psychology read chapter 17 therapy, psychopharmacology, & biomedical treatments

PSYCHOLOGY

READ Chapter 17Therapy,

Psychopharmacology, & Biomedical Treatments

ESSENTIAL QUESTION:

What techniques do psychologists and psychiatrists use to treat psychological disorders?

GPS STANDARD: SSPVB3- The student will identify abnormal behavior and treatment.

e.) compare the biomedical, psychoanalytical, cognitive, and behavioral approaches to the treatment of psychological disorders.

Therapy

Psychotherapy an emotionally charged, confiding

interaction between a trained therapist and someone who suffers from psychological difficulties

this includes talking about the patient’s problems and exploring new ways of thinking and acting

Therapy

Eclectic Approach an approach to psychotherapy that,

depending on the client’s problems, uses techniques from various forms of therapy

although the eclectic therapist may lean toward one treatment approach, they borrow methods from other types of therapy as well

Therapy:

Basic features of treatment: a client (or patient) a therapist who is accepted as capable

of helping the client the establishment of a special

relationship between the client and therapist that includes trust and honesty

Therapy: Basic features of treatment

Basic features of treatment continued:

all forms of treatment are based on some theory about the causes of the client’s problems

the theory in turn leads to special procedures dealing with the client’s problems

Therapists and their Training

Clinical psychologists Most are psychologists with a Ph.D.

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

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


Clinical or Psychiatric Social Worker A two-year Master of Social Work

graduate program plus postgraduate supervision prepares some social workers to offer psychotherapy, mostly to people with everyday personal and family problems

About half have earned the National Association of Social Workers’ designation of clinical social worker


Counselors Pastoral counselors provide

counseling to countless people Abuse counselors work with

substance abusers and with spouse and child abusers and their victims

Marriage and family counselors specialize in problems arising from family relations


Psychiatrists Physicians who specialize in the

treatment of psychological disorders Not all psychiatrists have had

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

Many have a private practice

Biomedical Therapies- antipsychotics/neuroleptics

ESSENTIAL QUESTION:

What drugs are used to treat psychological disorders? What are some of their negative side effects?



Psychopharmacology

Psychopharmacologystudy of the effects of drugs on mind and behavior

Psychopharmacology

Neuroleptics (or antipsychotics) the early 1950s saw the

introduction of a new group of drugs that revolutionized the treatment of severe mental disorders

these drugs dramatically reduced the intensity of such symptoms as hallucinations, delusions, paranoid suspiciousness, and disordered thinking in many mental patients

Psychopharmacology

Neuroleptics cont… these drugs were especially helpful

for patients with schizophrenia as a result of taking these drugs,

many mental patients became better able to take care of themselves

thousands of patients were able to leave the mental hospitals as a result of these drugs

Psychopharmacology: antipsychotic medications

Thorazine is used for the reduction of

symptoms of psychotic disorders such as schizophrenia

is also used for the short-term treatment of severe behavioral disorders in children, including explosive hyperactivity and combativeness


Thorazine cont… is also used for the “hyperenergetic”

phase of manic-depressive illness due to its sedative effects

has many side effects such as: dry mouth blurred vision urinary retention dizziness skin pigmentation problems

may also cause tardive dyskinesia


Thorazine cont… tardive dyskinesia- has effects similar

to those of Parkinson’s disease such as: muscle rigidity muscle spasms restlessness tremors slowed movement uncontrollable grotesque twitches in the

face & body uncontrollable grotesque thrusting of the

tongue


Thorazine cont… tardive dyskinesia

this side effect is an irreversible disorder of the motor system that appears only after years of neuroleptic use

it affects 25 percent of patients who take these drugs

in some ways tardive dyskinesia can be far worse than the mental disorder that led to treatment


Clozaril is given to people with severe

schizophrenia who have failed to respond to other drug treatments

it is not a cure but can help some people with schizophrenia return to a more normal life

does not cause movement disorder tardive dyskinesia


Clozaril may cause another disorder called

agranulocytosis in about 2% of the patients that take it

Agranulocytosis- is a potentially fatal disorder characterized by a loss of white blood cells and the consequent susceptibility to infectious disease

weekly blood tests are required to detect early signs of this disease


Haldol also used to treat schizophrenia and

other psychotic episodes prescribed to control tics

(uncontrollable muscle contractions of the face arms and shoulders)

also helps to control uncontrollable utterances (talking) associated with Tourette’s syndrome


