PSYCHOLOGY READ Chapter 17 Therapy Psychopharmacology Biomedical Treatments

PSYCHOLOGY READ Chapter 17 Therapy, Psychopharmacology, & Biomedical Treatments

ESSENTIAL QUESTION: What techniques do psychologists and psychiatrists use to treat psychological disorders? GPS STANDARD: SSPVB 3 - 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 § 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

Therapists and their Training § 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

Therapists and their Training § 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

Therapists and their Training § 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? GPS STANDARD: SSPVB 3 - The student will identify abnormal behavior and treatment. e. ) compare the biomedical, psychoanalytical, cognitive, and behavioral approaches to the treatment of psychological disorders.

Psychopharmacology § study of the effects of drugs on mind and behavior

Psychopharmacology § Neuroleptics (or antipsychotics) § the early 1950 s 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

Psychopharmacology: antipsychotic medications § 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

Psychopharmacology: antipsychotic medications § 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

Psychopharmacology: antipsychotic medications § 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

Psychopharmacology: antipsychotic medications § 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

Psychopharmacology: antipsychotic medications § 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

Psychopharmacology: antipsychotic medications § 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

Psychopharmacology: antipsychotic medications § 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: What drugs are used to treat psychological disorders? What are some of their negative side effects? GPS STANDARD: SSPVB 3 - The student will identify abnormal behavior and treatment. e. ) compare the biomedical, psychoanalytical, cognitive, and behavioral approaches to the treatment of psychological disorders.

Psychopharmacology: antidepressants § soon after antipsychotic drugs appeared, antidepressants were developed § these drugs were designed to relieve the symptoms of depression

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

Psychopharmacology: antidepressants § 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

Psychopharmacology: antidepressants § 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

Psychopharmacology: antidepressants § 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

Psychopharmacology: antidepressants § 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

Psychopharmacology: antidepressants § 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

Psychopharmacology: antidepressants § 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

Psychopharmacology: antidepressants § OTHER SSRIs (selective serotonin reuptake inhibitors) § Anafranil § Luvox § Effexor § Celexa § Paxil § Zoloft § Wellbutrin

Biomedical Therapies

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

Psychopharmacology: herbal remedies § 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

Psychopharmacology: herbal remedies § 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: What drugs are used to treat psychological disorders? What are some of their negative side effects? GPS STANDARD: SSPVB 3 - The student will identify abnormal behavior and treatment. e. ) compare the biomedical, psychoanalytical, cognitive, and behavioral approaches to the treatment of psychological disorders.

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

Psychopharmacology: bipolar disorder § 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

Psychopharmacology: bipolar disorder § Lithium cont… § With lithium attacks of mania occur as rarely as every 9 years

Psychopharmacology: bipolar disorder § 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

Psychopharmacology: bipolar disorder § 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? GPS STANDARD: SSPVB 3 - The student will identify abnormal behavior and treatment. e. ) compare the biomedical, psychoanalytical, cognitive, and behavioral approaches to the treatment of psychological disorders.

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 was trained in psychoanalytic methods but he began to question their value and usefulness § Rogers disliked being a detached expert observer in 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 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 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 § 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 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 therapist and client

Humanistic Therapy § Reflection cont…. § reflection shows 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 therapist asking disruptive questions which interfere with the client’s thinking process

Humanistic Therapy § Congruence (a. k. a. - genuineness) § congruence shows consistency between therapist’s feelings and actions § when 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? GPS STANDARD: SSPVB 3 - The student will identify abnormal behavior and treatment. e. ) compare the biomedical, psychoanalytical, cognitive, and behavioral approaches to the treatment of psychological disorders.

Therapy. Psychoanalysis § Psychoanalysis (Freud’s method of treatment) § the field of psychotherapy began when Sigmund Freud established the psychoanalytic approach in the late 1800 s § 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

Therapy. Psychoanalysis § 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 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

Therapy. Psychoanalysis § 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

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

ESSENTIAL QUESTION: What techniques do behavioral psychologists use to treat psychological disorders? GPS STANDARD: SSPVB 3 - The student will identify abnormal behavior and treatment. e. ) compare the biomedical, psychoanalytical, cognitive, and behavioral approaches to the treatment of psychological disorders.

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 § 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 Economy § an 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? GPS STANDARD: SSPVB 3 - The student will identify abnormal behavior and treatment. e. ) compare the biomedical, psychoanalytical, cognitive, and behavioral approaches to the treatment of psychological disorders.

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 Therapy § a 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?

Evaluating Psychotherapies § 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

Evaluating Psychotherapies Number of persons Average untreated person Poor outcome 80% of untreated people have poorer outcomes than average treated person Average psychotherapy client Good outcome

Evaluating Psychotherapies