Understanding Biological and Drug Therapies in Mental Health

1. TherapiesChapter 16 AP Psychology Alice F. Short Hilliard Davidson High School

2. Chapter Preivew • Biological Therapies • Psychotherapy • Sociocultural Approaches and Issues • Effectiveness of Psychotherapy • Therapies and Health and Wellness

3. Biological Therapies • Biomedical Approach • reduce/eliminate symptoms by altering body functioning • Common Forms of Biological Therapy • drug therapy • electroconvulsive therapy (ECT) • psychosurgery

4. Drug Therapy • antianxiety drugs – commonly known as tranquilizers, drugs that reduce anxiety by making the individual calmer and less excitable • benzodiazepines – the antianxiety drugs that generally offer the greatest relief for anxiety symptoms • potentially addictive • bind to receptor cites of neurotransmitters that become overactive during anxiety • examples: Xanax, Valium, Librium • nonbenzodiazepine– buspirone(BuSpar) – used to treat generalized anxiety disorder

5. Drug Therapy • antidepressant drugs – drugs that regulate mood • tricyclics – 3-ringed molecular structure • believed to work by increasing neurotransmitters, especially serotonin and norepinephrine • reduce symptoms of depression in 60-70 percent • takes 2-4 weeks to improve mood • side effects: restlessness, faintness, trembling, sleepiness, memory difficulties • tetracyclics – 4-ringed molecular structure • a.k.a. noradrenergic and specific serotonergic antidepressants (NaSSAs) • increases norepinephrine and serotonin • example: Remeron (mertazapine) – most effective in reducing depression • monoamine oxidase (MAO) inhibitors • block the enzyme monoamine oxidase (which breaks down serotonin and norepinephrine • worse side effects: high blood pressure, stroke (esp. with fermented foods, drugs) • selective serotonin reuptake inhibitors (SSRIs) • interfere with the reabsorption of serotonin in the brain • examples: Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline) • fewer side effects, still: insomnia, anxiety, headache, diarrhea, impaired sexual functioning

6. Antidepressant Drugs • 1996  2005 – number of Americans prescribed antidepressants doubled • anxiety disorders: generalized anxiety disorder, obsessive-compulsive disorder, social anxiety disorder • PTSD • Bipolar Disorder • lithium – the lightest of the solid elements in the periodic table of elements • effective dosage is precariously close to toxic levels • influences serotonin and norepinephrine (how unknown) • weight gain, going off drug • Risks of Antidepressants for Children • FDA hearings on risk of suicide (2004) • “Black Box” warning

7. Drug Therapy • antipsychotic drugs – powerful drugs that diminish agitated behavior, reduce tension, decrease hallucinations, improve social behavior, and produce better sleep patterns in individuals with a severe psychological disorder, especially schizophrenia • small dosages over time, may combine with vocation, family and social skills training • neuroleptics (side effect - tardive dyskinesia) • most used • ability to block dopamine action in the brain • tardive dyskinesia – a neurological disorder characterized by involuntary random movements of the facial muscles, tongue and mouth, as well as twitching of the neck, arms and legs • 20% on neuroleptics develop (can develop w/o drugs • atypical antipsychotic medications (introduced 1990s) • lower side effects • affects dopamine and serotonin (mechanism unknown) • examples: Clozaril (clozapine), Risperdal (risperidone)

8. Drug Therapy

9. Biological Therapies • electroconvulsive therapy (a.k.a. shock therapy) • small electric current produces a brief seizure • used to treat major depressive disorder which has not responded to other treatments • deep brain stimulation – a procedure for treatment-resistant depression that involves the implantation of electrodes in the brain that emit signals to alter the brains electrical circuitry • treatment-resistant depression, OCD • nucleus acumbens • improved dramatically, still memory loss and cognitive impairments • for acute depression, great risk of suicide

10. Biological Therapies • psychosurgery – a biological therapy, will irreversible effects, that involves removal or destruction of brain tissue to improve the individuals adjustments • prefrontal lobotomies • coined by Walter Freemen, “lobotomobile” • today: small lesion in amygdala or another part of the limbic system • OCD • major depression • bipolar disorders • not schizophrenia

11. Insight Therapies • insight therapies – encourage self-awareness as the key to psychological health • psychodynamic therapies • humanistic therapies

