Study Area 15 Psychological Therapies Treatment in the

Study Area 15 Psychological Therapies

Treatment in the Past • Mentally ill people began to be confined to institutions called asylums in the mid 1500 s • Treatments were harsh and often damaging • Philippe Pinel became famous for demanding that the mentally ill be treated with kindness, personally unlocking the chains of inmates in France

Therapy • Therapy: treatment methods aimed at making people feel better and function more effectively • Two broad categories: – one based primarily in psychological theory and techniques – the other uses medical intervention to bring symptoms under control

Therapy • Psychotherapy: therapy for mental disorders in which a person with a problem talks with a psychological professional – insight therapies: psychotherapies in which the main goal is helping people to gain insight with respect to their behavior, thoughts, and feelings – action therapy: psychotherapy in which the main goal is to change disordered or inappropriate behavior directly

Therapy • Biomedical therapy: therapy for mental disorders in which a person with a problem is treated with biological or medical methods to relieve symptoms • Biomedical therapies are physical or medical treatments such as drug therapy, electroconvulsive therapy (electroshock), or surgery (i. e lobotomy) that are used to treat mental or psychological disorders. Modern health treatment contains many examples of drug therapies; antidepressants, mood stabilizers, antipsychotics, etc.

Freud’s Psychoanalysis • Psychoanalysis: insight therapy based on theory of Freud, emphasizing the revealing of unconscious conflicts – dream interpretation § manifest content: the actual content of one’s dream § latent content: the symbolic or hidden meaning of dreams

Freud’s Psychoanalysis • Psychoanalysis (cont’d) – free association: Freudian technique in which a patient is encouraged to talk about anything that comes to mind without fear of negative evaluations – resistance: occurs when a patient becomes reluctant to talk about a certain topic, either changing the subject or becoming silent – transference: the tendency for a patient or client to project positive or negative feelings for important people from the past onto therapist

Psychoanalysis Today • Directive: actively giving interpretations of a client’s statements in therapy, even suggesting certain behavior or actions – psychoanalysis today is generally directive • Psychodynamic therapy: a newer and more general term for therapies based on psychoanalysis, with an emphasis on transference, shorter treatment times, and a more direct therapeutic approach

Psychoanalysis Today Interpersonal therapy (IPT): form of therapy for depression which incorporates multiple approaches and focuses on interpersonal problems

Gestalt Therapy • Gestalt therapy: form of directive insight therapy in which therapist helps clients accept all parts of their feelings and subjective experiences, using leading questions and planned experiences such as role-playing • Gestalt therapy is an existential/experiential form of psychotherapy that emphasizes personal responsibility, and that focuses upon the individual's experience in the present moment, therapist–client relationship, the environmental and social contexts of a person's life, and the self-regulating adjustments people make as a result of their overall situation. .

Rogers’s Person-Centered Therapy • Person-centered therapy: a nondirective insight therapy in which the client does all the talking and therapist listens – based on the work of Carl Rogers – nondirective: therapeutic style in which therapist remains relatively neutral and does not interpret or take direct actions with regard to the client, instead remaining a calm, nonjudgmental listener while the client talks

Rogers’s Person-Centered Therapy • Four elements: 1. authenticity: the genuine, open, and honest response of therapist to the client 2. unconditional positive regard: the warmth, respect, and accepting atmosphere created by therapist for the client in person-centered therapy 3. empathy: the ability of therapist to understand the feelings of the client 4. reflection: therapist restates what the client says rather than interpreting those statements

Rogers’s Person-Centered Therapy • Motivational interviewing (MI) – In contrast to client-centered therapy, MI has specific goals: namely, to reduce ambivalence about change and to increase intrinsic motivation to bring that change about

Today’s View of Humanistic Therapy • Humanistic therapies are not based in experimental research and work best with intelligent, highly verbal persons

Behavioral Therapy and Classical Conditioning Con • Behavior therapies: action therapies based on the principles of classical and operant conditioning and aimed at changing disordered behavior without concern for the original causes of such behavior

Behavioral Therapy and Classical Conditioning • Behavior modification or applied behavior analysis: use of learning techniques to modify or change undesirable behavior and increase desirable behavior

Behavioral Therapy and Classical Conditioning • Systematic desensitization: behavioral technique used to treat phobias, in which a client is asked to make a list of ordered fears and taught to relax while concentrating on those fears – counterconditioning: replacing an old conditioned response with a new one by changing the unconditioned stimulus

