Therapy Chapter 17

Types of Mental Health Care Professionals Counseling psychologist Clinical psychologist Psychiatrist Psychoanalyst Psychiatric nurse practitioner Clinical social worker Pastoral counselor 29

Therapy Because of new drugs and better therapy, the U.S. went to a policy of deinstitutionalization.

Psychological Therapies We will look at four major forms of psychotherapies based on different theories of human nature: Psychoanalytical theory Humanistic theory Behavioral theory Cognitive theory OBJECTIVE 2| Define psychoanalysis, and discuss the aims of this form of therapy.

Psychoanalytic Therapy Freud Bring repressed feeling from the unconscious out through hypnosis free association Dream Interpretation When energy devoted to id-ego-superego conflicts is released, the patient’s anxiety lessens. Transference Resistance

Psychoanalysis: Criticisms Hard to refute because it cannot be proven or disproven. Takes a long time and is very expensive.

The goal of psychoanalytical therapy is a) to change maladaptive behavior to more socially acceptable behavior b) to change negative thinking into more positive attributions c) to attain self-actualization d) to bring unconscious conflicts to conscious awareness and gain insight

Treating the therapist as though he were a very important person from one’s past, such as a parent, defines a) resistance b) transference c) frustration d) reaction formation

Humanistic Therapy Client-Centered Therapy by Carl Rogers Aim to promote self-fulfillment by increasing self-acceptance & self awareness Free will – clients makes the decisions and finds the solutions Active/reflective listening Unconditional positive regard Therapist responds with empathy Gestalt Therapy by Fritz Perls Patient experienced problems because his or her perception of reality was not consistent with what actually was occuring.

. Vic is encouraged to take charge of the therapy session and his therapist uses an active listening approach to mirror back the feelings he hears from him. Which therapy is most likely being described? a) client-centered therapy b) cognitive therapy c) psychodynamic therapy d) existential therapy

Behavioral Therapies Applies learning principles to the elimination of unwanted behaviors Classical Conditioning Counterconditioning –Mary Jones Aversive Conditioning Systematic desensitization Expoure/flooding techniques Bell & Pad treatment –bed wetting (NS)Alcohol + drug (UCS) = nausea (UCR)

Behavioral Therapies Operant conditioning Token economy- positive reinforcement Extinction/nonreinforcement Modeling

Systematic desensitization is a technique based on a) classical conditioning b) instrumental conditioning c) operant conditioning d) aversive conditioning

Cognitive (Thinking) Therapy Aaron Beck Teaches people new methods of thinking & acting. (change our schemas) Patient’s negative thoughts are responsible for psychological problem Albert Ellis & Rational Emotive Therapy- anxiety is causing their beliefs

Cognitive Therapy for Depression Rabin et al., (1986) trained depressed patients to record positive events each day, and relate how they contributed to these events. Compared to other depressed patients, trained patients showed lower depression scores.

Albert Ellis Rational Emotive Therapy vigorously challenges people’s illogical, self-defeating attitudes and assumptions; a confrontational therapy A-B-C theory of dysfunctional behavior A – Activating event B – Belief C – emotional Consequence based on that belief.

Example of Rational Thinking A= fail a midterm examination B=It’s unfortunate that I failed-I did not study hard enough and I must make sure that I study harder for the final C=no consequences (no emotional disturbance) A= Fail exam B= I’m stupid, I’ll never be able to pass this course and I will fail this course C=depression

Evaluating Psychotherapies Within psychotherapies cognitive therapies are most widely used, followed by psychoanalytic and family/group therapies.

The Relative Effectiveness of Different Therapies Which psychotherapy would be most effective for treating a particular problem? Disorder Therapy Depression Behavior, Cognition, Interpersonal Anxiety Cognition, Exposure, Stress Inoculation Bulimia Cognitive-behavior Phobia Behavior Bed Wetting Behavior Modification OBJECTIVE 14| Summarize the findings on which psychotherapies are most effective for specific disorders.

Evaluating Alternative Therapies Lilienfeld (1998) suggests comparing scientific therapies against popular therapies through electronic means. The results of such a search are below: OBJECTIVE 15| Evaluate the effectiveness of eye movements desensitization and reprocessing (EMDR) and light exposure therapies.

Group Therapy Is cheap, effective. 1 therapist, 6-8 clients, 90 minutes It allows people to gain insight into their own behaviors and thoughts People don’t feel like they are the only one with their problem

Light Exposure Therapy Seasonal Affective Disorder (SAD) light exposure therapy Courtesy of Christine Brune

The Biomedical Therapies Drug Treatments Surgery Electric-shock therapy

Psychopharmacology is the study of drug effects on mind and behavior. Drug Therapies Psychopharmacology is the study of drug effects on mind and behavior. OBJECTIVE 18| Define psychopharmacology, and explain how double-blind studies help researchers evaluate a drug’s effectiveness. With the advent of drugs, hospitalization in mental institutions has rapidly declined.

Antipsychotic Drugs Classical antipsychotics (Thorazine): Remove a number of positive symptoms associated with schizophrenia such as agitation, delusions, and hallucinations. Atypical antipsychotics (Clozapine): Remove negative symptoms associated with schizophrenia such as apathy, jumbled thoughts, concentration difficulties, and difficulties in interacting with others. OBJECTIVE 19| Describe the characteristics of antipsychotic drugs, and discuss their use in treating specific disorders. blocks receptors

Antidepressant Drugs Antidepressant drugs like Prozac, Zoloft, and Paxil are Selective Serotonin Reuptake Inhibitors (SSRIs) that improve the mood by elevating levels of serotonin by inhibiting reuptake. OBJECTIVE 21| Describe the characteristics of antidepressant drugs, and discuss their use in treating specific disorders.

Mood-Stabilizing Medications Lithium Carbonate, a common salt, has been used to stabilize manic episodes in bipolar disorders. It moderates the levels of norepinephrine and glutamate neurotransmitters. OBJECTIVE 22| Describe the use and effects of mood-stabilizing medications.

Electroconvulsive Therapy (ECT) Brain Stimulation Electroconvulsive Therapy (ECT) Used for severely depressed patients who do not respond to drugs. The patient is anesthetized and given a muscle relaxant. OBJECTIVE 23| Describe the use of electroconvulsive therapy (ECT) in treating severe depression, and describe some possible alternatives to ECT.

Transcranial Magnetic Stimulation (TMS) Alternatives to ECT Transcranial Magnetic Stimulation (TMS) a pulsating magnetic coil is placed over prefrontal regions of the brain to treat depression with minimal side effects.

Psychosurgery Although used sparingly today, about 200 such operations do take place in the US alone. OBJECTIVE 24| Summarize the history of the psychosurgical procedure known as lobotomy, and discuss the use of psychosurgery today. http://www.epub.org.br