CHAPTER 14

THERAPIES

INTRODUCTION

• The Lobotomist

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

3500 BC

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