13 psychological therapies

why study therapies for psychological disorders why study therapies for psychological disorders? There are almost as many therapy methods as there are disorders. Correctly matching the type of therapy to the disorder can mean the differ- ence between a cure or a crisis. It is important to know the choices available for treatment and how they relate to the different kinds of disorders so that an informed decision can be made and the best possible outcome can be achieved for mental health and wellness.

Learning Objective Menu LO 13.1 Two ways modern ways to treat psychological disorders LO 13.2 Elements of Freud’s psychoanalysis and psychoanalysis today LO 13.3 Basic elements Humanistic therapies LO 13.4 Behavior therapists’ use of classical and operant conditioning LO 13.5 Goals of cognitive therapies LO 13.6 Types of group therapy LO 13.7 Effectiveness of psychotherapy LO 13.8 Types of drugs used to treat psychological disorders LO 13.9 Modern electroconvulsive therapy and psychosurgery LO 13.10 How might computers be used in psychotherapy

LO 13.1 Two modern ways to treat psychological disorders Two Kinds of Therapy LO 13.1 Two modern ways to treat psychological disorders Therapy Treatment with goal of improved mood and functioning Psychotherapy Treats mental disorders

LO 13.1 Two modern ways to treat psychological disorders Two Kinds of Therapy LO 13.1 Two modern ways to treat psychological disorders Psychotherapy Talk with a psychological professional Insight therapy Gain insight about behavior, thoughts, and feelings Action therapy Change behavior directly

LO 13.1 Two modern ways to treat psychological disorders Two Kinds of Therapy LO 13.1 Two modern ways to treat psychological disorders Biomedical therapy Treatment with biological or medical methods to relieve symptoms Includes drugs, surgical methods, electroconvulsive treatment Medication alone not sufficient Treats symptoms of disorder Psychotherapy builds coping strategies, aids in adjustment

LO 13.1 Two modern ways to treat psychological disorders Treatment in the Past LO 13.1 Two modern ways to treat psychological disorders Early efforts to treat mentally ill 1500’s Bethlehem Hospital converted to asylum Treatments included beatings bloodletting, ice baths

LO 13.1 Two modern ways to treat psychological disorders Treatment in the Past LO 13.1 Two modern ways to treat psychological disorders Philippe Pinel’s Reforms Unchained inmates La Bicêtre Asylum, Paris 1793 Treated mentally ill with kindness Advocated “moral” therapy

In this famous painting by French artist Robert Fleury, French psychiatrist Dr. Philippe Pinel orders the chains removed from patients at a Paris asylum for insane women. Pinel was one of the first psychiatrists to recommend humane treatment of the mentally ill.

Freud’s Psychoanalysis LO 13.2 Elements of Freud’s psychoanalysis and psychoanalysis today Insight therapy Emphasizes revealing unconscious conflicts

Freud’s Psychoanalysis LO 13.2 Elements of Freud’s psychoanalysis and psychoanalysis today Two techniques for accessing unconscious: Dream interpretation Manifest content Actual dream and it’s events Latent content Symbolic or hidden meaning of dreams

Freud’s Psychoanalysis LO 13.2 Elements of Freud’s psychoanalysis and psychoanalysis today Two techniques for accessing unconscious: Free association Patient free to say anything that came to mind No fear of negative evaluation

Freud’s Psychoanalysis LO 13.2 Elements of Freud’s psychoanalysis and psychoanalysis today Resistance Patient reluctant to talk about certain topics Changes subject or becomes silent

Freud’s Psychoanalysis LO 13.2 Elements of Freud’s psychoanalysis and psychoanalysis today Transference Therapist becomes a symbol of parental authority figure from the past Countertransference Therapist has transference reaction to the patient

Evaluation of Psychoanalysis and Psychodynamic Approaches LO 13.2 Elements of Freud’s psychoanalysis and psychoanalysis today Criticisms Lack of scientific methodology Over-emphasis on sexual problems

Evaluation of Psychoanalysis and Psychodynamic Approaches LO 13.2 Elements of Freud’s psychoanalysis and psychoanalysis today Modern Psychodynamic therapy Client sits face-to-face with therapist Therapist is more directive Asks questions, suggests helpful behavior, and gives opinions Therapy not useful for clients with psychoses

Interpersonal Psychotherapy LO 13.2 Elements of Freud’s psychoanalysis and psychoanalysis today Developed to treat depression Insight-oriented therapy Focus on relationships Psychodynamic origins More eclectic Combines elements of humanistic and cognitive behavioral therapies Effectiveness supported by research

Psychotherapy often takes place one-on-one, with a client and therapist exploring various issues together to achieve deeper insights or to change undesirable behavior.

