Therapies for Psychological Disorders Chapter 13 AP Psychology

Therapies for Psychological Disorders Chapter 13 AP Psychology Juarez Community Academy Ms. Drew

Vocab Quiz on Friday! § § § § § Active listening Token economy Placebo effect Lobotomy Lithium Psychopharmacol ogy Double-blind procedure Xanax Free Association Stress inoculation training § § § § Evidence based practice § Regression toward§ the mean § Meta-analysis § Cognitive therapy Behavior therapy § Systematic desensitization § Cognitivebehavioral § therapy Client-centered therapy Exposure therapy Aversive therapy Psychoanalysis Preventive mental health Biomedical therapy Counterconditioni ng Insight therapy

What are Therapists are trained professionals who know the art of establishing a helping relationship and know how to apply the knowledge of psychology to an individual struggling with problems and choices.

Therapy We often hear that someone was in therapy, but what is therapy? There are many stereotypes about therapy, like the picture of a bearded therapist taking notes while a patient lies on a couch and spills his or her guts. This is a very Freudian image.

Therapy is a term used for any treatment process; in psychology and psychiatry, therapy refers to a variety of techniques used to deal with mental disorders or cope with problems of living. There are endless reasons why people go to see a therapist or counselor including making difficult decisions, dealing with academic problems, coping with the loss of a loved one, or dealing with an unhappy relationship.

Therapy There a variety of techniques and methods therapists and counselors use, but all center on developing a strong, supportive relationship with the patient. Another similarity amongst all therapy techniques is their end goal of changing a person’s functioning in some way.

Components of Therapy In addition to developing a strong relationship between client/patient and counselor, therapeutic process generally involves some or all of the following processes: 1. Identifying the problem 2. Identifying the cause of the problem or the current conditions that maintain the problem 3. Deciding on and carrying out some form of treatment

7 Main Types of Professional Help Professional Title Specialty and common work setting Credential and qualifications Counseling Psychologist Provides help in dealing with the common problems of normal living-relationships, child rearing, school problems. Typically counselors in schools clinics or other institutions Depends on the state; minimum master’s in counseling, but most commonly a Ph. D Clinical Psychologist Trained primarily to work with those who have more severe disorders, but may also work with clients having less severe problems. Usually private practice Usually required to hold a Ph. D and state certificate Psychiatrist A specialty of medicine; deals with sever mental MD; licensed by medical problems-most often prescribes drugs. May be board private practice or employed by clinics and mental hospitals Psychoanalyst Practitioners of Freudian therapy. Usually in private practice MD Psychiatric Nurse Practitioner A nursing specialty; licensed to prescribe drugs for mental disorders. May work in private practice or in clinics and hospitals Requires RN credential plus specialty training Clinical or Psychiatric Social Worker Social workers with a specialty in dealing with mental disorders, especially from the viewpoint of social and environmental contexts MSW-Masters of Social Work Pastoral A member of a religious order or ministry who Varies

Current Movements The world of psychology is constantly changing. One of the current movements is clinical psychologists who are seeking to obtain the privilege to give prescriptions to clients. New Mexico became the first state to allow this, putting psychologists through a rigorous program, including 850 hours of of course work and a supervised internship. Not surprisingly this is hotly contested in the medical profession.

History of Therapy Much like the history of psychology itself and psychological disorders, therapy has had its fair share of misguided theories. In medieval Europe, people often thought mental disorders were the work of the devil and other demons. The job therapists was to perform exorcisms.

Bedlam and its Origins One of the most well known asylums was that of Bethlehem Hospital in London. On the weekend, a person could pay a few pence to go sightseeing and watch the inmates who often put on a noisy and wild show. As a result, “Bedlam, ” the shortened term Londoners used for Bethlehem, became a word used to describe any noisy, chaotic place (Zimbardo et al. )

Medieval Asylums In the medieval asylums, patients, at most only custodial care; at worst, they were neglected and put in cruel restraints such as cages and straightjackets. Some received other forms of torture like beatings and cold showers.

Modern Approaches to Therapy There are two main modern approaches: Psychological therapies (psychotherapy) focus on changing disordered thoughts, feelings and behaviors using psychological techniques. They come in two main forms: § Insight therapy: focuses on helping people understand their problems and change their thoughts, motives or feelings. § Behavior therapy: focuses primarily on changing behavior.

