Treatments

1. Treatments

2. History of Treatments • Early treatments brutal transitioned to more humane methods • Dorothea Dix – 1st to transition to gentler treatments in U.S. • Today - Biomedical Drugs and better therapy has led deinstitutionalization.

3. Categories of Therapy 2 Main Categories • Psychotherapy – interaction between therapist and patient • Phobias • Biomedical – prescription meds that act on central nervous system • Schizophrenia Eclectic Approach– uses a variety of psych theories and approaches Example: combining medication (anti-depressants) with different types of psychotherapy such as Cognitive Therapy (change feelings of self-blame) and Behavioral (go out and run when feeling depressed)to treat depression

4. Perspectives and Disorders

5. Insight Therapies • Insight therapies – try to improve mental state by increasing client’s awareness of underlying motives and defenses • Psychoanalytic Therapy • Psychodynamic Therapy • Humanistic Therapy

6. Psychoanalytic Therapy • Psychoanalysis – uncovering childhood experiences to gain insight into the unconscious origins of the disorder • dreamanalysis – manifest and latent • free association – uncensored reporting of any thoughts that come to mind. • Resistance - blocking from consciousness anxiety-laden material during therapy. • Example: patient stutters when recalling sensitive information

7. Psychoanalytic Therapy • Transferring - expression toward a therapist of feelings linked with earlier relationships • Example: Hatred toward mother is expressed as hatred toward therapist

8. Psychoanalytic Therapy • Criticisms • Interpretations can’t be proven or disproven • Costly and time consuming (2 or more sessions/week for 2 or more years)

9. Psychodynamic Therapy • Psychodynamic therapy - try to understand patients' current symptoms by focusing on recurring patterns in their interpersonal relationships • Patients gain insight into unconscious conflicts • Face to face, once per week, several months • Interpersonal psychotherapy - effective in treating depression by helping patients improve their interpersonal skills • variation of psychodynamic therapy • 14-16 sessions • Example: helping a depressed patient resolve conflicts with friends

10. Humanistic Therapy • Humanistic Therapy - emphasize the importance of self-awareness and take responsibility for own feelings and actions to improve mental state • seek to promote personal growth and self-fulfillment. • Client-Centered Therapy (Rogers) -patients' discover their own ways of effectively dealing with difficulties • non-directive therapies – therapist listens without judging or giving insight • Genuineness, acceptance and empathy • Unconditional Positive Regard • Active listening – echoing, restating and seeking clarification of clients feelings

11. Geraldo, a high school senior, is so fearful of asking a girl out that he hasn't had a date in over three years. He has recently contacted a psychotherapist for help in overcoming his fear. Describe how a humanistic therapist and a psychoanalyst would treat Geraldo's problem.

12. A humanistic psychologist would focus on the present rather than the past (e.g., what Geraldo can do now to get up the nerve to ask for a date rather than what he failed to do in the past), conscious thoughts (e.g., what Geraldo thinks about dating and how he would approach a woman for a date), taking responsibility for his actions (e.g., what he can control in asking a woman out on a date rather than what he can't control). In contrast, a psychoanalyst would focus on what unconscious impulses or conflicts are causing Geraldo's fear—Does Geraldo have unconscious feelings of anxiety about his mother that he is transferring to other women?

13. Behavioral Therapies Behavior Therapies – applies learning principles to unwanted behaviors • Classical Conditioning • Maladaptive symptoms are conditioned responses • Operant Conditioning • Maladaptive symptoms are reinforced

14. Behavioral Therapy • Classical Conditioning • Counterconditioning (Pavlov)- procedure that trains people to make new responses to stimuli that currently trigger unwanted responses • 2 Types • Exposure Therapies • Flooding • Systematic Desensitization • Virtual Reality Exposure Therapy • Aversive Conditioning

