chapter 17 - therapy reading map
DESCRIPTION
Chapter 17 - Therapy Reading Map. Wednesday, April 4 – 659 - 669 Thursday, April 5 – Assembly Schedule – 669 - 673 Friday, April 6 to Friday, April 13 – Easter Monday, April 16 – 674 - 685 Tuesday, April 17 – 685 - end Wed, Apr 18 – Staff Mtg – Ch 17 Quiz/Cards/St Guide - PowerPoint PPT PresentationTRANSCRIPT
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Chapter 17 - TherapyReading Map
• Wednesday, April 4 – 659 - 669
• Thursday, April 5 – Assembly Schedule – 669 - 673
• Friday, April 6 to Friday, April 13 – Easter
• Monday, April 16 – 674 - 685
• Tuesday, April 17 – 685 - end
• Wed, Apr 18 – Staff Mtg – Ch 17 Quiz/Cards/St Guide
• Thursday, April 19 - Desk Mat due
• Thursday, April 19 – PLC day – 1st AP Exam
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Historical Perspective (659)
Old Methods• Holes in head• Warm baths• Bleeding• Beating the devil out
New Methods
• Philippe Pine (France) and Dorothea Dix (USA) saw mental disorders as DISEASES and treatable in HOSPITALS
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Two Main Perspectives (659)
1. Psychological Therapies
2. Biomedical Therapies
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The Psychological Therapies (660)
• are built on 4 main theories
– Psychoanalytic
– Humanistic
– Behavioral
– Cognitive
• Note - the Eclectic Approach - uses a blend of therapies
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Psychoanalysis (660)
Aims:
• to bring repressed impulses and conflicts from childhood into consciousness where the patient can deal with them
• gets patient to release the energy they previously devoted to the Id-Ego-Superego conflicts
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Psychoanalysis Methods (661)
• Free Association
• Resistance
• Dream Analysis
• Transference
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Psychoanalysis Methods (661)Free Association
• the patient retells his past, moment by moment, as it occurs to him without editing or censoring.
• Therapist mainly just listens for what is being said and not said
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Psychoanalysis Methods (661)Resistance
• the therapist listens for resistance - blocks in the free flow of the patient’s talking
• Resistance gives the therapist an opportunity to interpret what repressed ideas are causing the resistance.
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Psychoanalysis Methods (661)Dream Analysis
• used to uncover the latent (hidden) content of the patient's manifest (remembered) dreams.
• The latent dream reveals repressed ideas.
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Psychoanalysis Methods (661)Transference
• the patient will transfer strong feelings from his earlier relationships onto the therapist
• The patient “blames” the therapists - but this is a good step in the therapy
• this is another way for repressed ideas to be discovered
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Current Psychodynamic Therapy (662)
• try to understand a patient's current symptoms by exploring childhood experiences.
• probe for repressed information
• face-to-face therapy has replaced the couch
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Interpersonal Therapy (662)
• an alternative to psychodynamic therapy
• focuses on current relationships rather than childhood and assists people to improve their current relationship skills
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Humanistic Therapies (663)
• emphasizes humans’ inherent potential for self-fulfillment
• aims to boost self-fulfillment by helping people grow in self-awareness and self-acceptance
• Focuses on:– the present and future rather than the past (childhood)– conscious rather than the unconscious– taking responsibility for your feelings/actions rather
than uncovering hidden reasons– growth rather than curing illness
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Humanistic Therapies (663)Carl Roger’s Client-Centered Therapy
• focus on client's conscious self perceptions rather than the therapist's interpretations
• non-directive therapy where the therapist refrains from directing the client towards certain insights
• therapist shows acceptance, genuineness and empathy to allow client to feel unconditionally accepted and deepening their self-understanding and self-acceptance
• used active listening (echoing/restating/ seeking clarification/acknowledging expressed feelings) to give client unconditional positive regard.
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Behavior Therapies (665)
• Unlike the psychoanalysts and humanists, the behavior therapists doubt the healing power of self-awareness.
