chapter 12 major concepts sheet(1)

7/30/2019 Chapter 12 Major Concepts Sheet(1)

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MAJOR CONCEPTS: UNIT 4 EXAMChapter 12 Treatment (If its in BOLD TYPE, then KNOW IT)

NOTE: Compare and contrast means to define and explain similarities and differences betweenterms/concepts

Chapter 121. As discussed in class, up to 25% of the population meets criteria for a mental disorder and

requires treatment at any given time. Consider personal costs and social and financial coststhat motivate individuals for treatment. Also consider the reasons that 70% of theseindividuals cannot or will not seek treatment for their disorder(s)

2. Compare and contrast insight-oriented therapy, cognitive-behavior therapy, andbiologically-based treatments for mental disorders. Consider examples of each.

. Insight-oriented therapy is built on one of two major theories of the causes ofdisorders- psychoanalytic or humanistic theories- and focuses on promoting self-understanding. Cognitive-behavior therapy utilizes techniques developed frombehaviorism and cognitive theory to address symptoms directly. Biologically-basedtreatments focus on understanding and addressing the brains role in disorders. Finally,we will discuss treatment research and treatment effectiveness

Insight-oriented therapy and Cognitive-Behavior therapy patient or client interactswith a trained and licensed therapist (psychologist, psychiatrist, counselor, social worker);more work on the part of the client, but relatively few negative side effects.Biologically-based treatments disorder is treated with drugs, surgery, or otherprocedures using medical technology; relatively new (since 1950s), little work for theclient (swallow a pill or just show up to an office), potential for negative side effects is highand can be lethal

3. Define and describe psychoanalysis/psychodynamic therapy. Who founded this therapy?What is the goal of this therapy? How does it work?

Psychoanalysis istheoriginalinsight-orientedtherapy. DevelopedbySigmundFreud,psychoanalysisisatypeoftherapydirectlyconnectedtoFreudstheoryofpersonality,whichholdsthatpeoplespsychologicaldifficultiesarecausedbyunconscious conflictsamongthethreepsychicstructuresofthemind:theid,ego,andsuperego. Even thoughthe textbook differentiates between psychoanalysis and the newer psychodynamictherapy, that distinction will not be made here or required for the exam. These two termscan be considered interchangeable

The goal of psychoanalysis is to help patients understand the unconsciousmotivations that lead them to behave in specific ways- MAKE THE UNCONSCIOUSCONSCIOUS. Only after true understanding (insight) is attained can patientschoose more adaptive, satisfying, and productive behaviors.

4. Describe free association and dream analysis. What is interpretation? Compare andcontrast resistance and transference in psychoanalysis. Consider examples of each of

these techniques. Freud originally used hypnosis with his patients to get at unconscious issues butfound it unreliable. Over time, Freud developed the method of free association, in whichthe patient says whatever comes into his or her mind, without censorship or filtering. Theresulting train of thought reveals the issues that concern the patient and the patientsways of dealing with them.

Another important feature of psychoanalysis is the use of dream analysis, in whichthe therapist examines the content of dreams to gain access to the unconscious. Ratherthan taking a dream at face value (the manifest content), the psychoanalyst would seekout its hidden meaning (the latent content) to examine its importance for the client. Freudfelt that dreams were the royal road to the unconscious. Due to unreliability in


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interpretation, this technique is rarely used today.

5. Describe some of the problems with psychoanalysis as discussed in class.

6. Define and describe the humanistic technique ofclient-centered therapy. Who foundedthis therapy? What is the goal of this therapy? How does it work? Describe incongruence.

Carl Rogers, who developed a therapeutic approach that came to be called client-centeredtherapy, which focuses on peoples potential for growth and the importance of anempathic therapist.

Incongruence is a mismatch between the real self (who you actually are) and the ideal self(who you would like to be). Client-centered therapy helps to reduce this incongruence sothat the client feels better. Therapy is nondirective - therapist tends NOT to provide adviceor suggestions, but instead paraphrases the clients words.