Haldol cont… also used to treat children with

severe behavior problems such as hyperactivity and combativeness

some doctors also prescribe Haldol to relieve severe nausea or vomiting

also used to treat drug problems such as LSD flashbacks or PCP intoxication

Biomedical Therapies The emptying of U.S. mental hospitals

Antidepressants

ESSENTIAL QUESTION:




Psychopharmacology: antidepressants

soon after antipsychotic drugs appeared, antidepressants were developed

these drugs were designed to relieve the symptoms of depression


about 60 to 70 percent of patients who take these drugs show: improved mood greater physical activity increased appetite more deep sleep


although these drugs have an immediate effect on neurotransmitters (usually increasing serotonin or norepinephrine) their effects on depressive symptoms do not occur until one to three weeks after the dosage begins


MAO-I (monoamine oxidase inhibitors) effective for depression and panic

disorder serious side effect of severe

hypertension (high blood pressure) if mixed with foods containing tyramine: aged cheeses red wine chicken livers


Tricyclics work better than MAO-I(s)in reducing

depression tricyclics have fewer side effects and do not

raise the blood pressure Side effects of tricyclics include:

Sleepiness Dry mouth Dizziness Blurred vision Hypotension (lower blood pressure) Constipation Urinary retention


Tricyclics cont…. An extreme side effect of tricyclics is

that when they are combined with alcohol it increases the effects of both and the combination of the two can potentially result in the death of the patient


SSRIs (selective serotonin reuptake inhibitors) Prozac is the most popular drug

among the SSRIs it affects serotonin rather than

norepinephrine Prozac was introduced in 1986 and is

the most widely prescribed antidepressant in the United States


SSRIs (selective serotonin reuptake inhibitors) cont…. Its popularity is due to the fact that it

is as effective as the tricyclics and in most cases has fewer side effects

60 to 80 percent of the depressed patients that use Prozac get significant relief from their depression


OTHER SSRIs (selective serotonin reuptake inhibitors) Anafranil Luvox Effexor Celexa Paxil Zoloft Wellbutrin

Biomedical Therapies

Psychopharmacology: herbal remedies

St. John’s Wort

The most recent development in the pharmacological treatment of depression is the use of the herbal remedy St. John’s Wort

In Germany, where this treatment is paid for by health insurance, it is more popular than Prozac

The active ingredient in St. John’s Wort is hypericin

Hypericin is a substance thought to enhance serotonin activity in the brain and possibly act just like an MAO-I


St. John’s Wort cont… it has multiple uses:

Soothes the digestive system Relieves ulcers and gastritis Treats diarrhea and nausea Works as a sedative, painkiller, a topical

analgesic


St. John’s Wort cont…

one major side effect is that it causes photosensitivity

If a light-skinned animal or human eats the plant exposure to direct sunlight may cause: Dermatitis Inflammation of the mucous membranes Or more toxic reactions

Bipolar drugs, anti-anxiety drugs, electroconvulsive therapy

ESSENTIAL QUESTION:




Biomedical Therapies Electroconvulsive Therapy (ECT)

therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized patient

Psychosurgery surgery that removes or destroys brain

tissue in an effort to change behavior lobotomy

now-rare psychosurgical procedure once used to calm uncontrollably emotional or violent patients

Electroconvulsive Therapy

Psychopharmacology: bipolar disorder

Eskalith (lithium bicarbonate) around 1970, a mineral salt of the

element lithium was found to calm manic patients

if taken regularly, it prevents both the depression and the mania associated with bipolar disorders


Lithium bicarbonate (Eskalith) cont… lithium is effective for 80% of

manic patients Without lithium, the typical bipolar

patient has a manic episode about every 14 months and a depressive episode about every 17 months


Lithium cont… With lithium attacks of mania occur as rarely as every 9 years


Lithium cont… The lithium dosage must be exact

and carefully controlled Too much lithium causes:

Vomiting Nausea Tremors Fatigue Slurred speech With severe overdoses Coma OR Death


Lithium cont… lithium cannot treat a manic

episode in progress because it takes a week or two or regular use before its effects are seen

So just like with antidepressants, lithium’s effects probably occur through some long-term adaptation as the nervous system adjusts to the presence of the drug

Psychopharmacology: anxiety disorders

Anti-anxiety drugs- used for the treatment of anxiety or insomnia Ativan Valium Librium Rohypnol Klonopin Xanax

Anxiety Drugs Many anxiety drugs are in a class of

drugs called benzodiazepines Benzodiazepines are dangerous when

mixed with alcohol the benzodiazepines became the

worldwide drug treatment of choice for anxiety

these and the more modern drugs of this drug class continue to be the most widely prescribed and used of all legal drugs

Psychopharmacology: anxiety disorders

benzodiazepines cont… benzodiazepines have an

immediate calming effect on anxiety and are quite useful in the treatment of generalized anxiety disorder (GAD) and posttraumatic stress disorder (PTSD).

one of the newest of the benzodiazepines is Xanax

ESSENTIAL QUESTION:

How do humanistic therapists help their clients overcome the obstacles that prevent them from achieving their full human potential and experience…..

self-actualization?



