Copyright © 2014 McGraw-Hill Education. All rights reserved Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Therapy Types Insight Therapies (Psychodynamics, Person-centered Therapy) Behavioral Therapies Cognitive Therapies Biological Therapies

Effectiveness of Psychotherapy All therapies are “winners”. Factors in Successful Psychotherapy therapeutic alliance (monitored) therapist expertise & personality client active engagement Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 16-3

Psychodynamic Perspective Causes: fixation (early childhood), unresolved unconscious conflicts, breakdown of ego defense mechanisms Treatment methods: psychoanalysis (free association, dream analysis) Primary disorders treated: General feelings of unhappiness, unresolved problems from childhood.

Psychodynamics therapy techniques Free association: helps patients discover unconscious thoughts and feelings that had been repressed or ignored. Analysis of resistance: client is unwilling to discuss to discuss a particular topic—therapist have to interpret why it is occurring. Dream analysis: dreams represent wish fulfillment, unconscious desires, and conflicts. Analysis of transference: transfer of feelings from the past to someone in the present. (usually the therapist) https://www.youtube.com/watch?v=QV6DpJKW6a0 (dream analysis)

Humanistic Therapy Causes: blocking of normal tendency towards growth and self actualization Treatment methods: person-centered therapy (the therapist serves as a facilitator or a mirror and provides the client with unconditional positive regard) Primary disorders treated: general feelings of unhappiness, interpersonal problems Goals of therapy: Self-understanding and Personal Growth.

Client-Centered Therapy Founded by carl rogers Warm, supportive, encouraging environment Therapist must genuinely like the client Uses mirroring and reflective speech to promote self-actualization Therapist must have empathy for client Suggestion: Ask students, “If you had a mental illness and were seeking therapy, which would you prefer, psychoanalysis or client-centered therapy, and why?” Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 16-7

Only the client can judge if he or she is better Humanistic therapy Only the client can judge if he or she is better No way to independently verify success https://www.youtube.com/watch?v=0TmugJo-c9Y

Limitations of insight therapies A client must be motivated, intelligent, articulate, and rich https://www.youtube.com/watch?v=0TmugJo-c9Y Not effective as cognitive-behavioral therapy

Behavioral perspective Much more active and are related to the symptoms Causes: abnormal behavior is learned by reinforcement, or classical conditioning, or observation and modeling Treatment methods: behavior therapy (behavior modification, token economy, desensitization, therapy modeling, etc.) Primary disorders treated: fears, phobias, panic disorder, ocd, unhealthy habits. Goals of Therapy: reduce or eliminate maladaptive behaviors CBT- cognitive behavior therapy

Therapy based on classical conditioning Classical Conditioning Techniques Treating Phobias (systematic desensitization) Teach relaxation Exposure: Create a hierarchy ranging from least to most feared stimulus Work through a hierarchy while maintaining calm Flooding intense exposure without allowing avoidance https://www.youtube.com/watch?v=lMZ5o2uruXY It has helped a lot of people with anxiety or phobias. A lot of phobias because of classical conditioning. It was build by association by anxiety. Systematic. Help them to relax, you can’t be calm and anxious in the same time First step: Guided relaxation---lay down and relax, begin at feet (muscle relaxtion) clentch your toes and let go and as you let go think of beach Tight you calf muscles, work your way up the body and relaxing. Process takes 10-15 minutes. Conditioning relaxtion with a trigger work. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 16-11

Hierarchy of fears (public speech) Watching someone else speak Have others sing “happy birthday” to you Be asked to give a toast to a small gathering of friends Be asked to give a toast at a wedding Flooding intense exposure without allowing avoidance https://www.youtube.com/watch?v=lMZ5o2uruXY It has helped a lot of people with anxiety or phobias. A lot of phobias because of classical conditioning. It was build by association by anxiety. Systematic. Help them to relax, you can’t be calm and anxious in the same time First step: Guided relaxation---lay down and relax, begin at feet (muscle relaxtion) clentch your toes and let go and as you let go think of beach Tight you calf muscles, work your way up the body and relaxing. Process takes 10-15 minutes. Conditioning relaxation with a trigger work. Begin imaginary and then Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 16-12

Aversive Conditioning Nauseating Drug (Stimulus) UCS No Response Unlearned Reflex Repeatedly Paired NS UCR Alcohol (Stimulus 2) Nausea (Response) Learned Association CS CR Note: This example is illustrative only. Contrary to the implication of this diagram, Antabuse does not cause nausea when taken by itself: It only causes nausea if alcohol is also consumed. Moreover, in practice, Antabuse is not used so much to create a lasting distaste for alcohol as to prevent sneaking beers when in detox. Conditioned Stimulus Neutral Stimulus Unconditioned Stimulus Acquisition/Learning Innate S-R Association Unconditioned Response Conditioned Response https://www.youtube.com/watch?v=z0xgIE-SKpc (stimulus satiation)