7. Compare and contrast the following techniques of client-centered therapy: empathy andunconditional positive regard. Consider examples of each.

Unconditional positive regard - providing a nonjudgmental, warm, and acceptingenvironment in which the client can feel safe expressing his or her thoughts and feelings.

The therapist must provide unconditional positive regard by conveying positive feelings forthe client regardless of the clients thoughts, feelings, or actions. The therapist does thisby continually showing the client that he or she is inherently worthy as a human being.

8. Define and describe cognitive-behavior therapy. Consider how it was developed out ofbehavior therapy and cognitive therapy techniques.

Cognitive-behavior therapy (CBT) seeks both to change problematic behaviors andirrational thoughts and to provide new, more adaptive behaviors and beliefs to replace themaladaptive ones. This therapeutic approach combines techniques developed separatelyfrom behaviorism and cognitive theories.

9. Define and describe behavior therapy. How does this therapy work? What issues does thistherapy target? What learning principles is it based upon? Describe the ABCs of behaviortherapy.

Behavior therapy is based on well-researched learning principles focused on changingobservable, measurable behavior. It appeals to psychologists because of its emphasis onquantifiable results.

Antecedents (stimuli that trigger unwanted behaviors), the problematic behavior itself,and its consequences (what is reinforcing the behavior). The therapist takes an active,directive role in treatment.

10.Describe the following behavior therapy techniques based on classical conditioning andconsider examples: exposure (be familiar with the three types plus the concept ofresponse prevention), stimulus control, systematic desensitization (be familiar withprogressive muscle relaxation).

Exposure is a behavioral technique that rests on the principle of habituation,whereby through repeated encounters with a stimulus, the person becomes lessresponsive to that stimulus. Works exceptionally well for phobias. Patients are asked toexpose themselves to feared stimuli in a planned and usually gradual way. People can beexposed to the feared stimulus in three ways 1) Imaginal exposure involves imaginingthe feared stimulus. 2) In vivo exposure involves exposing themselves to the actualstimulus. 3) Virtual reality exposure involves using virtual reality techniques to exposethemselves to the stimulus.


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Exposure with response prevention is a planned programmatic procedure thatexposes the client to the anxiety-provoking object but prevents (has the client abstainfrom making) the usual maladaptive response. Exposure with response prevention hasbeen found to be as effective as medication for obsessive-compulsive disorder (OCD), andthe behavioral treatment can have longer-lasting benefits. However, not all people whohave OCD are willing to use this behavioral technique. This technique is also used intreating bulimia nervosa. Stimulus control involves controlling the exposure to a stimulus that elicits aconditioned response, so as to decrease or increase the frequency of the response. Forexample, if an alcoholic primarily drinks at bars, then limit or eliminate occasions of goingto bars.

Systematic desensitization teaches people to be relaxed in the presence of a fearedobject or situation. This technique was developed for treating phobias. It grew out of theidea that someone cannot be fearful and relaxed at the same time. It uses progressivemuscle relaxation, a technique whereby the person alternates tensing and relaxingmuscles sequentially from one end of the body to the other. This type of relaxation canalso be used by itself to induce relaxation. When using systematic desensitization toovercome a phobia, the therapist and client begin by constructing a hierarchy of real orimagined activities related to the feared object or situation. The hierarchy begins with theleast fearful activity and progresses to the most fearful. Over the course of a number ofsessions, the client works on becoming relaxed when imagining increasingly anxiety-provoking activities. This technique is frequently combined with in-vivo exposure at thelater stages. Highly effective for phobias and PTSD symptoms.

11.Describe the following behavior therapy techniques based on operant conditioning asdiscussed in class and consider examples: behavior modification, token economies,skills training, aversion therapy, extinction, self-monitoring techniques.

Secondary reinforcersthose that are learned and dont inherently satisfy abiological needare used in treatment programs with psychiatric patients, mentallyretarded children and adults, behaviorally disordered children, and prisoners. Tokeneconomies are treatment programs that use secondary reinforcers to change behavior.Patients and residents must earn tokens by behaving appropriately. These tokens canthen be traded for small items such as candy at a token store or for privileges.

