Therapies

Chapter 14

Defining Therapy Psychotherapy is the treatment of

emotional and behavioral problems through psychological techniques Uses psychological rather than

exclusively biological approaches to treatment

Involves conversation between an individual with psychological issues and someone trained to help correct the problem known as a therapist.

Dude…Why are my arms

so short?

Not to mention

your unusually

large head…

History of Treatment In early Stone Age society, trepanning was

used – many did not survive the procedure During Middle Ages, supernatural forces

were blamed for mental illness (demonology) and exorcism was used

During the French Revolution, more humane treatment started with the work of Philippe Pinel

By the mid-19th century, people began to connect abnormal behavior to damage to the brain/central nervous system

Sigmund Freud helped to popularize the “talking cure” in the early 20th century

Since then there has been an explosive growth in available therapies

Insight Therapies

Psychoanalysis

Designed to bring repressed feelings and thoughts to conscious awareness developed by Freud

Techniques Therapist must maintain a neutral relationship with the

client so that client may project unresolved feelings/issues upon him/her

Dream analysis Hypnosis and post-hypnotic suggestions Free association Transference and resistance Analysis of defense mechanisms Insight and working through

Person-Centered Therapy Developed by Carl Rogers Goal is to help clients become fully

functioning Therapist expresses unconditional positive

regard and empathy Therapist strives to be authentic, trying to be

genuine and real rather than formal Therapy is nondirective but engages in active

listening Therapist reflects or mirrors clients’

statements

Gestalt Therapy

Outgrowth of the work of Fritz Perls Emphasizes the wholeness of personality Attempts to reawaken people to their emotions

and sensations in the here-and-now Draws attention to what exists rather than what

is absent, and draws attention to client’s voice, posture, and movements

Encourages confrontation with issues Therapist is active and directive “Empty Chair” and “Hot Seat” technique

Ya, you are in ze hot seat!

Recent Developments Short-term psychodynamic

psychotherapy Focused on trying to help people correct the

immediate problems in their lives Forego long process of completely excavating

childhood Virtual therapy

Therapy delivered via chat room, phone or video conference

Client given techniques to use on their own after session ends

Behavior Therapies

Behavior Therapies

Based on the belief that all behavior – adaptive and maladaptive - is learned

Objective of therapy is to teach people new ways of behaving

Focuses on observable, measurable activities

Using Classical Conditioning Techniques

Systematic desensitization Gradually associating relaxation with what

was feared Extinction through counterconditioning

Ending of old fears or reactions through repeated exposure to new stimulus pairs

Flooding Full-intensity exposure to feared object

Aversive conditioning Eliminate undesirable behavior by

associating it with pain and discomfort Virtual reality exposure therapy

Expose client to fears in safe, virtual setting

Say hello to Mr. Spider!

Operant Conditioning Behavior contracting

Client and therapist set behavioral goals and agree on reinforcements the person will receive

Client engages in desired behaviors to attain reinforcement

Token economy Clients earn tokens for desired behaviors

and exchange them for desired items or privileges

Often used in schools and hospitals

Modeling

Person learns new behaviors by watching others perform those behaviors

Sometimes used in conjunction with operant conditioning

Therapist him/herself may model desirable behaviors for client

Cognitive Therapies

Meichenbaum’s Stress-Inoculation Therapy Type of cognitive therapy that trains

people to cope with stressful situations by learning a more useful patterns of self-talk

Taught to suppress negative and anxiety-provoking thoughts in times of stress

Particularly effective for treating anxiety disorders

Ellis’ Rational-Emotive Therapy (RET) A directive, confrontational therapy

based on the idea that psychological distress is caused by irrational and self-defeating beliefs

Core problem is belief in “musts” and “shoulds” that leave no room for making mistakes (no more “musterbation”)

Therapist’s job is to challenge client’s irrational beliefs

Beck’s Cognitive Therapy

Aimed at identifying and changing inappropriately negative and self-critical patterns of thought

Therapist points out automatic thoughts (instantaneous, habitual, and unconscious thoughts that impact mood and action) and catastrophizing beliefs and forces client to substantiate them

Good treatment for depression

Cognitive Distortions List All or nothing thinking (“always”,

“every”, “never” Mental filter (focus on negative

aspects while ignoring positive aspects)

Disqualifying the positive (shooting down positive experiences for no reason)

Jumping to conclusions (drawing conclusions with little/no evidence)

Overgeneralization (isolated case assumed for all)

Magnification/minimization (making mountains out of molehills, catastrophizing)

Emotional reasoning (decision making based on feelings, not logic)

Personalization (attributing personal responsibility when individual has no control over event) Should statements (emphasizing what should be rather than what is; what Ellis called “musterbation”)

Group Therapies

Family Therapy

Form of group therapy that sees the family as at least partly responsible for the individual’s problems

Seeks to change all family members’ behavior to the benefit of the family and the individual

