Therapies

1
Therapies
Chapter 14
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Psychotherapy

• Psychotherapy - use of psychological techniques
  to treat problems in personality and behavior (as
  opposed to biological therapies)
• General categories
• insight therapies
• behavioral therapies
• cognitive therapies
• group therapies

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Insight Therapies

• A variety psychotherapies designed to give people
  a better awareness and understanding of their
  feelings, motivations, and actions
• Types of insight therapies
• psychoanalysis
• client-centered therapy
• gestalt therapy

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Psychoanalysis

• Based on Freuds belief that anxiety and other
  problems are symptoms of inner conflicts
• Many of these conflicts have their origins in
  childhood traumas
• These conflicts are unconscious
• The goal of therapy is to make them conscious and
  understood

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Techniques used in Psychoanalysis

• hypnosis by Freud early in his career
• free association patient is encouraged to talk
  without inhibition about whatever thoughts or
  fantasies come to mind.
• dream interpretation therapist discovers the
  real meaning latent content from the patients
  description of his dreams manifest content

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Transference

• transference an essential part of
  psychoanalysis. Patient reacts to the analyst
  with feelings held toward childhood and other
  authority figures.
• positive transference warn loving feelings
  expressed toward the analyst
• usually happens early in the therapy process
• negative transference angry hostile feelings
  expressed toward the analyst
• usually happens later as therapy becomes harder

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Transference (cont.)

• counter-transference analyst unintentionally
  tranfers HIS feelings for others onto the patient
• insight The goal of psychoanalysis. Awareness
  of previously unconscious feelings and how they
  influence present behavior
• current status psychoanalysis is NOT among the
  more commonly used therapies today

8
Client-Centered Therapy

• a Nondirective form of therapy developed by the
  humanist Carl Rogers
• Rogers used the term client rather than
  patient to highlight the more active and equal
  role of the client
• goal is to make the client fully functioning
• One who is fully functioning is reaching his
  full potential, taking responsibility, and living
  life to its fullest

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Client-Centered Therapy

• unconditional positive regard the patient is
  fully accepted by the therapist despite his/her
  faults (within reason)
• The therapist must be nondirective and reflect or
  mirror back to the client what he/she has said
• current status This client-therapist
  relationship may be the key element in therapy.
  Rogers ideas do not receive the attention they
  should!

10
Gestalt Therapy

• a confrontive in your face style of therepy
  developed by Frederick Fritz Perls
• emphasizes the wholeness of the personality and
  living in the here-and-now
• recall that the term Gestalt means whole
• The GOAL is to make the person whole, responsible
  and self sufficient (in all ways, emotional,
  financial, etc.)

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Gestalt Therapy

• therapy takes place in the Here and Now
• Fritz Perls encouraged face-to-face
  confrontations to help people become more genuine
  or real in their day-to-day interactions
• The therapist is active and directive.
• current status not a widely used method

12
Behavior Therapies

• All behavior is learned. Therefore, bad
  behaviors can be unlearned and new more adaptive
  behaviors learned.
• behavior therapies are based on the principles
  of
• classical conditioning
• operant conditioning
• modeling (social learning)

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Use of Classical Conditioning

• systematic desensitization Technique for
  reducing fears and phobias by pairing a new
  response (relaxation) with stimuli that have been
  causing the fear and anxiety.
• Joseph Wolpe is the developer of systematic
  desensitization
• Wolpes focus is on promoting relaxation because
  (he feels) you cannot be both anxious and relaxed
  at the same time

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Systematic desensitization involves 3 steps
1. the client learns relaxation techniques such
as deep breathing and muscle relaxation 2. a
hierarchy or listing of fearful situations is
created 3. the client is gradually exposed to
more fearful and difficult situations while using
the relaxation techniques
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Other Uses of Classical Conditioning

• flooding idea is to eliminate anxiety through
  intense and prolonged exposure to
  anxiety-producing stimuli. Extinction is the
  mechanism of change
• example someone with a fear of contamination, as
  in OCD, might have to handle garbage until their
  fears subside
• flooding can also be done imaginally as opposed
  to in vivo (in reality)

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Other Uses of Classical Conditioning

• aversive conditioning eliminating undesirable
  behaviors by associating them with pain and
  discomfort
• examples
• drug-induced nausea paired with alcohol
• shock paired with puffing on a cigarette
• bad tasting nail coating for nail biting
• shock paired with a pedophiles sexual response

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Use of Operant Conditioning

• behavior contracting client and therapist agree
  on goals and reinforcements the client will
  receive upon reaching those goals.
• token economy Patients earn tokens
  (reinforcers) for desired behaviors and exchange
  them for desired items or privileges.
• token economy the ONLY therapy demonstrated
  effective with hospitalized schizophrenics