Therapies based on operant conditioning Ignore the maladaptive behaviors Rewarding positive behaviors Token economies: using tokens that can be exchanged for other items or privileges as a reinforcers (juvenile) Punishment (police) following some undesired behavior by an aversive stimulus. Give them the opportunities to gain tokens. Immediate reinforcement

Cognitive therapy Causes: abnormal behavior is caused by faulty, irrational, negative thinking. Treatment methods: cognitive therapy is aimed at developing more positive and rational thinking patterns-structured analysis and specific guidance. Primary disorders treated: depression, anxiety, panic disorder, general feelings of unhappiness. Goals of therapy: Cognitive reconstructing

Two cognitive therapies Rational emotive therapy Beck’s cognitive therapy

Elli’s Rational- emotive therapy Attempts to modify the irrational beliefs that causes distress It’s not events that causes our emotions and it’s our thinking about the events. irrational and self-defeating beliefs eliminate beliefs through rational examination directive, persuasive, confrontational

Elli’s Rational- emotive therapy Example, two students (individual presentation) are to present in front of class, two are well prepared!!

Elli’s Rational- emotive therapy Nervous C1 Confident B2 I am not capable and not good B1: I am capable and good Activating Event

Common irrational thoughts I must be prefect Everyone must love me The past determines the future It is catastrophic wen things don’t go as planned I have no control over my happiness

Beck’s cognitive therapy illogical automatic negative thoughts identify and challenge automatic thoughts reflective, open-ended dialogue, less directive Both are more effective in treating depression than drugs. https://www.youtube.com/watch?v=xrX43cCW6uE Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 16-21

Biological Therapies Causes: hereditary factors, malfunctioning of the NS or body’s biochemistry. Treatment methods: Drug therapies, electroconvulsive therapy (ECT) and Psychosurgery Primary disorders treated: Schizophrenia, depression, Bipolar disorder, anxiety disorders. Goals of therapy: reduce/eliminate symptoms by altering body functioning Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 16-22

Drug Therapy Antianxiety Drugs ---Family of Tranquilizers benzodiazepines e.g. Valium, Xanax short term effectiveness prone to tolerance Bipolar Disorder Lithium-evens out mood swings. majority improve substantially toxicity reactions Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 16-23

Antidepressant Drugs Antidepressant Drugs tricyclics selective serotonin reuptake inhibitors (SSRIs) majority improve moderately risk of multiple significant side effects Are Drugs Necessary in Treatment? This question presents an opportunity for students to reflect on the necessity/value of the various therapies described in this chapter. Suggestion: Instructor might bring up the fact that there is a controversy about whether drugs that alter neurotransmitter levels are in fact effective. For example, research shows that while antidepressant drugs effectively increase targeted neurotransmitter levels within an hour or so of administration, reduction of depressive symptoms does not typically occur till more than a week has passed. Note that this particular evidence does concede the effectiveness of the drug, but undermines the explanation of why the drug works. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 16-24

Antidepressant Drugs Antidepressant Drugs tricyclics tetracyclics monoamine oxidase (MAO) inhibitors selective serotonin reuptake inhibitors (SSRIs) Risks of Antidepressants for Children FDA hearings on risk of suicide (2004) “Black Box” warning Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 16-25

Drug Therapy Antipsychotic Drugs -Neuroleptics e.g. Compazine (treats hallucinations and delusions) --inhibits the NT (Dopamine) atypical antipsychotic medications Newer drugs- target both dopamine and serotonin Improves positive and negative symptoms of schizophrenia Clozapine Note: (As with antidepressants, see previous two slides) similar criticism of the dopamine connection to schizophrenia has been made in regard to antipsychotic drugs. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 16-26

Biological Therapies Electroconvulsive Therapy-used with informed consent (requires sedation and anesthesia) small electric current produces a brief seizure used to treat major depressive disorder which has not responded to other treatments Unilateral ETC (admin to the RH) Memory loss Psychosurgery (discontinued) prefrontal lobotomies Results are unpredictable Irreversible Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 16-27

Biological Therapies Modern treatment--Transcranial Magnetic Stimulation Therapy _ (TMS) Non invasive therapy No sedation required No side effects (seizures or memory loss) Highly effective in treating schizophrenia negative symptoms Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 16-28

Chapter Review Describe approaches to treating psychological disorders. Define psychotherapy and characterize four types of psychotherapy. Describe the biological therapies. Explain the sociocultural approaches and issues in treatment. Discuss therapy's larger implications for health and wellness and characterize the client's role in therapeutic success. Note: Instructors may use the learning objectives presented on this slide to review the chapter material. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 16-29