15. Exposure Therapies • Exposure Therapies - Repeatedly introducing people to things they fear and avoid • Flooding – forced exposure to the stimulus that is feared • Example: Putting a Susan who has Arachnophobia in a room full of spiders to show that they have no reason to fear them • Systematic Desensitization – gradual exposure to the actual stimulus by replacing a positive response with a negative response. • Progressive relaxation – imagined scene is repeatedly paired with relaxation and progresses to eventually facing the worst fear • Example: Therapist first asks Susan to relax and imagine a harmless spider climbing up the wall eventually she will face a room full of tarantula spiders, her greatest fear

16. Exposure Therapies • Virtual Reality Therapy – progressively exposing people to simulations of their greatest fears • Example: exposing Susan to Spiders using a 3 dimensional virtual world with life-like spiders • Fear of flying

17. Aversion Therapy • Aversion Therapy – unwanted behavior systematically associated with unpleasant experiences • Examples: consuming alcohol with a nausea producing drug • Gambling and shock treatments • Problem: cognition influences conditioning

18. Operant Conditioning • Behavior Modification - reinforcing desired behaviors, giving punishments for undesired behaviors • Example: Punishing aggressive behaviors of children with autism • Token Economy – earning a token for desired behavior that can be traded in for privileges • Example: Given tokens to ADHD students for staying in their seats and allowing them to trade them in for a prize

19. Describe how a therapist might apply operant conditioning techniques to help Rosemary overcome a compulsive habit of eating too much junk food. Be clear about the exact procedures that would be used.

20. A therapist might use behavior modification to change eating behaviors. The particular technique could involve either reinforcing the desired behavior (e.g.. encouraging Rosemary to treat herself to a favorite, healthy food [such as an energy drink] if she doesn't eat any chips or candy during the day) or punishing an undesirable behavior (e.g., having to put $5 in a jar each time she has a piece of candy).

21. Cognitive Therapy • Cognitive Therapy – change the way patient thinks (change schemas) • Irrational, Self-blaming, over-generalized thoughts, negative interpretations • Anxiety Disorders, Major Depressive Disorder, Suicide • Example: Dan thinks he can’t get an A in AP Psych because he’s incompetent • Beck’s Therapy for Depression • Stress Inoculation Training • Changes thinking in stressful events

22. Cognitive-Behavioral Therapy • Cognitive Behavioral - Changes the way we think and act • Example: When Olivia is anxious, her therapist teaches her to attribute her arousal to a highly reactive sympathetic nervous system and to play Temple Run on her phone instead.

23. One of your best friends feels that he fails at everything he does and that his life isn't worth living. When you suggest that he talk to a psychotherapist, your friend responds, “Talking won't help. The more I talk about myself, the more I think about my problems. The more I think about my problems, the more depressed I get.” What procedures would a cognitive therapist use to help your friend overcome his negative feelings?

24. A cognitive therapist would directly address the way your friend is thinking about life and depression. A cognitive therapist believes that the emotional reaction (depression) is produced by your friend's thinking about life events, and so would work with the client to change the ways he thinks about life events.

25. Family and Group Therapy • Group Therapy • Offered for: family conflict, stressful relationships, patients with similar problems • Improves communication skills and conflict resolution • Examples: obesity (OA), alcoholism (AA) • Family Therapy – unwanted behaviors are influenced by other family members Example: rebellious child

26. Evaluating Psychotherapy • Placebo effect – the beneficial consequences of merely expecting that a treatment will be effective. • Regression toward the mean – the tendency for unusual events or emotion to return to their ave. state . • Selective Justification – overestimating the actual benefits (both patients and therapists) • Eysenck and Eysenck – no more beneficial than no treatment at all

27. Evaluating Psychotherapy • Randomized Clinical Trials – compare treatment groups with control groups • Meta-analysis – a procedure for statistically combining the results of many different studies. • Bottom line – Those not undergoing therapy often improve, but those undergoing therapy are more likely to improve

