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Chapter 17 pt. 2: Cognitive and Biomedical Therapy. The Most Dominant Therapy is the Cognitive Approach. Most Common Illnesses Treated in Cognitive Perspective. 1. Depression 2. Eating Disorders 3. Chronic Pain 4. Marital Problems 5. Anxiety Disorders.
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Most Common Illnesses Treated in Cognitive Perspective • 1. Depression • 2. Eating Disorders • 3. Chronic Pain • 4. Marital Problems • 5. Anxiety Disorders
Assumption and Goal of Cognitive Therapy • Cognitive Therapy assumes that thoughts exist between events and responses. A person’s response depends on how they interpret the situation. • Goal of Cognitive therapy is to teach people new and more realistic, helpful, and adaptive patterns of thinking and acting. • Want to See glass half-full instead of half-empty!!
Two Major Therapies where Cognition Is A Strong Focus • 1. Aaron Beck’s Cognitive Therapy • 2. Albert Ellis’s Rational Emotive Therapy
Aaron Beck’s Views on Depression (NOT IN BOOK) • Beck believed the key to understanding depression was in an individual’s thought patterns. • Argued depressed people’s negative thought patterns and creation of negative schemas caused them to misinterpret the world which often caused them to feel worthless and incompetent. • Depressed people tend to view world with “dark sunglasses.”
Beck’s Examples of Negative Schemas (NOT IN BOOK) • Arbitrary Interference: drawing negative conclusions from an event without any evidence. • Ex: After an argument thinking “that person hates me.” • Dichotomous Thinking: irrational all or nothing thinking. • Ex: “I can’t be happy unless everyone likes me.”
Aaron Beck’s Cognitive Triad Theory of Depression • Beck developed a cognitive triad which looked at what person thinks about: • 1. His/Her Self • 2. His/Her World • 3. His/Her Future • Depressed people tended to have negative perceptions in all three areas.
Martin Seligman’s Theory of Explanatory Styles Effect on Depression • Depressed people tend to explain negative external events with a negative explanatory style. • Depressed people usually view problems as: 1. Personal: They caused the negative events; 2. Pervasive: the negative events will affect everything they do; 3. Permanent: and the negative events will last forever. • Belief Styles can lead to learned helplessness.
Pervasive Pessimism Also Tied to Locus of Control • If do good in the stock market it was luck (don’t have any control) if they do bad it was their fault (do have control) • Optimists believe good things happen because they’re smart and successful (their own control) and bad things are isolated occurrences (out of their control) • Pessimists shrug off the good and internalize the bad. Optimists do the opposite.
Rational Emotive Therapy is a Form of Cognitive-Behavior Therapy • Cognitive-Behavior Therapy: aims to alter the way people think (ex: irrational thought patterns) and act (ex: compulsions).
Albert Ellis’s Rational Emotive Behavior Therapy (NOT IN BOOK) • Albert Ellis also believed that people’s maladaptive thoughts led to maladaptive emotional responses (behaviors). • He promoted a form of treatment known as Rational Emotive Behavior Therapy: involves getting patients to recognize the irrationalities within their thought patterns and helping them create healthier forms of thinking and behaving.
Effectiveness of Psychotherapy? How do We Evaluate? • Is it therapy that helps people get better or would it occur naturally? • Regression towards the Mean: the tendency for for unusual emotions (depression/sadness) or events to return (regress) toward their average state with time.
Effectiveness of Psychotherapy? How do We Evaluate? • In order to test impact of treated vs. untreated, studies using meta-analysis must be used. • Meta-analysis: procedure for statistically combining the results of many different research studies.
Review: Who Conducts Therapy? • Clinical psychologists • Most are psychologists with a Ph.D. and expertise in research, assessment, and therapy, supplemented by a supervised internship. • About half work in agencies and institutions, half in private practice. • May work in conjunction with a psychiatrist.
Review: Who Conducts Therapy? • Counseling Psychologists • Marriage and family counselors specialize in problems arising from family relations. • Typically have one of advanced degrees • Pastoral counselors provide counseling to countless people. • Abuse counselors work with substance abusers and with spouse and child abusers and their victims.