• they assume that the problem behaviors ARE the problem
• they apply learning principles to eliminate unwanted behaviors (rather than look for the cause of the behavior)
• they replace maladaptive behavior with constructive behaviors
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Behavior Therapies (665)Classical Conditioning Techniques
• assumes that we learn behavior and emotion and therefore we can "unlearn" behavior and emotion
• O.H. Mowrer - uses classical condition to cure bed wetters - a liquid sensitive pad sounds an alarm waking the child - the child learns to associate a relaxed bladder with waking up -
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Behavior Therapies (665)Counter-Conditioning
• pair a trigger stimulus (ie small space) with a NEW response that is incompatible with fear (ie relaxation). The relaxation then displaces the old response of fear to the stimulus.
2 Types of Counter-Conditioning• 1. Systematic Desensitization• 2. Aversive Conditioning
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Counter-ConditioningSystematic Desensitization Therapies
• replace a fear response with a response that is incompatible with fear - the theory is that you cannot be relaxed and fearful at the same time - the relaxation will eventually displace the fear
• Mary Jones used a technique of having a child eat close to a rat that it feared - eventually the pleasure associated with the eating displaced the fear response to the rat
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Counter-ConditioningSystematic Desensitization Therapies
• Joseph Wolpe used a method called Exposure Therapy - people are over-exposed to a fearful stimulus and eventually they become habituated to the stimulus
• Progressive Relaxation - you relax one muscle group at a time until you achieve a drowsy state of relaxation and comfort - then the therapist has you imagine a mildly anxiety-arousing situation - this imagined scene is paired with your state of relaxation until you no longer feel the anxiety.
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Counter-ConditioningSystematic Desensitization Therapies
• Anxiety Hierarchies - as you are in your relaxed state you imagine "worse" situations and then you eventually experience actual anxiety causing situation.
• Virtual-Reality Exposure Therapy - client wears goggles that give them a 3D image of what they fear (ie flying)
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Counter-ConditioningAversive Conditioning (667)
• the therapist tries to replace a positive response to a harmful stimulus (ie alcohol) with a negative/aversive response. (The therapist will put a nausea drug in the alcohol)
• Note - for alcohol treatment only 33% of clients are still booze-free after 3 years using this method
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Counter-Conditioning
Systematic Desensitization
pair a stimulus (elevator) with a new response (relaxation) that is incompatible with anxiety
Aversive Conditioning
Replace a positive response to a harmful stimulus (alcohol) with a negative response (nausea)
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Behavior Therapies (668)Operant Conditioning
• voluntary behaviors are strongly influenced by consequences (reward and punishments)
• operant conditioning is used to deal with specific behaviors
• token economy - used in institutions - exchange tokens for concrete rewards
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Critics of Behavior Modification (668)
• will the behavior stop when the reward stops?• The behaviorists say that you can wean people off
of the rewards and move towards more intrinsic rewards
• is it ethical to control another's behavior with reward/punishment?
• The behaviorists say that behavior will always be "controlled" so we may as well control it for the "good"
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Cognitive Therapies (669)
• behavior therapy is good for treating specific fears and behaviors.
• when the client's fear/anxiety is less clearly defined, cognitive therapy is useful
• assumes that our thinking colours our feelings• aims to teach people new, more positive ways of
thinking
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Cognitive Therapy for Depression (670)
• reverse client's catastrophic beliefs• teach clients to view life differently and discover
their irrationalities (Aaron Beck - therapist)• depressed people don't exhibit the self-serving bias
common in healthy people• depressed people attribute their failures to
themselves and their successes to external circumstances
• Adele Rabin (therapist) has clients record a day's positive events and their contribution to each event
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Cognitive-Behavior Therapy (671)
• an integrated therapy that seeks to teach positive thinking and also alter behaviors
• ie - OCD patients are taught to re-label their compulsions. Instead of hand washing they force themselves to take a walk and they acknowledge and label the hand washing as an irrational urge.
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Stress Inoculation Training
• trains people to restructure your thinking in stressful situations
• self-talk - "relax - if the exam is hard it is hard for everyone. You studied and will do well."
• you are trained to dispute your negative thoughts.
