Therapy

1. Chapter 16 Therapy PSYCHOLOGY David G. Myers C. Nathan DeWall Twelfth Edition

2. Chapter Overview • Introduction to Therapy and the Psychological Therapies • Evaluating Psychotherapies • The Biomedical Therapies and Preventing Psychological Disorders

3. The History of Treatment

4. Approach Differences • Psychotherapy • Psychological techniques derived from psychological perspectives • Trained therapist uses psychological techniques to assist someone overcome difficulties or achieve personal growth • Biomedical therapy • Treatment with medical procedures • Trained therapist, most often a medical doctor, offers medications and other biological treatments • Eclectic approach • Uses techniques from various forms of therapy

5. Psychoanalysis • Goals: • Bring patients’ repressed feelings into conscious awareness • Help patients release energy devoted to id–ego–superego conflicts so they may achieve healthier, less anxious lives. • Techniques: • Historical reconstruction, initially through hypnosis and later through free association • Interpretation of resistance, transference

6. Psychodynamic Therapy • Goals: Help people understand current symptoms; explore and gain perspective on defended-against thoughts and feelings • Techniques: Client-centered face-to-face meetings; exploration of past relationship troubles to understand origins of current difficulties

7. Psychoanalysis and Psychodynamic Therapies • Psychodynamic therapy • Influenced by traditional psychoanalysis but differs from it in many ways • Differences • Lack of belief in id, ego, and superego • Briefer, less expensive, and more focused on helping clients find relief from their current symptoms • Helps clients understand how past relationships create themes that may be acted out in present relationships • Interpersonal therapy • Brief 12- to 16-session form of psychodynamic therapy that has been effective in treating depression

8. Humanistic Therapies (part 1) • Humanistic perspective • Theme: Emphasis on people’s potential for self-fulfillment; to give people new insights • Goals:Reduce inner conflicts that interfere with natural development and growth; help clients grow in self-awareness and self-acceptance promoting personal growth • Techniques:Client-centered therapy; focus on taking responsibility for feelings and actions, and on present and future rather than past

9. Understanding Differences • Both psychodynamic and humanistic therapies are insight therapies. • They attempt to improve functioning by increasing clients’ awareness of motives and defenses. • Behavior therapies are not insight therapies. • Their goal is to apply learning principles to modify problem behaviors.

10. Humanistic Therapies (part 2) • Rogers • Person-centered therapy that focuses on person’s conscious self-perceptions; non-directive; active listening; unconditional positive regard • Most people possess resources for growth. • Therapists foster growth by exhibiting genuineness, acceptance, and empathy.

11. Behavior Therapies (part 1) • Classical conditioning techniques • Counterconditioning: Uses classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors • Exposure therapies: Treat anxieties by exposing people (in imaginary or actual situations) to the things they fear and avoid • Systematic desensitization: Associates a pleasant, relaxed state with gradually increasing, anxiety-triggering stimuli

12. Virtual Reality Exposure Therapy • Treats anxiety by creative electronic simulations in which people can safely face their greatest fears, such as airplane flying, spiders, or public speaking

13. Behavior Therapies (part 2) • Aversive conditioning • Goals: • Substitute a negative response for a positive response to a harmful stimulus • Condition an aversion to something the person should avoid • Techniques: • Unwanted behavior is associated with unpleasant feelings • Ability to discriminate between aversive conditioning situation in therapy and other situations can limit treatment effectiveness

14. Aversion Therapy for Alcohol Abuse

15. Behavior Therapies (part 3) • Operant conditioning therapy: Consequences drive behavior; voluntary behaviors are strongly influenced by their consequences. • Behavior modification: Desired behavior is reinforced; undesired behavior is not reinforced, and sometimes punished. • Token economy:People earn a token for exhibiting a desired behavior and can later exchange the tokens for privileges or treats.

16. Behavior Therapies (part 4) • Critics: • How durable are the behaviors? Will people become so dependent on extrinsic rewards that the desired behaviors will stop when reinforcers stop? • Is it right for one human to control another’s behavior? • Proponents: • Treatment with positive rewards is more humane than punishing people or institutionalizing them for undesired behaviors.

17. Cognitive Therapies (part 1) • Cognitive therapies • Teach people new, more adaptive ways of thinking • Based on the assumption that thoughts intervene between events and our emotional reactions • Beck’s therapy for depression • Gentle questioning seeks to reveal irrational thinking and then to persuade people to change their perceptions of their own and others’ actions as dark, negative, and pessimistic • People trained to recognize and modify negative self-talk

18. A Cognitive Perspective on Psychological Disorders

19. Selected Cognitive Therapy Techniques

20. Cognitive Therapies (part 2) • Cognitive-behavioral therapy (CBT) • Integrative therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior) • Aims to alter the way people act AND the way they think • Helps people learn to make more realistic appraisals

21. Group and Family Therapies (part 1) • Group therapy • Conducted with groups rather than individuals • Used when client problems involve interactions with others • Group therapy benefits • Saves therapists’ time and clients’ money • Encourages exploration of social behaviors and social skill development • Enables people to see that others share their problems • Provides feedback as clients try out new ways of behaving

22. Group and Family Therapies (part 2) • Family therapy • Attempts to open up communication within the family and help family members to discover and use conflict resolution strategies • Treats the family as a system • Views an individual’s unwanted behaviors as influenced by, or directed at, other family members

23. Family Therapy • The therapist helps family members understand how their ways of relating to one another create problems. • The treatment’s emphasis is not on changing the individuals, but rather on changing their relationships and interactions.