Review: Who Conducts Therapy? • Psychiatrists • Physicians who specialize in the treatment of psychological disorders. • Not all psychiatrists have had extensive training in psychotherapy, but as M.D.s they can prescribe medications. Thus, they tend to see those with the most serious problems. • Many have a private practice.
Therapies outside of Psychotherapy Are Often Biomedical • The biomedical perspective focuses on altering body chemistry. • Biomedical perspective is rooted in discoveries of psychopharmacology: study of the effect of drugs on the mind and behavior.
State and county mental hospital residents, in thousands 700 600 500 400 300 200 100 0 Introduction of antipsychotic drugs Rapid decline in the mental hospital population 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 Year Social Effects of Drug Treatments
Drug Treatments: Antipsychotics (Neuroleptics) • Antipsychotics are used to treat psychotic disorders like schizophrenia. • Antipsychotics helps those experiencing both positive and negative symptoms. • Most Common Examples: • Thorazine: alleviates delusions/hallucinations (positive symptoms). • Clozaril: alleviates negative symptoms and social withdrawal. Also prescribed for those at risk for suicide.
Neuroleptics (Antipsychotics) Affect on Neurotransmitters • Drugs act as an antagonist and block dopamine receptors at the synapse to REDUCE the amount of dopamine in the brain. • Side affects are numerous: • Most worrisome is tardive dyskinesia: produces an incurable disturbance of motor controls (shaking, tremors), especially of the facial muscles. • Others include general lethargy, possible increase in negative symptoms, and sexual dysfunction.
Drug Treatments: Anti-Anxiety (Anxiolytics) • Anti-Anxiety drugs depress nervous system activity; (often called tranquilizers) • Drugs reduce stress and suppress anxiety. • Most common examples are (KNOW THESE): • Valium • Librium • Xanax
Anti-Anxiety Drugs Affect on Neurotransmitters • Most modern anti-anxiety compounds are in a prescribed class called benzodiazepines which include valium and xanax. • Work by increasing the activity of the neurotransmitter GABA (relaxation neurotransmitter, calming affect) • Benzodiazepines do have a high risk of physical and psychological addiction.
Drug Treatments: Anti-depressants • Most anti-depressants increase the availability of norepinephrine and serotonin which elevates arousal and mood. • Most common examples are (KNOW THESE): • Prozac • Zoloft • Paxil
Antidepressants Affect on Neurotransmitters • Most common antidepressants are known as Selective Serotonin Reuptake Inhibitors (SSRI’s): which prevent the reuptake of the neurotransmitter and allow INCREASED LEVELS OF SEROTONIN. Prolonged effect often lifts depressed mood. • Other types of antidepressants also lift norepinephrine which increases energy levels in addition to serotonin. • Drawback: antidepressants take few weeks to start working.
Drug Treatments:Mood Stabilizers for Bipolar Disorder • Most common is the salt lithium (carbonate) is most frequently used to treat the mood swings of bipolar disorder. • Decreases adrenaline and increases serotonin. • Often can have dangerous side effects including being toxic at high doses
Drug Treatments: Stimulants • Stimulants are often used to treat Attention-Deficit/Hyperactivity disorder (ADHD): a common problem for children who have difficulty controlling their behavior and focusing their attention. • Although its exact mechanism is unknown the stimulants have a calming and focusing effect in children by increasing neurotransmitters associated with such processes.
Electroconvulsive Therapy (ECT) • Electroconvulsive Therapy: used to treat the severely depressed after other treatments have failed. • Success rate is high. • Side effects can include some memory loss.
Psychosurgery is Most Drastic Intervention • Psychosurgery involves removing or destroying brain tissue in an effort to change behavior. • Best known procedure is a lobotomy: Ice pick like instrument is put through the eye sockets cutting the links between the frontal lobes and the emotional control centers. Used to be used to “cure” uncontrollably violent patients but now very rare.
