Chapter 13 Therapies for Psychological Disorders Copyright Allyn

What is Therapy? Therapy – General term for any treatment process; a variety of

The Components of Therapy In addition to the relationship between therapist and the patient,

Insight Therapies Insight therapies – Psychotherapies in which therapist helps patients understand (gain insight

Insight Therapies: Psychodynamic Therapies Psychoanalysis – The form of psychodynamic therapy developed by Sigmund

Psychoanalytic Terms Resistance—blocking from consciousness anxiety-laden material (you “don’t want to go there”) Interpretation—noting

Insight Therapies: Humanistic therapies (Carl Rogers) Rogers – (aka client-centered therapy) based on the

Behavior Therapies Behavior therapy – Therapy based on the principles of behavioral learning, especially

Classical Conditioning Therapies Exposure therapy – patient directly confronts the anxietyprovoking stimulus (as opposed

Counterconditioning—Therapy which uses classical conditioning to evoke new responses to stimuli that are triggering

Classical Conditioning Therapies Aversion therapy – Pairing a pleasant and unpleasant stimulus to condition

Operant Conditioning Therapies Contingency management – changing behavior by altering the consequences, (rewards and

Operant Conditioning Therapies Token economies – Applied to groups (e. g. classrooms, mental hospital

Participant Modeling: An Observational-Learning Therapy Participant modeling – Therapist demonstrates and encourages a client

Insight Therapies: Cognitive therapies Cognitive therapy – (Aaron Beck) Beck Emphasizes rational thinking as

Cognitive-Behavioral Therapy: A Synthesis Rational-emotive behavior therapy – a type of CBT developed by

Insight Therapies: Group therapies For many issues, couples counseling or family therapy can often

Cognitive-Behavioral Therapy: A Synthesis Cognitive-behavioral therapy Combines cognitive emphasis on thoughts with behavioral strategies

Insight Therapies: Group therapies Group therapy – Psychotherapy with more than one client Very

Differences between Rogers & Ellis Carl Rogers Albert Ellis Client (person) centered therapy REBT

Evaluating the Psychological Therapies Eysenck proposed that people with nonpsychotic problems recover just as

Is psychotherapy effective? Meta-analysis: The bottom line results after looking at many different research

Therapeutic alliance: Trust and bond between therapist and client. Resilience: Personal strength that helps

Quiz 1. What are some differences between psychologists and psychiatrists? 2. What is the

How might each approach view treatment? Cognitive Psychodynamic Humanistic Behavioral Sociocultural Biological Evolutionary Copyright

Short Film Note what therapeutic techniques therapist uses over the course of the film.

How Is the Biomedical Approach Used to Treat Mental Disorders? Biomedical therapies treat mental

Drug Therapy Psychopharmacology – Using prescription drugs to treat mental disorders (often to make

Drug Therapy Antipsychotic drugs Include Thorazine, Haldol, Risperdal, Clozapine Usually affect dopamine pathways May

Drug Therapy Antianxiety drugs • Include [rarely] barbiturates (CNS depressants) and benzodiazepines (Valium and

Drug Therapy Antidepressants (in order of usage) • SSRIs like Prozac, Paxil, Celexa, Lexapro

Drug Therapy Stimulants (Ritalin and Adderall) suppress activity level in persons with attentiondeficit/hyperactivity disorder

Brain-Stimulation Therapies Electroconvulsive therapy is used for the treatment of severe depression Peter’s ECT

Psychosurgery – The general term for surgical intervention in the brain to treat psychological

Hospitalization and the Alternatives Deinstitutionalization – Policy of removing patients, whenever possible, from mental

Let’s practice identifying therapies http: //courses. bfwpub. com/arga/Psych. Sim_ ARGA 2/42_mystery. Therapist/index_ang el. html

Let’s look at the diagnosis chart Identify the likely disorder, and speculate about what

Types of Mental Health Care Professionals Counseling psychologist Clinical psychologist Psychiatrist Psychoanalyst Psychiatric nurse

Professional Title Counseling psychologist Specialty: Clinical psychologist Adjustment disorders Psychiatrist Work setting: Psychoanalyst Schools,

Professional Title Counseling psychologist Specialty: Clinical psychologist Those with severe disorders Psychiatrist Work setting:

Professional Title Counseling psychologist Clinical psychologist Psychiatrist Psychoanalyst Psychiatric nurse practitioner Clinical social worker

Professional Title Counseling psychologist Clinical psychologist Psychiatrist Psychoanalyst Specialty: Freudian therapy Work setting: Psychiatric

Professional Title Counseling psychologist Clinical psychologist Psychiatrist Specialty: Social worker with specialty in dealing

End of Chapter 13 The worst therapy ever Copyright © Allyn & Bacon 2007

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What is Therapy? Therapy – General term for any treatment process; a variety of psychological and biomedical techniques aimed at dealing with mental disorders or coping with problems of living Copyright © Allyn & Bacon 2007