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Modeling

• based on Albert Banduras Social Learning Theory
• the patient learns desired behaviors by observing
  a model perform those behaviors and imitating
  the behaviors
• uses include overcoming fears (e.g., snake
  phobia) or learning new skills (social skills
  training)

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Cognitive Therapies

• Goal is to change maladaptive belief systems
  held by the patient
• stress-inoculation therapy
• Albert Elliss rational-emotive-therapy
• Becks cognitive therapy

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Stress-Inoculation Therapy

• helps clients prepare for stressful situations
• differs from systematic desensitization in that
  it is pre-emptive
• Steps involved
• discussing beliefs and their accuracy with
  therapist
• getting familiar (practice) with the situation
• actually entering and coping with the situation
• examples dental work, air travel, surgery

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Cognitive Therapy and RET

• Both Ellis and Beck assume distress is caused by
  irrational and self-defeating beliefs and the
  therapists job is to challenge those
  dysfunctional beliefs.
• Examples ofIrrational/self-defeating beliefs
• musts and shoulds
• all or none (black and white) thinking
• over-generalization
• personalization

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Cognitive Therapy and RET

• directive cognitive therapists are directive and
  tell the client what is rational and what is not
• expert therapists the therapists are the experts
  (in contrast to Rogers approach)
• homework the client may be sent out on
  assignments to test his/her beliefs
• logical argument is used to convince the client
  of the irrationality of his beliefs

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Group Therapies

• Many are modeled after individual therapies
  (e.g., Gestalt, client centered)
• particularly well suited to problems involving
  interaction with others (e.g., social phobia)
• Types of group therapies
• family therapy
• marital/couples therapy
• self-help/support groups

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Advantages of Group Therapy

• Allows therapist to see how client acts around
  others.
• Offers a client social support system.
• Client can develop new behaviors via
  observational learning and modeling.
• Interaction with others may lead to insight into
  ones own behavior.
• Less expensive than individual therapy.

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Self-help/Support Groups

• Come in a wide variety
• Usually there is NO professional leader
• Can provide information and support at minimal or
  no charge
• Alcoholics Anonymous is one example
• In many cases, someone who has suffered a
  disorder may have more insight into problems than
  a professional

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Family Therapy

• The family system is the patient.
• Often one person is the scapegoat for the
  familys problems.
• Family relationships (dynamics) are targeted.
• Problems can cross generations (e.g.,
  grandparents sabotaging parents efforts)

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Marital/Couples Therapy

• Focus is on improving
• 1 poor communication People often dont listen
  to each other. They may be fighting about one
  thing when they are really angry about something
  else.
• 2 correcting unrealistic expectations especially
  true for young couples. They may have
  unrealistic ideas about what the other is capable
  of or should be doing.

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Effectiveness of Psychotherapy
Data from the Consumer Reports Survey
Note a change score of 180 (not 0) indicates no
change
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Does Psychotherapy Work?

• About 2/3 of people say therapy helped them.
• About 1/3 of people improve without therapy.
• Starting with Hans Eysenck in 1952, many have
  questioned (and continue to question) the
  effectiveness of psychotherapy
• Many studies supporting therapy (such as the
  Consumer Reports Survey) may be flawed.
• This question continues to be difficult to answer

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Does Psychotherapy Work?

• In general, no one therapy appears to be more
  effective than another. Why?
• The main ingredient may be just having someone
  to talk to (as in client centered therapy)
• Experts agree that therapy may be more effective
  for specific minor problems (fear of flying) than
  for more general and severe problems (major
  depression or OCD)

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Biological Treatments

• A group of treatment that focus on changing the
  biology of the brain.
• May be used alone or in conjunction with
  psychotherapy.
• Types of biological treatments
• medications/drugs
• electroconvulsive therapy (ECT)
• psychosurgery

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Basic Categories of Drugs

• antipsychotics used to treat very severe
  disorders of thought such as schizophrenia.
• antidepressants to combat depression (as well
  as panic, OCD, and social phobia).
• anxiolytics to treat a wide variety of anxiety
  and stress related problems
• pychostimulants to treat ADHD and other
  disorders involving impulsivity and conduct

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Antipsychotics

• chemical class neuroleptics, phenothiazines
• examples Thorazine, Mellaril, Prolixin
• mechanism blocking dopamine receptors
• side effects these drugs have many severe side
  effects that cause people to not want to take the
  drugs
• tardive dyskinesia a severe irreversible side
  effect involving disruption of motor activity
  (movement), occurs with long term use

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3 Classes of Antidepressants

