Approaches to Treatment and Therapy

1. Approaches to Treatment and Therapy Chapter 17 ©2002 Prentice Hall

2. Approaches to Treatment and Therapy • Biological treatments. • Kinds of psychotherapy. • Evaluating psychotherapy. ©2002 Prentice Hall

3. Biological Treatments • The question of drugs. • Surgery and electroshock. ©2002 Prentice Hall

4. The Question of Drugs ©2002 Prentice Hall

5. Antipsychotic Drugs • Many block or reduce sensitivity of brain receptors that respond to dopamine. • Some increase levels of serotonin, a neurotransmitter that inhibits dopamine activity. • Can relieve positive symptoms of schizophrenia but are ineffective for or even worsen negative symptoms. ©2002 Prentice Hall

6. Antidepressant Drugs • Monoamine oxidase inhibitors (MAOIs) • Elevate norepinephrine and serotonin in brain by blocking an enzyme that deactivates these neurotransmitters. • Tricyclic antidepressants • Boost norepinephrine and serotonin in brain by preventing normal reuptake of these substances. • Selective serotonin reuptake inhibitors • work same way as tricyclic antidepressants but target serotonin. ©2002 Prentice Hall

7. Tranquilizers • Increase the activity of the neurotransmitter gamma-aminobutyric acid (GABA). • Developed for treatment of mild anxiety and often overprescribed by general physicians for patients who complain of any mood disorder. ©2002 Prentice Hall

8. Lithium Carbonate • Used to treat bipolar disorder. • Moderates levels of norepinephrine or by protecting cells from being overstimulated by the neurotransmitter, glutamate. • Must be given in right dose and bloodstream levels need to be monitored. • Newer drug treatments for bipolar disorder include Tegetrol and Depakote. ©2002 Prentice Hall

9. Cautions About Drug Treatment • Placebo effect • High Relapse and dropout rates. • Dosage problems. • Long-term risks ©2002 Prentice Hall

10. Placebo effect • The apparent success of a treatment that is due to the patient’s expectation of hopes rather than to the drug or treatment itself. • Meta-analyses indicates that clinicians considered medication helpful yet patient ratings in treatment groups were no greater than patient ratings in placebo groups. ©2002 Prentice Hall

11. High Relapse and Dropout Rate • There may be short term success but many patients (50% to 66%) stop taking medication due to side effects. • Individuals who take antidepressants without learning to cope with problems are more likely to relapse. ©2002 Prentice Hall

12. Dosage Problems • Finding the therapeutic window or the amount of medication that is enough but not too much. • Drugs may be metabolized differently in: • men and women, old and young, and in different ethnic groups. • Groups may differ in dosages due to variations in metabolic rates, amount of body fat, number or type of drug receptors in the brain, smoking and eating habits. ©2002 Prentice Hall

13. Long term risks • Antipsychotic drugs can be dangerous, even fatal if taken for many years. • Tardive dyskinesia • Antidepressants are assumed to be same but no long term studies have been conducted. ©2002 Prentice Hall

14. Surgery and Electroshock • Psychosurgery • Any surgical procedure that destroys selected areas of the brain believed to be involved in emotional disorders or violent, impulsive behavior. • Electroconvulsive Therapy (ECT) • A procedure used in cases of prolonged and severe major depression, in which a brief brain seizure is induced. ©2002 Prentice Hall

15. Kinds of Psychotherapy • Psychodynamic therapy. • Behavioral and Cognitive therapy. • Humanist and Existential therapy. • Family therapy. ©2002 Prentice Hall

16. Psychodynamic Therapy • Goal is exploring the unconscious • Free Association • In psychoanalysis, a method of uncovering unconscious conflicts by saying freely whatever comes to mind. • Transference • In psychodynamic therapies, a critical step in which the client transfers unconscious emotions or reactions, such as conflicts about his or her parents, onto the therapist. ©2002 Prentice Hall

17. Behavior and Cognitive Therapy • Behavior therapy • Systematic desensitization. • Aversive conditioning. • Exposure treatments. • Behavioral records and contracts. • Skills training. • Cognitive therapy ©2002 Prentice Hall

18. Behavior Therapy • A form therapy that applies principles and techniques of classical and operant conditioning to help people change self defeating or problematic behaviors. ©2002 Prentice Hall

19. Systematic Desensitization • A step by step process of desensitizing a client to a feared object or experience, • Based on counterconditioning. ©2002 Prentice Hall