Modern Approaches to Therapy Biomedical therapies focus on treating mental problems by changing the underlying biology of the brain. To do so, a physician or nurse practitioner can use a variety of drugs, including antidepressants, tranquilizers and stimulants.

Disorders and Therapies are Cultural The way a disorder is treated relies on the way it is viewed. The way it is viewed is heavily dependent on the culture is is being treated in. Individualistic Western views generally regard psychological disorders to be a result of disease process, abnormal genetics, disordered thinking, unhealthy environments or stressors. Collectivist cultures often think of mental disorders as a disconnect between the person and the group. In such cultures, treating mentally disturbed people by removing them from society is unthinkable.

How do Psychologists Treat Disorders? Treatment of disorders falls into one of the two categories we just discussed. Insight therapies were the first truly psychological treatments used. In recent years, behavioral therapies have also become common and effective.

Insight Therapies Insight therapies attempt to change people on the inside-changing the way they think and feel. These are sometimes called think therapies. These therapies share the assumption that distressed persons need to develop an understanding of the disordered thoughts, emotions and motives that underline their mental difficulties.

Freudian Psychoanalysis In the classical Freudian view, psychological problems arise from tension in the unconscious mind by forbidden impulses and threatening memories. Psychoanalysis, therefore, probes the unconscious in an attempt to bring these issues into the “light of day” or into consciousness. The major goal of psychoanalysis, then, is to reveal and interpret the contents of the unconscious mind.

Psychoanalysis In the final stages of psychoanalysis, patients learn how their relationship with therapist mirrors the unresolved issues they have with their parents. This is referred to as analysis of transference. According to this theory, people will recover when they are finally released from the repressive mental restraints established in the relationship with their parents during early childhood.

Neo-Freudian Psychodynamic Therapies These therapies were developed by psychologists why embraced some of Freud’s ideas, but disagreed with others. While they follow many of the same techniques, their emphasis is on the conscious, rather than the unconscious, mind. Basically they spend less time probing for hidden conflicts and repressed memories.

Psychotherapy Insight Therapies Psychodynamic Therapies Humanistic Therapies Freudian Psychoanalysis Neo-Freudian Therapies Behavior Therapies Cognitive Therapies based on Operant Conditioning Therapies Based On Observational Learning Therapies Based on Classical Conditioning

Humanistic Therapies Many people struggle with the problems of everyday existence. These are commonly called existential crises. This term underscores the idea that many problems deal with questions about the meaning and purpose of one’s existence. Humanistic psychology developed theories to specifically address these problems

Humanistic Therapies Humanistic psychology believes that people are generally motivated by healthy needs for growth and psychological well being. Problems only occur when conditions interfere with normal development and produce low self esteem. These therapies, then, try to help clients confront their problems by recognizing their own freedom, enhancing their self-esteem and realizing their fullest potential.

Client-Centered Therapy This therapy assumes that people all have a need to realize their fullest potential (self actualization). But, development can be hindered by a conflict between one’s desire for a positive self image and criticism by self and others. One therapy technique called “reflection of feeling, ” or reflective listening, is where therapist paraphrases the clients words, making sure to capture the emotional tone, so the client can see and hear themselves.

Listening Empathetically n Empathy is the act of adopting the client’s perspective, of walking in the client’s shoes. n Carl Rogers encouraged therapists to exhibit empathy. n When they accurately sense and reflect their clients’ feelings, clients increase in selfunderstanding and self-acceptance. n An empathetic, trusting, caring relationship is key to being an effective psychotherapist

13 -3 “Listening Empathetically” n “As you listen to me role-play a client, pretend you are a counselor or a therapist. Your task is to adopt my (or the client’s) perspective. Try to see the world through my eyes. Circle only the statements that demonstrate empathy. (adopting the patient’s point of view. )”

13 -3 n In your groups, try to reach a consensus.