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Groups and Family Therapy (672)
• saves time and money• all but traditional
psychoanalysis can be done in a group setting
• often used for family conflict
• group context allows people to discover that others share their problems
• allows people to try out new ways of behaving
• ex. AA 12 step program
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Evaluating Psychotherapies (674)Client’s Perspective
• 3 out of 4 are satisfied with the effectiveness• However, the critics of psychotherapy say:
– people enter therapy in crisis and then attribute normal improvement (that would have happened anyway) to therapy
– client's spend time/money on therapy therefore they "need" to believe that therapy is effective
– clients like their therapists so they find something positive about the therapy
– selective/biased recall by clients
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Joan McCord Study
• 500 boys aged 5 to 13 headed for delinquency• half were put into counseling and the control
group was not. • 30 years later although the counseled group
attributed their success to the counseling, there was not a statistically significant difference between the 2 groups - in fact - in second crime, alcoholic tendencies, death rate and job satisfaction, the control group actually had fewer problems
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Evaluating PsychotherapiesClinicians’ Perceptions (675)
• Clients over-estimate problems when entering therapy, over-emphasize their well being when leaving therapy and stay in touch only if satisfied
• therapists are more aware of other therapists' failures
• clients find a new therapist if their problems reoccur
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Outcome Research (676)
Hans Eysenck (1952) found that • 2/3rds of people suffering non-psychotic
disorders improved markedly after psychotherapy
• HOWEVER • 2/3rds of untreated people with non-
psychotic disorders also improved
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Outcome Research
• Today meta-analysis (statistically combining the results of many different studies as if they had come from one huge study with thousands of participants) is finding:
• the average therapy patient ends up better off than 80% of the untreated individuals
• depression is better improved with treatment• psychotherapy is more effective than medical therapy• therapy is most effective for clear-cut, specific problems (ie
phobia)• depression and anxiety therapy works in the short term but
relapses frequently occur• chronic schizophrenia is rarely helped by psychotherapy alone
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Regression Toward the Mean (676)
• the tendency for unusual events or emotions to return to a more average state on their own
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Placebo Effect (676)
• the belief in a treatment will cause the treatment to succeed
• therefore what ever we doing following a "low" will be perceived as an improvement - we are naturally regressing to the mean (back to normal) but in comparison to the low - normal is an improvement
• SO, when we evaluate whether a therapy is effective we must ask whether the improvement that follows a therapy exceeds what we could expect from the placebo effect and the regression toward the mean effect.
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The Relative Effectiveness of Different Therapies p. 678
Mary Smith's meta-analysis reveals:
Disorder Best Therapy
Depression Cognitive, interpersonal and behavior
Anxiety Cognitive, exposure and stress inoculation
Bulimia Cognitive-behavioral
Bed Wetting Behavior modification
Phobia/OCD Behavioral conditioning
Sex Disorders Behavioral conditioning
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Therapeutic Touch (680)
• popular alternate therapy• hands move a few inches from your body and
push energy fields into balance• used for headaches to cancer• Rosa (1998) - using 9 year old Emily doing
research for a science fair - therapists could not tell whether they were close to Emily's hand more than 47% of the time (less than chance odds)
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Eye Movement Desensitization and Reprocessing (680)
• Francine Shapiro discovered that anxious thoughts vanished as her eyes spontaneously darted about. She developed a technique where she treats anxiety patients by triggering eye movement as they recall traumatic memories.
• 40,000 health professionals now trained in this method
• critics say this is just exposure therapy in a safe context (in trials patients had the same results with and without the eye movement)
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Light Exposure Therapy (681)
• Seasonal Affective Disorder - a form of wintertime depression
• treated with doses of intense light• the light affects our circadian clock - morning
light exposure decreases the hormone melatonin. In evening darkness increases melatonin.
• controlled trials show a difference in effectiveness between using morning light, evening light and placebo - morning light is best
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Commonalities Among Psychotherapies (682)
All therapies offer at least 3 benefits:
1. hope for demoralized people
2. a new perspective on yourself and the world
3. empathetic, trusting, caring relationships
These 3 things are also offered by self-help groups, support groups, traditional healers, elders, etc.
