Therapy The type of therapy used depends on the problem. PsychotherapyInteraction between a trained therapist and someone who suffers from psychological difficulties EX: treating phobias that are psychologically learned Biomedical TherapyPrescribed medications or medical procedures that act directly on the patient’s nervous system. EX: treating schizophrenia with medication because it is biologically rooted in the brain

Psychotherapies Psychoanalysis Humanistic Behavioral Cognitive Group Therapies

Psychoanalysis  Based upon the ideas of Freud GoalTechniquesCriticisms Try to help patients gain insight into the subconscious origins and roots of their disorders and work through anxiety- ridden feelings. Free association - patient relaxes and starts talking about anything Dream interpretation Interpretation – the analyst’s noting supposed dream meanings, and other significant behaviors and events in order to promote insight into the subconscious Interpretations cannot be proven or disproven; psychoanalysts say that psychoanalysis is therapy, not a science. Time consuming – years long Expensive – several sessions a week

Psychoanalysis  Transference – in psychoanalysis, the patient’s transfer to the analyst of emotions linked with other relationships (such as love or hatred for a parent).  Patients can develop strong negative or positive feelings for the therapist, including dependency, mingled love and anger.  Example Session Example Session

Psychodynamic Therapy  Influenced by Freud, but not the same as psychoanalysis GoalTechniques Try to understand a patient’s current symptoms by focusing on themes across important relationships Face-to-face conversation Once a week for a few weeks/months Look for patterns in behaviors/relationships

Humanistic Therapy  Emphasis on human potential and self-fulfillment GoalTechniquesCriticisms Aim to boost self- fulfillment by helping people grow in self-awareness and self-acceptance Focusing on the future instead of the past Focusing on conscious rather than unconscious thoughts “Clients” rather than “patients”  client-centered therapy in which the client feels unconditionally accepted. Active listening – therapist echoes, restates, and clarifies Active listening Not scientific enough

With a neighbor…  Think of the last thing recently that:  Made you angry  Made you sad  Made you anxious/nervous  For 2-3 minutes, talk about the event and feelings. The active listener should:  Remain unbiased and nonjudgmental  Paraphrase statements  Ask for clarification  Reflect the feelings of the speaker with, “I understand” or “Yes, that would be frustrating” etc  Did you notice any differences when you were active listening compared to how you listen everyday?

Behavioral Therapy  Behavioral therapists do not emphasize the mental root of a disorder as they assume that the problem behaviors are the problems GoalTechniquesCriticisms Applies learning principles to the elimination of unwanted behaviors (useful for phobias) Counter-conditioning – using classical conditioning to produce new responses to stimuli that trigger unwanted behaviors Aversive therapy - associates an unpleasant state (such as nausea) with an unwanted behavior (such as drinking alcohol or smoking) Systematic desensitization - associates a pleasant relaxed state with anxiety-triggering stimuli Token economy – uses operant conditioning principles to produce new behaviors based on rewarding good behaviors and punishing bad behaviors Doesn’t address mental processes behind disorders When reinforcement disappears/stops, behaviors may come back.

Cognitive Therapy  Best for disorders in which the roots are unclear, like generalized anxiety disorder and major depressive disorder GoalTechniques Tries to change unhealthy or maladaptive patterns in thinking Ex: a depressed person writes 3 positive things that happened that day and how they contributed to them Ex: a person with test-anxiety repeats positive things to themselves before an exam

Cognitive-Behavioral Therapy  a popular integrated therapy that combines cognitive therapy (changes in thinking) with behavior therapy (changing behaviors) GoalTechniques Seeks to make people aware of maladaptive thinking patterns and replace them with new ways of thinking, AND to practice the more positive approaches and behaviors as well. EX: OCD sufferers – changing thinking patterns concerning obsessive thoughts and changing behaviors concerning compulsions EX: Anorexia nervosa – changing thinking patterns concerning depression and negative body image and changing behaviors concerning eating.