• 1. Monoamine Oxidase Inhibitors (MAOs)
• the first group to be discovered
• examples Parnate, Nardil
• mechanism blocks MAO, increases levels of
  norepinephrine and serotonin
• side effects dry mouth, dizziness, sexual
  dysfunction, digestive problems, etc.
• dietary restrictions must avoid certain foods to
  prevent high blood pressure and stroke

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2. Tricyclic Antidepressants

• the second major group to be discovered
• examples Elavil, Anafranil
• mechanism llike MAOs, increases levels of
  norepinephrine and serotonin
• side effects dry mouth, dizziness, sexual
  dysfunction, digestive problems, etc.
• Side effects are similar to the MAOs except for
  the dietary restrictions

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3. Serotonin Reuptake Inhibitors (SSRIs)

• the most recent group to be discovered (1987)
• examples Prozac, Paxil, Zoloft
• mechanism prevents reuptake of serotonin leaving
  more in synapse
• side effects fewer than MAO or Trichyclics but
  still headache, anxiety, sexual dysfunction
• popularity because of the less severe side
  effects, more people are willing to take these.

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Lithium Carbonate

• Lithium is a naturally occurring salt that is
  used to treat bipolar disorder.
• Lithium helps level out the extreme highs of
  mania and the extreme lows of depression.
• Exact mechanism is not known but may involve NA
  (sodium) channels in CNS axons
• Narrow window of effectiveness, too little - no
  effect, too much - danger
• Blood levels must be checked often

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Anxiolytics (anti-anxiety) Drugs

• Two basic categories
• barbiturates powerful sedatives, first
  anxiolytic to be developed
• example Seconal
• mechanism CNS depressant
• side effects sleepiness, slowed reflexes, very
  dangerous when combined with alcohol
• tolerance and dependence are potential problems

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2. Benzodiazepines

• safer than barbiturates, highly prescribed
• examples Valium, Xanax, Tranxene, Ativan
• mechanism binds to GABA (gamma amino butyric
  acid) receptors in the CNS
• side effects few and minor, some drowsiness,
  slowed reflexes, etc.
• tolerance and dependence psychological and
  physical dependence are possible. However, many
  experts disagree on this issue

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Psychostimulants

• in children and some adults these improve
  attention, help the person settle down, and
  reduce impulsivity
• example - Ritalin
• mechanism - these are CNS stimulants
• side effects - sedation, some long term physical
  effects
• tolerance or dependence - usually not a problem

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Other Biological Treatments

• Electroconvulsive therapy (ECT)
• Psychosurgery brain surgery performed to change
  a persons behavior and/or emotional state
• prefontal lobotomy
• modern psychosurgery

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Electroconvulsive Therapy (ECT)

• An electrical current is passed through the brain
  for a second or two
• This produces convulsions and temporary coma.
  Today, muscle relaxants reduce severity of
  convulsions
• Seen by most as a treatment of last resort for
  the most severe depressions
• The mechanism by which ECT works remains unknown.

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Psychosurgery

• prefrontal lobotomy ice pick surgery widely
  used during the first half of this century before
  modern medications
• a crude operation in which axons connecting
  the frontal lobes with lower brain areas were
  severed, rarely used today.
• modern psychosurgery in addition to traditional
  methods, multi-source beams of low energy
  radiation can modify brain tissue with pinpoint
  accuracy

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Deinstitutionalization

• treating people with severe psychological
  disorders in the community rather than in large
  public hospitals.
• made possible largely by the development of
  anti-psychotic drugs in the 1950s

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Problems with Deinstitutionalization

• Community mental-health centers are poorly funded
  and understaffed.
• Ex-patients are poorly prepared to live in the
  community.
• Not enough housing available.
• Social stigma of having a mental disorder,
  neighborhoods may resist these centers.
• Large insurance companies would rather pay for
  inpatient care.

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Types of Mental Illness Prevention

• primary prevention
• secondary prevention
• tertiary prevention

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Prevention

• Primary Prevention Improving the social
  environment so that new cases of mental disorders
  do not develop.
• Secondary Prevention identifying high risk groups
  and intervening before problems become serious.
• Tertiary Prevention helping people adjust to
  community life after release from a mental
  hospital.

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Gender Differences in Treatment

• Women are more likely than men to be in
  psychotherapy, possibly because is more socially
  accepted for women.
• Women receive more psychotropic medications than
  men.
• Men are more likely to self medicate with alcohol
  and other drugs.

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Cultural Differences in Treatment

• Ones ethnic and cultural background may
  influence how he/she responds to a therapist.
• A therapist who is more similar to the client
  (e.g., gender, cultural group) may be better able
  to understand and relate to the problems of a
  particular client.