Therapy Chapter 13

1. TherapyChapter 13

2. Therapy Treating Psychological Disorders The Psychological Therapies • Psychoanalysis • Humanistic Therapies • Behavior Therapies • Cognitive Therapies • Group and Family Therapies

3. Therapy Evaluating Psychotherapies • Is Psychotherapy Effective? • Which Therapies Work Best? • How Do Psychotherapies Help People? • Culture and Values in Psychotherapy

4. Therapy The Biomedical Therapies • Drug Therapies • Brain Stimulation • Psychosurgery • Therapeutic Lifestyle Change Preventing Psychological Disorders

5. Treating Psychological Disorders • In earlier times, efforts to treat psychological disorders were often cruel and often based on irrational beliefs • The chair on the right was once considered a more humane form of treatment.

6. Treatment Reformers • Reformers pushed for gentler, more humane treatments • Constructed mental hospitals • Since 1950s mental hospitals have been emptied in favor of drug therapies and community-based treatments Dorothea Dix (1802-1887)

7. Today’s Therapies • Psychotherapy: treatment involving psychological techniques • Consists of interactions with a trained therapist • Many therapists use an eclectic approach, using a blend of therapy techniques • Biomedical therapy: Prescribed medications or medical procedures

8. The Psychological Therapies • The most influential types of psychotherapies: • Psychoanalytic • Humanistic • Behavioral • Cognitive • Most can be used one-on-one or in groups

9. Psychoanalysis • Originally developed by Freud • Today, not generally practiced as Freud did • Provides part of the foundation for treating psychological disorders

10. Psychoanalysis • Goals • Bring patients’ repressed or disowned feelings into conscious awareness • Giving them insight into the origins of their disorder helps them take responsibility for their own growth

11. Techniques of Psychoanalysis • Free association • Talking about whatever comes to mind • Can reveal unconscious blocking of anxiety-laden material (resistance) • The psychoanalyst’s interpretationmay provide the patient with insight • Transference: the patient may transfer to the analyst emotions linked with other relationships

12. Psychoanalysis • Few U.S. therapists offer traditional psychoanalysis • Underlying theory not supported by scientific research • Interpretations cannot be proven or disproven • Can take years of several expensive sessions per week • Contemporarypsychodynamic therapieshave evolved from psychoanalysis

13. Psychodynamic Therapy • Tries to help people understand their symptoms by focusing on themes across important relationships including childhood experiences and the therapist relationship • Often face-to-face • Shorter time frame than traditional psychoanalysis

14. Humanistic Therapies • Therapists aim to boost patients’ self-fulfillment by growing in self-awareness and self-acceptance • Differences from psychoanalytic therapies • Focuses on promoting growth, not curing illness • Path to growth is taking immediate responsibility for one’s feelings and actions • Conscious thoughts are more important than unconscious • The present and future are more important than the past

15. Humanistic Therapies • Client-centered therapy • Developed by Carl Rogers • Combines active listening with a genuine, accepting, empathic, environment to promote clients’ growth • Includes unconditional positive regardfrom the therapist

16. Active Listening Hints for active listening, even among friends • Summarize • Repeat the other’s statements in your own words • Invite clarification • “What might be an example of that?” • Reflect Feelings • “It sounds frustrating.”

17. Behavior Therapies • Doubts the healing power of self-awareness • Applies learning principles to the elimination of unwanted behaviors

18. Classical Conditioning Techniques • Maladaptive symptoms may be examples of conditioned responses • Treatment for bed-wetters (O.H. Mowrer) • Connect liquid-sensitive pads to an alarm • Associates urinary relaxation with waking, stops the bed-wetting • Counterconditioning: pairs the trigger stimulus (e.g., enclosed space) with a new response (e.g., relaxation) • Exposure therapies • Aversive conditioning

19. Exposure Therapies • Treat anxiety by exposing people to the things they fear and avoid • Systematic desensitization: associates a relaxed state with gradually increasing anxiety-triggering stimuli • Virtual reality exposure therapy: progressively exposes people to simulations of their greatest fears

20. Aversive Conditioning • Associates an unpleasant state with an unwanted behavior

21. Operant Conditioning • Behavior modification: • Reinforce desirable behaviors • Don’t reinforce (or even punish) undesirable behaviors • Useful for solving specific behavior problems • Token economy: a procedure in which people earn a token for exhibiting a desired behavior, and can later exchange the tokens for privileges or treats

22. Cognitive Therapies • Behavior therapies are good for specific fears and problem behaviors • What about range of behaviors accompanying depression or anxiety? • Cognitive therapies teach people new, more adaptive ways of thinking and acting • Based on the assumption that thoughts intervene between events and our emotional reactions

23. A Cognitive Perspective

24. Beck’s Therapy for Depression • Aaron Beck and his colleagues developed cognitive therapy • Gentle questioning seeks to reveal irrational thinking and then persuade people to remove “dark glasses” through which they view life

25. Beck’s Therapy for Depression • Many students become anxious before an exam • “This exam’s going to be impossible” • “I wish I were better prepared” • To change negative self-talk, therapists teach people to alter their thinking in stressful situations • “I’ve studied well, now it’s time to show what I know” • Training people to “talk back” to negative thoughts can be effective at curbing depression

26. Cognitive-Behavioral Therapy • An integrative therapy combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior) • Shown to be effective at treating anxiety disorders (like OCD) and depression • Albert Ellis suggested that even when cognitive therapy works, feeling better is not enough: “You have to back it up with action, action, action.”

