Chapter 17 Approaches to Treatment and Therapy

Biological vs. Psychological Treatments Drugs vs. Psychotherapy Why have drugs become so popular???

Biological Treatments Four primary drugs prescribed for mental and emotional disorders 1. Antipsychotic Drugs (neuroleptics) Risperdal Zyprexa Treat schizophrenia and other psychoses Also used to treat severe depression, dementia, and bipolar disorder

Antipsychotic Drugs Psychosis is caused by excess dopamine Antipsychotic drugs reduce the sensitivity to dopamine or increase amounts of serotonin Typically reduces delusions and hallucinations Does not cure jumbled thoughts or emotional flatness

2. Antidepressants Prozac, Zoloft, Wellbutrin, etc. Used to treat depression, anxiety disorder, OCD, etc. Act on the norepinephrine and serotonin in the brain Side effects: headaches, constipation, weight gain, decreased sex drive, etc.

3. Tranquilizers Valium, Xanax, etc. Increase the activity of gamma- aminobutyric acid (GABA) Not good for long-term usage Can become addictive and build up tolerances

4. Lithium Carbonate Primarily used to treat bipolar disorder Moderates levels of norepinephrine Side effects: tremors, kidney damage, etc. Can become toxic

Problems with administering drugs 1.The placebo effect People respond positively to a new drug because of their expectations of a drugs effects After time the placebo effect dissipates and psychotic symptoms return Only 40% of those put on antidepressants actually respond to the biological effects of the drug

2. High relapse and dropout rates 50-66% of people who take antipsychotics or antidepressants stop taking them because of negative side effects Relapses often occur with discontinuance of usage Relapses are most frequent when patients have not learned how to cope with their own problems

3. Dosage problems Therapeutic window: the amount that is enough but not too much Drugs are metabolized differently in men and women, young and old, and even different ethnic groups

4. Long-term risks 25% of adults who take antipsychotic drugs develop tardive dyskinesia Long-term effects of antidepressant usage is unknown Paxil and other antidepressants may increase suicidal thoughts in teens

Overprescription??? Health care providers would rather pay for one visit than a series of visits Advertising by drug companies

Direct Brain Intervention

Psychosurgery: surgically destroying selected areas of the brain thought to be responsible for emotional disorders Prefrontal lobotomy: cut or crush nerve fibers running from the prefrontal lobes to other areas Cingulotomies: burning holes in the frontal lobes of the brain

Direct Brain Intervention Electroconvulsive therapy: electrically stimulating the brain and causing a seizure Rarely has lasting effects Proven ineffective with schizophrenia and alcoholism yet still used

Direct Brain Intervention Transcranial magnetic stimulation (TMS): Holding a pulsing magnetic coil over the left prefrontal cortex Slightly better results than with a placebo

Types of Psychotherapy 1.Psychodynamic Therapy 2.Behavior Therapy 3.Cognitive Therapy 4.Humanist and Existential Therapy 5.Family and Couples Therapy

Psychodynamic Therapy Sigmund Freud father of psychoanalysis Examine the unconscious by talking about dreams and childhood memories

Modern Psychodynamic Approaches Free association Transference: transferring emotional elements onto the therapist Transference allows patients to see their emotional conflicts in action and work through them Most psychologists are moving to more goal oriented therapies

Behavior and Cognitive Therapy Behavior therapy: based on applied behavioral analysis (applying techniques derived from classical and operant conditioning) Examines the roles of reinforcement and punishment on behavior 4 basic behavioral techniques: Exposure, Systematic desensitization, behavioral self- monitoring, and skills training

Behavioral Techniques 1.Exposure: used for treating fears and panic; expose the patient to the terrifying stimulus until it no longer has the same psychological effect 2.Systematic desensitization: Reverse classical conditioning; patient learns to feel relaxed while in the presence of the stimulus

Behavioral Techniques 3. Behavioral self-monitoring: Record behavior that is supposed to change; establish a treatment program aimed at eliminating undesirable behavior 4. Skills training: Using conditioning techniques, modeling, and role-playing to teach a patient appropriate skills;

Cognitive Techniques Constructive thinking can reduce or dispel fear, anger, and depression Critical thinking is taught through identifying assumptions and biases, examining evidence, and considering alternative interpretations

Ellis’s rational emotive behavior therapy (REBT) Emotionally upset people overgeneralize and catastrophize Use rational arguments to challenge a client’s unrealistic beliefs or expectations

Humanist therapy Human nature is good People behave badly or develop problems when they are warped by self-imposed limits Do not need to dig into the past Focus on helping the person to develop the will and confidence to change and achieve goals

Roger’s client-centered therapy Listen to the client’s needs in an accepting, nonjudgmental manner Display unconditional regard Goal: to build the client’s self-esteem and sense of acceptance; find a more productive way to cope with problems The client will internalize the therapist’s support and become self-accepting

Existential therapy Explore the meaning of existence and help people accept the great questions of existence People have the power and free will to choose their own destiny Goal of therapy: to help clients cope with the inescapable realities of life and death and the struggle for meaning

Family and Couples therapy People’s problems develop within the context of the family unit and must be solved within that context Changes made to our lives affect our whole family; to treat one member and not the others will never work Couples therapy: help couples manage the inevitable conflicts that occur in all relationships

Integrative approach Draw on methods and ideas from various schools and avoid strong allegiance to any one theory Use whatever methods are most appropriate and effective Goal: motivate the client to desire and pursue change

Evaluating Psychotherapy Is psychotherapy an art or a science??? Scientist-practitioner gap: the breach between scientists and therapists NLP, EMDR, Hypnotherapy, etc.

Evaluating Psychotherapy Therapeutic alliance: the bond that occurs between the client and the therapist A client is more likely to improve when both parties respect and understand one another Success of therapy can depend on the personalities of those involved Cultural differences can make therapy more challenging

Evaluating Psychotherapy Problems in assessing therapy: Justification of effort effect causes people to view any therapy as having been successful Placebo effect Randomized controlled trials: conducted to scientifically evaluate the effectiveness of therapy

Most effective therapies? Depression - - Cognitive approach Anxiety disorders (PTSD and phobias) - - exposure treatments Anxiety disorders (Panic attacks and OCD) - - Cognitive-behavior therapy Anger and impulsive violence - - Cognitive therapy Health problems - - Cognitive and behavior therapies

Most effective therapies? Childhood behavior problems - - Behavior therapy Schizophrenia - - Cognitive-behavior therapy and family therapy

Risky therapy??? 1.The use of empirically unsupported, potentially dangerous techniques 2.Prejudice or cultural ignorance on the part of the therapist 3.Inappropriate or coercive influence, which can create new problems for the client 4.Sexual intimacies or other unethical behavior on the part of the therapist

Once you decide that you need therapy Choose a therapist that is right for you 2.Choose the type of therapy that is appropriate to your problem 3.Decide how long you will stay with therapy

Your Assignment! On a separate piece of paper describe the type of therapist you would choose and the techniques you would like them to use if you were to go to therapy for a help with a problem (1-2 paragraphs)