The Components of Therapy In addition to the relationship between therapist and the patient, therapeutic process typically involves: • Identifying the problem • Identifying the cause of the problem or the conditions that maintain the problem • Deciding on and carrying out some form of treatment Copyright © Allyn & Bacon 2007

Insight Therapies Insight therapies – Psychotherapies in which therapist helps patients understand (gain insight into) their problems Freudian psychoanalysis Neo-Freudian therapies Humanistic therapies Cognitive therapies Group therapies Copyright © Allyn & Bacon 2007

Psychoanalytic Terms Resistance—blocking from consciousness anxiety-laden material (you “don’t want to go there”) Interpretation—noting supposed dream meanings, resistances, and other behaviors in order to promote insight Transference—patient’s transfer to the analyst of emotions linked with other relationships (lack of trust in parent may manifest as lack of trust in therapist) Copyright © Allyn & Bacon 2007

Insight Therapies: Humanistic therapies (Carl Rogers) Rogers – (aka client-centered therapy) based on the assumption that people can grow and self actualize; people may be blocked by an unhealthy environment Reflection of feeling – Paraphrasing client’s words using active listening to capture the emotional tone expressed Copyright © Allyn & Bacon 2007

Behavior Therapies Behavior therapy – Therapy based on the principles of behavioral learning, especially operant conditioning and classical conditioning Systematic desensitization Exposure Therapy Aversion therapy Contingency management Participant modeling Token economies Copyright © Allyn & Bacon 2007

Classical Conditioning Therapies Exposure therapy – patient directly confronts the anxietyprovoking stimulus (as opposed to imagining it) – aka flooding Systematic desensitization – anxiety is extinguished by gradually exposing the patient to increasing levels of an anxiety-provoking stimulus (aka graduated exposure therapy) Copyright © Allyn & Bacon 2007

Counterconditioning—Therapy which uses classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors (e. g. exposure therapies and aversive conditioning) VR exposure therapy —Exposing patient to their fears using virtual reality technology Copyright © Allyn & Bacon 2007

Classical Conditioning Therapies Aversion therapy – Pairing a pleasant and unpleasant stimulus to condition a repulsive reaction UCS (foul odor) UCR (nausea) CS CR (cigarette smoke) Copyright © Allyn & Bacon 2007

Operant Conditioning Therapies Contingency management – changing behavior by altering the consequences, (rewards and punishments) of behavior -e. g. shaping, timeouts, contracts, voucher systems (WDFY), token economies Copyright © Allyn & Bacon 2007

Operant Conditioning Therapies Token economies – Applied to groups (e. g. classrooms, mental hospital wards) involving distribution of “tokens” contingent on desired behaviors; tokens can later be exchanged for privileges, food, or other reinforcers Copyright © Allyn & Bacon 2007

Insight Therapies: Cognitive therapies Cognitive therapy – (Aaron Beck) Beck Emphasizes rational thinking as the key to treating mental disorder CT for depression/anxiety involves Challenging faulty thinking Testing and modifying beliefs Copyright © Allyn & Bacon 2007

Cognitive-Behavioral Therapy: A Synthesis Rational-emotive behavior therapy – a type of CBT developed by Albert Ellis a person is not affected emotionally by outside things but rather by ‘perceptions and attitudes about outside things. ‘ Hamlet: “Nothing is good or bad, but…” Ellis’s style was confrontational, the opposite of Carl Rogers’s Copyright © Allyn & Bacon 2007

Insight Therapies: Group therapies For many issues, couples counseling or family therapy can often be more effective than individual therapy with one individual at a time Copyright © Allyn & Bacon 2007

Cognitive-Behavioral Therapy: A Synthesis Cognitive-behavioral therapy Combines cognitive emphasis on thoughts with behavioral strategies that alter reinforcement contingencies Assumes irrational self-statements cause maladaptive behavior Seeks to help the client develop a sense of self-efficacy Copyright © Allyn & Bacon 2007

Insight Therapies: Group therapies Group therapy – Psychotherapy with more than one client Very effective for depression and PTSD Self-help support groups – Groups that provide social support and a forum to share common problems; typically NOT run by professional therapists “Anonymous” groups: AA FAMILY THERAPY Copyright © Allyn & Bacon 2007

Differences between Rogers & Ellis Carl Rogers Albert Ellis Client (person) centered therapy REBT Supportive Confrontational Client has answers Therapist has answers Mostly cognitive Cognitive-behavioral Copyright © Allyn & Bacon 2007

Evaluating the Psychological Therapies Eysenck proposed that people with nonpsychotic problems recover just as well with or without therapy Reviews of evidence have shown: That therapy is better than no therapy It is best to match specific therapies with specific conditions—i. e. , not all therapies work for all conditions Copyright © Allyn & Bacon 2007

Is psychotherapy effective? Meta-analysis: The bottom line results after looking at many different research studies Evidence-based practice: Making clinical decisions by factoring in research, clinical expertise, and patient characteristics/preferences Copyright © Allyn & Bacon 2007

