trends View abnormal behavior as a symptom
of an underlying physical disorder Typically favor biological therapy (drugs,
psychosurgery, ECT, etc.)
Drug Therapies Psychopharmacotherapy is the
treatment of mental disorders with medication – also known as drug therapy
Major reasons for widespread use of drugs Drugs are effective at treating disorders –
especially serious disorders Drug therapies are often less expensive
that psychotherapy
Antipsychotic Drugs (Neuroleptics) Used for schizophrenia or psychosis
(hallucinations, delusions, paranoia, disordered thinking, incoherence)
All antipsychotics block dopamine receptors in the brain
Side effects include drowsiness, dry mouth, muscular rigidity, and Tardive Dyskinesia
Examples include Thorazine, Haldol, Mellaril, Clozapine, and Risperidone
60-70% show improvement in symptoms when these drugs are used
Antidepressant Drugs (Thymoleptics)
Tricyclics and MAO (monoamine oxidase) inhibitors Most common antidepressants prior to late 1980s Work by increasing amount of the neurotransmitters
serotonin and norepinephrine Effective, but have serious side effects such as heart
complications and weight gain Examples: Tofranil, Elevil (Tricyclics), Nardil (MAOi)
Selective Serotonin Reuptake Inhibitors (SSRIs) Work by blocking the reuptake of serotonin Examples: Prozac, Paxil, Zoloft, Effexor
Side effects: sleepiness, reduced sex drive 60-70% show improvement though it may take two
weeks for changes to take effect
Action of SSRIs
Antimania Drugs:Lithium A naturally occurring salt (lithium
carbonate) that is used to treat bipolar disorder (manic depression) with 80% effectiveness
Nobody knows how lithium works to alleviate symptoms
Problem with establishing proper dosage and with people stopping medication when symptoms ease
Examples: lithium carbonate, Eskalith
Antianxiety Drugs (Anxiolytics) Use to treat anxiety disorders and are
often referred to as tranquilizers Most widely prescribed of all legal drugs Produce a feeling of calm and mild
euphoria Side effects include physical
dependence and withdrawal symptoms is abruptly discontinued
Examples: Valium, Librium, Xanax, Equanil
Psychostimulants Used to treat disorders such as AD/HD Concern that psychostimulants are being
overused Side effects: lethargy, depression,
aggression
Electroconvulsive Therapy Commonly known as “shock therapy” 1938 Italian physicians Ugo Cerletti and Lucio
Bini created seizures in patients by passing an electric current through their brains
During 1940s and 50s, used as a treatment for depression, schizophrenia and sometimes mania; now used only for severe depression
Causes brief convulsions and temporary loss of consciousness
Side effects include memory loss and difficulty learning following the procedure
Up to 100,000 people receive ECT each year
Psychosurgery Brain surgery performed to change a
person’s behavior or emotional state History of Lobotomy: Egas Moniz and
Walter Freeman Prefrontal lobotomy (EM) Transorbital lobotomy (WF) Tragedies
Psychosurgery is rarely used today and removes far less brain tissue
Alternatives to Institutionalization
Deinstitutionalization
Releasing people with severe psychological disorders into the community
Can cause problems Some people are ill-prepared to deal with life
outside of a hospital Up to 40% of homeless are mentally ill Alternative forms of treatment (many)
Half-way houses Family-crisis interventions Day-care
Prevention Primary prevention
Improve the social environment so that new cases of mental disorders do not develop
e.g. Family planning, Genetic counseling Secondary prevention
Interventions with high risk groups e.g., suicide hot-lines, job training in economically
depressed areas Tertiary prevention
Help people adjust after they are released from the hospital in order to help prevent a relapse
e.g. halfway houses, long-term outpatient care Community psychology attempts to minimize or
prevent mental disorders – not just treat them