Introduction

Treatment of Psychological DisordersC:\Users\mburt\Desktop\AP Psych\psych disorders\video\Sheldon the Therapist - The Big Bang Theory.mp4

Introduction • History of treatment - Maltreatment of the insane throughout the ages was the result of irrational views. Many patients were subjected to strange, debilitating, & downright dangerous treatments. C:\Users\mburt\Desktop\AP Psych\Therapy\239_Early_Treatment_Mental_Disorders.mp4 • Philippe Pinel: France • Dorothea Dix: US/CA • founded humane movements to care for the mentally sick.

Therapies Psychotherapy involves an emotionally charged, confiding interaction between a trained therapist and a mental patient. Biomedical therapyuses drugs or other procedures that act on the patient’s nervous system, treating his or her psychological disorders. AnEclectic approachuses various forms of healing techniques depending upon the client’s unique problems.

The Psychological Therapies4 Major Therapies

Psychoanalysis • PsychoanalysisSigmund Freud’s therapeutic technique. Freud believed the patient’s free associations, resistances, dreams, & transferences – & the therapist’s interpretations of them – released previously repressed feelings, allowing the patient to gain self-insight. • When energy devoted to id-ego-superego conflicts is released, the patient’s anxiety lessens. • - 4:09 C:\Users\mburt\Desktop\AP Psych\psych disorders\video\Application of Psychoanalytic Therapy.flv • Aims of therapy • Childhood impulses & conflicts

PsychoanalysisMethods • Free association • Resistancein psychoanalysis, the blocking from consciousness of anxiety-laden material • Interpretation in psychoanalysis, analyst’s noting supposed dream meanings, resistances, & other significant behaviors & events in order to promote insight of the meaning • Dream analysis • Transference

Psychoanalysis: Methods at work During free association, the patient edits his thoughts, resisting his or her feelings to express emotions. Such resistance becomes important in the analysis of conflict-driven anxiety. Eventually the patient opens up & reveals his or her innermost private thoughts, developing positive or negative feelings (transference) towards the therapist. C:\Users\mburt\Desktop\AP Psych\psych disorders\video\Psychoanalysis - explained.mp4

Psychoanalysis C:\Users\mburt\Desktop\AP Psych\Therapy\247_Psychodynamic_Therapies.mp4 Psychodynamic Therapy • therapy deriving from the Freud’s psychoanalytic tradition that views individuals as responding to unconscious forces & childhood experiences, & that seeks to enhance self-insight • Aims of psychodynamic therapy ….understand symptoms & themes across important relationships in a patient’s life. • Similarities & Differences to psychoanalysis Interpersonal psychotherapy, a variation of psychodynamic therapy, is effective in treating depression. It focuses on symptom relief here & now, not an overall personality change.

Humanistic Therapies • Insight therapies a variety of therapies that aim to improve psychological functioning by increasing the client’s awareness of underlying motives & defenses. focus more on: • the present rather than the past • conscious rather than the unconscious • taking immediate responsibility • promoting growth instead of curing

Humanistic Therapies • Client-centered therapy(AKA person-centered therapy.) Humanistic therapy, developed by Carl Rogers, the therapist uses techniques such as active listening within a genuine, accepting, empathic environment to facilitate client’s growth. • Nondirective therapy • Genuineness, acceptance, & empathy • Active listeningempathic listening in which the listener echoes, restates, & clarifies. • Paraphrase • Invite clarification • Reflect feelings • Unconditional positive regard

Behavior Therapies C:\Users\mburt\Desktop\AP Psych\Therapy\244_Cognitive_and_Behavioral_Therapies.mp4 • Behavior Therapy- therapy that applies learning principles to the elimination of unwanted behaviors. Focus: the ACTION, not the thought patterns associated with the behavior, doesn’t look for the “inner cause” • Classical conditioning techniques • We learn various behaviors & emotions via classical conditioning • Operant conditioning techniques • Behavior modification – reinforces desired behaviors & withholding reinforcement for undesired behaviors or punishments

Behavior TherapiesClassical Conditioning Therapies Counterconditioningbehavior therapy procedure that uses classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors; Includes 242_Drug_Addiction.mp4 • Exposure therapies behavior therapy procedure that uses classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors; Includes • Systematic desensitization • Virtual reality exposure therapy • Aversive conditioningassociates unpleasant state (e.g. nausea) with unwanted behavior (e.g. alcohol).

