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Treatment Modalities for Psychological Disorders. “Brutal” to “Gentle” Transition. Dorothea Dix and Philippe Pinel (mid 1800s) Advocates of mental hospitals to provide more human treatment Mid 1950s: exodus from mental hospitals: Introduction of therapeutic drugs
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“Brutal” to “Gentle” Transition • Dorothea Dix and Philippe Pinel (mid 1800s) • Advocates of mental hospitals to provide more human treatment • Mid 1950s: exodus from mental hospitals: • Introduction of therapeutic drugs • Community-based treatment programs
Two Main Treatment Modalities • Psychotherapy • Biomedical therapy • Combination of the two • 50% of psychotherapists say they use an “ecclectic approach,” using a blend of therapies
4 Main Psychological Therapies • 1. Psychoanalysis • Sigmund Freud • 2. Humanistic • Carl Rogers • 3. Behavioral • Pavlov/Skinner • 4. Cognitive • Aaron Beck
1. Psychoanalysis • Psychological problems = • Repressed impulses and conflicts from childhood • Aim: work through ‘buried’ feelings and take responsibility for their own growth • Release energy ‘wasted’ on id-ego-superego conflicts
1. Psychoanalysis • How does it work? • Free association • But watch out for “resistance”… blocks in the flow of free association • Therapist would interpret the ‘meaning’ of your resistance • Interpretation of latent content in dreams
1. Psychoanalysis • One result of therapy: • Transference • Occasionally followed by “Countertransference” • This is why the APA has a “Code of Ethics”!
1. Psychoanalysis • Be ready to open you wallet! • Traditional psychoanalysis is 3-4 visits/week for several years • Conservatively speaking, at $125/hour, this is $68,250 for 3 years • Maybe just take a few nice vacations!
1. Psychoanalysis • Modern “alternative” is: • Psychodynamic Therapy • Goal is to understand current symptoms in terms of childhood and important relationships • Face-to-face; generally once a week for several months
2. Humanistic Therapy • Carl Rogers (1902-1987) • “Client-centered therapy” (Not “patient”) • Aim is to grow in self-awareness and acceptance • Focus is on: • Dealing with present & future • Conscious thoughts rather than unconscious • Taking responsibility for one’s feelings & actions
2. Humanistic Therapy • Therapists strive to exhibit : • Genuineness • Acceptance • Empathy • Which leads to “unconditional positive regard” • Mechanism: “Active Listening”
3. Behavior Therapies • You don’t need “self-awareness” to heal from psychological problems! • A. Classical Conditioning Techniques • B. Operant Conditioning Techniques
3A. Classical Conditioning • “Counter-conditioning”: Pair the trigger stimulus with a new response (relaxation) • Idea: can’t be both fearful AND relaxed • Two techniques: • Exposure therapy • Aversive conditioning
3A. Classical Conditioning • Exposure Therapy/Response Prevention (ERP)
3A. Classical Conditioning • Aversive Conditioning: Substitute an aversive response for a positive response to a harmful stimulus Also, Faradic aversion conditioning!
3B. Operant Conditioning • Behavior Modification • Use positive reinforcers to shape behavior
3B. Operant Conditioning • Token Economies
3B. Operant Conditioning • Concerns with Behavior Modification • How ‘durable’ are the effects? • It is OK for one human to control another’s behavior?
4. Cognitive Therapy • Works with the assumption that our thoughts color our feelings • Aaron Beck: Expose irrational thinking, and then persuade the person to remove the dark glasses through which they view life
Therapies to Avoid! • Energy therapy – manipulating invisible energy fields • Recovered-memory therapy • Rebirthing therapy • Facilitated communication • Crisis debriefing
Biomedical Therapies: Drugs • Antipsychotic Drugs • Antianxiety Drugs • Antidepressant Drugs • Mood-Stabilizing Drugs
Biomedical Therapies: Adjuncts or Alternatives to Drugs • Electroconvulsive Therapy • Magnetic Stimulation • Deep-Brain Stimulation
Biomedical Therapies: Drugs • Antipsychotic Drugs • Most common drugs help alleviate “positive” symptoms of schizophrenia • Ex. Chlorpromazine (Thorazine) • Work by blocking activity of dopamine • Major side-effects: tardivedyskinesia, obesity, diabetes
Biomedical Therapies: Drugs • “Atypical” Antipsychotic Drugs • Help alleviate ‘negative’ symptoms of schizophrenia • Ex. clozapine (Clozaril)
Biomedical Therapies: Drugs • Anti-anxiety Drugs • Examples: Xanax, Atavan, Valium • ALL depress the central nervous system • Anti-anxiety drugs plus ________ make a lethal combination? • ALCOHOL!
Biomedical Therapies: Drugs • Anti-anxiety Drugs • Criticisms: • 1. do not treat underlying problem, just symptoms • 2. Psychological dependence: “popping a Xanax” • 3. Physiological dependence: cessation of drug can lead to great anxiety and insomnia • New standard drug treatment for anxiety….
Biomedical Therapies: Drugs • Antidepressant Drugs • Also successfully treat anxiety disorders in addition to depression • Selective-serotonin-reuptake inhibitors (SSRIs) • Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine)
Biomedical Therapies: Brain Stimulation • Electroconvulsive Therapy • 1938: 100 volts administered to wide-awake patient • Today: general anesthesia, muscle relaxant, 30 second electrical stimulation • Refractory Depression: 80% of patients improve with ECT, but 4 in 10 relapse within 6 months
Biomedical Therapies: Brain Stimulation • Electroconvulsive Therapy
Biomedical Therapies: Brain Stimulation • Alternative Neurostimulation • 1. Magnetic Stimulation: repetitive transcranialmegnetic stimulation (rTMS)
Biomedical Therapies: Brain Stimulation • Alternative Neurostimulation • 2. Deep-Brain Stimulation
Biomedical Therapies: Psychosurgery • Frontal Lobotomy • 1930s, Portuguese physician, Dr. Moniz • In the U.S. during 1950s: 35,000 lobotomies performed • J.F. Kennedy’s sister, Rosemary, received a lobotomy • No longer performed • Nobel Peace Prize awarded to Moniz
Therapeutic Life-Style Change • Aerobic exercise: 30 min. 3x a week • Adequate sleep: 7-8 hours per night • Light exposure • Social connection • Anti-rumination • Nutritional supplements: omega-3 fatty acids