Psychoanalytic Treatment

1. Psychoanalytic Treatment In the Freudian system, anxiety is the main problem people face. Anxiety is produced when sexual and aggressive impulses are repressed. Guilt occurs when the impulses are partially expressed. These impulses occur at the unconscious level. Today psychoanalytic techniques are called psychodynamic or insight therapy.

2. Humanistic Therapy People have the power to control their fate, ideas, and movements as they move towards self-actualization. This therapy is now known as person (client) centered therapy. Therapist and client are considered equal partners in therapy. In this therapy, the client decides what is to be discussed and what direction the therapy will take.

3. Humanistic Therapy (continued) People need to accept themselves as they are, while working toward fulfilling their potential. The therapist develops an atmosphere of trust and understanding. The therapist acts as a mirror to the client, reflecting ideas and concepts. The therapist does not judge the client. Thoughts, feelings, and ideas represent a person seeking to grow and seeking to be understood.

4. Behavior Therapy • Behavior Therapy • therapy that applies learning principles to the elimination of unwanted behaviors • Counterconditioning • procedure that conditions new responses to stimuli that trigger unwanted behaviors • based on classical conditioning • includes systematic desensitization and aversive conditioning

5. Behavioral Therapy Behavioral therapy attempts to change behavior using the techniques of learning. Behaviorists assume that abnormal behaviors are the result of faulty (inappropriate) learning.

6. Why is psychoanalysis a lot quicker for a man than for a woman? Because when it’s time to go back to childhood, a man is already there.

7. Gestalt Therapy Developed by Fritz Perls to combine the psychoanalytic emphasis on bringing unconscious feelings to awareness and the humanistic emphasis on getting “in touch with oneself” Aims: to help people become more aware of and able to express their feelings, and to take responsibility for their feelings and actions. Emphasizes the importance of encouraging people to sense and express their own true moment-to-moment feelings.

8. Cognitive Therapy Cognitive-Behavioral Therapy a popular integrated therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior)

9. Rational Emotive Therapy • Developed by Albert Ellis • ABC model • Activating Event • Beliefs • Consequences • Identification and elimination of core irrational beliefs

11. Aaron Beck’s Cognitive Therapy • Problems due to negative cognitive bias that leads to distorted perceptions and interpretations of events • Recognize the bias then test accuracy of these beliefs • Therapist acts as model and aims for a collaborative therapeutic climate

13. Effectiveness of Psychotherapy Most people do not seek help with problems Many people report spontaneous remission Meta-analyses show that psychotherapy is more effective than no treatment Generally no differences among the types of psychotherapy

14. Evaluating Psychotherapies • Regression toward the mean • tendency for extremes of unusual scores to fall back (regress) toward their average • Meta-analysis • procedure for statistically combining the results of many different research studies

15. The Relative Effectiveness of Different Therapies • The Relative Effectiveness of Different Therapies Although no one type of therapy can be said to be most effective overall, some therapies are particularly well-suited to specific disorders. • 1. Behavioral Therapy— works best when treating specific behaviors such as phobias, compulsions, or sexual dysfunctions. • 2.Cognitive Therapy— best treatment for depression. • 3. Psychotherapists— increasingly offer particular treatments for specific problems.

16. Evaluating Alternative Therapies Eye Movement Desensitization and Reprocessing (EMDR) While people imagined traumatic scenes, Francine Shapiro triggered eye movements by waving her finger in front of their eyes. 84 to 100% of the trauma victims said it worked. ...or is it another placebo effect???

17. Evaluating Alternative Therapies Light-Exposure Therapy Treatment for Seasonal Affective Disorder (SAD) – wintertime depression. Give SAD people a daily dose of intense light and it will relieve symptoms associated with wintertime depression. This does work!

18. Biomedical Therapies • Psychopharmacology • study of the effects of drugs on mind and behavior

19. Antipsychotic Drugs • Antipsychotic Drugs The molecules of antipsychotic drugs are similar enough to molecules of the neurotransmitter dopamine to occupy its receptor sites and block its activity. (Thorazine, Clozapine )

20. Antianxiety Drugs • Antianxiety Drugs Valium, Xanax, Lithium – depress nervous system activity.

21. Antidepressant Drugs • Antidepressant Drugs Most antidepressants work by increasing the availability of the neurotransmitters norepinephrine or serotonin, which elevate arousal and mood and appear scarce during depression.

22. Antidepressant Drugs • Lithium— a chemical that provides an effective drug therapy for the mood swings of bipolar (manic-depressive) disorders. • Prozac— (fluoxetine) blocks the reabsorption and removal of serotonin from synapses. • Zoloft— cousin to Prozac; blocks reabsorption of serotonin. • Paxil— cousin to Prozac; serotonin-uptake-inhibitor.

23. Biomedical Therapies

24. Anti-Depressant Medication • First generation—tricyclics and MAO inhibitors • Effective for about 75% of patients • Produce troubling side effects • MAO inhibitors can have serious physiological side effects when taken with some common foods • Tricyclics caused weight gain, dry mouth, dizziness, sedation

25. Anti-Depressant Medication • Second generation—chemically different but no more effective than earlier drugs (Wellbutrin, Desyrel) • Selective serotonin reuptake inhibitors(SSRI)— have fewer undesirable side effects than earlier drugs (Prozac, Paxil, Zoloft) • Double blind studies indicate placebo effect also effective. (p. 714) Produced improvement comparable to 75% of active drug’s effect.

26. Mood Stabilizing drugs • Lithium (a salt) has been effective in stabilizing mood swings in bi polar patients • Depakote, orginally used to treat epilepsy, has proven effective for bi polar disorder.

27. Dual diagnosis • Patient having a mental illness and also a drug addiction. Few facilities are equipped to treat both at the same time effectively.

28. Electroconvulsive Therapy-ECT • Used for severe depression • Very effective for quick relief of symptoms of severe depression (can be used until medication begins to work) • May have cognitive side effects such as short term memory loss • Brief electric current sent through the brain of an anesthetized patient • Very controversial treatment

29. ECT generally lasts about 10-20 minutes

30. New Alternatives to ECT • rTMS (repetitive transcranial magnetic stimulation – no seizures, memory loss or side effects. Pulse surges through a magnetic coil. • Chest implant that intermittently stimulates the vagus nerve that sends a message to the limbic system This stimulation appears to reduce activity in the brain that is hyperactive to depression

31. Vagus Nerve Stimulation rTMS

32. Psychosurgery • surgery that removes or destroys brain tissue in an effort to change behavior • Lobotomy- developed by Egas Moniz • now-rare psychosurgical procedure once used to calm uncontrollably emotional or violent patients • Nerves connecting the frontal lobes to the emotion controlling centers of inner brain are severed.

33. Psychiatrist Walter Freeman performing a lobotomy

34. Deinstitutionalization • The emptying of U.S. mental hospitals

35. Deinstitutionalization • 1963 Congress passed legislation establishing a network of community mental health centers around the nation. • Through the years, funding has dried up, facilities have closed and there is little guidance as well as affordable housing for many who are mentally ill. • It is estimated that around 20-25 % of the adult single homeless in U.S. are mentally ill

36. Deinstitutionalization • Recent federal statistics (2006) reveal that the number of mentally ill inmates in U.S. prisons has quadrupled in the past 6 years. • More than half of all prison and state inmates report mental health problems including major depression, mania, psychotic disorders.(federal Bureau of Justice Statistics) • 55% of male inmates and 75% of female inmates have mental health problems.