Behavior TherapiesAversion Therapy

Behavior TherapiesAversion Therapy Short term success (66%) Long term less successful (33%) Often used in combo with other treatments

Behavior TherapiesOperant Conditioning • Behavior modification- reinforce desired behaviors withholding reinforcement for undesired behavior or punishment. Can work b/c a behavior strongly influenced by consequences. (effective with autism, retardation, schizophrenia). Rewards used to modify behavior vary from praise, to attention to more concrete rewards, food. • Raises ethical Questions • Token economyoperant conditioning procedure. People earn a token of some sort for exhibiting a desired behavior & can later exchange tokens for various privileges/treats. Successful in various settings, cultures, & many mental disorders.

Cognitive Therapies • Cognitive therapythat teaches people new, more adaptive ways of thinking & acting; based on the assumption that thoughts intervene btwn events & our emotional reactions • Aaron Beck’s therapy for depression • Catastrophizing beliefs- recurring negative themes of loss, rejection, abandonment, self-blaming & over generalizing that perpetuate existing feelings of depression • Cognitive-behavioral therapypopular integrative therapy that combines cognitive therapy (changing self-defeating thinking) w/ behavior therapy (changing behavior). Seeks to restructure thinking (retrain) people to restructure negative thinking 249_OCD.mp4

Beck’s Therapy for Depression Aaron Beck (1979) suggests that depressed patients believe that they can never be happy (thinking) and thus associate minor failings (e.g. failing a test [event]) in life as major causes for their depression. Beck believes that cognitions such as “I can never be happy” need to change in order for depressed patients to recover. This change is brought about by gently questioning patients.

Cognitive Therapy Teaches people adaptive ways of thinking & acting based on the assumption that thoughts intervene between events & our emotional reactions.

Stress Inoculation Training Meichenbaum trained people to restructure their thinking in stressful situations. “Relax, the exam may be hard, but it will be hard for everyone else too. I studied harder than most people. Besides, I don’t need a perfect score to get a good grade.”

Group & Family Therapies Utilized by all Therapy Types accept Psychoanalysis Group Therapy • saves therapists’ time & client’s money. • As is often no less effective than individual therapy • Occurs 1 time a week for about 90 minutes • Unique benefit: the social context allows people both to discover that others have problems similar to their own & to receive feedback as they try out new ways of behaving Family therapy • treats the family as a system • guides family members toward positive relationships & improved communication.

Group & Family Therapies • Methods & Goals & Participation • Family therapists work with family groups to heal relationships and to mobilize family resources • to help family members discover the role they play within their family’s social system • To open up communication within the family or the help family members discover new ways of preventing or resolving conflicts • Self-help support groups are widely used & require a high live of involvement for success • Great for stigmatized illnesses (AIDS, Alcoholism, Anorexia, etc)

Comparison of Psychotherapies

Evaluating Psychotherapies

Evaluating Therapies Who do people turn to for help with psychological difficulties?

Is Psychotherapy Effective? It is difficult to gauge the effectiveness of psychotherapy because there are different levels upon which its effectiveness can be measured. • Does the patient sense improvement? • Does the therapist feel the patient has improved? • How do friends and family feel about the patient’s improvement?

Client’s Perceptions If you ask clients about their experiences of getting into therapy, they often overestimate its effectiveness. Critics however remain skeptical. • Clients enter therapy in crisis, but crisis may subside over the natural course of time (regression to normalcy). • Clients may need to believe the therapy was worth the effort. • Clients generally speak kindly of their therapists.

