psy i chapt.14 west
TRANSCRIPT
Geri Lavrov / Photographer's Choice / Getty Images
Treating Psychological DisordersThe psychological therapies
Evaluating psychotherapies
The biomedical therapies
Preventing psychological disorders
THE HISTORY OF TREATMENTVisitors to eighteenth-century mental hospitals paid to gawk at patients,as though they were viewing zoo animals. William Hogarth’s (1697–1764) painting captured one of these visits to London’s St. Mary of Bethlehem hospital (commonly called Bedlam).
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Approach Differences
PsychotherapyTherapy in which a trained therapist uses psychological techniques to assist someone seeking to overcome difficulties or achieve personal growth
Biomedical therapyTherapy in which a trained therapist, most often a medical doctor, offers medications and other biological treatments
Eclectic approachUses blend of therapies
The Psychological Therapies
Psychoanalysis and psychodynamic therapy
Humanistic therapies
Behavior therapies
Cognitive therapies
Group and family therapies
The Psychological Therapies
PsychoanalysisGoals: To bring patients’ repressed feelings into conscious awareness; to help patients release energy devoted to id-ego-superego conflicts
Techniques: Historical reconstruction, initially through hypnosis and later through free association; Interpretation of resistance, transference
In psychoanalysis, patients may experience strong feelings for their analyst, which is called ________.
Patients are said to demonstrate anxiety when they put up mental blocks around sensitive memories—showing ________.
The analyst will attempt to offer insight into the underlying anxiety by offering a(n) ________ of the mental blocks.
Psychodynamic Therapy
Goals: To help people understand current symptoms; to explore and gain perspective on defended-against thoughts and feelings
Techniques: Client-centered face-to-face meetings; Exploration of past relationship troubles to understand the origins of current difficulties
FACE-TO-FACE THERAPY In this type of therapy session, the couch has disappeared. But the influenceof psychoanalytic theory may not have, especially if the therapist seeks information from the patient’schildhood and helps the patient reclaim unconscious feelings.
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Humanistic Therapies
Theme: Emphasis on people’s potential for self-fulfillment; to give people new insights
Goals: To reduce inner conflicts that interfere with natural development and growth
Techniques: Client-centered therapy; focus on taking responsibility for feelings and actions and on present and future rather than past
Humanistic Therapies
RogersPerson-centered therapy focuses on a person’s conscious self-perceptions; non-directive; active listening; unconditional positive regard
Most people possess resources for growth
Therapists foster growth by exhibiting genuineness, acceptance, and empathy
ACTIVE LISTENING Carl Rogers (right) empathized with a client during this group therapy session.
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Humanistic Therapies
Strengthening communication: RogersSummarize
Invite clarification
Reflect feelings
Behavior TherapiesClassical conditioning techniques
Counterconditioning: Uses classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors
Exposure therapies: Treat anxieties by exposing people (in imagination or actual situations) to the things they fear and avoid
Systematic desensitization: Associates a pleasant, relaxed state with gradually increasing, anxiety-triggering stimuli
Virtual Reality Exposure Therapy
Treats anxiety by creative electronic simulations in which people can safely face their greatest fears, such as airplane flying, spiders, or public speaking
Within the Within the confines of a confines of a room, virtual room, virtual
reality reality technology technology
exposesexposespeople to vivid people to vivid simulations of simulations of feared stimuli, feared stimuli,
such as walking such as walking across a rickety across a rickety bridge high off bridge high off
the ground.the ground.
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Aversion Therapy for Alcohol Abuse
Therapists gave people with a history of alcohol abuse a mixed drink containing alcohol and Therapists gave people with a history of alcohol abuse a mixed drink containing alcohol and a drug that produces severe nausea. After repeated treatments, some people developed at a drug that produces severe nausea. After repeated treatments, some people developed at
least a temporary conditioned aversion to alcohol. (Classical conditioning terms: US is least a temporary conditioned aversion to alcohol. (Classical conditioning terms: US is unconditioned stimulus, UR is unconditioned response, NS is neutral stimulus, CS is unconditioned stimulus, UR is unconditioned response, NS is neutral stimulus, CS is
conditioned stimulus, and CR is conditioned response.)conditioned stimulus, and CR is conditioned response.)