Roger’s Person-Centered Therapy LO 13.3 Basic elements of Humanistic therapies Non-directive insight therapy Based on the work of Carl Rogers Client talks and the therapist listens

Roger’s Person-Centered Therapy LO 13.3 Basic elements of Humanistic therapies Four Elements: Reflection Therapist restates client’s talk No interpretation of statements Unconditional positive regard Accepting atmosphere created by therapist Empathy Therapist understands client feelings

Roger’s Person-Centered Therapy LO 13.3 Basic elements of Humanistic therapies Four Elements: Authenticity Genuine, open, and honest response of therapist

A Rogerian person-centered therapist listens with calm acceptance to anything the client says. A sense of empathy with the client’s feelings is also important.

LO 13.3 Basic elements of Humanistic therapies Gestalt Therapy LO 13.3 Basic elements of Humanistic therapies Founded by Fritz Perls People hide parts of self behind false “mask” Mask is socially acceptable behavior Inner self not matching mask causes conflict

LO 13.3 Basic elements of Humanistic therapies Gestalt Therapy LO 13.3 Basic elements of Humanistic therapies Therapist is confrontational and directive Lead clients through exercises Attention to body language Focus on “denied parts” not hidden past of psychoanalysis

In Gestalt therapy, it is not unusual to find a client talking to an empty chair. The chair represents some person from the past with whom the client has unresolved issues, and this is the opportunity to deal with those issues.

Evaluation of Humanistic Therapy LO 13.3 Basic elements of Humanistic therapies Little experimental research to support ideas Theories built around case studies Clients need to be intelligent, highly verbal Not a good choice for seriously mentally ill

Behavioral Therapy and Classical Conditioning LO 13.4 Behavior therapists’ use of classical and operant conditioning Action-based rather than insight-based therapy Change behavior through learning new responses Learning created problem New learning corrects problem

Therapies Based on Classical Conditioning LO 13.4 Behavior therapists’ use of classical and operant conditioning Through classical conditioning: Old and undesirable automatic responses can be replaced by desirable ones Techniques originally called Behavior Modification

Therapies Based on Classical Conditioning LO 13.4 Behavior therapists’ use of classical and operant conditioning Applied behavior analysis Newer term Highlights need for a functional analysis of behavior Analysis followed by conditioning

Therapies Based on Classical Conditioning LO 13.4 Behavior therapists’ use of classical and operant conditioning Systematic desensitization Used to treat phobias Client is first taught deep muscle relaxation Next creates a list of ordered fears Hierarchy of fears Pairs relaxation with fears Computer generated simulations used

Therapies Based on Classical Conditioning LO 13.4 Behavior therapists’ use of classical and operant conditioning Aversion therapy Undesirable behavior is paired with aversive stimulus Reduces frequency of behavior

This device allows the delivery of high levels of nicotine to the smoker in a process known as rapid smoking. Rapid smoking is an aversive technique for helping people to quit smoking and is based on the classical conditioning principle of counterconditioning.

Therapies Based on Classical Conditioning LO 13.4 Behavior therapists’ use of classical and operant conditioning Flooding Technique for treating phobias, stress disorders Person is intensely exposed to fear-provoking situation Prevented from making avoidance or escape response

Therapies Based on Classical Conditioning LO 13.4 Behavior therapists’ use of classical and operant conditioning Techniques include reinforcement, extinction, shaping, and modeling Change the frequency of voluntary behavior Results quick and practical

Therapies Based on Classical Conditioning LO 13.4 Behavior therapists’ use of classical and operant conditioning Modeling Learning through observation, imitation of a model Participant modeling Model demonstrates the desired behavior in a step-by-step process Client is encouraged to imitate

Therapies Based on Classical Conditioning LO 13.4 Behavior therapists’ use of classical and operant conditioning Reinforcement Strengthening of response by following it with: A pleasurable consequence (positive reinforcement) Removal of an unpleasant stimulus (negative reinforcement)

Therapies Based on Classical Conditioning LO 13.4 Behavior therapists’ use of classical and operant conditioning Reinforcement Token economy Tokens to reinforce behavior Can be accumulated and exchanged for desired items or privileges Used effectively to modify behavior of disturbed institutionalized individuals

Therapies Based on Classical Conditioning LO 13.4 Behavior therapists’ use of classical and operant conditioning Contingency contract Formal, written agreement between the therapist and client Goals for behavioral change, reinforcements, and penalties are clearly stated Useful in treating problems such as drug addiction

Therapies Based on Classical Conditioning LO 13.4 Behavior therapists’ use of classical and operant conditioning Extinction Removal of a reinforcer Reduces frequency of behavior Time-out Extinction process Person is removed from situation reinforcing an undesirable behavior Placed away from attention and reinforcement opportunities

This boy is sitting in the “time-out” corner at his school This boy is sitting in the “time-out” corner at his school. By removing the attention that he found rewarding, the teacher is attempting to extinguish the behavior that earned the boy a time-out. Do you see anything in this time-out corner that might make it less effective?

