Treatments

1. Treatments

2. History of Treatments • Early treatments brutal • Transitioned to more humane methods • Dorothea Dix – 1st to transition to gentler treatments in U.S. • Today - Biomedical Drugs and better Psychotherapy has led deinstitutionalization.

3. Categories of Therapy 2 Main Categories • Psychotherapy – interaction between therapist and patient • Example: Psychoanalytic Therapy • Psychotherapist - trained therapist(clinical psych) who uses psychological techniques to assist someone to overcome • Example: psychodynamic therapist who treats an anxiety disorder 2. BiomedicalTherapy – prescription meds that act on central nervous system • Example: Antipsychotic drugs to treat Schizophrenia Ecclectic Approach– uses a variety of psych theories and approaches to treat mental illness Example: combining medication (anti-depressants) with different types of psychotherapy such as Cognitive Therapy (change feelings of self-blame) and Behavioral (go out and run when feeling depressed)to treat depression

4. Perspectives and Disorders

5. Insight Therapies • Insight therapies – try to improve mental state by increasing client’s awareness of underlying motives and defenses • Examples: • Psychoanalytic Therapy • Psychodynamic Therapy • Humanistic Therapy

6. Psychoanalytic Therapy • Psychoanalysis – uncovering childhood experiences to gain insight into the unconscious origins of the disorder • dreamanalysis – manifest and latent • free association – uncensored reporting of any thoughts that come to mind. • Resistance - blocking from unconsciousness anxiety-laden material during therapy. • Example: stuttering, omitting or forgetting events, pausing, changing the subject, ending a session

7. Psychoanalytic Therapy • Transferring – strong positive or negative feelings patients may feel about the psychoanalyst that reflect similar unconscious feelings repressed from earlier relationships. • Seen as helpful to the therapy process • Example: Hatred toward mother is expressed as hatred toward therapist

8. Psychoanalytic Therapy • Criticisms • Interpretations can’t be proven or disproven • Costly and time consuming (2 or more sessions/week for 2 or more years)

9. Psychodynamic Therapy • Psychodynamic therapy - try to understand patients' current symptoms by focusing on recurring patterns in their interpersonal relationships • Patients gain insight into unconscious conflicts • Face to face, once per week, several months • Interpersonal psychotherapy - effective in treating depression by helping patients improve their interpersonal skills • variation of psychodynamic therapy • 14-16 sessions • Example: helping a depressed patient resolve conflicts with friends

10. Humanistic Therapy • Humanistic Therapy - emphasize the importance of self-awareness and take responsibility for own feelings and actions to improve mental state • Focus onpresent • Focus on Conscious thought • Taking responsibility for own actions • Promote personal growth • Does NOT analyze motive, diagnose or recommend a cure. .

11. Humanistic Psychology • Client-Centered Therapy (Rogers) -patients' discover their own ways of dealing with difficulties • non-directive therapies – therapist listens without judging or giving insight • Genuineness, acceptance and empathy • Unconditional Positive Regard • Active listening – echoing, restating and seeking clarification of clients feelings

12. Geraldo, a high school senior, is so fearful of asking a girl out that he hasn't had a date in over three years. He has recently contacted a psychotherapist for help in overcoming his fear. Describe how a humanistic therapist and a psychoanalyst would treat Geraldo's problem.

13. HUMANISTIC PSYCHOLOGIST • focus on the present rather than the past - what Geraldo can do now to get up the nerve to ask for a date rather than what he failed to do in the past • conscious thoughts - what Geraldo thinks about dating and how he would approach a woman for a date • taking responsibility for his actions - what he can control in asking a woman out on a date rather than what he can't control • PSYCHOANALYST • focus on what unconscious impulses or conflicts are causing Geraldo's fear—Does Geraldo have unconscious feelings of anxiety about his mother that he is transferring to other women?