Operant Conditioning
Operant conditioning therapy: Consequences drive behavior
Behavior modification: The desired behavior is reinforced; undesired behavior is not reinforced and is sometimes ignored or punished
Token economy: People earn a token for exhibiting a desired behavior and can later exchange the tokens for privileges or treats
Quick Comparisons
Insight therapists•Assume self-awareness and psychological well-being are complementary
Psychodynamic therapists
•Expect people’s problems lessen insight into unresolved and unconscious tensions gained
Humanistic therapists•Expect people’s problems to lessen as they get in touch with their feelings
Behavior therapists•Assume problem behaviors are the problems
How do the insight therapies differ from behavior therapies?
Some maladaptive behaviors are learned. What hope does this fact provide?
Exposure therapies and aversive conditioning are applications of ________ conditioning. Token economies are an application of ________ conditioning.
Cognitive Therapies
Cognitive Therapies
Cognitive therapiesTeach people new, more adaptive ways of thinking; Based on the assumption that thoughts intervene between events and our emotional reactions
Beck’s therapy for depressionGentle questioning seeks to reveal irrational thinking and then to persuade people to change their perceptions of their own and others’ actions as dark, negative, and pessimistic
People are trained to recognize and modify negative self-talk
Selected Cognitive Therapy Techniques
Cognitive Therapies
Cognitive-behavioral therapyAn integrative therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior)
Aims to alter the way they act AND they way they think
Helps people learn to make more realistic appraisals
How do the humanistic and cognitive therapies differ?
What is cognitive-behavioral therapy, and what sorts of problems does this therapy address?
Group and Family Therapies
Group therapy Conducted with groups rather than individuals, providing benefits from group interaction
Often used when client problems involve interactions with others
Family therapy Treats the family as a system
Views an individual’s unwanted behaviors as influenced by, or directed at, other family members
FAMILY THERAPY This type of therapy often acts as a preventive mental health strategy.
•The therapist helps family The therapist helps family members understand how their members understand how their ways of relating to one another ways of relating to one another
create problemscreate problems
•The treatment’s emphasis is The treatment’s emphasis is not on changing the not on changing the
individuals, but on changing individuals, but on changing their relationships and their relationships and
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Which therapeutic technique has focused more on the present and future than the past, and has promoted unconditional positive regard and active listening?
Which of the following is NOT a benefit of group therapy?a. more focused attention from the therapistb. less expensivec. social feedbackd. reassurance that others share troubles
Evaluating Psychotherapies
Is psychotherapy effective?
Which psychotherapies work best?
How do psychotherapies help people?
How do culture and values influence psychotherapy?
CLOSE-UP: A consumer’s guide to psychotherapists
Evaluating Psychotherapies
Clients’ perceptionsClient self-reports indicate that psychotherapy is effective
Critics of client self-reportsClients may need to justify their investment of effort and money
Clients generally speak in positive terms of their therapists
Clients often enter therapy in crisis
Evaluating Psychotherapies
Clinicians’ perceptionsTherapists are most aware of the failure of other therapists
Outcome researchWith or without psychotherapy: People improved noticeably over time (Eyenck)
After extensive research review: Those not undergoing therapy often improve, but those undergoing therapy are more likely to improve
Evaluating Psychotherapies
Which Psychotherapies Work Best?
Some forms of psychotherapy work best for particular problems
Behavior therapies: Bed-wetting, phobias, compulsions, marital problems, and sexual dysfunctions
Psychodynamic therapy: Depression and anxiety
Cognitive therapies: Anxiety, depression, and posttraumatic stress disorder
Which Psychotherapies Work Best?
Unsupported approachesEnergy therapies
Recovered memories therapies
Rebirthing therapies
Which Psychotherapies Work Best?
Therapy is more likely to be helpful in those with the ________ (most/least) clearly defined problems.
What is evidence-based practice?
How Do Psychotherapies Help People?
Three basic benefits for all psychotherapies
Hope for demoralized peopleA new perspective for oneself and the worldAn empathic, trusting, caring relationship
A CARING RELATIONSHIP A CARING RELATIONSHIP Effective counselor aboard a ship, Effective counselor aboard a ship,
form a bond of trust with the form a bond of trust with the people they are serving.people they are serving.