Evaluation of Behavioral Therapies LO 13.4 Behavior therapists’ use of classical and operant conditioning Effective in treating specific problems Bedwetting, drug addictions, phobias More serious psychological disorders do not respond as well to behavioral treatments Overall behavior therapies are: Relatively quick and efficient Eliminate or greatly reduce symptoms

LO 13.5 Goals of cognitive therapy Focus on: Helping clients recognize distortions in thinking Replace distorted, unrealistic beliefs with realistic thoughts Is critical thinking applied to one’s own beliefs

LO 13.5 Goals of cognitive therapy Beck Identified five common distortions Arbitrary inference Jumping to conclusions Drawing conclusions not based on evidence

Beck's Cognitive Therapy LO 13.5 Goals of cognitive therapy Selective thinking Focusing on one aspect of a situation Ignoring all other relevant aspects Overgeneralization Drawing sweeping conclusions based on only one incident Applying conclusions to events unrelated to original

Beck's Cognitive Therapy LO 13.5 Goals of cognitive therapy Magnification and minimization Negative event blown out of proportion to its importance (magnification) Ignore relevant positive events (minimization) Personalization Taking responsibility for events unconnected to the person

Cognitive-Behavioral Therapy LO 13.5 Goals of cognitive therapy Assumes disorders come from illogical, irrational cognitions Is an action therapy Learning to think more rationally and logically

Cognitive-Behavioral Therapy LO 13.5 Goals of cognitive therapy Three goals: Relieve the symptoms and solve the problems Develop strategies for solving future problems Help change irrational, distorted thinking

Rational-Emotive Behavior Therapy LO 13.5 Goals of cognitive therapy A cognitive-behavioral therapy Clients are directly challenged on irrational beliefs Restructures thinking into rational belief statements Therapists are directive Provide homework assignments Challenge “my way or nothing” statements

LO 13.5 Goals of cognitive therapy Success of CBT LO 13.5 Goals of cognitive therapy CBT has seemed successful in treating Depression, stress disorders, and anxiety Criticized for focusing on symptoms, not causes of disordered behavior

Table 13.1 Characteristics of Psychotherapies

LO 13.6 Types of group therapy Group Therapies LO 13.6 Types of group therapy Therapist may use one of many approaches or a combination Insight, cognitive-behavioral, person-centered, behavioral Share problems, provide support

LO 13.6 Types of group therapy Group Therapies LO 13.6 Types of group therapy Family counseling Family members meet together with a counselor Discover and resolve unhealthy patterns of relating Open lines of communication Resolve problems that affect the entire family

LO 13.6 Types of group therapy Group Therapies LO 13.6 Types of group therapy Self-help groups People with similar problems meet together without a therapist or counselor Purpose is discussion, problem solving, emotional support

In family therapy, all family members participate in therapy sessions, with the therapist guiding them through open communication. Although it appears that the young boy in the corner is the focus of this session, all family members are encouraged to see how their own behavior may contribute to the problem behavior.

Advantages of Group Therapy LO 13.6 Types of group therapy Lower cost Exposure to way other persons view and handle the same kinds of problems Opportunity for therapist and client to see interaction with others Social and emotional support from people with similar problems

In group therapy, several people who share similar problems gather with a therapist to discuss their feelings and concerns. The presence of others who are going through the same kind of emotional difficulties can be comforting as well as provide the opportunity for insights into one’s own problems by hearing about the problems of others.

Disadvantages of Group Therapy LO 13.6 Types of group therapy Need to share therapist’s time with others in the group Lack of a private setting in which to reveal concerns Possibility that shy people will not be able to speak up within a group setting Inability of people with severe disorders to tolerate being in a group

Does Psychotherapy Really Work? LO 13.7 Effectiveness of psychotherapy Psychotherapy is more effective than no treatment at all. 75 to 90 percent of people who receive therapy improve Longer a person stays in therapy the better the improvement Psychotherapy works as well alone as with drugs

Does Psychotherapy Really Work? LO 13.7 Effectiveness of psychotherapy Some types of psychotherapy are more effective for certain types of problems No one psychotherapy method is effective for all problems

Characteristics of Effectiveness Psychotherapy LO 13.7 Effectiveness of psychotherapy Common factors approach Modern approach to eclecticism Focuses on factors common to successful outcomes in therapy

