Chapter 17 pt. 2: Cognitive Chapter 17 pt. 2: Cognitive and Biomedical Therapyand Biomedical Therapy

The Most Dominant Therapy is The Most Dominant Therapy is the Cognitive Approachthe Cognitive Approach

Most Common Illnesses Most Common Illnesses Treated in Cognitive Treated in Cognitive

PerspectivePerspective1. Depression1. Depression2. Eating Disorders2. Eating Disorders3. Chronic Pain3. Chronic Pain4. Marital Problems4. Marital Problems5. Anxiety Disorders5. Anxiety Disorders

Assumption and Goal of Assumption and Goal of Cognitive TherapyCognitive Therapy

Cognitive TherapyCognitive Therapy assumes assumes that thoughts exist between that thoughts exist between events and responses. A events and responses. A person’s response depends on person’s response depends on how they interpret the situation. how they interpret the situation.

Goal of Cognitive therapyGoal of Cognitive therapy is to is to teach people new and more teach people new and more realistic, helpful, and adaptive realistic, helpful, and adaptive patterns of thinking and acting. patterns of thinking and acting.

Want to See glass half-full Want to See glass half-full instead of half-empty!!instead of half-empty!!

Two Major Therapies where Two Major Therapies where Cognition Is A Strong FocusCognition Is A Strong Focus1. Aaron Beck’s 1. Aaron Beck’s

Cognitive TherapyCognitive Therapy

2. Albert Ellis’s 2. Albert Ellis’s Rational Emotive Rational Emotive TherapyTherapy

Aaron Beck’sAaron Beck’s Views on Views on Depression (NOT IN BOOK)Depression (NOT IN BOOK)

Beck believed the key to Beck believed the key to understanding depression was in understanding depression was in an individual’s thought patterns.an individual’s thought patterns.

Argued depressed people’s Argued depressed people’s negative thought patterns and negative thought patterns and creation of negative schemas creation of negative schemas caused them to misinterpret the caused them to misinterpret the world which often caused them to world which often caused them to feel worthless and incompetent. feel worthless and incompetent.

Depressed people tend to view Depressed people tend to view world with “dark sunglasses.” world with “dark sunglasses.”

Beck’s Examples of Beck’s Examples of Negative Schemas (NOT IN Negative Schemas (NOT IN

BOOK)BOOK) Arbitrary Interference:Arbitrary Interference: drawing drawing

negative conclusions from an event negative conclusions from an event without any evidence. without any evidence.

Ex:Ex: After an argument thinking “that After an argument thinking “that person hates me.”person hates me.”

Dichotomous Thinking:Dichotomous Thinking: irrational irrational all or nothing thinking. all or nothing thinking.

Ex:Ex: “I can’t be happy unless “I can’t be happy unless everyone likes me.” everyone likes me.”

Aaron Beck’s Cognitive Triad Aaron Beck’s Cognitive Triad Theory of DepressionTheory of Depression

Beck developed a cognitive triad Beck developed a cognitive triad which looked at what person thinks which looked at what person thinks about:about:– 1. His/Her Self1. His/Her Self– 2. His/Her World2. His/Her World– 3. His/Her Future3. His/Her Future

Depressed people tended to have Depressed people tended to have negative perceptions in all three negative perceptions in all three areas. areas.

Martin Seligman’s Theory of Martin Seligman’s Theory of Explanatory Styles Effect on Explanatory Styles Effect on

DepressionDepression Depressed people tend to explain Depressed people tend to explain negative external events with a negative external events with a negative explanatory style. negative explanatory style.

Depressed people usually view problems Depressed people usually view problems as: 1. as: 1. Personal:Personal: They caused the They caused the negative events; 2. negative events; 2. Pervasive:Pervasive: the the negative events will affect everything negative events will affect everything they do; 3. they do; 3. Permanent:Permanent: and the and the negative events will last forever. negative events will last forever.

Belief Styles can lead to Belief Styles can lead to learned learned helplessness. helplessness.

Pervasive Pessimism Also Tied Pervasive Pessimism Also Tied to Locus of Control to Locus of Control

If do good in the stock market it was If do good in the stock market it was luck (don’t have any control) if they do luck (don’t have any control) if they do bad it was their fault (do have control)bad it was their fault (do have control)

Optimists believe good things happen Optimists believe good things happen because they’re smart and successful because they’re smart and successful (their own control) and bad things are (their own control) and bad things are isolated occurrences (out of their isolated occurrences (out of their control)control)

Pessimists shrug off the good and Pessimists shrug off the good and internalize the bad. Optimists do the internalize the bad. Optimists do the opposite. opposite.

Rational Emotive Therapy is a Rational Emotive Therapy is a Form of Cognitive-Behavior Form of Cognitive-Behavior

TherapyTherapy Cognitive-Behavior Therapy:Cognitive-Behavior Therapy:

aims to alter the way people think aims to alter the way people think (ex: irrational thought patterns) (ex: irrational thought patterns) and act (ex: compulsions).and act (ex: compulsions).