12. Psychotherapy • psychotherapy (face-to-face and cybertherapy) a nonmedical process that helps people with psychological disodresrecognize and overcome psychological and interpersonal difficulties • 32% in 1996  20% in 2005 • Preview of Psychotherapies • psychodynamic therapies • humanistic therapies • behavior therapies • cognitive therapies

13. Psychodynamic Therapies • Emphasis of this Approach • unconscious mind • therapeutic interpretation • early childhood experiences • Goals of Therapy • recognize maladaptive coping strategies • identify sources of unconscious conflicts

14. Psychodynamic Therapies • Freudian Psychoanalysis – Freud’s therapeutic technique for analyzing an individual’s unconscious thoughts • free association – a psychoanalytic technique that involves encouraging individuals to say aloud whatever comes to mind, no matter who trivial or embarrassing • catharsis – the release of emotional tension a person experiences when reliving an emotionally charged and conflicting experience • interpretation – a psychoanalyst’s search for symbolic, hidden meanings in what the client says and does during therapy • dream analysis – a psychoanalytic technique for interpreting a person’s dreams • manifest content • latent content • transference – a client's relating to the psychoanalyst in ways the reproduce or relive important relationships in the individual’s life • resistance – a client’s unconscious defense strategies that interfere with the psychoanalysts understanding of the individuals problems • examples: showing up late/missing sessions, arguing, faking free associations • Contemporary Psychodynamic Therapies • still interested in childhood trauma • accord more power to the conscious mind and a person’s current relationships • less emphasis on sex • Heinz Kohut(1977) – therapist replaces unhealthy childhood relationship (empathic, understanding)

15. Humanistic Therapies • humanistic therapies – treatments, unique in their emphasis on people’s self-healing capacities, that encourage clients to understand themselves and to grow personally • self healing • conscious thoughts • self-fulfillment • goals of therapy • self-understanding • personal growth

16. Roger’s Client-Centered Therapy • client-centered therapy – also called Rogerian therapy or nondirective therapy, a form of humanistic therapy, developed by Rogers, in which the therapist provides a war, supportive atmosphere to improve the client’s self-concept and to encourage the client to gain insight into problems • identify and understand his or her own genuine feelings • warm, supportive atmosphere • active listening • reflective speech – a technique in which the therapist mirrors the client’s own feelings back to the client • Roger’s3 essential elements to grow: • unconditional positive regard • empathy • genuineness

17. Behavior Therapies • behavior therapies – treatments, based on the behavioral and social cognitive theories of learning, that use principles of learning to reduce or eliminate maladaptive behavior • emphasis: overt behavior change rather than insights into self or into underlying causes • goal: reduce or eliminate maladaptive behaviors • common methods: classical and operant conditioning

18. Behavior Therapies • Classical Conditioning Techniques Treating Phobias • systematic desensitization – a method of behavior therapy that treats anxiety by teaching the client to associate deep relaxation with increasingly intense anxiety-producing situations (p. 533) • develop hierarchy of fearful scenes • learn relaxation techniques • apply relaxation while imagining fearful scenes • Flooding • intense exposure to feared stimuli without allowing avoidance

19. Desensitization for Test Anxiety

20. Aversive Conditioning • noxious stimuli paired with conditioned stimulus

21. Behavior Therapies • Operant Conditioning Techniques… • unlearning maladaptive behavior (e.g., OCD) through altered consequences. • Applied Behavior Analysis • positive reinforcement of adaptive behaviors • extinguish maladaptive behaviors • does not depend on gaining insight

22. Cognitive Therapies • cognitive therapies • Emphasis of this Approach • thoughts (cognitions) are the primary source of psychological problems • how we think controls how we feel • attempt to change the individual’s feelings and behaviors by changing cognitions • focus on overt problems (unlike Freud) • structured analysis and specific guidance (unlike Rogers) • Goals of Therapy • cognitive restructuring – a general concept for changing a pattern of thought that is presumed to be causing maladaptive behavior or emotion

23. Cognitive Therapies • Albert Ellis’s Rational-Emotive Behavior Therapy • assertion that individuals develop a psychological disorder because of irrational and self-defeating beliefs • eliminate beliefs through rational examination • directive, persuasive, confrontational • musterbating • Beck’s Cognitive Therapy • illogical automatic negative thoughts • identify and challenge automatic thoughts • reflective, open-ended dialogue, less directive • Both are more effective in treating depression than drugs.