Characteristics of Effectiveness Psychotherapy LO 13.7 Effectiveness of psychotherapy Therapeutic Alliance Relationship between client and therapist Protected setting Privacy, safety for client Opportunity for catharsis Learning and practice of new behavior

Culture, Ethnic and Gender Concerns LO 13.7 Effectiveness of psychotherapy Differences between therapist and client Difficult for the therapist to understand concerns Misunderstandings and misinterpretations can occur

Culture, Ethnic and Gender Concerns LO 13.7 Effectiveness of psychotherapy Four barriers to effective psychotherapy Language Culture-bound values Class-bound values Nonverbal communication

LO 13.7 Effectiveness of psychotherapy Cybertherapy LO 13.7 Effectiveness of psychotherapy Psychotherapy offered on the Internet Offers advantages of low or no cost, accessible, anonymous No guarantee cybertherapist has credentials or training in psychotherapy Difficult for cybertherapist to assess client’s body language or emotional state

LO 13.8 Types of drugs used to treat psychological disorders Biomedical Therapies LO 13.8 Types of drugs used to treat psychological disorders Therapies directly affecting the biological functioning of body and brain Psychopharmacology The use of drugs to control or relieve the symptoms of psychological disorders

LO 13.8 Types of drugs used to treat psychological disorders Biomedical Therapies LO 13.8 Types of drugs used to treat psychological disorders Psychopharmacology Anti-psychotic drugs Used to treat psychotic symptoms Delusions, hallucinations, and other bizarre behavior Anti-anxiety drugs Include anti-anxiety and antidepressant drugs

LO 13.8 Types of drugs used to treat psychological disorders Biomedical Therapies LO 13.8 Types of drugs used to treat psychological disorders Psychopharmacology Anti-manic drugs Used to treat bipolar disorder Include lithium and anticonvulsant drugs Antidepressant drugs Used to treat depression and anxiety Include MAOIs, tricyclics, SSRIs

Table 13.2 Types of Drugs Used in Psychopharmacology

Electroconvulsive Therapy LO 13.9 Modern electroconvulsive therapy and psychosurgery Treats severe depression Electrodes are placed on one or both sides of the head Bilateral ECT Electrodes are placed on both sides of the head Unilateral ECT Electrodes are placed on only one side of the head and forehead

Electroconvulsive therapy consists of applying an electric shock to one or both sides of the head. The result is rapid improvement in mood. It has been shown to be most effective in treating severe depression that has not responded to medication or where medication side effects cannot be tolerated.

Electroconvulsive Therapy LO 13.9 Modern electroconvulsive therapy and psychosurgery Treats severe depression An electric current is passed through the electrodes Strong enough to cause a seizure or convulsion

LO 13.9 Modern electroconvulsive therapy and psychosurgery Surgery performed on brain tissue to relieve or control severe psychological disorders Prefrontal lobotomy Connections between prefrontal cortex to other brain areas are severed

LO 13.9 Modern electroconvulsive therapy and psychosurgery Surgery performed on brain tissue to relieve or control severe psychological disorders Bilateral cingulotomy MRI used to guide electrode to area in brain Electrode is inserted into the cingulate gyrus

LO 13.9 Modern electroconvulsive therapy and psychosurgery Surgery performed on brain tissue to relieve or control severe psychological disorders Bilateral cingulotomy Small current run to electrode to destroy small area of cells Referred to as deep lesioning Effective in ⅓ to ½ cases of major depression, bipolar and OCD

LO 13.9 Modern electroconvulsive therapy and psychosurgery Emerging Techniques LO 13.9 Modern electroconvulsive therapy and psychosurgery Repetitivetranscranial magnetic stimulation (rTMS) Magnetic pulses are applied to the cortex Transcranial direct current stimulation (tDCS) Scalp electrodes used to pass low amplitude currents to the brain

Repetitive transcranial magnetic stimulation (rTMS) uses a pulsating magnetic field to activate specific parts of the brain’s surface. As seen above, by placing an electromagnet on the scalp, TMS can be used to stimulate small areas of the cortex and is being evaluated as a way to control some psychological symptoms, such as those related to depression and PTSD. Photo courtesy of Martijn Arns, http://www.brainclinics.com

LO 13.10 How might computers be used in psychotherapy Virtual Realities LO 13.10 How might computers be used in psychotherapy Software-generated, three-dimensional simulated environment Useful with exposure therapy Vivid and realistic imagery possible Particularly helpful for clients that do not visualize well Post-traumatic stress disorder (PTSD) Benefits from the use of VR psychotherapy

Some behavioral therapists now use virtual reality to expose patients to phobic objects and situations—like the cabin of an airplane. As part of systematic desensitization, this patient receives exposure to anxiety-provoking visual displays through a virtual reality headset. Credit: Charles Undermost, Delft University of Technology.