THERAPY AND TREATMENT AP Psychology Types of Therapy

THERAPY AND TREATMENT AP Psychology

Types of Therapy • The type of therapy used depends on the problem! Psychotherapy Social interaction between a trained therapist and someone who suffers from psychological difficulties Ex: Eclectic Approach an approach that depending Ex: on the client’s problems, uses techniques from various forms of psychotherapy Biomedical Therapy Prescribed medications or medical procedures that act directly on the patient’s brain and/or nervous system. EX:

PSYCHOTHERAPIE S Psychoanalysis Humanistic Behavioral Cognitive Group Therapies

PSYCHOANALYSIS “Look into the depths of your own soul and learn first to know yourself, then you will understand why this illness was bound to come upon you and perhaps you will thenceforth avoid falling ill. ” - Sigmund Freud

Psychoanalysis • Based upon the ideas of Freud Goal Try to help patients gain insight into the unconscious origins and roots of their disorders and work through anxietyridden feelings. Techniques Criticisms • Free association - patient relaxes and starts talking about anything • Interpretations cannot be proven or disproven; psychoanalysts say that psychoanalysis is therapy, not a science • Dream interpretation • Interpretation – the analyst’s noting of supposed meanings of dreams, free association, projective tests, etc in order to promote insight into the subconscious • Time consuming – years long • Expensive – several sessions a week

Psychoanalytic Phenomena • Resistance – the blocking from consciousness of anxiety -laden material • Hints that anxiety exists and you are defending against sensitive material • Transference – the patient’s transfer to the analysts of emotions linked with other relationships • such as love or hatred for a • Example Psychoanalytic Session • What About Bob Trailer

Psychodynamic Therapy • Influenced by Freud, but not the same as psychoanalysis Goal Try to understand a patient’s current symptoms by focusing on themes across important relationships Techniques • Face-to-face conversation • Once a week for a few weeks/months • Look for patterns in behaviors/relationships

HUMANISTIC THERAPY “We have two ears and one mouth that we may listen that more an talk the less. ” - Zeno. 335 -263 BC

Humanistic Therapy • Emphasis on self-actualization and self-fulfillment • Developed largely by Carl Rogers Goal Aim to boost selffulfillment by helping people grow in selfawareness and self-acceptance Techniques • Focusing on the future instead of the past • Focusing on conscious rather than unconscious thoughts • “Clients” rather than “patients” → clientcentered therapy in which the client feels unconditional positive regard and therapist is nondirective (refrains from offering personal interpretations). • Active listening – therapist echoes, restates, and clarifies Active Listening Example Criticisms • Not scientific enough

With a neighbor… • Think of the last thing recently that: • Made you angry • Made you sad • Made you anxious/nervous • For 2 -3 minutes, talk about the event and feelings. The active listener should: • Use Active Listening Tips sheet • Paraphrase – check your understanding by summarizing the speaker’s words in your own words and ask if you are correct. • Invite clarification – “What might be an example of that? ” may encourage the speaker to say more. • Reflect feelings – “It sounds frustrating” might mirror what you’re sensing from the speaker’s body language and intensity. • Remain unbiased and nonjudgmental • Do you notice any differences when you were active listening compared to how you listen everyday?

BEHAVIORAL THERAPIES

Behavioral Therapy • Behavioral therapists do not emphasize the mental root of a disorder as they assume that the problem behaviors are the problems Goal Apply learning principles to the elimination of unwanted behaviors Techniques Criticisms • Counter-conditioning - conditioning new responses to stimuli that trigger unwanted behaviors, based on classical conditioning. • Exposure therapy (systematic desensitization) • Aversion therapy • Virtual reality therapy • Doesn’t address mental processes behind disorders • Behavior modification - reinforcing desired behaviors and or using punishment/withholding reinforcement for undesired behaviors • Token economy • When reinforcement disappears/stops, behaviors may come back. • Is it right for one human to control another’s behavior? • Is punishment unethical?

Counter-conditioning • Systematic Desensitization (exposure therapy) – associating a pleasant relaxed state with gradually increasing anxietytriggering stimuli • • commonly used to treat phobias. Ex: fear of public speaking. • • 1. Ranked list (high to low anxiety) 2. Establish a relaxed state 3. Induce mild anxiety by imagining situations on the list 4. When too much anxiety → return to relaxed state 5. Repeat the pairing until the anxiety is replaced by relaxed feelings 6. Move up the anxiety list implementing desensitization each time. 7. Move from imagined situations to real situations.