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Culture and Values in Psychotherapy (683)
• Clients often adopt their therapist's values.• Do the patient's and therapist's religious beliefs affect
the therapy?• Albert Ellis (1980) - a therapist that says "no one and nothing is
supreme. Self-gratification should be encouraged, unequivocal love, commitment, service and fidelity, especially marriage, leads to harmful consequences.
• Bergin (1980) - says "because God is supreme, humility and the acceptance of divine authority are virtues. Self-control and commitment, love and self-sacrifice are to be encouraged. Infidelity to any personal commitment, especially marriage, leads to harmful consequences."
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Cultural Differences
• North America, Europe, Australia - individualism is reflected by the therapists
• Asia - more collectivist
• Training in cultural sensitivity for therapists becomes important given the different types of societies.
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The Biomedical Therapies (685)
• Drugs
• Electroconvulsive therapy
• Surgery
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Biomedical TherapyDrug Therapy (685)
• most common biomedical therapy• introduced in the 1950's• reduced hospitalizations and surgeries• Psychopharmacology - the study of drug effects
on the mind and behavior• Double Blind - is important technique to reduce
placebo effect and the regression to the mean effect
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Antipsychotic Drugs (686)
• accidental discovery that certain drugs used for other medical purposes calmed psychotic patients
• antipsychotic drugs mimic dopamine and occupy its receptor sites and block its activity
• Chlorpromazine (thorazine) - used with schizophrenic patients with positive symptoms (thought to be caused by too much dopamine)
• Note that thorazine can have the side effect of tremors/twitches similar to Parkinsons (which is caused by too little dopamine)
• Clozapine - used with schizophrenic patients with negative symptoms
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Antianxiety Drugs (687)
• ex. alcohol - valium - xanax• depress central nervous system activity• help people cope with fear and anxiety• dependency on drug and on withdrawal issues• critics say the drugs reduce symptoms without
resolving underlying problems
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Antidepressant Drugs (687)
• increase norepinephrine and seratonin which elevate mood and arousal
• ex. Prozac partially blocks the reuptake of seratonin -
• Prozac takes about 4 weeks for relief of symptoms - why - increased seratonin promotes growth of new brain cells
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Antidepressant Drugs
• drug therapy is often combined with cognitive therapy and exercise
• placebos that mimic the real drug's side effects are nearly as effective as the actual drug in double-blind trials
• Prozac does not result in an elevated rate of suicide although their are individual anecdotes of users of Prozac committing suicide
• Lithium - used for bipolar patients
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Electroconvulsive Therapy (689)
• shock treatment - introduced in 1938• electricity produces convulsions and brief unconsciousness• used for severe depression that does not respond to drugs• some memory loss is a side effect• How does it work?????? We don't know!!!!!• maybe it causes release of norepinephrine???• maybe it calms brain area where over-activity would cause
depression?????• ECT treated patients often have relapses of depression
• http://www.youtube.com/watch?v=zYl13Relzbs
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Some Gentler Alternatives
• Vagus Nerve stimulation - chest implant intermittently stimulates the vagus nerve which sends impulses to the limbic system. Video clip http://www.youtube.com/watch?v=G7uu1dcc-qo&feature=related
• Repetitive Transcranial Magnetic Stimulation - magnetic coil held close to the skull above the right eye - energizes the left frontal lobe - produces no seizures or memory loss and shows 50% improvement in trials of depressed patients
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Psychosurgery (690)
• least commonly used• 1930's - Egas Moniz developed the lobotomy (won the Nobel
prize) - sever nerves connecting frontal lobe with the emotion-controlling centres of the inner brain
• used to calm uncontrollably emotional and violent patients• hammer an ice-pick like instrument through each eye socket and
wiggle it to sever connections to the frontal lobe• lobotomies - effects - permanent lethargic, immature, impulsive
personality• today lobotomies are almost never performed• today psychosurgery used for extreme seizures and excessive
OCD patients
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Prevention (690)
• deal with poverty, work issues, racism, sexism to prevent psychological disorders
• keep our bodies healthy
• mind body connection