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Those who undergo psychotherapy are ________ (more/less) likely to show improvement than those who do not undergo psychotherapy.
How Do Culture and Values InfluencePsychotherapy?
Psychotherapists’ personal beliefs and values influence their practice
Differences in cultural and moral diversity and religious values can create a mismatch
The Biomedical Therapies
Drug therapies
Brain stimulation
Psychosurgery
Therapeutic lifestyle change
The Biomedical Therapies
Drug therapiesAre the most widely used biomedical treatments
Include prescribed antidepressants for 27 million Americans
Involve placebo and double-blind techniques to evaluate drug effectiveness
The Biomedical Therapies
Most common drug treatments for psychological disorders
Antipsychotic drugs
Antianxiety drugs
Antidepressant drugs
Mood-stabilizing medications
Let’s take a closer look at each of these.
Drug Therapies
Antipsychotic drugsMimic certain neurotransmitters (e.g., block or increase activity of dopamine); reduce overreaction to irrelevant stimuliMay produce sluggishness, tremors, twitches, and tardive dyskinesia; ThorazineSuccessfully used with life-skills programs and family support to treat schizophrenia
Antianxiety drugsDepress CNS activity; Xanax or AtivanUsed in combination with psychological therapyMay reduce symptoms without resolving underlying problems; withdrawal linked to increased anxiety and insomnia
Drug Therapies
Antidepressant drugsIncrease availability of norepinephrine or serotonin; promote birth of new brain cells
Slow synaptic vacuuming up of serotonin (SSRIs)
Effectiveness sometimes questioned due to spontaneous recovery and placebo effect
Mood-stabilizing medicationsDepakote: Controlling manic episodes
Lithium: Levels emotional highs and lows of bipolar disorder
How do researchers evaluate the effectiveness of particular drug therapies?
The drugs given most often to treat depression are called ________. The drugs that are now often given to treat anxiety disorders are called ________. Schizophrenia is often treated with ________ drugs.
Brain Stimulation
Electroconvulsive therapyManipulates the brain by shocking it
Involves the administration of a general anesthetic and muscle relaxation to prevent convulsions
Causes less memory disruption than earlier versions
AMA concluded that ECT methods among most positive treatment effects; reduces suicidal thoughts
Involves several theories about the reason for effectiveness
Brain Stimulation
Brain Stimulation
Alternative neurostimulation therapiesVagus nerve stimulation: Stimulates neck nerve that sends signals to limbic system; increases available serotonin by increasing firing rate of some neuronsDeep brain stimulation: Manipulates depressed brain via pacemaker; stimulates inhibition activity related to negative emotions and thoughtsRepetitive transcranial magnetic stimulation (rTMS): Sends magnetic energy to brain surface through coiled wire held close to brain; fewer side effects; modest effectiveness
Severe depression that has not responded to other therapy may be treated with ________, which can cause memory loss. More moderate neural stimulation techniques designed to help alleviate depression include ________ stimulation, ________ stimulation, and ________ magnetic stimulation.
Brain Stimulation
PsychosurgeryInvolves surgery that removes or destroys brain tissue in an effort to change behaviorIs irreversible; is the least used biomedical therapy
LobotomyPsychosurgical procedure once used to calm uncontrollably emotional or violent patients Procedure cut the nerves connecting the frontal lobes to the emotion-controlling centers of the inner brain (Moniz)Today less invasive techniques are used; MRI-guided surgery in severe disorders
Therapeutic Lifestyle Change
Training seminarsHuman brains and bodies were designed for physical activity and social engagement
Our ancestors hunted, gathered, and built in groups with little evidence of disabling depression
12-week training with the following goalsAerobic exercise, adequate sleep, light exposure, social connection, antirumination, nutritional supplements
Comparing Therapies
What are some examples of lifestyle changes we can make to enhance our mental health?
Preventing Psychological Disorders
ResilienceInvolves personal strength that helps most people cope with stress and recover from adversity and trauma
Can be seen in New Yorkers after 9/11, spinal cord injury patients, Holocaust survivors, and others
PreventionThrough identification and elimination of conditions that cause psychological casualties
Through support of programs and providers that control or eliminate stress
What is the difference between preventive mental health and psychological or biomedical therapy?