Counter-conditioning • Aversion therapy - associates an unpleasant state with an unwanted behavior • Commonly used to treat addictions • Ex: quitting smoking • 1. Therapist shocks a patient when a drag is inhaled • 2. Patient smokes rapidly, inducing many shocks • 3. Pair together several times • 4. Patient associates pain of shock with smoking • 5. Quit smoking • Highly successful in the short-run, but has mixed results in the long-run.

Behavior Modification • Behaviors are influenced by their consequences • operant conditioning – reinforcement and punishment • Token economy –earn a token of some sort for exhibiting a desired behavior and can later exchange the tokens for various privileges or treats. • Used to help autistic children become more social. • Can teach schizophrenic sufferers or the mentally retarded to care for themselves.

COGNITIVE THERAPY “Life does not consist mainly, or even largely, of facts and happenings. It consists mainly of the storm of thoughts that are forever blowing through one’s mind. ” - Mark Twain

Cognitive Therapy • Best for disorders in which the roots are unclear, like generalized anxiety disorder and major depressive disorder Goal Tries to change unhealthy or maladaptive patterns in thinking by teaching new healthier ways of thinking Techniques Depressed people do not exhibit the self-serving bias common in non-depressed people. Instead they attribute their failure to themselves and attribute their successes to external circumstances. → must change that pattern of thinking • Ex: a depressed person writes 3 positive things that happened that day and how they contributed to them • Ex: a person with test-anxiety repeats positive things to themselves before an exam

Cognitive-Behavioral Therapy • Useful for disorders that involve maladaptive mental and behavioral elements Goal Combines changes in thinking (cognitive) and changes in behaviors (behavioral) Techniques Rational-emotive behavior therapy – proposes that unrealistic and irrational beliefs cause maladaptive behaviors; focuses on changing thinking patterns. 1. Identify the underlying irrational thought patterns/beliefs 2. Challenge the irrational beliefs 3. Gain insight and recognize irrationality Best for OCD, eating disorders, etc (any disorder with cognitive/behavior roots)

Other examples of CBT • EX: OCD sufferers – changing thinking patterns concerning obsessive thoughts and changing behaviors concerning compulsions • EX: Anorexia nervosa – changing thinking patterns concerning depression and negative body image and changing behaviors concerning eating.

GROUP THERAPIES “The feeling of having shared in a common peril is one element in the powerful cement that binds us. ” - Alcoholics Anonymous member

Group Therapy and Support Groups • Except for psychoanalytic therapies, psychotherapy techniques can be used in therapist-led small groups. • Group therapy does not allow for the same degree of individual attention, but it is time and cost effective and has often been found no less effective than individual therapy. • The social context of group therapy often allows client to feel as if they are not alone in their problems. It can be a relief to find that others share your problems and feelings. • EX: AA, cancer or AIDS support groups, online support groups

Family Therapy • Treats the family as a system in which undesirable behaviors are influenced by and affect other members • • tries to foster healthier relationships within the family. Ex: A family might attend therapy if one member is addicted to drugs/medication during which therapist would evaluate relationships in the family that could contribute to conflict and possible drug abuse. Crash Course - Psychotherapy

EVALUATING PSYCHOTHERAPIE S

Is Therapy Effective? Clients… Clinicians… • YES • Self-justification – rationalize the time and money spent. • Confirmation bias and selective recall • More aware of the failures of otherapists. • The same person with the same recurring problems could be considered a “success story” for several therapists. • Enter therapy in troubled state, when we return to a “normal” state, we attribute this to whatever we have done in the interim. • Placebo effect? • Although treatments have varied widely, every generation of therapists view its own approach as the most enlightened and effective. • Self-serving bias

Outcome Research • Controlled experiments! • Outcome studies are randomized clinical trials in which people on a waiting list receive therapy or no therapy. • Meta-analysis – a procedure for statistically combining the results of many different research studies • People who remain untreated often improve (2/3) who receive psychotherapy are more likely to improve. • People who receive psychological treatment spend less time and money later seeking other medical treatments, compared with those on the waiting list.

EVALUATING PSEUDOTHERAPIE S As critical thinkers, exploring and evaluating pseudotherapies requires a scientific attitude -- being skeptical but not cynical, and open to surprise but not gullible.

