Geraldo, a high school senior, is so fearful of asking a girl out that he hasn't had a date in over three years. He has recently contacted a psychotherapist for help in overcoming his fear. Describe how a humanistic therapist and a psychoanalyst would treat Geraldo's problem. (Objectives 1 & 2) Describe how a therapist might apply operant conditioning techniques to help Rosemary overcome a compulsive habit of eating too much junk food. Be clear about the exact procedures that would be used. (Objective 3) One of your best friends feels that he fails at everything he does and that his life isn't worth living. When you suggest that he talk to a psychotherapist, your friend responds, “Talking won't help. The more I talk about myself, the more I think about my problems. The more I think about my problems, the more depressed I get.” What procedures would a cognitive therapist use to help your friend overcome his negative feelings? (Objective 4)

Geraldo, a high school senior, is so fearful of asking a girl out that he hasn't had a date in over three years. He has recently contacted a psychotherapist for help in overcoming his fear. Describe how a humanistic therapist and a psychoanalyst would treat Geraldo's problem. (Objectives 1 & 2)

Describe how a therapist might apply operant conditioning techniques to help Rosemary overcome a compulsive habit of eating too much junk food. Be clear about the exact procedures that would be used. (Objective 3)

Unit 13: Treatment of Psychological Disorders

Treatment Psychoanalysis Humanistic Cognitive Behavioral

Psychotherapy Treatment

History of treatment Eclectic approach Psychotherapy Philippe Pinel Dorothea Dix Psychotherapy treatment involving psychological techniques consists of interactions between a trained therapist & someone seeking to overcome psychological difficulties or achieve personal growth. Eclectic approach

The Psychological Therapies

Psychoanalysis Psychotherapy Treatment

Psychoanalysis Sigmund Freud Freud believed the patient’s free associations, resistances, dreams, & transferences – and the therapist’s interpretations of them – released previously repressed feelings, allowing the patient to gain self-insight. Childhood impulses &conflicts

Psychoanalysis Methods Free association Resistance Blocking anxiety-laden material Interpretation Dream analysis Transference in psychoanalysis, the patient’s transfer to the analyst of emotions linked with other relationships (such as love or hatred for a parent).

Psychoanalysis Psychodynamic Therapy therapy deriving from the psychoanalytic tradition that views individuals as responding to unconscious forces and childhood experiences, and that seeks to enhance self-insight. Similarities with psychoanalysis Differences with psychoanalysis Face-to-face/once a week for a few months

Psychoanalysis Humanistic Psychodynamic Psychotherapy patients unconscious past hidden determinants curing illness Psychoanalysis resistance transference interpret Psychodynamic Psychotherapy Humanistic promoting growth “How does that make you feel?” conscious present & future personal responsibility insight client-centered clients active listening UPR

Humanistic Therapies Insight therapies focus more on: increasing the client’s awareness of underlying motives and 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 (person-centered) Nondirective therapy Genuineness, acceptance, and empathy Active listening Paraphrase Invite clarification Reflect feelings Unconditional positive regard I know how you feel…. What is an example of that?…. empathetic listening echoing & restating That sounds frustrating… self-awareness self-acceptance

Behavioral Psychoanalysis Humanistic Psychotherapy Psychodynamic behavior mod operant conditioning Psychoanalysis token economy classical conditioning Psychodynamic counter-conditioning Psychotherapy exposure aversion Humanistic desensitization virtual reality insight client-centered active listening UPR

Behavior Therapies uses learning principles to get rid of unwanted behaviors Classical conditioning techniques Operant conditioning techniques

Behavior Therapies Classical Conditioning Therapies Counterconditioning evoke new responses to stimuli that are triggering unwanted behaviors repeated exposure = less anxious Exposure therapies Systematic desensitization progressive relaxation anxiety hierarchy Virtual reality exposure therapy Aversive conditioning can’t be simultaneously anxious & relaxed

Behavior Therapies Aversion Therapy Sys. Des. = substitute a fearful/negative response with a relaxed/positive response to a HARMLESS stimulus Aversion = substitute a positive response with a negative /aversive response to a HARMFUL stimulus (alcohol)

Behavior Therapies Aversion Therapy

Behavior Therapies Aversion Therapy DOES IT WORK?

Behavior Therapies Operant Conditioning Behavior modification Token economy Criticisms?