Group Therapy and Support Groups  Except for psychoanalytic therapies, these techniques can be used in therapist-led small groups.  Group therapy does not allow for the same degree of individual attention, but it is time and cost effective and has often been found no less effective than individual therapy.  The social context of group therapy often allows client to feel as if they are not alone in their problems. It can be a relief to find that others share your problems and feelings.  EX: AA and cancer, AIDS support groups  Go On Trailer Go On

Effectiveness of Different Therapies Is there a “best” therapy?

Relative Effectiveness  Therapy is most effective when the problem is clear- cut and specific.  Phobias or panic disorder sufferers can hope for improvement.  Less-focused problems, such as depression and anxiety, usually benefit in the short-run but often relapse later.  Those who have chronic schizophrenia or who wish to change their personality are unlikely to benefit from psychotherapy alone.

Effective Therapy Depends on the Problem Psycho- dynamic Exposure Therapy Behavioral Therapy Cognitive Therapy DepressionXXX AnxietyXX BulimiaXX PhobiasXX OCDXX Marital problems X Reducing suicide risk X

When Should You Consider Therapy?  The APA suggests considering seeking a mental health profession if you display: Feelings of hopelessness Deep and lasting depression Self-destructive behaviors Disruptive fearsSudden mood shifts Thoughts of suicide Compulsive rituals

The Biomedical Therapies “Medicine, the only profession that labors incessantly to destroy the reason for its existence,” - James Bryce

Psychopharmacology  The study of the effects of drugs on mind and behavior.  Led to more independent lives for sufferers of psychological disorders  Reduced hospitalization of many people  To evaluate the effectiveness of new drugs, researchers use the double-blind experimental technique to reduce researcher bias.

Antipsychotic Drugs GoalUseful for…ExamplesNegative Effects Lessen responsiveness to random stimuli by blocking dopamine receptors Schizophrenia (regulates dopamine) Lessens hallucinations, delusions, and inappropriate or disorganized behaviors Clozapine Risperdal Zyprexa Long-term use can lead to increased risk of obesity and diabetes

Anti-anxiety Drugs GoalUseful for…ExamplesNegative Effects Depress central nervous system reactivity Anxiety Phobias Can help a person learn to cope with frightening situations and fear-triggering stimuli. Xanax Ativan Can be used a crutch, without actually solving the root of the anxiety. Users can become tolerant, addicted, and dependent on the medication.

Anti-depressant Drugs  Zoloft commercial Zoloft GoalUseful for…ExamplesNegative Effects Regulate levels of neurotransmitters in the brain (serotonin and norepinephrine) that can elevate mood Depression Anxiety Selective-serotonin- reuptake-inhibitors (SSRIs) Zoloft Prozac Paxil Full effects take 4 weeks – high suicide risk when starting medication

Mood Stabilizing Drugs GoalUseful for…ExamplesNegative Effects Stabilize fluctuating moods Bipolar Disorder Lithium Unclear how it works – maybe strengthens nerve connections in brain that regulate mood? Increased thirst Headaches Memory loss Some tremors or twitches

Brain Stimulation GoalUseful for… ExamplesNegative Effects Send an electric current through the brain while the patient is anesthetized Severe depression that does not respond to medication Electroconvulsive therapy Not exactly sure how it works – maybe calms the area of the brain that is over active and causing depression? Memory loss Stigmatized (bad reputation)

Psychosurgery  Lobotomy – a now-rare psychosurgical procedure that cut the nerves that connect the frontal lobes to the emotion-controlling centers of the inner brain. Lobotomy  Developed in the 1930s  Shock the patient into a coma  Hammer an ice pick-like instrument through each eye socket into the brain, then wiggle it to sever connections running up to the frontal lobes. GoalUseful for… ExamplesNegative Effects Remove or destroy brain tissue to change behavior EpilepsyCutting the corpus callosum Lobotomy – NOT performed anymore Irreversible – least used therapy

Lobotomies  Crude but easy and inexpensive (10 minutes)  Tens of thousands of severely disturbed people were lobotomized during the 1940s- 50s  The lobotomy usually produced a permanently lethargic, immature, impulsive personality.  In the 1950s, calming drugs were introduced and lobotomized fell out of favor in the US.  Other early therapies Other early therapies