Therapies

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Therapies

• Chapter 14

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Introduction

• The Lobotomist

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Defining Therapy
Not to mention your unusually large head

• Psychotherapy is the treatment of emotional and
  behavioral problems through psychological
  techniques
• Uses psychological rather than exclusively
  biological approaches to treatment
• Involves conversation between an individual with
  psychological issues and someone trained to help
  correct the problem known as a therapist.

DudeWhy are my arms so short?
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History of Treatment

• In early Stone Age society, trepanning was used
  many did not survive the procedure
• During Middle Ages, supernatural forces were
  blamed for mental illness (demonology) and
  exorcism was used
• During the French Revolution, more humane
  treatment started with the work of Philippe Pinel
• By the mid-19th century, people began to connect
  abnormal behavior to damage to the brain/central
  nervous system
• Sigmund Freud helped to popularize the talking
  cure in the early 20th century
• Since then there has been an explosive growth in
  available therapies

? 3500 BC
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Insight Therapies
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Psychoanalysis

• Designed to bring repressed feelings and thoughts
  to conscious awareness developed by Freud
• Techniques
• Therapist must maintain a neutral relationship
  with the client so that client may project
  unresolved feelings/issues upon him/her
• Dream analysis
• Hypnosis and post-hypnotic suggestions
• Free association
• Transference and resistance
• Analysis of defense mechanisms
• Insight and working through

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Person-Centered Therapy

• Developed by Carl Rogers
• Goal is to help clients become fully functioning
• Therapist expresses unconditional positive regard
  and empathy
• Therapist strives to be authentic, trying to be
  genuine and real rather than formal
• Therapy is nondirective but engages in active
  listening
• Therapist reflects or mirrors clients statements

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Gestalt Therapy
Ya, you are in ze hot seat!

• Outgrowth of the work of Fritz Perls
• Emphasizes the wholeness of personality
• Attempts to reawaken people to their emotions and
  sensations in the here-and-now
• Draws attention to what exists rather than what
  is absent, and draws attention to clients voice,
  posture, and movements
• Encourages confrontation with issues
• Therapist is active and directive
• Empty Chair and Hot Seat technique

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Recent Developments

• Short-term psychodynamic psychotherapy
• Focused on trying to help people correct the
  immediate problems in their lives
• Forego long process of completely excavating
  childhood
• Virtual therapy
• Therapy delivered via chat room, phone or video
  conference
• Client given techniques to use on their own after
  session ends

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Behavior Therapies
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Behavior Therapies

• Based on the belief that all behavior adaptive
  and maladaptive - is learned
• Objective of therapy is to teach people new ways
  of behaving
• Focuses on observable, measurable activities

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Using Classical Conditioning Techniques

• Systematic desensitization
• Gradually associating relaxation with what was
  feared
• Extinction through counterconditioning
• Ending of old fears or reactions through repeated
  exposure to new stimulus pairs
• Flooding
• Full-intensity exposure to feared object
• Aversive conditioning
• Eliminate undesirable behavior by associating it
  with pain and discomfort
• Virtual reality exposure therapy
• Expose client to fears in safe, virtual setting

Say hello to Mr. Spider!
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Operant Conditioning

• Behavior contracting
• Client and therapist set behavioral goals and
  agree on reinforcements the person will receive
• Client engages in desired behaviors to attain
  reinforcement
• Token economy
• Clients earn tokens for desired behaviors and
  exchange them for desired items or privileges
• Often used in schools and hospitals

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Modeling

• Person learns new behaviors by watching others
  perform those behaviors
• Sometimes used in conjunction with operant
  conditioning
• Therapist him/herself may model desirable
  behaviors for client

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Cognitive Therapies
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Meichenbaums Stress-Inoculation Therapy

• Type of cognitive therapy that trains people to
  cope with stressful situations by learning a more
  useful patterns of self-talk
• Taught to suppress negative and anxiety-provoking
  thoughts in times of stress
• Particularly effective for treating anxiety
  disorders

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Ellis Rational-Emotive Therapy (RET)

• A directive, confrontational therapy based on the
  idea that psychological distress is caused by
  irrational and self-defeating beliefs
• Core problem is belief in musts and shoulds
  that leave no room for making mistakes (no more
  musterbation)
• Therapists job is to challenge clients
  irrational beliefs

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Becks Cognitive Therapy

• Aimed at identifying and changing inappropriately
  negative and self-critical patterns of thought
• Therapist points out automatic thoughts
  (instantaneous, habitual, and unconscious
  thoughts that impact mood and action) and
  catastrophizing beliefs and forces client to
  substantiate them
• Good treatment for depression

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Cognitive Distortions List

• All or nothing thinking (always, every,
  never)
• Mental filter (focus on negative aspects while
  ignoring positive aspects)
• Disqualifying the positive (shooting down
  positive experiences for no reason)
• Jumping to conclusions (drawing conclusions with
  little/no evidence)
• Overgeneralization (isolated case assumed for
  all)

• Magnification/minimization (making mountains out
  of molehills, catastrophizing)
• Emotional reasoning (decision making based on
  feelings, not logic)
• Personalization (attributing personal
  responsibility when individual has no control
  over event)
• Should statements (emphasizing what should be
  rather than what is what Ellis called
  musterbation)

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Group Therapies
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Family Therapy

• Form of group therapy that sees the family as at
  least partly responsible for the individuals
  problems
• Seeks to change all family members behavior to
  the benefit of the family and the individual

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Self-Help Groups and Couple Therapy

• Self Help Groups
• Small, local gatherings of people who share
  common problems and provide mutual assistance at
  very low cost
• Alcoholics Anonymous is an example
• Good for empathy, but may trigger temptation to
  relapse
• Couple Therapy
• A form of group therapy intended to help troubled
  partners improve their communication and
  interaction
• Empathy training partners taught to share
  feelings and listen to and understand partners
  feelings

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Evaluating Psychotherapies
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Overall Effectiveness of Psychotherapy

• Does Psychotherapy Work?
• Psychotherapy helps about 2/3rd of people treated
• Approximately 1/3 would improve without therapy
• Which Type of Therapy is Best for Which Disorder?
  