Behavioral Therapy and Classical Conditioning Conditionin • Aversion therapy: form of behavioral therapy in which an undesirable behavior is paired with an aversive stimulus to reduce the frequency of the behavior

Behavioral Therapy and Classical Conditioning • Exposure therapy: behavioral techniques that introduce the client to situations (under carefully controlled conditions) that are related to their anxieties or fears – flooding: technique for treating phobias and other stress disorders in which the person is rapidly and intensely exposed to the fearprovoking situation or object and prevented from making the usual avoidance or escape response

Behavioral Therapy and Classical Conditioning • Exposure therapy (cont’d) – eye-movement desensitization reprocessing (EMDR): controversial therapy for posttraumatic stress disorder and similar anxiety problems in which the client is directed to move the eyes rapidly back and forth while thinking of a disturbing memory § needs more controlled studies

Behavioral Therapy and Operant Conditioning • Modeling: learning through the observation and imitation of others – participant modeling: technique in which a model demonstrates the desired behavior in a step-by-step, gradual process while the client is encouraged to imitate the model

Behavioral Therapy and Operant Conditioning Condit • Reinforcement: the strengthening of a response by following it with a pleasurable consequence or the removal of an unpleasant stimulus – token economy: the use of objects called tokens to reinforce behavior in which the tokens can be accumulated and exchanged for desired items or privileges

Behavioral Therapy and Operant Conditioning • Reinforcement (cont’d) – contingency contract: a formal, written agreement between therapist and client (or teacher and student) in which goals for behavioral change, reinforcements, and penalties are clearly stated

Behavioral Therapy and Operant Conditioning • Extinction: the removal of a reinforcer to reduce the frequency of a behavior – time-out: an extinction process in which a person (usually a child) is removed from the situation that provides reinforcement for undesirable behavior, usually by being placed in a quiet corner or room away from possible attention and reinforcement opportunities

Effectiveness of Behavioral Therapy • Behavior therapies can be effective in treating specific problems, such as bedwetting, drug addictions, and phobias • Behavior therapies can also help improve some of the more troubling behavioral symptoms associated with more severe disorders

Cognitive Therapy • Cognitive therapy: therapy in which the focus is on helping clients recognize distortions in their thinking and replace distorted, unrealistic beliefs with more realistic, helpful thoughts

Cognitive Therapy • Cognitive distortions: – arbitrary inference: drawing a conclusion without any evidence – selective thinking: focusing on only one aspect of a situation while ignoring all other relevant aspects – overgeneralization: drawing sweeping conclusions based on only one incident or event and applying those conclusions to events that are unrelated to the original

Cognitive Therapy LO 15. 5 Goals of Cognitive Therapies • Cognitive distortions (cont’d): – magnification and minimization: blowing a negative event out of proportion (magnification) while ignoring relevant positive events (minimization) – personalization: taking responsibility or blame for events that are unconnected to the person

Cognitive-Behavioral Therapies Therapi • Cognitive-behavioral therapy (CBT): action therapy in which the goal is to help clients overcome problems by learning to think more rationally and logically

Cognitive-Behavioral Therapies • Three goals: 1. Relieve the symptoms and solve the problems. 2. Help develop strategies for solving future problems. 3. Help change irrational, distorted thinking.

Rational Emotive Therapy • Rational emotive behavior therapy (REBT): cognitive-behavioral therapy in which clients are directly challenged in their irrational beliefs and helped to restructure their thinking into more rational belief statements

Success of CBT • CBT has seemed successful in treating depression, stress disorders, and anxiety. • CBT has been criticized for focusing on the symptoms, not the causes, of disordered behavior.