Humanistic Therapy

Client-Centered Therapy humanistic therapy developed by

Carl Rogers therapist uses techniques such as

active listening within a genuine, accepting, empathic environment to facilitate clients’ growth

Humanistic Therapy

Carl Rogers Carl Rogers was trained in

psychoanalytic methods but he began to question their value and usefulness

Rogers disliked being a detached expert observer in the therapy process whose job is to figure out what is wrong with the client

Humanistic Therapy

Carl Rogers cont… Rogers became convinced that a less

formal approach would be more effective for the client and more comfortable for the therapist

Rogers developed a non-directive form of therapy which depends on the client’s own drive toward growth or personal actualization

Humanistic Therapy

Carl Rogers cont… Rogers allowed his clients to

decide what to talk about and when, without direction, judgment, or interpretation by the therapist which is the main idea behind client-centered therapy

Humanistic Therapy Carl Rogers developed client-centered

therapy

Humanistic Therapy

Unconditional Positive Regard treating the client as a valued

person no matter what they say or what they have done

the therapist listens without interrupting and accepts everything the client says without evaluating it

Humanistic Therapy

Unconditional Positive Regard cont… The therapist need not approve of

everything the client says but he or she must accept statement as reflecting a part of the person

because they trust their clients to solve their own problems, Rogerian therapists rarely give advice

Humanistic Therapy

Unconditional Positive Regard cont… If the therapist gives advice, Rogers

believed that this would undermine the human growth potential of the client by subtly implying that they are incompetent to solve their own problems

They must be confident that they can solve their own problems and not become dependent on others for help

Humanistic Therapy

Empathy Client-centered therapists try to

appreciate how the world looks from the client’s point of view

This involves far more than saying, “I know what you mean.”

The therapist tries to replace their external frame of reference- looking at the patient from the outside- with an internal frame of reference.

Humanistic Therapy

Empathy cont…. The therapist tries to replace their

external frame of reference- looking at the patient from the outside- with an internal frame of reference.

The internal frame of reference is characterized by empathy

Empathy- the emotional understanding of what the client might be thinking and feeling

Humanistic Therapy

Client-centered therapy conveys empathy to the client by active listening

The therapist: makes eye contact with the client nods in recognition as the client speaks gives other signals of careful attention

Humanistic Therapy Active Listening-empathic listening in

which the listener echoes, restates, and clarifies

Humanistic Therapy

Client-centered therapists also use reflection (or mirroring)

Reflection- is a paraphrased summary of the client’s words and especially the feelings and meanings that appear to accompany those words

Reflection confirms that real communication is going on between the therapist and client

Humanistic Therapy

Reflection cont…. reflection shows the therapist’s level of interest

reflection helps the client perceive and focus on the thoughts and feelings that they are expressing

This method helps the client bring important material into the open without the therapist asking disruptive questions which interfere with the client’s thinking process

Humanistic Therapy

Congruence (a.k.a.- genuineness) congruence shows consistency between

the therapist’s feelings and actions when the therapist’s unconditional

positive regard and empathy are genuine, the client is able to see that relationships between people can be built on openness and honesty

this will hopefully help the client to become more congruent or genuine in their other relationships

ESSENTIAL QUESTION:

What techniques does psychoanalysis use to treat and resolve conflicts?



Therapy- Psychoanalysis

Psychoanalysis (Freud’s method of treatment) the field of psychotherapy began when

Sigmund Freud established the psychoanalytic approach in the late 1800s

central to his approach is the assumption that personality and behavior reflects the efforts of the ego (the self) to resolve internal conflicts between our unconscious desires for pleasure and the rules and values of society which tell us what we should and should not do


Psychoanalysis (Freud’s method of treatment)

Psychoanalysis is aimed at understanding the unconscious conflicts and how they affect the client a one-to-one method of studying and treating

people a systematic search for relationships between

an individual’s life history and their current problems

an emphasis on thoughts and emotions during treatment

a focus on the patient-therapist relationship

Therapy- Psychoanalysis Psychoanalysis cont…

Freud believed the patient’s free associations, resistances, dreams, and transferences – and the therapist’s interpretations of them – released previously repressed feelings, allowing the patient to gain self-insight

classical psychoanalytic treatment aims to help clients gain insight into their problems by recognizing unconscious thoughts and emotions and then discover, or work through, the many ways in which those unconscious elements affect their everyday life