Cognitive-Behavioral (CBT) Humanistic operant conditioning Psychoanalysis http://www.youtube.com/watch?v=GVNgmJ4tIpo Buckbeak 1st 3 minutes classical conditioning Psychodynamic http://www.youtube.com/watch?v=doxxfXqpKYA Boggart’s Wardrobe 4min Psychotherapy Cognitive Cognitive-Behavioral (CBT) Humanistic insight client-centered active listening UPR

Cognitive Therapies Cognitive therapy Beck’s therapy for depression Catastrophizing beliefs CBT stress inoculation training re-label obsessive thoughts assertive

Assertiveness Test B A C A C B C B A C A B B C A Nonassertive Aggressive Assertive B A C A C B C B A C A B B C A

Cognitive Therapies

Cognitive Therapies

Cognitive Therapies

Cognitive Therapies

Cognitive Therapies

Cognitive Therapies

Cognitive-Behavioral Psychoanalysis Group Therapy Psychodynamic Psychotherapy BioMedical Humanistic Cognitive-Behavioral (CBT)

Objective 5: Group & Family Therapy What are the aims & benefits of group and family therapy?

Evaluating Psychotherapies

(#6)Is Psychotherapy Effective? Regression toward the mean Client’s perceptions crisis time & $ speak well of therapist Mass. Study Clinician’s perceptions Feedback usually positive Outcome research – time heals Meta-analysis Those not in therapy often improve; those in therapy more likely to improve Placebo treatments

(#7)The Relative Effectiveness of Different Therapies Behavioral Bed wetting, phobias, compulsions Cognitive Depression Negative Symptoms of Schizophrenia / change entire personality will see less benefit from psychotherapy alone More specific the problem the greater the hope

The Relative Effectiveness of Different Therapies Evidence-based practice Insurance

(#8)Evaluating Alternative Therapies Eye movement desensitization & reprocessing (EMDR) anxious thoughts vanished as eyes darted about Unlock & reprocess previously frozen memories What is actually therapeutic is the combination of exposure therapy - repeatedly associating w/ trauma memories a safe context & a robust placebo effect. Light exposure therapy Seasonal affective Disorder (SAD) Morning bright light does dim symptoms as effectively (for some) as antidepressant drugs or CBT Not a lot of evidence for or against When comparing any treatment against nothing at all, it to would seem effective = placebo

(#9)Commonalities Among Psychotherapies placebo effect Hope for demoralized people A new perspective on oneself & the world An empathic, trusting, caring relationship plausible explanation communicate their concern, show respect, reassure therapeutic alliance

Culture & Values in Psychotherapy (#10) Similarities between cultures Differences between cultures minorities reluctance to seek therapy religion Albert Ellis & Allen Bergin thought stopping values differ & those values effect how a therapist views a healthy person. rational-emotive therapy

The Biomedical Therapies

Introduction Biomedical therapy Drugs Electroconvulsive therapy Magnetic impulses Psychosurgery Psychiatrist

Drug Therapies (#11) Psychopharmacology Factors to consider with drug therapy Normal recovery rate of untreated patients Placebo effect Double blind procedure

Drug Therapies

Drug Therapies

Drug Therapies

Drug Therapies

Drug Therapies Antipsychotic Drugs Psychoses Chlorpromazine (Thorazine) Dopamine block Tardive dyskinesia Atypical antipsychotics (clozapine) negative symptoms (& positive) xxx dampens responsiveness side effects like Parkinson’s b/c too little dopamine stimulate glutamate = atypical antipsychotic

Drug Therapies Antianxiety Drugs Xanax, Ativan, D-cycloserine acts upon a receptor that helps the extinction of learned fears Physiological dependence? rid of symptoms w/o getting rid of problem

Antidepressant drugs aerobic exercise CT Use with mood and anxiety disorders 4 weeks increase the availability of norepinephrine & serotnin Neurogenesis – birth of new brain cells Fluoxetine (Prozac), Paxil Selective-serotonin-reuptake inhibitors Side effects of antidepressants aerobic exercise CT top-down/bottom-up

Drug Therapies Antidepressant Drugs

Drug Therapies Antidepressant Drugs

Drug Therapies Antidepressant Drugs

Drug Therapies Mood-Stabilizing Medications Lithium bipolar

Brain Stimulation (#12) Electroconvulsive Therapy Procedure general anesthetic muscle relaxant 30-60 seconds no memory of treatment 3 sessions/wk 2-4 weeks Severe depression Problems/side effects 4 in 10 relapse calm neural centers where overactivity causes depression

Brain Stimulation Electroconvulsive Therapy

Brain Stimulation Alternative Neurostimulation Therapies Magnetic Stimulation Repetitive transcranial magnetic stimulations (rTMS) left frontal lobe Deep-Brain Stimulation excites neurons that inhibit negative emotion-feeding activity (frontal lobe & limbic system) sTMS – awake, weeks, no side effects