Quiz 1. What are some differences between psychologists and psychiatrists? 2. What is the difference between group therapy & self-help support groups? 3. What is the main difference between insight and behavioral therapies? 4. Give an example of a behavioral therapy Copyright © Allyn & Bacon 2007

How Is the Biomedical Approach Used to Treat Mental Disorders? Biomedical therapies treat mental disorders by changing the brain’s chemistry with drugs, its circuitry with surgery, or its patterns of activity with pulses of electricity or powerful magnetic fields Copyright © Allyn & Bacon 2007

Drug Therapy Antipsychotic drugs Include Thorazine, Haldol, Risperdal, Clozapine Usually affect dopamine pathways May have side effects Tardive dyskinesia – Incurable disorder of motor control resulting from long-term use of antipsychotic drugs Copyright © Allyn & Bacon 2007

Drug Therapy Antianxiety drugs • Include [rarely] barbiturates (CNS depressants) and benzodiazepines (Valium and Xanax) • Should not be: • taken for more than a few days at a time • combined with alcohol Copyright © Allyn & Bacon 2007

Drug Therapy Antidepressants (in order of usage) • SSRIs like Prozac, Paxil, Celexa, Lexapro (inhibit serotonin reuptake) • Include tricyclics like Elavil (inhibit reuptake) • monoamine oxidase (MAO) inhibitors like Nardil (inhibit reuptake of norepinephrine) • Mood stabilizers (for bipolar disorder): • Lithium (carbonate) Copyright © Allyn & Bacon 2007

Brain-Stimulation Therapies Electroconvulsive therapy is used for the treatment of severe depression Peter’s ECT session Transcranial magnetic stimulation, stimulation a possible alternative to ECT, can also be used for the treatment of addiction, depression, schizophrenia, and bipolar disorder Copyright © Allyn & Bacon 2007

Psychosurgery – The general term for surgical intervention in the brain to treat psychological disorders The infamous prefrontal lobotomy is no longer performed Severing the corpus callosum, however, can reduce life-threatening seizures Copyright © Allyn & Bacon 2007

Hospitalization and the Alternatives Deinstitutionalization – Policy of removing patients, whenever possible, from mental hospitals Community mental health movement – Effort to deinstitutionalize mental patients and to provide therapy from outpatient clinics Copyright © Allyn & Bacon 2007

Types of Mental Health Care Professionals Counseling psychologist Clinical psychologist Psychiatrist Psychoanalyst Psychiatric nurse practitioner Clinical social worker Pastoral counselor Copyright © Allyn & Bacon 2007

Professional Title Counseling psychologist Specialty: Clinical psychologist Adjustment disorders Psychiatrist Work setting: Psychoanalyst Schools, clinics, other institutions Psychiatric nurse practitioner Clinical social worker Pastoral counselor Credentials: At least a Master’s in counseling Copyright © Allyn & Bacon 2007

Professional Title Counseling psychologist Specialty: Clinical psychologist Those with severe disorders Psychiatrist Work setting: Psychoanalyst Psychiatric nurse practitioner Clinical social worker Pastoral counselor Private practice, mental health agencies, hospitals Credentials: Psy. D Copyright © Allyn & Bacon 2007

Professional Title Counseling psychologist Clinical psychologist Psychiatrist Psychoanalyst Psychiatric nurse practitioner Clinical social worker Pastoral counselor Specialty: Severe mental disorders (often uses drug therapies) Work setting: Private practice, clinics, hospitals Credentials: MD Copyright © Allyn & Bacon 2007

Professional Title Counseling psychologist Clinical psychologist Psychiatrist Psychoanalyst Specialty: Freudian therapy Work setting: Psychiatric nurse practitioner Private practice Clinical social worker Credentials: Pastoral counselor Ph. D Copyright © Allyn & Bacon 2007

Professional Title Counseling psychologist Clinical psychologist Psychiatrist Psychoanalyst Psychiatric nurse practitioner Clinical social worker Pastoral counselor Specialty: Nursing specialty; licensed to prescribe drugs Work setting: Private practice, clinics, hospitals Credentials: RN – plus special training in treating mental disorders and prescribing drugs Copyright © Allyn & Bacon 2007

Professional Title Counseling psychologist Clinical psychologist Psychiatrist Specialty: Social worker with specialty in dealing with mental disorders Psychoanalyst Work setting: Psychiatric nurse practitioner Often employed by government Clinical social worker Pastoral counselor Credentials: MSW Copyright © Allyn & Bacon 2007

Professional Title Counseling psychologist Clinical psychologist Psychiatrist Psychoanalyst Psychiatric nurse practitioner Clinical social worker Pastoral counselor Specialty: Combines spiritual guidance with practical counseling Work setting: Religious order or ministry Credentials: Varies Copyright © Allyn & Bacon 2007