Cognitive Therapies

Albert Ellis Rational-Emotive Therapy catastrophic thinking ABC model

activating event belief system consequence

Rational-Emotive Therapy

Rational-Emotive Therapy “D” component of the

model detecting instances of catastrophic thinking

disputing irrationality of this thinking

Beck’s Cognitive Theory

depressives: blame setbacks on themselves focus on negative events unduly pessimistic make overly negative evaluations

Behavioural Therapies General Principles

behaviour is the product of learning what has been learned can be unlearned

Systematic Desensitization Wolpe, 1950’s based on classical conditioning phobias

relaxation training anxiety hierarchy

Anxiety Hierarchy

Behavioural Therapies

Social Skills Training

Token Economies

Theoretical Orientations

Clinician's Theoretical Orientations

0 5 10 15 20 25 30 35 40 45

Eclectic

Psychodynamic

Cognitive

Client-Centred

Other

Behavioral

Existential

Family

Gestalt

% of Respondents

• eclecticism

Biomedical Therapies Psychosurgery

Golz - 1890 Burkhardt - 1892 Jacobsen - 1935

lobotomy (lobe-cutting) Dr. Antônio Egas Moniz - 1936

leukotomy (white matter cutting)

PsychosurgeryWalter Freeman1936 initial procedure

Freeman-Watts Standard Procedure

prefrontal lobotomy

cingulotomy

“ice-pick” lobotomy (1945)18,000+ between 1939 & 1951

1949 Nobel Prize

Psychopharmacotherapy Antianxiety drugs

e.g., Valium, Xanax, BuSpar

Psychopharmacotherapy Antipsychotics

e.g., Thorazine, Haldol side effects

tardive dyskinesia Antidepressants

tricyclics MAO inhibitors selective serotonin reuptake

inhibitors (SSRIs) Prozac, Paxil, Zoloft

Psychopharmacotherapy Lithium

tx for bipolar mood disorder

Electroconvulsive Therapy (ECT)

• 70-120 volt AC• 1-3 times/week• 2-4 weeks• side-effects

•total amnesia•retrograde amnesia•anterograde amnesia

Evaluating Therapeutic Outcomes

Eysenck’s (1952) criticism 2/3rds spontaneous remission same as success rate later spontaneous remission revised to 30%

meta analysis (Smith, 1980) people who were treated were better off than 80%

of non-treated

Efficacy of Different Therapies

0 20 40 60 80 100

% Improved More Than Control

Evaluating Therapeutic Outcomes

Sloane et al, (1975)

0

0.5

1

1.5

2

2.5

3

3.5

Behavioural Psychodynamic Wait List Control

Seve

rity

Of S

ympt

oms

Pre Tx4 Month

Changes in Treatment of Disorders

Community Health Movement local, community-based care reduced reliance on hospitalization focus on prevention

deinstitutionalization

Changes in Treatment of Disorders

deinstitutionalizationAdvantages:

more cost effective improved tx in hospitals

Disadvantages: increased re-admissions lack of appropriate alternatives

results in increased # of homeless