Therapy

The type of therapy used depends on the problem.

Psychotherapy Interaction between a trained therapist and someone who suffers from psychological difficulties

EX: treating phobias that are psychologically learned

Biomedical Therapy

Prescribed medications or medical procedures that act directly on the patient’s nervous system.

EX: treating schizophrenia with medication because it is biologically rooted in the brain

Psychotherapies

Psychoanalysis

Humanistic

Behavioral

Cognitive

Group Therapies

Psychoanalysis Based upon the ideas of

Freud

Goal Techniques Criticisms

Try to help patients gain insight into the subconscious origins and roots of their disorders and work through anxiety-ridden feelings.

•Free association - patient relaxes and starts talking about anything

•Dream interpretation

•Interpretation – the analyst’s noting supposed dream meanings, and other significant behaviors and events in order to promote insight into the subconscious

•Interpretations cannot be proven or disproven; psychoanalysts say that psychoanalysis is therapy, not a science.

•Time consuming – years long

•Expensive – several sessions a week

Psychoanalysis

Transference – in psychoanalysis, the patient’s transfer to the analyst of emotions linked with other relationships (such as love or hatred for a parent). Patients can develop

strong negative or positive feelings for the therapist, including dependency, mingled love and anger.

Example Session

Psychodynamic Therapy Influenced by Freud, but

not the same as psychoanalysis

Goal Techniques

Try to understand a patient’s current symptoms by focusing on themes across important relationships

•Face-to-face conversation•Once a week for a few weeks/months•Look for patterns in behaviors/relationships

Humanistic Therapy Emphasis on human

potential and self-fulfillment

Goal Techniques Criticisms

Aim to boost self-fulfillment by helping people grow in self-awareness and self-acceptance

•Focusing on the future instead of the past•Focusing on conscious rather than unconscious thoughts

•“Clients” rather than “patients” client-centered therapy in which the client feels unconditionally accepted.•Active listening – therapist echoes, restates, and clarifies

•Not scientific enough

With a neighbor… Think of the last thing recently that:

Made you angry Made you sad Made you anxious/nervous

For 2-3 minutes, talk about the event and feelings. The active listener should: Remain unbiased and nonjudgmental Paraphrase statements Ask for clarification Reflect the feelings of the speaker with, “I understand” or “Yes,

that would be frustrating” etc

Did you notice any differences when you were active listening compared to how you listen everyday?

Behavioral Therapy Behavioral therapists do not emphasize the mental root of a

disorder as they assume that the problem behaviors are the problems

Goal Techniques Criticisms

Applies learning principles to the elimination of unwanted behaviors (useful for phobias)

•Counter-conditioning – using classical conditioning to produce new responses to stimuli that trigger unwanted behaviors• Aversive therapy - associates

an unpleasant state (such as nausea) with an unwanted behavior (such as drinking alcohol or smoking)

• Systematic desensitization - associates a pleasant relaxed state with anxiety-triggering stimuli

•Token economy – uses operant conditioning principles to produce new behaviors based on rewarding good behaviors and punishing bad behaviors

•Doesn’t address mental processes behind disorders

•When reinforcement disappears/stops, behaviors may come back.

Cognitive Therapy Best for disorders in which the roots are

unclear, like generalized anxiety disorder and major depressive disorder

Goal Techniques

Tries to change unhealthy or maladaptive patterns in thinking

•Ex: a depressed person writes 3 positive things that happened that day and how they contributed to them

•Ex: a person with test-anxiety repeats positive things to themselves before an exam

Cognitive-Behavioral Therapy a popular integrated therapy that

combines cognitive therapy (changes in thinking) with behavior therapy (changing behaviors)

Goal Techniques

Seeks to make people aware of maladaptive thinking patterns and replace them with new ways of thinking, AND to practice the more positive approaches and behaviors as well.

•EX: OCD sufferers – changing thinking patterns concerning obsessive thoughts and changing behaviors concerning compulsions

•EX: Anorexia nervosa – changing thinking patterns concerning depression and negative body image and changing behaviors concerning eating.

Group Therapy and Support Groups Except for psychoanalytic therapies, these techniques

can be used in therapist-led small groups. Group therapy does not allow for the same degree of

individual attention, but it is time and cost effective and has often been found no less effective than individual therapy.