24. Self-Help Groups • More than 100 million Americans have participated in small religious, interest, or support groups that meet regularly. • In an individualist age, with more people living alone or feeling isolated, the popularity of support groups—for the addicted, the bereaved, the divorced, or simply those seeking fellowship and growth—may reflect a longing for community and connectedness.

25. Comparing Modern Psychotherapies

26. Is Psychotherapy Effective? • Clients’ and therapists’ positive testimonials cannot prove that psychotherapy is actually effective. • The placebo effect makes it difficult to judge whether improvement occurred because of the treatment. • Research indicates that those persons who do not undergo treatment often improve, but those undergoing psychotherapy are more likely to improve more quickly, and with less chance of relapse.

27. Treatment Versus No Treatment

28. Which Psychotherapies Work Best? • Some forms of psychotherapy work best for particular problems. • Cognitive and cognitive-behavioral therapies: anxiety, depression, and posttraumatic stress disorder • Behavioral conditioning therapies: bed-wetting, phobias, compulsions, marital problems, and sexual dysfunctions • Psychodynamic therapy: depression and anxiety • Nondirective (client-centered) counseling: mild to moderate depression

29. Evidence-Based Clinical Decision Making

30. Evaluating Alternative Therapies • Alternative therapies • Abnormal states often return to normal and the placebo effect can mislead effectiveness evaluation • Eye movement desensitization and reprocessing • Some effectiveness shown—not from the eye movement but rather from the exposure therapy nature of the treatments • Light exposure therapy • Provides relief from depression symptoms for persons with a seasonal pattern of major depressive disorder by activating a brain region that influences arousal and hormones

31. How Do Psychotherapies Help People? • Three basic benefits for all psychotherapies • Hope for demoralized people • New perspective for oneself and the world • Empathic, trusting, caring relationship (therapeutic alliance)

32. Culture and Values in Psychotherapy • Psychotherapists’ personal beliefs and values influence their practice. • Differences in cultural and moral diversity and religious values can create a mismatch.

33. Finding a Mental Health Professional • A person seeking therapy is encouraged to ask about • Treatment approach • Values • Credentials • Fees • An important consideration is whether the potential client feels comfortable and able to establish a bond with the therapist.

34. Therapists and Their Training

35. The Biomedical Therapies and PreventingPsychological Disorders • Psychopharmacology • Study of drug effects on mind and behavior • Has helped make drug therapy the most widely used biomedical therapy • Drug therapies • The most widely used biomedical treatments • 27 million Americans take prescribed antidepressants • Placebo and double-blind techniques are used to evaluate drug effectiveness

36. The Biomedical Therapies • Most common drug treatments for psychological disorders • Antipsychotic drugs • Antianxiety drugs • Antidepressant drugs • Mood-stabilizing medications Let’s take a closer look at each of these.

37. Drug Therapies (part 1) • Antipsychotic drugs • Mimic certain neurotransmitters (e.g., block or increase activity of dopamine); reduce overreaction to irrelevant stimuli • May produce sluggishness, tremors, twitches, and tardive dyskinesia; Thorazine • Successfully used with life-skills programs and family support to treat schizophrenia • Antianxiety drugs • Depress CNS activity; Xanax, Ativan • Used in combination with psychological therapy • May reduce symptoms without resolving underlying problems; withdrawal linked to increased anxiety and insomnia

38. Drug Therapies (part 2) • Antidepressant drugs • Increase availability of norepinephrine or serotonin; promote birth of new brain cells • Slow synaptic vacuuming up of serotonin (SSRIs) • Effectiveness sometimes questioned due to spontaneous recovery and placebo effect • Mood-stabilizing medications • Depakote: Controls manic episodes • Lithium: Levels out the emotional highs and lows of bipolar disorder

39. Biology of Antidepressants

40. Brain Stimulation (part 1) • Electroconvulsive therapy (ECT) • Manipulates the brain by shocking it • Involves administration of a general anesthetic and muscle relaxation to prevent convulsions • Causes less memory disruption than earlier versions • AMA concluded that ECT methods have some of the most positive treatment effects; reduce suicidal thoughts • Several theories about the reason for its effectiveness

41. Brain Stimulation (part 2) • Alternative neurostimulation therapies • Transcranial electrical stimulation (tDCS): Administers a weak (1- to 2-milliamp) current directly to the scalp. Skeptics argue that such a current is too weak to penetrate to the brain; studies do not confirm cognitive benefits • Repetitive transcranial magnetic stimulation (rTMS): Sends magnetic energy to brain surface through coiled wire held close to brain; fewer side effects; modest effectiveness • Deep brain stimulation: Manipulates the depressed brain via pacemaker; stimulates inhibition activity related to negative emotions and thoughts

42. Brain Stimulation (part 3) • Psychosurgery • Removes or destroys brain tissue in an effort to change behavior • Is irreversible; least used biomedical therapy • Lobotomy • Psychosurgical procedure once used to calm uncontrollably emotional or violent patients • Cuts the nerves connecting the frontal lobes to the emotion-controlling centers of the inner brain (Moniz) • Today, less invasive techniques are used; MRI-guided surgery may be performed in severe disorders

43. Comparing Biomedical Therapies

44. Preventing Psychological Disorders and Building Resilience • Preventive mental health programs work to build resilience. • Based on the idea that many psychological disorders could be prevented by changing oppressive, esteem-destroying environments into more benevolent, nurturing environments that foster growth and self-confidence • Resilience • Personal strength that helps most people cope with stress and recover from adversity and trauma • Can be seen in New Yorkers after 9/11, patients who experience spinal cord injury, and Holocaust survivors, among others