Albert Ellis’s Rational Emotive Albert Ellis’s Rational Emotive Behavior Therapy (NOT IN Behavior Therapy (NOT IN

BOOK)BOOK) Albert Ellis also believed that people’s Albert Ellis also believed that people’s

maladaptive thoughts led to maladaptive maladaptive thoughts led to maladaptive emotional responses (behaviors). emotional responses (behaviors).

He promoted a form of treatment known He promoted a form of treatment known as as Rational Emotive Behavior Rational Emotive Behavior Therapy:Therapy: involves getting patients to involves getting patients to recognize the irrationalities within their recognize the irrationalities within their thought patterns and helping them thought patterns and helping them create healthier forms of thinking and create healthier forms of thinking and behaving. behaving.

Effectiveness of Cognitive Effectiveness of Cognitive TherapyTherapy

Effectiveness of Effectiveness of Psychotherapy? How do We Psychotherapy? How do We

Evaluate?Evaluate? Is it therapy that helps people get Is it therapy that helps people get better or would it occur naturally?better or would it occur naturally?

Regression towards the Regression towards the Mean:Mean: the tendency for for the tendency for for unusual emotions unusual emotions (depression/sadness) or events to (depression/sadness) or events to return (regress) toward their return (regress) toward their average state with time. average state with time.

Effectiveness of Effectiveness of Psychotherapy? How do We Psychotherapy? How do We

Evaluate?Evaluate? In order to test impact of treated In order to test impact of treated

vs. untreated, studies using vs. untreated, studies using meta-analysis must be used. meta-analysis must be used.

Meta-analysis:Meta-analysis: procedure for procedure for statistically combining the results statistically combining the results of many different research of many different research studies.studies.

Meta-analysis Illustrates Meta-analysis Illustrates Success of PsychotherapySuccess of Psychotherapy

Review: Who Conducts Review: Who Conducts Therapy?Therapy?

Clinical psychologistsClinical psychologists– Most are psychologists with a Ph.D. Most are psychologists with a Ph.D.

and expertise in research, and expertise in research, assessment, and therapy, assessment, and therapy, supplemented by a supervised supplemented by a supervised internship. internship.

– About half work in agencies and About half work in agencies and institutions, half in private practice.institutions, half in private practice.

– May work in conjunction with a May work in conjunction with a psychiatrist.psychiatrist.

Review: Who Conducts Review: Who Conducts Therapy?Therapy?

Counseling PsychologistsCounseling Psychologists– Marriage and family counselors Marriage and family counselors

specialize in problems arising from specialize in problems arising from family relations.family relations.

– Typically have one of advanced Typically have one of advanced degreesdegrees

– Pastoral counselors provide Pastoral counselors provide counseling to countless people.counseling to countless people.

– Abuse counselors work with Abuse counselors work with substance abusers and with spouse substance abusers and with spouse and child abusers and their victims.and child abusers and their victims.

Review: Who Conducts Review: Who Conducts Therapy?Therapy?

PsychiatristsPsychiatrists– Physicians who specialize in the Physicians who specialize in the

treatment of psychological disorders. treatment of psychological disorders. – Not all psychiatrists have had Not all psychiatrists have had

extensive training in psychotherapy, extensive training in psychotherapy, but as but as M.D.s they can prescribe M.D.s they can prescribe medications.medications. Thus, they tend to Thus, they tend to see those with the most serious see those with the most serious problems.problems.

– Many have a private practiceMany have a private practice..

Therapies outside of Therapies outside of Psychotherapy Are Often Psychotherapy Are Often

BiomedicalBiomedical The biomedical The biomedical

perspective focuses on perspective focuses on altering body chemistry. altering body chemistry.

Biomedical perspective is Biomedical perspective is rooted in discoveries of rooted in discoveries of psychopharmacology:psychopharmacology: study of the effect of study of the effect of drugs on the mind and drugs on the mind and behavior. behavior.

Social Effects of Drug Social Effects of Drug TreatmentsTreatments

Introduction of antipsychotic drugs

Rapid declinein the mental

hospitalpopulation

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990Year

700

600

500

400

300

200

100

0

State and countymental hospital

residents, inthousands

Drug Treatments: Drug Treatments: Antipsychotics (Neuroleptics)Antipsychotics (Neuroleptics)

AntipsychoticsAntipsychotics are used to treat are used to treat psychotic disorders like psychotic disorders like schizophrenia.schizophrenia.

Antipsychotics helps those experiencing Antipsychotics helps those experiencing both positive and negative symptoms.both positive and negative symptoms.

Most Common Examples:Most Common Examples:– Thorazine:Thorazine: alleviates alleviates

delusions/hallucinations (positive delusions/hallucinations (positive symptoms).symptoms).

– Clozaril:Clozaril: alleviates negative symptoms alleviates negative symptoms and social withdrawal. Also prescribed and social withdrawal. Also prescribed for those at risk for suicide. for those at risk for suicide.

Neuroleptics (Antipsychotics) Affect Neuroleptics (Antipsychotics) Affect on Neurotransmitterson Neurotransmitters

Drugs act as an Drugs act as an antagonist antagonist and and block dopamine receptors at the block dopamine receptors at the synapse to REDUCE the amount of synapse to REDUCE the amount of dopaminedopamine in the brain. in the brain.