Skills training - designed to improve interpersonal or basic technical skills.Emphasizes modeling, behavioral rehearsal, and shaping. Used often and effectively withsevere mental illness (basic work skills), children/teenagers with behaviorproblems/developmental delays, and also in couples/family treatment. Skills such as thesecan last a lifetime because the reinforcements used by the therapist are later replaced bythe rewards of successful skilled behavior.

Aversion therapy - using positive punishment to reduce the frequency of anundesirable behavior (Antabuse for alcoholism, aversion therapy for child molesters).Treatment effects dont last long (a few months).

Extinction (eliminating a behavior by not reinforcing it) is another important tool ofthe behavioral therapist.

Operant conditioning principles also led to the development of self-monitoringtechniques, such as keeping a daily log of a problematic behavior. These techniques canhelp identify the behaviors antecedents and consequences.

12.Define and describe cognitive therapy. What two individuals are most associated with this


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therapy? What is this therapy designed to target? Cognitive therapy is designed to help clients think realistically and rationally inorder to reinterpret events that otherwise would lead to distressing thoughts, feelings,and/or behaviors. It highlights the importance of the way people perceive and think aboutevents.

THEORIES OF COGNITIVE THERAPY Two particularly important contributors to cognitive therapy were Albert Ellis andAaron Beck.

13.Compare and contrast Ellis rational-emotive behavior therapy and Becks cognitivetherapy. Describe cognitive distortions.

In the 1950s, Albert Ellis, a clinical psychologist, developed a treatment calledrational-emotive behavior therapy (REBT). REBT emphasizes rational, logical thinking andassumes that distressing feelings or symptoms are caused by faulty or illogical thoughts.People may develop illogical or irrational thoughts as a result of their experiences andnever assess whether these thoughts are valid. Psychiatrist Aaron Beck developed a form of (Becks) cognitive therapy that rests onthe premise that irrational thoughts are the root cause of psychological problems.Recognition of irrationality and adoption of more realistic, rational thoughts causepsychological problems to improve.

Irrational thoughts that arise from systematic biases in the way a person thinksabout events and people (including oneself) are considered cognitive distortions, whichare learned and maintained through reinforcement. There are many recognized andresearched cognitive distortions, such as dichotomous (or black-and-white) thinking, whichallows for nothing in between the extremes. For example, a person is considered eitherperfect or a piece of garbage.

14.Describe the following cognitive therapy techniques and consider examples: cognitiverestructuring, psychoeducation.

Becks cognitive therapy utilizes cognitive restructuring, a process of helping clientsto view their situation in a new light, by teaching them to shift their thinking fromautomatic, distorted, negative thoughts to more realistic ones.

15.Consider the unique features ofcognitive-behavior therapy compared to other treatmentsas discussed in class.

Problem focused - CBT is undertaken for specific problems and has been applied toa wide range of disorders. Action oriented - CBT tries to solve these problems by encouraging the client to act(outside of sessions). Practice in the form of homework assignments is common. Structured - CBT sessions typically begin with setting an agenda for the meetingand a review of homework from the previous week. Then focus is on learning and practiceof new skills. Frequently homework is assigned for the next week.

Transparent nothing is withheld from the client. Clients have a very goodunderstanding of the treatment and techniques, unlike psychodynamic or humanistictechniques. Flexible can be catered to the unique needs of the client. Treatment is short term(10-20 sessions); can be used on individuals, couples, families, or groups; frequency ofsessions can be altered.

16.What general approaches are used in biologically-based treatments of disorders? Physical and pharmacological interventions targeting the brain have been usedthroughout recorded history, but have only been scientifically tested and developed forthe specific use on psychological disorders over the last 60-80 years. The treatmentsinclude drugs, surgery, and other means of physical brain intervention.