Types of Group Therapy • Family counseling (family therapy): family members meet together with a counselor or therapist to resolve problems that affect the entire family

Types of Group Therapy • Self-help group (support group): a group composed of people who have similar problems and who meet together without a therapist or counselor for the purpose of discussion, problem solving, and social and emotional support

When Is Group Therapy Useful? • Group therapy is most useful to persons who: – cannot afford individual therapy – may obtain a great deal of social and emotional support from other group members

Group Therapy • Advantages: – low cost – exposure to other people with similar problems; social interaction with others – social and emotional support from people with similar disorders or problems

Group Therapy • Disadvantages: – need to share therapist’s time with others in the group – lack of a private setting in which to reveal concerns – inability of people with severe disorders to tolerate being in a group

Effectiveness of Psychotherapy • Psychotherapy is more effective than no treatment at all • Between 75 and 90 percent of people who receive therapy feel it has helped them – the longer a person stays in therapy, the greater the improvement – psychotherapy works as well alone as with drugs

Effectiveness of Psychotherapy Psychoth • Some types of psychotherapy are more effective for certain types of problems, and no one psychotherapy method is effective for all problems – effective therapy should be matched to the particular client and the particular problem

Effectiveness of Psychotherapy • Eclectic therapies: therapy style that results from combining elements of several different therapy techniques • Common factors approach: modern approach to eclecticism focusing on factors seen as the source of success Common Factors refers to aspects of psychotherapy that are present in most, if not all, approaches to therapy. These characteristics of treatment occur across all theoretical lines and are present in all psychotherapeutic activities, resulting in the name Common Factors.

Effectiveness of Psychotherapy LO 15. 7 The Effectiveness of Psychotherapy • Common factors approach – therapeutic alliance: the relationship between therapist and client that develops as a warm, caring, accepting relationship characterized by empathy, mutual respect, and understanding – protected setting – learning and practice of new behaviors – positive experiences for the client

Effectiveness of Psychotherapy LO 15. 7 The Effectiveness of Psychotherapy • Evidence-based treatment (EBT) refers to techniques or interventions that have produced desired outcomes, or therapeutic change in controlled studies

Culture and Psychotherapy • When the cultures, ethnic groups, or genders of therapist and the client differs, misunderstandings and misinterpretations can occur. • Four barriers to effective psychotherapy exist when culture the backgrounds of client and therapist differ 1. 2. 3. 4. culture-bound values class-bound values language nonverbal communication

Cybertherapy • Cybertherapy: psychotherapy that is offered on the Internet – also called online, Internet, or Web therapy or counseling – offers the advantages of anonymity and therapy for people who cannot otherwise get to a therapist

Drug Treatments • Biomedical therapies: therapies that directly affect the biological functioning of the body and brain

Drug Treatments • Psychopharmacology: the use of drugs to control or relieve the symptoms of psychological disorders – antipsychotic drugs: used to treat psychotic symptoms such as delusions, hallucinations, and other bizarre behavior – antianxiety drugs: used to treat and calm anxiety reactions § typically minor tranquilizers

Drug Treatments • Psychopharmacology (cont’d) – mood-stabilizing drugs: used to treat bipolar disorder § include lithium and certain anticonvulsant drugs – antidepressant drugs: used to treat depression and anxiety – The SSRIs (selective serotonin reuptake inhibitors) are the most commonly prescribed class of antidepressants. They act on a chemical in the brain called serotonin. The SSRIs include drugs such as Prozac, Zoloft, and Paxil. SSRIs are not atypical antidepressants. Wellbutrin is.

Electroconvulsive Therapy • Electroconvulsive therapy (ECT): biomedical treatment in which electrodes are placed on either one or both sides of a person’s head an electric current strong enough to cause a seizure or convulsion is passed through the electrodes – still used to treat severe depression

Psychosurgery • Psychosurgery: surgery performed on brain tissue to relieve or control severe psychological disorders – prefrontal lobotomy: the connections of the prefrontal lobes of the brain to the rear portions are severed

Psychosurgery • Psychosurgery (cont’d) – Bilateral anterior cingulotomy: an electrode wire is inserted into the anterior cingulated gyrus area of the brain for the purpose of destroying that area of brain tissue with an electric current § electrode is inserted with the guidance of a magnetic resonance imaging (MRI) machine

Psychosurgery LO 15. 9 Electroconvulsive Therapy and Psychosurgery • Emerging techniques – repetitive transcranial magnetic stimulation (r. TMS): magnetic pulses are applied to the cortex – transcranial direct current stimulation (t. DCS): uses scalp electrodes to pass very low amplitude direct currents to the brain

Virtual Reality – exposure therapy • Virtual reality is a software-generated three-dimensional simulated environment with can be used in the treatment of PTSD – like playing a video game - Virtual reality (VR) integrates real-time computer graphics, bodytracking devices, visual displays, and other sensory input devices to immerse a participant in a computer-generated virtual environment that changes in a natural way with head and body motion.