Brain Stimulation Alternative Neurostimulation Therapies

Psychosurgery (#13) surgery that removes or destroys brain tissue in an effort to change behavior Lobotomy History – 1930s Procedure – cut nerves connecting frontal lobe w/ emotion controlling centers coma; eye socket; wiggle to severe connection Side effects Use today

Therapeutic Life-Style Change (#14) Integrated biopsychosocial system Therapeutic life-style change Aerobic exercise Adequate sleep Light exposure Social connection Anti-rumination Nutritional supplements

Preventing Psychological Disorders

Preventing Psychological Disorders (#15) Resilience Preventing psychological disorders water rescue medicine - vaccinate

C. systematic desensitization. D. transference. While focusing on several intrusive thoughts that had been bothering her recently, Jenny was instructed by her therapist to report any ideas or memories stimulated by these thoughts. Jenny’s therapist was making use of a technique known as: A. active listening. B. free association. C. systematic desensitization. D. transference. Answer: B

Humanistic therapies differ from psychoanalytic therapies in all of the following ways, EXCEPT: A. psychoanalytic therapists are more likely to encourage the client to take immediate responsibility for feelings. B. humanistic therapists are more oriented to the present and future, rather than the past. C. psychoanalytic therapists are more likely to emphasize unconscious processes. D. humanistic therapists are more growth-oriented. Answer: A

McKenzie’s therapist believes that active listening is an extremely important component of therapy. He is probably a: A. psychoanalyst. B. cognitive therapist. C. behavior therapist. D. client-centered therapist. Answer: D

Client-centered therapists emphasize the importance of: A. exploring clients’ childhood relationships with other family members. B. interpreting the meaning of clients’ nonverbal behaviors. C. enabling clients to feel unconditionally accepted. D. helping clients identify a hierarchy of anxiety-arousing experiences. Answer: C

A therapist helps Rebecca overcome her fear of water by getting her to swim in the family’s backyard pool three times a day for two consecutive weeks. The therapist’s approach to helping Rebecca best illustrates: A. stress inoculation training. B. aversive conditioning. C. exposure therapy. D. humanistic therapy. Answer: C

A cognitive therapist would be most likely to say: A. “That sounds quite frustrating. It isn’t easy to be in a situation like that.” B. “Can you think of a more positive interpretation of what happened?” C. “Just say whatever comes to mind, no matter how trivial or irrelevant it might seem.” D. “Next time you start to feel anxious, you can use the relaxation techniques we’ve been working on.” Answer: B

For which of the following disorders is psychotherapy most likely to be effective in the long run? A. generalized anxiety disorder B. major depressive disorder C. chronic schizophrenia D. phobias Answer: D

Researchers have sought to answer the question, “Does psychotherapy work?” Generally speaking, the answer seems to be: A. yes, people in therapy improve more than people in control groups. B. yes, but people in therapy improve at the same rate as people who are receiving placebo treatments. C. no, therapy does not provide any benefits; people who just let time pass improve at the same rate as people in therapy. D. no one really knows, because so far the only method used to answer this question has been interviewing former therapy clients. Answer: A

The effectiveness of psychotherapy shows little if any connection to: A. the level of training and experience of the therapist. B. the length of time a client has experienced symptoms of disorder prior to therapy. C. the particular disorder experienced by a client. D. the extent to which the process depends on changing clients’ personalities. Answer: A

The placebo effect best illustrates the importance of _______ in therapeutic success. A. active listening B. psychopharmacology C. behavior modification D. cognitive processes Answer: D

If a therapist tells a client, “Rank order the things that frighten you from least to most,” the therapist is most likely practicing: A. Freudian therapy. B. systematic desensitization. C. Gestalt therapy. D. token economy. Answer: B

Jon’s therapist laces his alcoholic drink with a drug that makes Jon sick. After getting sick a few times, just the sight of the drink makes Jon nauseous. In this example, the conditioned stimulus is the: A. drug. B. alcohol. C. nauseous response to the drug. D. nauseous response to the sight of the drink. Answer: B

Your therapist asks you to try to remember your dreams Your therapist asks you to try to remember your dreams. He also encourages you to review incidents in early childhood. Your therapist is most likely practicing: A. Freudian therapy. B. cognitive therapy. C. behavior therapy. D. humanistic therapy. Answer: A

In your therapy session you often review your current behaviors as compared to what you think you should be doing. Your therapist is kind and listens to your ideas, even if you think they are silly. Your therapist is most likely practicing: A. Freudian therapy. B. Jungian therapy. C. cognitive therapy. D. humanistic therapy. Answer: D

Samuel receives some very bad news, and feels quite low Samuel receives some very bad news, and feels quite low. As time passes, you would expect: A. his emotions to return to their usual state. B. his emotions to stay low until something unusually good happens to him. C. him to become much happier than usual, since people typically bounce back and forth between emotional extremes. D. him to stay emotionally low unless he goes in for psychotherapy. Answer: A

QUIZ Thursday 4/4

Definition Slides

Eclectic Approach = an approach to psychotherapy that, depending on the client’s problems, uses techniques from various forms of therapy.