Clinician’s Perceptions Like clients, clinicians believe in therapy’s success. They believe the client is better off after therapy than if the client had not taken part in therapy. • Clinicians are aware of failures, but they believe failures are the problem of other therapists. • If a client seeks another clinician, the former therapist is more likely to argue that the client has developed another psychological problem. • Clinicians are likely to testify to the efficacy of their therapy regardless of the outcome of treatment.

Outcome Research How can we objectively measure the effectiveness of psychotherapy?

Is Psychotherapy Effective? Client & Clinician perceptions of therapy’s effectiveness are vulnerably to inflation from 2 Phenomena • Placebo effect & Regression toward the Mean the tendency for extreme or unusual scores to fall back (regress) toward their average. Pg 702 Client’s perceptions- justify & overly positive (placebo effect or belief in a treatment = Placebo Treatment or expectation of relief analogous with a reward) Clinician’s perceptions- seem to mainly recognize only other clinician’s failures 251_Therapeutic_Effectiveness.mp4 • Outcome research • Meta-analysisa procedure for statistically combining the results of many different research studies.

Outcome Research Meta-analysis of a # of studies suggests that 1000s of patients benefit more from therapy than those who did not go to therapy. Research shows that treated patients were 80% better than untreated ones.

The Relative Effectiveness of Different Therapies Which psychotherapy would be most effective for treating a particular & specific problem?

Evaluating Alternative Therapies Eye movement desensitization & reprocessing (EMDR) therapist attempts to unlock & reprocess previous frozen traumatic memories by waving a finger in front of the eyes of the client. • EMDR has not held up under scientific testing. • Light exposure therapy • Seasonal affective disorder (SAD) a form of depression, has been effectively treated by light exposure therapy. • This form of therapy has been scientifically validated.

Commonalities Among Psychotherapies Three commonalities shared by all forms of psychotherapies are the following: • Hope for demoralized people • A fresh perspective • An empathic, trusting, caring relationship

Culture & Values in Psychotherapy Psychotherapists may differ from each other & from clients in their personal beliefs, values, & cultural backgrounds. A therapist search should include visiting two or more therapists to judge which one makes the client feel more comfortable.

Therapists & Their Training Clinical psychologists: They have PhDs mostly. They are experts in research, assessment, and therapy, all of which is verified through a supervised internship. Clinical or Psychiatric Social Worker (LCSW):They have a Masters of Social Work. Postgraduate supervision prepares some social workers to offer psychotherapy, mostly to people with everyday personal and family problems.

Therapists & Their Training Counselors:Pastoral counselors or abuse counselors work with problems arising from family relations, spouse and child abusers & their victims, & substance abusers. Psychiatrists:They are physicians who specialize in the treatment of psychological disorders. Not all psychiatrists have extensive training in psychotherapy, but as MDs they can prescribe medications.

The Biomedical Therapies

Introduction • Biomedical therapy - prescribed medications or medical procedures that act directly on the patient’s nervous system. • Drug therapy • Brain Stimulation (Electroconvulsive therapy), Magnetic impulses • Psychosurgery • Psychiatrist

Drug Therapies • Psychopharmacologythe study of the effects of drugs on mind & behavior Factors to consider with drug therapy • Normal recovery rate of untreated patients • Recovery due to Placebo effect • Double blind procedure To test the effectiveness of a drug, patients are tested with the drug & a placebo. 2 groups of patients & medical health professionals are unaware of who is taking the drug & who is taking the placebo. In such studies several drugs have proven useful in treating Psych Disorders`

Drug Therapies Psychopharmacology is the study of drug effects on mind & behavior.

Drug Therapies

Drug Therapies However, many patients are left homeless on the streets due to their ill-preparedness to cope independently outside in society. Les Snider/ The Image Works

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