28. Comparison of Psychotherapies • Evidence Based Practices - Clinical decision making that integrates the best available research with clinical expertise and an understanding of patient characteristics • **Scientifically Unsupported Therapies - Energy Therapy, Recovered-memory Therapy, Rebirthing Therapies, Facilitated Communication, Crisis Debriefing

29. Alternative Therapies • EMDR (Eye Movement Desensitization and Reprocessing - Rapidly moving one's eyes while recalling traumatic experiences • similar to exposure treatment • Originally developed for anxiety • Value in placebo effect and exposure therapy • Light Exposure Therapy – exposure to intense light that mimics outdoor light • activity in the brain region responsible for arousal • Seasonal Affective Disorder – depression caused by lack of exposure to natural light

30. Biomedical Therapy Biomedical Therapy – drugs, or treatments that act on the brain’s central nervous system • Examples: • Drugs, electroconvulsive therapy, • Magnetic impulses • Psychosurgery

31. Biomedical Therapy Psychopharmacology – study of the effects of drugs on the mind and behavior • Antipsychotics (thorazine,Chlorpromazine, Clozapine) • Anti-anxiety ( Xanax, Ativan d-cycloserine) • Anti-depressants (Paxil, Prozac, Zoloft – SSRI’s) • Mood Stabilizers Bipolar (lithium, Depakote)

32. Anti-Psychotics • Anti-Psychotic Drugs – drugs used to treat schizophrenia that block receptor sites for dopamine • Thorazine & Chlorpromazine – dampen responsiveness to irrelevant stimuli in schizophrenia patients with positive symptoms –hallucinations and paranoia • Tardive dyskinesia -Sluggishness, tremors, twitches, involuntary movements of face, tongue, limbs from long-term use • Atypical antipsychotics • Block both dopamine and serotonin receptors • Clozapine –used to treat negative symptoms –apathy and withdrawal

33. Anti-Anxiety Drugs • Anti-anxiety drugs – depress central nervous system activity • Xanax & Ativan • D-cycloserine – acts on receptor site that extinguishes learned fear –helps with PTSD and OCD • Addictive • Withdrawal symptoms – increased anxiety and insomnia

34. Anti-Depressants • Anti-depressants – used to treat depression & anxiety by increasing the availability of serotonin and norepinephrine that elevate arousal and mood • Paxil, Prozac, Zoloft (SSRIs) – blocks serotonin reuptake • Dual Action Drugs – block both the reuptake of serotonin and norepinephrine • Delay in increased serotonin due to neurogenesis

35. Alternatives for Depression • Cognitive-Therapy + antidepressants • Cognitive therapy top down • Antidepressant bottoms-up – works on limbic system • Mood Stabilizing Drugs • Lithium – simple salt used to treat Bipolar disorder • Depakote – epilepsy drug used to treat mania • Exercise

36. Brain Stimulation • 3 Types Used to Treat Depression • ECT (Electroconvulsive therapy) – electric shock therapy for patients with sever depression • Can trigger seizures and memory loss • rTMS (repetitive transcranial magnetic stimulation)- repeated pulses of magnetic energy to brain’s surface • No seizures or memory loss • Triggers long-term potentiation of inactive left frontal lobe nerve cells. • Deep Brain Stimulation – uses implanted electrodes to inhibit activity in an area of the cortex that triggers negative emotions

37. Psychosurgery • Psychosurgery – removes or destroys brain tissue • Lobotomy - cut the nerves connecting the frontal lobes to the emotion controlling centers of inner-brain • Once used to calm severely emotional or violent patients • MRI-guided precision surgery – cut brain circuits of severe OCD

38. Preventing Psychological Disorders • Therapeutic Lifestyle Change – reverses the symptoms of psychological disorders • Aerobic exercise, adequate sleep, light exposure, and social engagement, anti-rumination, nutrition • Resilience – ability to cope with stress and recover from adversity