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These treatments have broad effects and should not be thought of as magicbullets targeting only the symptoms displayed by an individual or a specific disorder.

17.What is psychopharmacology? Compare and contrast antipsychotic, antidepressant,and antianxiety medications as discussed in class. What is each class of drugs designed totarget? How quickly does each drug class take effect? What are advantages anddisadvantages (e.g., side effects) of each drug class?

The use of medication to treat psychological disorders and problems is known aspsychopharmacology

18.Describe the side effect oftardive dyskinesia and explain how atypical antipsychoticshave addressed this problem.

Long-term use of these medications can cause tardive dyskinesia, an irreversibleneurological and movement disorder in which the affected person experiences involuntarysmacking of the lips, facial grimaces, and other side effects (involuntary movements of theextremities). Atypical (2nd generation) antipsychotics (e.g., Clozaril, Risperidal, and Zyprexa)were introduced in 1990s and add the effects of reducing negative symptoms (apathy,lack of interest, and social withdrawal) without the high risk of severe side effects such astardive dyskinesia (also still work well on positive symptoms). There is an increased risk ofblood sugar disorders (diabetes).

19.Consider the drawbacks ofmonoamine oxidase inhibitors (MAOIs) and tricyclicantidepressants (TCAs).

Monoamine oxidase inhibitors (MAOIs) were the first antidepressant medicationsdiscovered. MAOIs require users not to eat foods containing tyramine (e.g., cheese andwine) because of potentially fatal changes in blood pressure. They are also difficult totolerate. They are particularly effective in treating atypical depression involving increasedappetite and hypersomnia but less effective in alleviating typical symptoms of depression.

More effective pharmacological treatment for depression emerged in the 1950s withthe discovery of tricyclic antidepressants (TCAs). For decades, TCAs were the onlyeffective antidepressant medications readily available. Common side effects of TCAsinclude constipation, dry mouth, blurred vision, and low blood pressure. TCAs affectserotonin levels. They take weeks to work.

20.In what class of drugs are SSRIs(selective serotonin reuptake inhibitors)? How dothese drugs work and how commonly are they used?

In the 1980s, selective serotonin reuptake inhibitors (SSRIs) (e.g., Prozac, Zoloft,Paxil, Celexa) were developed for the treatment of depression. SSRIs block the reuptake ofserotonin in the brain; fewest and most mild side effects of all psychopharmacotherapeuticdrugs; possible to take for long term (lifetime); among the most commonly prescribed

drugs on the planet. Like TCAs, they can take weeks to work. One common side effect ofSSRIs is decreased sexual interest. Researchers found that SSRI use among children andadolescents was associated with an increased risk of suicide.

Researchers continue to discover drugs that can alleviate symptoms of depressionwithout producing as many side effects and work via other biological mechanisms so thatpatients who do not respond to existing antidepressants can obtain relief. The newerantidepressants called serotonin/norepinephrine reuptake inhibitors (SNRIs) affect boththe serotonin and norepinephrine systems. Little is known yet about this newest class.

21.Describe mood stabilizers and discuss how they are used for treatment. What class ofdrugs are viable alternatives to mood stabilizers for those who cannot tolerate their side


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effects? Mood stabilizers medications used to suppress swings between mania anddepression of bipolar disorder (Lithium and Valproate). Side effects can be intense, soclose monitoring is required. Lithium requires monitoring because of potential damage tokidneys and thyroid (its basically a poison), so Valproate is more commonly prescribed.

22.Discuss the main drawbacks of the benzodiazepines.Benzodiazepines type of tranquilizer that is most commonly used antianxiety (e.g.,Valium, Ativan, and Xanax). Significant potential for overuse (abuse), tolerance (need for higher doses toachieve the same effects with long-term use), and eventual dependence- can be like analcohol or heroin addiction (drug of choice for middle-aged women, particularlyhousewives).

Dangerous and potentially lethal when combined with alcohol.