27. Group and Family Therapies • Most therapies may also occur in small groups (except traditional psychoanalysis)

28. Group and Family Therapies • Unique benefits • Relief to find that others share your problems • Receive feedback as you try out new behaviors • Family therapy treats the family as a system. View an individual’s unwanted behaviors as influenced by or directed at other family members

29. Evaluating Psychotherapies • Is Psychotherapy Effective? • Which Therapies Work Best? • How Do Psychotherapies Help People? • Culture and Values in Psychotherapy

30. Is Psychotherapy Effective? • Clients’ Perceptions: Almost 90% of patients at least “fairly well satisfied” • Criticisms of using client satisfaction as a measure of effectiveness include: • People often enter therapy in crisis, and might have then improved without therapy

31. Is Psychotherapy Effective? • Clinician’s Perceptions • Therapists tend to be aware of their own successes and the failures of others • To objectively evaluate psychotherapies, psychologists turn to controlled research studies

32. Outcome Research • Eysenck (1952) showed with or without therapy, about two-thirds of patients show improvement with time • Research methods potentially flawed • Today, randomized clinical trials show that psychotherapy works • Those not undergoing therapy often improve, but those undergoing therapy are more likely to improve

33. Outcome Research • NIMH Study • Experienced therapists trained in cognitive therapy, interpersonal therapy, or drug therapy • 239 depressed participants randomly assigned to one of those 3 or control group • After 16 weeks, depression lifted for more than half in each of treatment groups • Only 29% improved in control group

34. Outcome Research Figure is a compilation of 475 studies

35. Which Therapies Work Best? • No one type of therapy is best across the board • Some forms work best for particular problems • Behavior conditioning for specific behavior problems (bed-wetting, phobias, compulsions)

36. Therapies with Little Scientific Support • Energy therapies • Recovered-memory therapies • Rebirthing therapies • Facilitated communication • Crisis debriefing

37. Clinical Decision MakingWhat role should science play in clinical practice? Ideal decision making is upheld by (1) research evidence, (2) clinical expertise, (3) knowledge of the patient

38. How Do Psychotherapies Help People? • 3 basic benefits • Hope for demoralized people • A new perspective on oneself and the world • An empathic, trusting, caring relationship

39. Culture and Values in Psychotherapy • A mismatch can occur when therapist and client have different cultural values • E.g., clients from collectivist cultures may have trouble thinking only of their own well-being • Highly religious people prefer therapists who share their values • Psychotherapists’ personal beliefs and values influence their practice • Clients tend to adopt their therapists’ values • Therapists should perhaps express those values more openly

40. A Consumer’s Guide to Psychotherapists

41. When to Seek Treatment Adapted APA list of warning symptoms, which don’t include relationship problems: - Feeling worthless - Withdrawing from others - Deep, lasting depression - Fears preventing daily life - Self-destructive behavior - Problems with substance abuse - Extreme mood shifts - Wanting to die or hurt self - Compulsive rituals - Sexual difficulties affecting daily life - Hearing voices or seeing things that others don’t perceive

42. The Biomedical Therapies • Drug Therapies • Brain Stimulation • Psychosurgery • Therapeutic Life-Style Change

43. Drug Therapies • Increase in use of drug therapies coincides with an emptying of U.S. mental hospitals

44. Drug Therapies • To judge the effectiveness of a new treatment, we need to compare its effectiveness to the rates of the following: • Normal recovery among untreated people • Recovery due to the placebo effect • In double-blind (neither scientist nor subject know who is getting the real drug) studies, several types of drugs have proven useful in treating psychological disorders

45. Antipsychotic Drugs • Drugs used to treat schizophrenia and other forms of severe thought disorders • Useful for treating positive symptoms • E.g., hallucinations, paranoia • Not as helpful in treating negative symptoms • E.g., apathy, withdrawal • Work by blocking dopamine receptors, mimicking certain neurotransmitters.

46. Antipsychotic Drugs • Powerful side effects • Sluggishness, tremors, twitches • Newer-generation antipsychotics produce fewer side effects • Despite drawbacks, antipsychotics can help people with schizophrenia when combined with life-skills programs and family support

47. Antianxiety Drugs • Drugs used to control anxiety and agitation • Depress central nervous system activity • Calm anxiety as person learns to cope with fear-triggering stimuli • Made reduce symptoms without resolving underlying problems

48. Antidepressant Drugs • Used to treat depression and some anxiety disorders • Different types work by altering the availability of various neurotransmitters • Prozac, Zoloft, and Paxil are selective-serotonin-reuptake-inhibitors (SSRIs) • May take up to four weeks to reach full therapeutic effect

49. How SSRIs Work

50. Using Antidepressant Drugs • Best approach may be to use antidepressants in combination with cognitive-behavioral therapy • In double-blind trials, placebos produced about 75% of the improvement as active drug • Some conclude that there may be little reason to use except for the most severely depressed patients