Interpretation the analyst’s noting supposed dream

meanings, resistances, and other significant behaviors in order to promote insight

Transference the patient’s transfer to the analyst of

emotions linked with other relationships e.g. love or hatred for a parent

Resistance blocking from consciousness of anxiety-laden

material


Psychoanalysis cont… the use of psychoanalysis has rapidly decreased in recent years

ESSENTIAL QUESTION:

What techniques do behavioral psychologists use to treat psychological disorders?



Behavior Therapy

Behavior Therapy therapy that applies learning principles

to the elimination of unwanted behaviors

behavior therapists help clients view their psychological problems as learned behaviors

these learned behaviors can be changed without understanding the hidden meanings or underlying processes

Behavior Therapy

Behavior Therapy for instance, panic attacks can be

reduced without looking for the meaning of the underlying behavior

Behavior therapy would discover the underlying learning principles that caused the fear and then would teach the person new learned responses in fearful situations

Behavior Therapy

Counterconditioning procedure that conditions new

responses to stimuli that trigger unwanted behaviors

based on classical conditioning

includes exposure therapy, systematic desensitization, and aversive conditioning

Behavior Therapy Exposure Therapy

treat anxieties by exposing people (in imagination or reality) to the things they fear and avoid

Behavior Therapy Systematic Desensitization

type of counterconditioning it is a method in which the client

visualizes a series of anxiety-provoking stimuli while maintaining a state of relaxation

it associates a pleasant, relaxed state with the stimuli that once caused the anxiety

commonly used to treat phobias

Behavior Therapy Aversive Conditioning

many unwanted behaviors are so habitual and temporarily rewarding that they must be made less attractive if the client is to have any chance of learning alternatives

type of counterconditioning that associates an unpleasant state with an unwanted behavior

Nausea producing drug Antabuse ---> makes you sick when you drink alcohol

Behavior Therapy Systematic Desensitization

Behavior Therapy

Aversion therapy for alcoholics

Behavior Therapy Punishment sometimes the only way to eliminate

a dangerous or disruptive behavior is to punish it with an unpleasant but harmless stimulus, such as shouting “No!” or a mild electric shock

punishment presents the unpleasant stimulus after the undesirable response occurs

Behavior Therapy

Token Economyan operant conditioning procedure that rewards desired behavior

patient exchanges a token of some sort, earned for exhibiting the desired behavior, for various privileges or treats

ESSENTIAL QUESTION:

What techniques do cognitive psychologists use to treat psychological disorders?



Cognitive Therapy

Cognitive Therapy it assumes that our thinking affects our feelings

somewhere between the event and our response to it lies the human mind which interprets the event and creates an emotional response

if we can control our reaction to the event we can also control our response

cognitive teaches people new, more adaptive ways of thinking and acting

Cognitive Therapy

Cognitive Therapy & Depression self-blaming and over-generalized

explanations of “bad” events are often part of the vicious cycle of depression

the person experiencing depression interprets a suggestion such as criticism disagreement as dislike friendliness as pity

dwelling on negative thoughts sustains a bad mood

Cognitive Therapy

Cognitive Therapy & Depression if depressed thinking patterns can be

learned then they can also be replaced cognitive therapists teach people new,

more constructive ways of thinking If people are miserable they can be

helped to change their minds

Cognitive Therapy

The Cognitive Revolution

Cognitive Therapy

A cognitive perspective on psychological disorders

Cognitive Therapy

Cognitive therapy for depression

Cognitive Therapy

Cognitive-Behavioral Therapya popular integrated therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior)

Group and Family Therapies

Family Therapy treats the family as a system views an individual’s unwanted

behaviors as influenced by or directed at other family members

attempts to guide family members toward positive relationships and improved communication

Evaluating Psychotherapies

To whom do people turn for help for psychological difficulties?


Regression toward the mean tendency for extremes of unusual

scores to fall back (regress) toward their average

Meta-analysis procedure for statistically

combining the results of many different research studies


Poor outcome Good outcome

Averageuntreated

person

Averagepsychotherapy

client

Number ofpersons

80% of untreated people have pooreroutcomes than average treated person

psychology read chapter 17 therapy, psychopharmacology, & biomedical treatments

Documents

behavior slide

acting slide

honesty slide

treatment approach

therapy psychotherapy

biomedical treatments

forms of treatment

private practice slide