A person using these drugs can develop tolerance and dependence and canexperience withdrawal reactions. Withdrawal risks include shakiness, insomnia, agitation,and anxiety. For these reasons, drugs of this class are often prescribed only for shortperiods of time. Need to reduce use gradually to come off medication when used long-term.

Side effects include drowsiness, poor coordination (be careful driving), impairedmemory.

23.Medications by far are the most common type of therapy for mental illness. Discussadvantages and disadvantages of medications in general as discussed in class.

24.Compare and contrast electroconvulsive therapy (ECT) and transcranial magneticstimulation (TMS). What disorder are they currently and most frequently used to treat asdiscussed in class? What disorder was ECT previously used to treat, INEFFECTIVELY, severaldecades ago as discussed in class?

Electroconvulsive Therapy (ECT) is essentially a controlled brain seizure. Thetreatment that involves inducing a mild seizure by delivering an electrical shock to thebrain. Can be effective to treat severe depression that is nonresponsive to other forms oftherapy. Originally used from the 1930s-1970s to treat schizophrenia, but the procedurehas shown no efficacy for this illness. Originally quite violent, frightening, and painful. Nowused with anesthetic and muscle relaxants so that cortical seizures are mild. Since the1980s, the use of ECT for depression has increased. Side effects include impaired short-term memory.

TRANSCRANIAL MAGNETIC STIMULATION Transcranial Magnetic Stimulation (TMS) - a treatment that involves placing apowerful pulsed magnet (electromagnetic coil) over a persons scalp, which altersneuronal activity in the brain. Useful in treating severe depression unresponsive to

medication. Does not require anesthesia and no side effects as compared to ECT. TMS hasalso been administered to people with bipolar disorder, schizophrenia, and PTSD.

25.Briefly describe psychosurgery and phototherapy as discussed in class. What disorders dothese treatments target? Consider the controversial early history of psychosurgery vialobotomy.

Psychosurgery - the surgical destruction of specific brain areas. Very rare, but usefuas a treatment for severe obsessive-compulsive disorder (OCD). This treatment has acontroversial history starting with lobotomy, which was used for agitated or violentpatients (not any real diagnostic indications). It involved severing brain connections withan instrument inserted through eye sockets or holes drilled in skull... a lot like trepanningpractices of ancient times and about as accurate in its aim. Lobotomy was successful at


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times (inventor won Nobel Prize) but also produced extreme lethargy or impulsivity andother severe side effects. Lobotomy was abandoned after medication was introduced.

Todays psychosurgeries are much more precise and involve considerably fewer sideeffects.

Phototherapy - a therapy that involves repeated exposure to bright light. Used totreat seasonal patterns of depression [e.g., seasonal affective disorder (SAD)]

26.Describe eclectic therapy as discussed in class and consider examples. Describe therapyprotocols and consider reasons for their use in treatment.

In the last quarter century, many therapists have moved away from identifying theirwork as exclusively employing one theoretical orientation. Between 68 and 98 percent ofall mental health professionals identify themselves as eclectic in orientation. Eclectictherapy involves drawing on techniques from different forms of therapy, depending on theclient and the problem. Rather than sticking to one theoretical perspective, therapy isfitted to the client and his/her specific set of problems.

27.Compare and contrast outcome studies and process studies of psychological treatmentas discussed in class.

Outcome studies - designed to evaluate whether a particular treatment works, oftenin relation to some other treatment or a control condition.

Process studies - designed to answer questions regarding why a treatment works orunder what circumstances a treatment works. Process studies also can examine whethersome parts of the treatment are particularly helpful, whereas others are irrelevant to thetreatments success. Process studies can refine therapies and target their influence tomake them more effective.

28.Be familiar with how ethnic diversity may affect treatment considerations.29.Compare and contrast the therapeutic relationship to other professional relationships and/or

friendships. What can you expect in the therapeutic relationship? Consider factors that areimportant in finding a therapist and fitting therapy to the problem. SEE ONLINE HANDOUTS.

chapter 12 major concepts sheet(1)

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