13 -4 Role Playing – Practice with Pat, then with a friend. n Client-centered approach n 1 st repeat what the person said as you understand it. “What I hear you saying is…” n 2 nd reflect back the person’s feelings. “It seems you are feeling …about the situation. ”

Empathic Listening n What was good about empathic listening in everyday life? n What are some possible obstacles about empathic listening in everyday life?

Humanistic vs. Psychoanalysis In stark contrast to psychoanalysis, humanistic therapists assume that people are generally good and healthy, but can be negatively effected by pressure from oneself and society. Humanistic therapists accomplish treatment through genuineness, empathy, and unconditional regard and acceptance for their clients.

Cognitive Therapies see rational thinking as the key to therapeutic change. The assumption is that psychological problems arise from erroneous thinking. Cognitive therapists help the individuals confront the destructive thoughts that support depression.

The Way I Think n Samples of cognitive therapy techniques Fill in the blank: 1) “I often worry that I ________. ”

n 2. “If this worry of yours was indeed true, what does it mean to you and why does it bother you so much? ” n In other words, “If what you JUST wrote was indeed true, what does it mean to you and why does it bother you so much? ” n “If what you JUST wrote was indeed true, what does it mean to you and why does it bother you so much? ”

“Look back over the various things you wrote so far and answer this question: ” 3. “What’s the worst thing that could possibly happen? What do you fear most of all? ”

n 4. “When you think of the worst thing that could happen, do you really think that it’s likely to happen? If so, how could you learn to cope with it? ”

Look back over the worrisome thoughts that you have written about so far, and answer this questions: n 5. “What do you (perhaps ‘secretly’) get out of thinking like this? How does it work to your advantage? ”

6. Persuade a Friend n “Pretend that your friend has some of the same worrisome beliefs that you do. Look back over the things you wrote for questions 1 -3. Pick out one of those statements and write it down, as if your friend just said it. Now skip a line, and write a response to your friend’s statement. In that response, be a compassionate, rational, and realistic thinker. After you write your response, skip a line and have your friend reply.

6. Persuade a Friend n Maybe your friend is a bit stuck in her/his thinking. Then skip a line, and respond again to your friend. Keep this conversation going for 10 lines or so.

7. Positive imagery anecdotes n Select 3 positive images, real memory or imagination, related to: 1. confidence & strength in your life 2. Safety & peacefulness in your life 3. Love in your life Make sure you can see each one clearly.

n Now imagine a real or imaginary scene related to one of their negative thoughts. n When the time feels right, move from the negative image to the positive one that feels like the right anecdote, then back again to the negative image, repeating the cycle until you feel comfortable ending the exercise with the positive image firmly in mind.

8. “I accept myself even though I ______” (Do not use the word “Am”) By not using the word “am” give yourself a global label and it should encourage you to focus on specific trait or behaviors. Write this sentence 10 times!

Behavior Therapies Behavior therapy, or behavior modification, is based on the assumption that undesirable behaviors have been learned, and therefore, can be unlearned. Behavior therapist focus on the problem behaviors rather than inner thoughts, motives or emotions. Their goal is to determine how these behaviors were learned and see if they can eliminate them.

Systematic Desensitization One behavioral technique to extinguish anxiety is systematic desensitization. In this, a patient is exposed to an anxiety producing stimulus gradually. Over time, the anxiety will become extinguised.

Steps of Systematic Desensitization For a fear of public speaking: 1. 2. 3. 4. 5. 6. 7. 8. Seeing a picture of a person giving a speech Watching another person give a speech Preparing a speech to give Having to introduce oneself to a large group Waiting to be called upon to speak at a meeting. Being introduced as a speaker to a group Walking to the podium to make a speech Making a speech to a large group

13 -7 –Systematic desensitization 1. What is one thing that gives you anxiety? 2. Adapt handout 13 -7 to fit your own fear.

13 -8 n Then train yourself in progressive relaxation.

Aversion Therapy Aversion therapy takes on the psychological problems with a conditioning procedure designed to make tempting stimulus less provocative by pairing them with an unpleasant (aversive) stimuli. In time, the negative reaction (UCR) associated with the averse stimuli come to be associated with the conditioned stimuli. This is usually a last resort type of therapy, though it has been shown to be successful.