20. Exposure (Flooding) • A technique whereby a person suffering from an anxiety disorder such as a phobia or panic attack, is taken directly into the feared situation until the anxiety subsides. ©2002 Prentice Hall

21. Behavioral Records • A method of keeping careful data on the frequency and consequences of the behavior to be changed. ©2002 Prentice Hall

22. Skills Training • An effort to teach a client skills he or she may lack as well as new more constructive behaviors to replace self-defeating ones. ©2002 Prentice Hall

23. Cognitive Techniques • Examine the evidence for beliefs. • Consider other explanations for the behavior of others. • Identify assumptions and biases. ©2002 Prentice Hall

24. Humanist Therapy • Humanist therapy • Based on the assumption that people seek self-actualization and self-fulfillment. • Emphasized people’s free will to change, not past conflicts. • Client-Centered (Nondirective) Therapy • Developed by Carl Rogers and emphasizes the therapist’s empathy with the client, seeing the world as client does, and creating climate of Unconditional Positive Regard. ©2002 Prentice Hall

25. Existential Therapy • Helps clients explore the meaning of existence and face with courage the great issues of life such as death, freedom, free will, alienation and loneliness. ©2002 Prentice Hall

26. Family and Couples Therapy • Problems develop in the context of family, are sustained by the dynamics of the family and that any changes made will affect all members of the family. • Can look for patterns of behavior across generations and create a family tree of psychologically significant events. • Family-System Perspective • Therapy with individuals or families that focuses on how each member forms part of a larger interacting system. ©2002 Prentice Hall

27. One Family’s Genogram ©2002 Prentice Hall

28. Primary Goals of Therapies • Psychodynamic • Insight into unconscious motives and feelings. • Cognitive-Behavioral • Modification of behavior and irrational beliefs. • Humanist • Insight; self-acceptance and self-fulfillment. • Family • Modification of individual habits and family patterns. ©2002 Prentice Hall

29. Primary Methods of Therapies • Psychodynamic • Probing the unconscious through dream analysis, free association, transference. • Cognitive-Behavioral • Behavioral techniques such as systematic desensitization, flooding; cognitive exercises to identify and change faulty beliefs. • Humanist • Providing a safe, non-judgmental setting in which to discuss life issues. • Family • Working with couples, families, and sometimes individuals to identify and change patterns that perpetuate problems. ©2002 Prentice Hall

30. Evaluating Psychotherapy • The scientist-practitioner gap. • When therapy helps. • Which therapy for which problem? • When therapy harms. ©2002 Prentice Hall

31. The Scientist-Practitioner Gap • Some psychotherapists believe that evaluating therapy using research methods is futile. • Scientists find that therapists who do not keep up with empirical findings are less effective and can do harm to clients. • Economic pressures require empirical assessment of therapies. ©2002 Prentice Hall

32. Is More Psychotherapy Better? • With additional therapy sessions, the percentage of people improved increased up to 26 sessions. • Rate of improvement then levels off • Based on a summary of 15 studies, 2400 clients (Howard, et al., 1996). • Patients’ sense of improvement slower but more steady. ©2002 Prentice Hall

33. Psychotherapy Research Questions • What are the common ingredients in successful therapies? • What kinds of therapy are best suited for which problems? • Under what conditions can therapy be harmful? ©2002 Prentice Hall

34. Common Ingredients in Successful Therapies • When there is a bond between therapist and client (a.k.a. Therapeutic Alliance). • When participants want to be helped. • When therapists distinguish normal cultural patterns from individual psychological problems. ©2002 Prentice Hall

35. Which Therapy for Which Problem? • Depression • Cognitive therapy’s greatest success has come in treatment of mood disorders. • Anxiety Disorders • Exposure techniques are more effective than others. • Anger and Impulsive Violence • Cognitive therapy is extremely successful. ©2002 Prentice Hall

36. Which Therapy for Which Problem? • Health Problems • Cognitive and behavior therapies are effective for a wide range of health problems. • Childhood and Adolescent Behavior Problems • Behavior therapy is the most effective treatment. ©2002 Prentice Hall

37. Successful Therapy • Psychotherapy outcome depends not only on method of therapy. • Qualities of client and therapist, and their alliance, also determine success. ©2002 Prentice Hall

38. When Therapy Harms • Sexual intimacies, or other unethical behavior on the part of the therapist. • Prejudice or cultural ignorance on the part of the therapist. • Inappropriate or coercive influence, which can create new problems for the client. • The use of empirically unsupported, potentially dangerous techniques. ©2002 Prentice Hall