Therapies

1. Therapies Chapter 14

2. Introduction • The Lobotomist

3. Defining Therapy Not to mention your unusually large head… • 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?

4. 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  3500 BC

5. Insight Therapies

6. 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

7. 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

8. Gestalt Therapy Ya, you are in ze hot seat! • 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

9. 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

10. Behavior Therapies

11. 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

12. 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!

13. 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

14. 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

15. Cognitive Therapies

16. 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

17. 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

18. 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

19. 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”)

20. Group Therapies

21. 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

22. 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

23. Evaluating Psychotherapies

24. 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

25. 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

26. 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

27. Biological Treatments

28. Biological Treatments:Overall Trends • View abnormal behavior as a symptom of an underlying physical disorder • Typically favor biological therapy (drugs, psychosurgery, ECT, etc.)

29. 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

30. 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

31. 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

32. Action of SSRIs

33. 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

34. 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

35. Psychostimulants • Used to treat disorders such as AD/HD • Concern that psychostimulants are being overused • Side effects: lethargy, depression, aggression

36. Electroconvulsive Therapy • Commonly known as “shock therapy” • 1938 Italian physicians UgoCerletti and LucioBini 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

37. 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

38. Alternatives to Institutionalization

39. 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

40. 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