Side affects are numerous:Side affects are numerous:– Most worrisome is Most worrisome is tardive dyskinesia:tardive dyskinesia:

produces an incurable disturbance of produces an incurable disturbance of motor controls (shaking, tremors), motor controls (shaking, tremors), especially of the facial muscles. especially of the facial muscles.

– Others include general lethargy, Others include general lethargy, possible increase in negative symptoms, possible increase in negative symptoms, and sexual dysfunction. and sexual dysfunction.

Drug Treatments: Drug Treatments: Anti-Anxiety (Anxiolytics)Anti-Anxiety (Anxiolytics)

Anti-Anxiety drugs depress nervous Anti-Anxiety drugs depress nervous system activity; (often called tranquilizers)system activity; (often called tranquilizers)

Drugs reduce stress and suppress anxiety.Drugs reduce stress and suppress anxiety. Most common examples are (KNOW Most common examples are (KNOW

THESE): THESE): – ValiumValium– LibriumLibrium– XanaxXanax

Anti-Anxiety Drugs Affect on Anti-Anxiety Drugs Affect on NeurotransmittersNeurotransmitters

Most modern anti-anxiety compounds Most modern anti-anxiety compounds are in a prescribed class called are in a prescribed class called benzodiazepinesbenzodiazepines which include valium which include valium and xanax.and xanax.

Work by Work by increasing the activity of increasing the activity of the neurotransmitter GABAthe neurotransmitter GABA (relaxation neurotransmitter, calming (relaxation neurotransmitter, calming affect)affect)

Benzodiazepines do have a high risk of Benzodiazepines do have a high risk of physical and psychological addiction.physical and psychological addiction.

Drug Treatments: Drug Treatments: Anti-depressantsAnti-depressants

Most anti-depressants increase the Most anti-depressants increase the availability of norepinephrine and availability of norepinephrine and serotonin which elevates arousal and serotonin which elevates arousal and mood. mood.

Most common examples are (KNOW Most common examples are (KNOW THESE):THESE):– ProzacProzac – ZoloftZoloft – Paxil Paxil

Antidepressants Affect on Antidepressants Affect on NeurotransmittersNeurotransmitters

Most common antidepressants are known Most common antidepressants are known as as Selective Serotonin Reuptake Selective Serotonin Reuptake Inhibitors (SSRI’s):Inhibitors (SSRI’s): which prevent the which prevent the reuptake of the neurotransmitter and allow reuptake of the neurotransmitter and allow INCREASED LEVELS OF SEROTONIN. INCREASED LEVELS OF SEROTONIN. Prolonged effect often lifts depressed mood.Prolonged effect often lifts depressed mood.

Other types of antidepressants also lift Other types of antidepressants also lift norepinephrine which increases energy norepinephrine which increases energy levels in addition to serotonin.levels in addition to serotonin.

Drawback:Drawback: antidepressants take few antidepressants take few weeks to start working.weeks to start working.

Drug Treatments:Drug Treatments:Mood Stabilizers for Bipolar Mood Stabilizers for Bipolar

DisorderDisorder Most common is the salt Most common is the salt

lithium (carbonate)lithium (carbonate) is is most frequently used to most frequently used to treat the mood swings of treat the mood swings of bipolar disorder. bipolar disorder.

Decreases adrenaline Decreases adrenaline and increases serotonin. and increases serotonin.

Often can have Often can have dangerous side effects dangerous side effects including being toxic at including being toxic at high doseshigh doses

Drug Treatments: StimulantsDrug Treatments: Stimulants Stimulants are often used to treat Stimulants are often used to treat

Attention-Deficit/Hyperactivity Attention-Deficit/Hyperactivity disorder (ADHD):disorder (ADHD): a common a common problem for children who have problem for children who have difficulty controlling their behavior difficulty controlling their behavior and focusing their attention. and focusing their attention.

Although its exact mechanism is Although its exact mechanism is unknown the stimulants have a unknown the stimulants have a calming and focusing effect in calming and focusing effect in children by increasing children by increasing neurotransmitters associated with neurotransmitters associated with such processes.such processes.

Electroconvulsive Therapy Electroconvulsive Therapy (ECT)(ECT)

Electroconvulsive Electroconvulsive Therapy:Therapy: used to used to treat the severely treat the severely depressed after other depressed after other treatments have treatments have failed.failed.

Success rate is high. Success rate is high. Side effects can Side effects can

include some include some memory loss. memory loss.

Psychosurgery is Most Psychosurgery is Most Drastic InterventionDrastic Intervention

Psychosurgery involves removing or Psychosurgery involves removing or destroying brain tissue in an effort to destroying brain tissue in an effort to change behavior.change behavior.

Best known procedure is a Best known procedure is a lobotomy:lobotomy: Ice pick like instrument is put through Ice pick like instrument is put through the eye sockets cutting the links the eye sockets cutting the links between the frontal lobes and the between the frontal lobes and the emotional control centers. Used to be emotional control centers. Used to be used to “cure” uncontrollably violent used to “cure” uncontrollably violent patients but now very rare.patients but now very rare.

LobotomyLobotomy