The social context of group therapy often allows client to feel as if they are not alone in their problems. It can be a relief to find that others share your problems and feelings.

EX: AA and cancer, AIDS support groups

Go On Trailer

Effectiveness of Different Therapies

Is there a “best” therapy?

Relative Effectiveness Therapy is most effective when the

problem is clear-cut and specific. Phobias or panic disorder sufferers can hope for

improvement.

Less-focused problems, such as depression and anxiety, usually benefit in the short-run but often relapse later.

Those who have chronic schizophrenia or who wish to change their personality are unlikely to benefit from psychotherapy alone.

Effective Therapy Depends on the Problem

Psycho-dynamic

ExposureTherapy

BehavioralTherapy

CognitiveTherapy

Depression X X X

Anxiety X X

Bulimia X X

Phobias X X

OCD X X

Marital problems

X

Reducing suicide risk

X

When Should You Consider Therapy? The APA suggests considering seeking a

mental health profession if you display:

Feelings of hopelessness

Deep and lasting depression

Self-destructive behaviors

Disruptive fears

Sudden mood shifts

Thoughts of suicide

Compulsive rituals

The Biomedical Therapies

“Medicine, the only profession that labors incessantly to destroy the reason for its existence,”

- James Bryce

Psychopharmacology The study of the effects of drugs on mind and

behavior. Led to more independent lives for sufferers of

psychological disorders Reduced hospitalization of many people

To evaluate the effectiveness of new drugs, researchers use the double-blind experimental technique to reduce researcher bias.

Antipsychotic DrugsGoal Useful for… Example

sNegative Effects

Lessen responsiveness to random stimuli by blocking dopamine receptors

Schizophrenia (regulates dopamine)

Lessens hallucinations, delusions, and inappropriate or disorganized behaviors

Clozapine

Risperdal

Zyprexa

Long-term use can lead to increased risk of obesity and diabetes

Anti-anxiety DrugsGoal Useful for… Examples Negative

Effects

Depress central nervous system reactivity

AnxietyPhobias

Can help a person learn to cope with frightening situations and fear-triggering stimuli.

Xanax

Ativan

Can be used a crutch, without actually solving the root of the anxiety.

Users can become tolerant, addicted, and dependent on the medication.

Anti-depressant Drugs

Zoloft commercial

Goal Useful for…

Examples Negative Effects

Regulate levels of neurotransmitters in the brain (serotonin and norepinephrine) that can elevate mood

DepressionAnxiety

Selective-serotonin-reuptake-inhibitors (SSRIs)

ZoloftProzacPaxil

Full effects take 4 weeks – high suicide risk when starting medication

Mood Stabilizing Drugs

Goal Useful for…

Examples Negative Effects

Stabilize fluctuating moods

Bipolar Disorder

Lithium

Unclear how it works – maybe strengthens nerve connections in brain that regulate mood?

Increased thirstHeadachesMemory lossSome tremors or twitches

Brain Stimulation

Goal Useful for…

Examples Negative Effects

Send an electric current through the brain while the patient is anesthetized

Severe depression that does not respond to medication

Electroconvulsive therapy

Not exactly sure how it works – maybe calms the area of the brain that is over active and causing depression?

Memory loss

Stigmatized (bad reputation)

Psychosurgery

Lobotomy – a now-rare psychosurgical procedure that cut the nerves that connect the frontal lobes to the emotion-controlling centers of the inner brain. Developed in the 1930s Shock the patient into a coma Hammer an ice pick-like instrument

through each eye socket into the brain, then wiggle it to sever connections running up tothe frontal lobes.

Goal Useful for…

Examples Negative Effects

Remove or destroy brain tissue to change behavior

Epilepsy Cutting the corpus callosum

Lobotomy – NOT performed anymore

Irreversible – least used therapy

Lobotomies Crude but easy and

inexpensive (10 minutes) Tens of thousands of

severely disturbed people were lobotomized during the 1940s-50s

The lobotomy usually produced a permanently lethargic, immature, impulsive personality.

In the 1950s, calming drugs were introduced and lobotomized fell out of favor in the US.

Other early therapies