14. Behavioral Therapies Behavior Therapies – applies learning principles to unwanted behaviors • Classical Conditioning • Maladaptive symptoms are conditioned responses • Operant Conditioning • Maladaptive symptoms are reinforced

15. Behavioral Therapy • Classical Conditioning • Counterconditioning (Pavlov)- replaces a negative behavior (anxiety, fear) with a positive behavior (relaxation) • Example: Child wets the bed, condition to wake up when bladder relaxes by using an alarm • 2 Types • Exposure Therapies • Flooding • Systematic Desensitization • Virtual Reality Exposure Therapy • Aversive Conditioning

16. Exposure Therapies • Exposure Therapies - Repeatedly introducing people to things they fear and avoid • Flooding – forced exposure to the stimulus that is feared • Example: Putting a Susan who has Arachnophobia in a room full of spiders to show that they have no reason to fear them • Systematic Desensitization – gradual exposure to the actual stimulus by replacing a positive response with a negative response. • Progressive relaxation – imagined scene is repeatedly paired with relaxation and progresses to eventually facing the worst fear • Example: Therapist first asks Susan to relax and imagine a harmless spider climbing up the wall eventually she will face a room full of tarantula spiders, her greatest fear

17. Exposure Therapies • Virtual Reality Therapy – progressively exposing people to simulations of their greatest fears • Examples: exposing Susan to Spiders using a 3 dimensional virtual world with life-like spiders • Fear of flying, heights, animals and public speaking

18. Aversion Therapy • Aversion Therapy – replaces a positive behavior with a negative behavior • Examples: consuming alcohol (euphoria - positive) with a nausea producing drug (negative) • Gambling and shock treatments • Problem: cognition influences conditioning

19. Operant Conditioning • Behavior Modification - reinforcing desired behaviors, giving punishments for undesired behaviors • Example: Punishing aggressive behaviors of children with autism • Token Economy – earning a token for desired behavior that can be traded in for privileges • Example: Given tokens to ADHD students for staying in their seats and allowing them to trade them in for a prize

20. Describe how a therapist might apply operant conditioning techniques to help Rosemary overcome a compulsive habit of eating too much junk food. Be clear about the exact procedures that would be used.

21. behavior modification - reinforcing the desired behavior (e.g.. encouraging Rosemary to treat herself to a favorite, healthy food [such as an energy drink] if she doesn't eat any chips or candy during the day) or punishing an undesirable behavior (e.g., having to put $5 in a jar each time she has a piece of candy).

22. Cognitive Therapy • Cognitive Therapy – change the way patient thinks (change schemas) • Irrational, Self-blaming, over-generalized thoughts, negative interpretations • Anxiety Disorders, Major Depressive Disorder, Suicide • Example: Dan thinks he can’t get an A in AP Psych because he’s incompetent • Beck’s Therapy for Depression – uses gentle questioning to reveal irrational thinking • Stress Inoculation Training • Teaches to change thinking in stressful events

23. Cognitive-Behavioral Therapy • Cognitive Behavioral - Changes the way we think and act • Example: When Olivia is anxious, her therapist teaches her to attribute her anxiety to a highly reactive sympathetic nervous system and to play Temple Run on her phone instead. • Rational Emotive Behavior Therapy (REBT, Ellis) – helps people change their irrational beliefs by having therapist dispute the client's irrational beliefs and behavioral problems • Example: • "Where is it written that other people must treat you fairly?"

24. One of your best friends feels that he fails at everything he does and that his life isn't worth living. When you suggest that he talk to a psychotherapist, your friend responds, “Talking won't help. The more I talk about myself, the more I think about my problems. The more I think about my problems, the more depressed I get.” What procedures would a cognitive therapist use to help your friend overcome his negative feelings?

25. A cognitive therapist - believes that the emotional reaction (depression) is produced by your friend's thinking about life events, and so would work with the client to change the ways he thinks about life events.