Pseudotherapies • Every therapy, based on testimonials, will seem effective for some people. • Placebo effect? Regression toward the mean? • For many pseudotherapies, little/no scientific evidence about the effectiveness exists (uncontrolled exp. , unreliable results) Hypnotherapy • Anger-release therapists • Reflexologists • Aromatherapists • Massage therapy • Herbal medicines •

Eye Movement Desensitization and Reprocessing (EMDR) • A therapist attempts to unlock and reprocess previously frozen traumatic memories by waving a finger/flashing a light in front of the eyes of a person imagining a traumatic scene. • EDMR has its believers and also its critics. • Combination of exposure therapy (repeatedly reliving traumatic memories in a safe and reassuring context) and the placebo effect? EMDR

Light Exposure Therapy • Light exposure therapy – exposure to daily timed doses of light that mimics outdoor light. • Seasonal affective disorder – (SAD) a form of depression linked to periods of decreased sunlight. • Light comes out of manufactured light boxes that can be bought or rented from health supply and lighting stores. • Research and controlled experiments suggest that light exposure therapy diminishes symptoms associated with SAD.

THE BIOMEDICAL THERAPIES “Medicine, the only profession that labors incessantly to destroy the reason for its existence, ” - James Bryce

Biomedical Therapies • Physically change the brain’s functioning… • • Altering chemistry with medication Overloading its circuits with electroconvulsive shock Using magnetic impulses to stimulate or dampen activity Altering its circuits through psychosurgery

Psychopharmacology • The study of the effects of drugs on mental processes and behaviors. • Led to more independent lives for sufferers of psychological disorders • Reduced hospitalization of many people • To evaluate the effectiveness of new drugs, researchers use the double-blind experimental technique to reduce researcher bias.

Antipsychotic Drugs Goal Useful for… Lessen responsiveness to random stimuli by blocking dopamine receptors Schizophrenia (regulates dopamine by blocking it at the synapse) Examples Thorazine Clozapine Risperdal Zyprexa Dopamine Lessens positive AKA hypothesis symptoms Neuroleptics schizophrenia is related to overactivity of dopamine. = Dopamine = Antipsychotic drug Tardive Dyskenesia Negative Effects Tardive dyskenesia – involuntary mov’ts of facial muscles, tongue, and limbs Increased risk of obesity and diabetes

Anti-anxiety Drugs Goal Useful for… Depress Anxiety central nervous Phobias system reactivity Can help a person learn to cope with frightening situations and fear-triggering stimuli. Examples Xanax Ativan Negative Effects Can be used as a crutch, without actually solving the root of the anxiety. Users can become tolerant, addicted, and dependent on the medication.

Anti-depressant Drugs Goal Regulate levels of neurotransmitters in the brain (serotonin and norepinephrine) that can elevate mood Useful for… Depression Anxiety Examples Negative Effects Selective-serotoninreuptake-inhibitors (SSRIs) – slow/block the reabsorption or reuptake of serotonin Full effects take 4 weeks – high suicide risk when starting medication Zoloft Prozac Paxil

Mood Stabilizing Drugs Goal Stabilize fluctuating moods Useful for… Bipolar Disorder Examples Lithium Unclear how it works – maybe strengthens nerve connections in brain that regulate mood? Negative Effects Increased thirst Headaches Memory loss Some tremors or twitches

Brain Stimulation Goal Useful for… “Shock” Trailer Examples Send an electric current through the brain while the patient is anesthetized Severe depression that does not respond to meds Electroconvulsive therapy (ECT) repeated pulses of magnetic energy to the brain Severe depression that does not respond to meds Repetitive transcranial magnetic stimulation (r. TMS) - used to stimulate or suppress brain activity Alternative to ECT Not exactly sure how it works – maybe calms the area of the brain that is over active and causing depression? • Does not penetrate surface of brain • Painless, wide-awake • No memory loss • No seizures Negative Effects • Memory loss • Stigmatized (bad reputation)

Psychosurgery Goal Remove or destroy brain tissue to change behavior Useful for… Epilepsy Tumors Examples Negative Effects Cutting the corpus callosum Irreversible – least Removing tumor masses used therapy Lobotomy – NOT performed anymore • Lobotomy – a now-rare psychosurgical procedure that cut the nerves that connect the frontal lobes to the emotion-controlling centers of the inner brain. • Developed in the 1930 s • Shock the patient into a coma • Hammer an ice pick-like instrument through each eye socket into the brain, then wiggle it to sever connections running up to the frontal lobes.

Lobotomies Crude but easy and inexpensive (10 minutes) • Tens of thousands of severely disturbed people were lobotomized during the 1940 s-50 s • The lobotomy usually produced a permanently lethargic, immature, impulsive personality. • In the 1950 s, calming drugs were introduced and lobotomized fell out of favor in the US. • Other early therapies • Crash Course – Biomedical Therapies •