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Therapy

Chapter 13

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Therapy

Treating Psychological DisordersThe Psychological Therapies

Psychoanalysis

Humanistic Therapies

Behavior Therapies

Cognitive Therapies

Group and Family Therapies

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Therapy

Evaluating Psychotherapies Is Psychotherapy Effective?

Which Therapies Work Best?

How Do Psychotherapies Help People?

Culture and Values in Psychotherapy

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Therapy

The Biomedical Therapies Drug Therapies

Brain Stimulation

Psychosurgery

Therapeutic Lifestyle Change

Preventing Psychological Disorders

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Treating Psychological Disorders• In earlier times, efforts to treat psychological

disorders were often cruel and often based on irrational beliefs

• The chair on the right was once considered a more humane form of treatment.

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Treatment Reformers

• Reformers pushed for gentler, more humane treatments– Constructed mental hospitals

• Since 1950s mental hospitals have been emptied in favor of drug therapies and community-based treatments

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Today’s Therapies

• Psychotherapy: treatment involving psychological techniques

• Biomedical therapy: Prescribed medications or medical procedures

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The Psychological Therapies

• The most influential types of psychotherapies:– Psychoanalytic– Humanistic– Behavioral– Cognitive

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Psychoanalysis

• Originally developed by Freud• Today, not generally practiced as Freud did

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Psychoanalysis

• Goals– Bring patients’ repressed feelings

into conscious awareness– Giving them insight into the origins of

their disorder

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Techniques of Psychoanalysis

• Free association– Talking about whatever comes to mind– The psychoanalyst’s interpretation may

provide the patient with insight

• Transference: the patient may transfer to the analyst emotions linked to other people—e.g., mother or father

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Psychoanalysis

• Few U.S. therapists offer traditional psychoanalysis– Can take years of several sessions per week

• Contemporary psychodynamic therapies have evolved from psychoanalysis

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Psychodynamic Therapy

• Tries to help people understand their symptoms by focusing on important relationships such as childhood experiences– Usually one-on-one, rather than group sessions– Shorter time frame than traditional psychoanalysis

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Humanistic Therapies

• Therapists aim to boost patients’ self-acceptance

– Differences from psychoanalytic therapies• Focuses on growth, not curing illness• Path to growth is taking responsibility for one’s feelings

and actions• Conscious thoughts are more important than unconscious• The present and future are more important than the past

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Humanistic Therapies

• Client-centered therapy– Developed by Carl Rogers– Combines active listening with a genuine, accepting,

empathic, environment to promote clients’ growth– Includes unconditional positive regard from the

therapist

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Active Listening

Hints for active listening, even among friends

1.Summarize– Repeat the other’s statements in your own

words

2.Invite clarification– “What might be an example of that?”

3.Reflect Feelings– “It sounds frustrating.”

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Behavior Therapies

• Applies learning principles to the elimination of unwanted behaviors

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Classical Conditioning Techniques

• Maladaptive symptoms may be examples of conditioned responses

• Treatment for bed-wetters (O.H. Mowrer)– Connect liquid-sensitive pads to an alarm– Associates urinary relaxation with waking, stops the bed-wetting

• Counter conditioning: pairs the trigger stimulus (e.g., enclosed space) with a new response (e.g., relaxation)– Exposure therapies– Aversive conditioning

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Exposure Therapies

• Treat anxiety by exposing people to the things they fear and avoid

• Systematic desensitization: associates a relaxed state with gradually increasing anxiety-triggering stimuli

• Virtual reality exposure therapy: progressively exposes people to simulations of their greatest fears

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Aversive Conditioning

• Associates an unpleasant state with an unwanted behavior—e.g., Anabuse

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Operant Conditioning

• Behavior modification:– Reinforce desirable behaviors– Don’t reinforce (or even punish) undesirable

behaviors– Useful for solving specific behavior problems

• Token economy: a procedure in which people earn a token for exhibiting a desired behavior, and can later exchange the tokens for privileges or treats

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Cognitive Therapies

• Cognitive therapies teach people new, more adaptive ways of thinking and acting

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A Cognitive Perspective

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Beck’s Therapy for Depression

• Aaron Beck and his colleagues developed cognitive therapy– Gentle questioning seeks to reveal irrational

thinking and then persuade people to stop viewing life in a gloomy way.

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Beck’s Therapy for Depression

• Many students become anxious before an exam– “This exam’s going to be impossible”– “I wish I were better prepared”

• To change negative self-talk, therapists teach people to alter their thinking in stressful situations– “I’ve studied well, now it’s time to show what I know”

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Cognitive-Behavioral Therapy

• Integrates cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior)– Shown to be effective at treating anxiety

disorders (like OCD) and depression– According to Albert Ellis--feeling better is not

enough: “You have to back it up with action, action, action.”

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Group and Family Therapies

• Most therapies may also occur in small groups

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Group and Family Therapies

• Unique benefits– Relief to find that others share your problems– Receive feedback as you try out new

behaviors

• Family therapy treats the family as a system. View an individual’s unwanted behaviors as influenced by or directed at other family members

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Evaluating Psychotherapies

• Is Psychotherapy Effective?

• Which Therapies Work Best?

• How Do Psychotherapies Help People?

• Culture and Values in Psychotherapy

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Is Psychotherapy Effective?

• Clients’ Perceptions: Almost 90% of patients at least “fairly well satisfied”

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Is Psychotherapy Effective?