Operant Conditioning Therapies These therapies rely on the tools of operant conditioning: reward and punishment. Contingency Management: An approach to changing behavior by changing the consequences associated with a behavior. Token Economy: A technique involving the distribution of “tokens” or indicators of reinforcement contingent on desired behaviors

Cognitive-Behavioral Therapy This therapy combines a cognitive emphasis on thoughts and attitudes with the behavioral strategies. This approach assumes that an irrational self-statement often underlies maladaptive behavior.

Cognitive-Behavioral Therapy In this form of treatment, therapist and client work together to modify irrational self-talk, set attainable behavioral goals and develop realistic strategies for attaining them. In this way, people change the way they approach problems and gradually develop new skills and a sense of self-efficacy.

Does Therapy Actually Work? In 1952, Hans Eysenck shook the psychology world by releasing a study that suggested 2/3 of all people with nonspychotic problems recovered within two years if the onset of the problem, whether they got therapy or not. Essentially he was arguing that therapy was worthless, and no better than having no treatment at all.

Response to Eysenck As you can imagine, this set off a fire storm of studies on this subject. Overall (375 studies) research supports two major conclusions: 1. Therapy is more effective than nontherapy. 2. Eysenck overestimated the improvement rate in no-therapy control groups.

Biomedical Approach Biomedical therapies seek to treat psychological disorders by changing the brain’s chemistry with drugs, its circuitry with surgery or its patterns of activity with pulses of electricity or magnetic fields.

Drug Therapy/Psychopharmacology The first psychological drugs were administered in 1953 with the antipsychotic drugs. In 1955, over ½ a million Americans were living in mental institutions, each staying an average of a few years. Then, with the introduction of tranquilizers, the number declined. By 1965, the number of patients was down to ¼ million, with most patients staying for only a few months.

Antipsychotic Drugs Antipsychotic drugs are used to treat the symptoms of psychosis: delusions, hallucinations, social withdrawal and agitation. Most work by reducing the activity of the neurotransmitter dopamine. Although the exact reason why this has an antipsychotic effect, these drugs have proven to be quite effective.

+/- of Antipsychotic Drugs While these drugs reduce the overall brain activity, they do not simple put the patient in a trance. Instead they simply reduce the “positive” symptoms of psychosis. Unfortunately, long-term use can cause problems like tardive dyskinesia, which produces an uncontrollable disturbance of motor control, especially in the facial muscles.

Positive and Negative Categories Often times, researchers now simply characterize symptoms of schizophrenia into positive and negative categories. Positive symptoms refer to active process such as delusions, and hallucinations while negative symptoms refer to passive processes like social withdrawal.

Antidepressant Drugs There are three major classes of antidepressant drugs, and all three work by “turning up the volume” on messages transmitted over certain brain pathways, especially those using norepinephrine and serotonin. The major downside of these drugs is that it often takes a few weeks for them to have an effect. In some cases, time is not a luxury a mentally ill patient has.

Antianxiety Drugs Antianxiety drugs most commonly fall into two categories: barbiturates and benzodiazepines. Barbiturates act as a central nervous system depressant, so they have a relaxing effect. Benzodiazepines work by increasing the activity of certain neurotransmitters.

Stimulants is a broad category that includes everything from caffeine to nicotine to amphetamines to cocaine-they are any drugs that produce excitement or hyperactivity. These drugs are prescribed for a variety of disorders including narcolepsy and ADHD.

Truths About Drugs n n n Cannot cure any mental illness Can alter the brain to suppress some symptoms Can have negative long term effects Can be habit forming Often over prescribed

Psychosurgery is the general term given for any surgical intervention in the brain to treat a psychological disorder. These surgeries were far more common in the past, and today have become a method of last resort.

Brain-Stimulation Therapies Electroconvulsive Therapy (ECT)A treatment used primarily for depression that involves the application of an electric current to head, producing a generalized seizure. Transcranial Magnetic Stimulation (TMS)A treatment that involves magnetic stimulation of specific regions of the brain, but unlike ECT, it does not produce a seizure.

Study for the Free Response! n Electroconvulsive therapy (ECT) n Transference n Token economy n Systematic desensitization n Resistance n Psychopharmacology n Psychoanalytic perspective n Learning perspective n Biological perspective