24. Cognitive Therapy Techniques • challenge idiosyncratic meanings • question the evidence • reattribution • examine options and alternatives • decatastrophize • fantasize consequences • examine advantages and disadvantages • turn adversity to advantage • guided association • scaling • thought stopping • distraction • labeling of distortions

25. Cognitive-Behavior Therapy • Albert Banduraand Self Efficacy • self-efficacy – concept that one can master a situation and produce positive outcomes • cognitive-behavior therapy – a therapy that combines cognitive therapy and behavior therapy with the goal of developing self-efficacy • self-defeating thoughts • incorporates behavior therapy • self-instructional methods

26. Therapy Integrations • Techniques from different therapies are combined for the benefit of the client (e.g., dialectical behavior therapy).

27. Comparing Psychotherapies • integrative therapy – a combination of techniques from different therapies based on the therapist’s judgment of which particular methods will provide the greatest benefit for the client • most therapists use an eclectic approach

28. How Does Therapy Affect the Brain? • Brain Imaging Studies • use of functional magnetic resonance imaging (fMRI) • shows that brain function can be normalized (e.g., cognitive remediation therapy increases prefrontal cortex activity in schizophrenics)

29. Sociocultural Approaches • Emphasis • influence of various social/cultural factors • Approaches to Therapy • group therapy – a sociocultural approach to the treatment of psychological disorders that brings together individuals who share a particular psychological disorders in sessions that are typically led by a mental health professional • family therapy – group therapy with a family • validation • reframing • structural change • detriangulation – shift attention away from scapegoat • couples therapy – group therapy with married or unmarried couples whose major problem lies within their relationship • self-help support groups • community mental health

30. Sociocultural Approaches and Issues • Group Therapy • group shares disorder • professional facilitates • Family and Couples Therapy • symptoms are a function of relationships • therapeutic techniques • validation • reframing • structural change • detriangulation

31. Sociocultural Approaches and Issues • Self-Help Support Groups • conducted by paraprofessionals – individuals who have been thought by a professional to provide some mental health services but who not have formal mental health training • Community Mental Health Act of 1963 • deinstitutionalization (rise in homelessness) – large numbers of individuals with psychological disorders were transferred from mental institutions to community based facilities • prevention • empowerment

32. Sociocultural Approaches and Issues • Cultural Perspectives • individualistic v. collectivistic cultures • ethnicity • match between client and therapist • gender • balance between independence and relatedness • feminist therapies

33. Effectiveness of Psychotherapy • Research results show that all therapies are “winners”. • Common Themes in Successful Psychotherapy • expectations of help • increased sense of competence • emotional arousal is a motivator • therapeutic alliance - the relationship between the therapist and client—an important element of successful psychotherapy • client factors (active engagement)

34. Effectiveness of Psychotherapy

35. Effects of Therapy on Health and Wellness • stress reduction in cancer patients • reduces physical health risks in those who are depressed • not only reduces symptoms, but enhances psychological wellness • well-being therapy (WBT) • short-term, problem-focused, directive • notice and celebrate positive experiences

36. Chapter Summary • Describe the biological approaches to therapy. • Define and characterize four types of psychotherapy. • Explain the sociocultural approaches and issues in treatment. • Discuss the effectiveness of psychotherapy. • Discuss the impact that therapy has on health and wellness.

37. Chapter Summary • Biological Therapies • drug therapy • electroconvulsive therapy • psychosurgery • Psychodynamic Therapies • Freud’s psychoanalysis • Humanistic Therapies • Rogers’s client-centered therapy

38. Chapter Summary • Behavior Therapies • systematic desensitization and flooding • aversive conditioning • Cognitive Therapies • Ellis’s rational-emotive behavior therapy • Beck’s cognitive therapy • cognitive-behavior therapies

39. Chapter Summary • Sociocultural Approaches and Issues • group, family, and couples therapy • self-help groups and community mental health • cultural perspectives • Effectiveness of Psychotherapy • Therapies and Health and Wellness • physical health and preventing disorders