26. Family and Group Therapy • Group Therapy • Offered for: family conflict, stressful relationships, patients with similar problems • Improves communication skills and conflict resolution • Examples: obesity (OA), alcoholism (AA) • Family Therapy – unwanted behaviors are influenced by other family members Example: rebellious child

27. Evaluating Psychotherapy • Placebo effect – the beneficial consequences of merely expecting that a treatment will be effective. • Regression toward the mean – the tendency for unusual events or emotion to return to their ave. state . • Example: Dan got an unusually high grade on a test, he performed less on the second even though he studied the same amount

28. Evaluating Psychotherapy • Randomized Clinical Trials – compare treatment groups with control groups • Meta-analysis – a procedure for statistically combining the results of many different studies. – gives bottom line results • Psychotherapies bottom line – Those not undergoing therapy often improve, but those undergoing therapy are more likely to improve

29. Comparison of Psychotherapies • Evidence Based Practices - Clinical decision making that integrates the best available research with clinical expertise and an understanding of patient characteristics • **Scientifically Unsupported Therapies - Energy Therapy, Recovered-memory Therapy, Rebirthing Therapies, Facilitated Communication, Crisis Debriefing

30. Alternative Therapies • EMDR (Eye Movement Desensitization and Reprocessing - Rapidly moving one's eyes while recalling traumatic experiences • similar to exposure treatment • Originally developed for anxiety • Value in placebo effect and exposure therapy • Light Exposure Therapy – exposure to intense light that mimics outdoor light • activity in the brain region responsible for arousal • Seasonal Affective Disorder – depression caused by lack of exposure to natural light

31. Biomedical Therapy Biomedical Therapy – drugs, or treatments that act on the brain’s central nervous system • Examples: • Drugs, electroconvulsive therapy, • Magnetic impulses • Psychosurgery

32. Biomedical Therapy Psychopharmacology – study of the effects of drugs on the mind and behavior • Antipsychotics (Thorazine,Chlorpromazine, Clozapine) • Anti-anxiety ( Xanax, Ativan d-cycloserine) • Anti-depressants (Paxil, Prozac, Zoloft – SSRI’s) • Mood Stabilizers Bipolar (lithium, Depakote)

33. Anti-Psychotics • Anti-Psychotic Drugs – drugs used to treat schizophrenia that block receptor sites for dopamine • Thorazine – Helps positive symptoms only – hallucinations and paranoia • Tardive dyskinesia –Side effects: sluggishness, tremors, twitches, involuntary movements of face, tongue, limbs from long-term use ( • Atypical antipsychotics • Block both dopamine and serotonin receptors • Clozapine –used to treat negative symptoms –apathy and withdrawal

34. Anti-Anxiety Drugs • Anti-anxiety drugs – depress central nervous system activity • Xanax & Ativan • D-cycloserine – acts on receptor site that extinguishes learned fear –helps with PTSD and OCD • Addictive • Withdrawal symptoms – increased anxiety and insomnia

35. Anti-Depressants • Anti-depressants – used to treat depression & anxiety by increasing the availability of serotonin and norepinephrine that elevate arousal and mood • Paxil, Prozac, Zoloft (SSRIs) – blocks serotonin reuptake • Dual Action Drugs – block both the reuptake of serotonin and norepinephrine

36. Alternatives for Depression • Cognitive-Therapy + antidepressants • Cognitive therapy top down • Antidepressant bottoms-up – works on limbic system • Mood Stabilizing Drugs • Lithium – simple salt used to treat Bipolar disorder • Depakote – epilepsy drug used to treat mania • Exercise

37. Brain Stimulation • Treatments for Depression • ECT (Electroconvulsive therapy) – electric shock therapy for patients with sever depression • Can trigger seizures and memory loss • rTMS (repetitive transcranial magnetic stimulation)- repeated pulses of magnetic energy to brain’s surface • No seizures or memory loss • Triggers long-term potentiation of inactive left frontal lobe nerve cells. • Deep Brain Stimulation – uses implanted electrodes to inhibit activity in an area of the cortex that triggers negative emotions

38. Psychosurgery • Psychosurgery – removes or destroys brain tissue • Lobotomy - cut the nerves connecting the frontal lobes to the emotion controlling centers of inner-brain • Once used to calm severely emotional or violent patients • MRI-guided precision surgery – cut brain circuits of severe OCD

39. Preventing Psychological Disorders • Therapeutic Lifestyle Change – reverses the symptoms of psychological disorders • Aerobic exercise, adequate sleep, light exposure, and social engagement, anti-rumination, nutrition • Resilience – ability to cope with stress and recover from adversity