Psychotherapy = treatment involving psychological techniques; consists of interactions between a trained therapist and someone seeking to overcome psychological difficulties or achieve personal growth.

Psychoanalysis = Sigmund Freud’s therapeutic technique. Freud believed the patient’s free associations, resistances, dreams, and transferences – and the therapist’s interpretations of them – released previously repressed feelings, allowing the patient to gain self-insight.

Resistance = in psychoanalysis, the blocking from consciousness of anxiety-laden material.

Interpretation = in psychoanalysis, the analyst’s noting supposed dream meanings, resistances, and other significant behaviors and events in order to promote insight.

Transference = in psychoanalysis, the patient’s transfer to the analyst of emotions linked with other relationships (such as love or hatred for a parent).

Psychodynamic Therapy = therapy deriving from the psychoanalytic tradition that views individuals as responding to unconscious forces and childhood experiences, and that seeks to enhance self-insight.

Insight Therapies = a variety of therapies that aim to improve psychological functioning by increasing the client’s awareness of underlying motives and defenses.

Client-centered Therapy = a humanistic therapy, developed by Carl Rogers, in which the therapist uses techniques such as active listening within a genuine, accepting, empathic environment to facilitate client’s growth. (Also called person-centered therapy.)

Active Listening = empathic listening in which the listener echoes, restates, and clarifies. A feature of Roger’s client-centered therapy.

Unconditional Positive Regard = a caring, accepting, nonjudgmental attitude, which Carl Rogers believed would help clients to develop self-awareness and self-acceptance.

Behavior Therapy = therapy that applies learning principles to the elimination of unwanted behaviors.

Counterconditioning = a behavior therapy procedure that used classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors; includes exposure therapies and aversive conditioning.

Exposure Therapies = behavioral techniques, such as systematic desensitization, that treat anxieties by exposing people (in imagination or actuality) to the things they fear and avoid.

Systematic Desensitization = a type of exposure therapy that associates a pleasant relaxed state with gradually increasing anxiety-triggering stimuli. Commonly used to treat phobias.

Virtual Reality Exposure Therapy = an anxiety treatment that progressively exposes people to simulations of their greatest fears, such as airplane flying, spiders, or public speaking.

Aversive Conditioning = a type of counterconditioning that associates an unpleasant state (such as nausea) with an unwanted behavior (such as drinking alcohol).

Token Economy = an operant conditioning procedure in which people earn a token of some sort for exhibiting a desired behavior and can later exchange the tokens for various privileges or treats.

Cognitive Therapy = therapy that teaches people new, more adaptive ways of thinking and acting; based on the assumption that thoughts intervene between events and our emotional reactions.

Cognitive-behavioral Therapy = a popular integrative therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior).

Family Therapy = therapy that treats the family as a system. Views an individual’s unwanted behaviors as influenced by, or directed at, other family members.

Regression Toward the Mean = the tendency for extreme or unusual scores to fall back (regress) toward their average.

Meta-analysis = a procedure for statistically combining the results of many different research studies.

Evidence-based Practice = clinical decision-making that integrates the best available research with clinical expertise and patient characteristics and preferences.

Biomedical Therapy = prescribed medications or medical procedures that act directly on the patient’s nervous system.

Psychopharmacology = the study of the effects of drugs on mind and behavior.

Antipsychotic Drugs = drugs used to treat schizophrenia and other forms of severe thought disorder.

Tardive Dyskinesia = involuntary movements of the facial muscles, tongue, and limbs; a possible neurotoxic side effect of long-term use of antipsychotic drugs that target certain dopamine receptors.

Antianxiety Drugs = drugs used to control anxiety and agitation.

Antidepressant Drugs = drugs used to treat depression; also increasingly prescribed for anxiety. Different types work by altering the availability of various neurotransmitters.

Electroconvulsive Therapy (ECT) = a biomedical therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized patient.

Repetitive Transcranial Magnetic Stimulation (rTMS) = the application of repeated pulses of magnetic energy to the brain; used to stimulate or suppress brain activity.

Psychosurgery = surgery that removes or destroys brain tissue in an effort to change behavior.

Lobotomy = a now-rare psychosurgical procedure once used to calm uncontrollably emotional or violent patients. The procedure cut the nerves connecting the frontal lobes to the emotion-controlling centers of the inner brain.

Resilience = the personal strength that helps most people cope with stress and recover from adversity and even trauma.