• Clinician’s Perceptions– Therapists tend to be aware of their own

successes and the failures of others

• To objectively evaluate psychotherapies, psychologists turn to controlled research studies

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Outcome Research

• Eysenck (1952) showed with or without therapy, about two-thirds of patients show improvement with time

• Today, randomized clinical trials show that psychotherapy works– Those not undergoing therapy often improve,

but those undergoing therapy are more likely to improve

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Outcome Research

• NIMH Study– Experienced therapists trained in cognitive

therapy, interpersonal therapy, or drug therapy

– 239 depressed participants randomly assigned to one of those 3 or control group

– After 16 weeks, depression lifted for more than half in each of treatment groups

– Only 29% improved in control group

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Outcome Research

Figure is a compilation of 475 studies

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Which Therapies Work Best?

• No one type of therapy is best across the board

• Some forms work best for particular problems– Behavior conditioning (behavior) for specific

behavior problems (bed-wetting, phobias, compulsions)

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When to Seek Treatment

Adapted APA list of warning symptoms, which don’t include relationship problems:

- Feeling worthless - Withdrawing from others- Deep, lasting depression - Fears preventing daily life- Self-destructive behavior - Problems with substance abuse- Extreme mood shifts - Wanting to die or hurt self- Compulsive rituals - Sexual difficulties affecting daily life- Hearing voices or seeing things that others don’t perceive

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The Biomedical Therapies

• Drug Therapies

• Brain Stimulation

• Psychosurgery

• Therapeutic Life-Style Change

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Drug Therapies• Increase in use of drug therapies coincides

with an emptying of U.S. mental hospitals

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1960 versus 2000• U.S. population

– 1960 180,000,000– 2000 280,000,000

• Mental Hospital population– 1960 550,000 550,000/180,000,000 = .0031– 2000 75,000

• Incidence of hospitalization– The 1960 incidence was .0031– Had it remained at the 1960 level, it would

have risen to 1,150,000 in 2000

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Drug Therapies

• To judge the effectiveness of a new treatment, we need to compare its effectiveness to the rates of the following: – Normal recovery among untreated people– Recovery due to the placebo effect

• In double-blind (neither scientist nor subject know who is getting the real drug) studies, several types of drugs have proven useful in treating psychological disorders

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Antipsychotic Drugs

• Drugs used to treat schizophrenia and other forms of severe thought disorders

• Useful for treating positive symptoms– E.g., hallucinations, paranoia

• Not as helpful in treating negative symptoms– E.g., apathy, withdrawal

• Work by blocking dopamine receptors, mimicking certain neurotransmitters.

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Anti-psychotic Drugs

• Powerful side effects– Sluggishness, tremors, twitches– Newer-generation antipsychotics produce

fewer side effects

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Anti-anxiety Drugs

• Drugs used to control anxiety and agitation

• Depress central nervous system activity

• Calm anxiety as person learns to cope with fear-triggering stimuli

• Made reduce symptoms without resolving underlying problems

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Anti-depressant Drugs

• Used to treat depression and some anxiety disorders

• Different types work by altering the availability of various neurotransmitters

• Prozac, Zoloft, and Paxil are examples

• May take up to four weeks to reach full therapeutic effect

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Using Antidepressant Drugs

• Best approach may be to use antidepressants in combination with cognitive-behavioral therapy

• In double-blind trials, placebos produced about 75% of the improvement as active drug– Some conclude that there may be little

reason to use except for the most severely depressed patients

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Mood-Stabilizing Medications

• Levels the emotional highs and lows, as with bipolar disorder– Such as lithium

• Unclear how lithium works, but about 7 in 10 bipolar patients benefit

– Risk of suicide is one-sixth of those not taking lithium

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Brain Stimulation

• Electroconvulsive Therapy (ECT)

• Alternative Neurostimulation Therapies

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Electroconvulsive Therapy

• A biomedical therapy for severely depressed patients

• A brief (30-60 sec) electric current is sent through the brain of an anesthetized patient

• Can effectively treat severe depression in patients who have not responded to drug therapy

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Electroconvulsive Therapy

Eagleton was McGovern’s running mate for 18 days in 1972

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Alternative Neurostimulation Therapies

• Vagus nerve stimulation: Stimulates vagus nerve in neck, sending signals to brain’s limbic system

• Deep-brain stimulation – Administered via implanted electrodes

• Repetitive Transcranial Magnetic Stimulation (rTMS)

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Psychosurgery

• Surgery that removes or destroys brain tissue in an effort to change behavior– Most dramatic and least-used biomedical

intervention

• Lobotomy: a psychosurgical procedure once used to calm uncontrollably emotional or violent patients– Cut the nerves connecting the frontal lobes to

the emotion-controlling centers of the inner brain

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Lobotomy

• Usually decreased misery or tension

• Also produced a permanently listless, immature, uncreative personality

• No longer performedRosemary Kennedy (middle in photo) had a lobotomy for mood swings; spent rest of life in hospital, with infantile mental capacity.

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Therapeutic Life-Style Change

• Human brains and bodies were designed for physical activity and social engagement:– Lack of these can feed depression.

• exercise reduces depression and anxiety– Exercise is a useful adjunct to antidepressant drugs and

psychotherapy

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Comparing Therapies

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Preventing Psychological Disorders

• Lifestyle change can reverse some symptoms– Such change can also prevent some

disorders by building resilience• Which is the personal strength that helps people

cope with stress and recover from trials and tribulations

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Resilience

• Faced with unforeseen trauma, most adults exhibit resilience– New Yorkers after 9/11, especially those with

supportive close relationships– Holocaust survivors

• Struggling with challenging crises can lead to post-traumatic growth– Cancer survivors had a higher appreciation for life,

more meaningful relationships, increased personal strength, changed priorities

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Fostering Growth and Human Flourishing

• Many psychological disorders are responses to stress.– Preventive mental health seeks to identify and wipe

out conditions that cause psychological casualties.• employment/income stress, discrimination, etc.