• No one type of therapy is better
• Key is to match the problem with the appropriate
  therapy

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Effectiveness of Insight and Cognitive Therapies

• Difficult to judge as spontaneous remission may
  occur
• Who should be asked to judge the effectiveness of
  therapy? Therapist or client?
• Meta-analysis may be the best bet to evaluate
  these therapies
• 75-80 result in improvement vs. no therapy at
  all
• Only 10 were worse after therapy
• Works best with those who are not severely
  disturbed

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Effectiveness of Behavior Therapies

• Work well for certain problems such as phobias,
  compulsive behaviors, impulse control, and
  learning new social skills to displace
  maladaptive ones
• Criticized for ignoring internal thoughts and
  expectations and just treating symptoms rather
  than underlying causes
• Not well suited for some types of problems

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Biological Treatments
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Biological TreatmentsOverall Trends

• View abnormal behavior as a symptom of an
  underlying physical disorder
• Typically favor biological therapy (drugs,
  psychosurgery, ECT, etc.)

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Drug Therapies

• Psychopharmacotherapy is the treatment of mental
  disorders with medication also known as drug
  therapy
• Major reasons for widespread use of drugs
• Drugs are effective at treating disorders
  especially serious disorders
• Drug therapies are often less expensive that
  psychotherapy

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Antipsychotic Drugs (Neuroleptics)

• Used for schizophrenia or psychosis
  (hallucinations, delusions, paranoia, disordered
  thinking, incoherence)
• All antipsychotics block dopamine receptors in
  the brain
• Side effects include drowsiness, dry mouth,
  muscular rigidity, and Tardive Dyskinesia
• Examples include Thorazine, Haldol, Mellaril,
  Clozapine, and Risperidone
• 60-70 show improvement in symptoms when these
  drugs are used

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Antidepressant Drugs (Thymoleptics)

• Tricyclics and MAO (monoamine oxidase) inhibitors
• Most common antidepressants prior to late 1980s
• Work by increasing amount of the
  neurotransmitters serotonin and norepinephrine
• Effective, but have serious side effects such as
  heart complications and weight gain
• Examples Tofranil, Elevil (Tricyclics), Nardil
  (MAOi)
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Work by blocking the reuptake of serotonin
• Examples Prozac, Paxil, Zoloft, Effexor
• Side effects sleepiness, reduced sex drive
• 60-70 show improvement though it may take two
  weeks for changes to take effect

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Action of SSRIs
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Antimania DrugsLithium

• A naturally occurring salt (lithium carbonate)
  that is used to treat bipolar disorder (manic
  depression) with 80 effectiveness
• Nobody knows how lithium works to alleviate
  symptoms
• Problem with establishing proper dosage and with
  people stopping medication when symptoms ease
• Examples lithium carbonate, Eskalith

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Antianxiety Drugs (Anxiolytics)

• Use to treat anxiety disorders and are often
  referred to as tranquilizers
• Most widely prescribed of all legal drugs
• Produce a feeling of calm and mild euphoria
• Side effects include physical dependence and
  withdrawal symptoms is abruptly discontinued
• Examples Valium, Librium, Xanax, Equanil

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Psychostimulants

• Used to treat disorders such as AD/HD
• Concern that psychostimulants are being overused
• Side effects lethargy, depression, aggression

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Electroconvulsive Therapy

• Commonly known as shock therapy
• 1938 Italian physicians Ugo Cerletti and Lucio
  Bini created seizures in patients by passing an
  electric current through their brains
• During 1940s and 50s, used as a treatment for
  depression, schizophrenia and sometimes mania
  now used only for severe depression
• Causes brief convulsions and temporary loss of
  consciousness
• Side effects include memory loss and difficulty
  learning following the procedure
• Up to 100,000 people receive ECT each year

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Psychosurgery

• Brain surgery performed to change a persons
  behavior or emotional state
• History of Lobotomy Egas Moniz and Walter
  Freeman
• Prefrontal lobotomy (EM)
• Transorbital lobotomy (WF)
• Tragedies
• Psychosurgery is rarely used today and removes
  far less brain tissue

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Alternatives to Institutionalization
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Deinstitutionalization

• Releasing people with severe psychological
  disorders into the community
• Can cause problems
• Some people are ill-prepared to deal with life
  outside of a hospital
• Up to 40 of homeless are mentally ill
• Alternative forms of treatment (many)
• Half-way houses
• Family-crisis interventions
• Day-care

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Prevention

• Primary prevention
• Improve the social environment so that new cases
  of mental disorders do not develop
• e.g. Family planning, Genetic counseling
• Secondary prevention
• Interventions with high risk groups
• e.g., suicide hot-lines, job training in
  economically depressed areas
• Tertiary prevention
• Help people adjust after they are released from
  the hospital in order to help prevent a relapse
• e.g. halfway houses, long-term outpatient care
• Community psychology attempts to minimize or
  prevent mental disorders not just treat them