Self-Help Groups and Couple Therapy

Self Help Groups Small, local gatherings of people who

share common problems and provide mutual assistance at very low cost

Alcoholics Anonymous is an example Good for empathy, but may trigger

temptation to relapse Couple Therapy

A form of group therapy intended to help troubled partners improve their communication and interaction

Empathy training: partners taught to share feelings and listen to and understand partner’s feelings

Evaluating Psychotherapies

Overall Effectiveness of Psychotherapy

Does Psychotherapy Work? Psychotherapy helps about 2/3rd of people

treated Approximately 1/3 would improve without therapy

Which Type of Therapy is Best for Which Disorder? No one type of therapy is better Key is to match the problem with the appropriate

therapy

Effectiveness of Insight and Cognitive Therapies Difficult to judge as spontaneous remission

may occur Who should be asked to judge the effectiveness

of therapy? Therapist or client? Meta-analysis may be the best bet to evaluate

these therapies 75-80% result in improvement vs. no therapy at

all Only 10% were worse after therapy

Works best with those who are not severely disturbed

Effectiveness of Behavior Therapies Work well for certain problems such as phobias,

compulsive behaviors, impulse control, and learning new social skills to displace maladaptive ones

Criticized for ignoring internal thoughts and expectations and just treating symptoms rather than underlying causes

Not well suited for some types of problems

Biological Treatments

Biological Treatments:Overall Trends View abnormal behavior as a symptom

of an underlying physical disorder Typically favor biological therapy (drugs,

psychosurgery, ECT, etc.)

Drug Therapies Psychopharmacotherapy is the

treatment of mental disorders with medication – also known as drug therapy

Major reasons for widespread use of drugs Drugs are effective at treating disorders –

especially serious disorders Drug therapies are often less expensive

that psychotherapy

Antipsychotic Drugs (Neuroleptics) Used for schizophrenia or psychosis

(hallucinations, delusions, paranoia, disordered thinking, incoherence)

All antipsychotics block dopamine receptors in the brain

Side effects include drowsiness, dry mouth, muscular rigidity, and Tardive Dyskinesia

Examples include Thorazine, Haldol, Mellaril, Clozapine, and Risperidone

60-70% show improvement in symptoms when these drugs are used

Antidepressant Drugs (Thymoleptics)

Tricyclics and MAO (monoamine oxidase) inhibitors Most common antidepressants prior to late 1980s Work by increasing amount of the neurotransmitters

serotonin and norepinephrine Effective, but have serious side effects such as heart

complications and weight gain Examples: Tofranil, Elevil (Tricyclics), Nardil (MAOi)

Selective Serotonin Reuptake Inhibitors (SSRIs) Work by blocking the reuptake of serotonin Examples: Prozac, Paxil, Zoloft, Effexor

Side effects: sleepiness, reduced sex drive 60-70% show improvement though it may take two

weeks for changes to take effect

Action of SSRIs

Antimania Drugs:Lithium A naturally occurring salt (lithium

carbonate) that is used to treat bipolar disorder (manic depression) with 80% effectiveness

Nobody knows how lithium works to alleviate symptoms

Problem with establishing proper dosage and with people stopping medication when symptoms ease

Examples: lithium carbonate, Eskalith

Antianxiety Drugs (Anxiolytics) Use to treat anxiety disorders and are

often referred to as tranquilizers Most widely prescribed of all legal drugs Produce a feeling of calm and mild

euphoria Side effects include physical

dependence and withdrawal symptoms is abruptly discontinued

Examples: Valium, Librium, Xanax, Equanil

Psychostimulants Used to treat disorders such as AD/HD Concern that psychostimulants are being

overused Side effects: lethargy, depression,

aggression

Electroconvulsive Therapy Commonly known as “shock therapy” 1938 Italian physicians Ugo Cerletti and Lucio

Bini created seizures in patients by passing an electric current through their brains

During 1940s and 50s, used as a treatment for depression, schizophrenia and sometimes mania; now used only for severe depression

Causes brief convulsions and temporary loss of consciousness

Side effects include memory loss and difficulty learning following the procedure

Up to 100,000 people receive ECT each year

Psychosurgery Brain surgery performed to change a

person’s behavior or emotional state History of Lobotomy: Egas Moniz and

Walter Freeman Prefrontal lobotomy (EM) Transorbital lobotomy (WF) Tragedies

Psychosurgery is rarely used today and removes far less brain tissue

Alternatives to Institutionalization

Deinstitutionalization

Releasing people with severe psychological disorders into the community

Can cause problems Some people are ill-prepared to deal with life

outside of a hospital Up to 40% of homeless are mentally ill Alternative forms of treatment (many)

Half-way houses Family-crisis interventions Day-care

Prevention Primary prevention

Improve the social environment so that new cases of mental disorders do not develop

e.g. Family planning, Genetic counseling Secondary prevention

Interventions with high risk groups e.g., suicide hot-lines, job training in economically

depressed areas Tertiary prevention

Help people adjust after they are released from the hospital in order to help prevent a relapse

e.g. halfway houses, long-term outpatient care Community psychology attempts to minimize or

prevent mental disorders – not just treat them