1. Chapter 14 Treating Psychological Disorders Christina Graham, Ph.D.

2. Outline: Therapy  Does Therapy Work?  Approaches  Psychoanalytic Therapy  Humanistic Therapy  Cognitive-Behavioral Therapy  Treatment for Mood Disorders  Treatment for Anxiety Disorders

3. Outline: Therapy  Does Therapy Work?  Approaches  Psychoanalytic Therapy  Humanistic Therapy  Cognitive-Behavioral Therapy  Treatment for Mood Disorders  Treatment for Anxiety Disorders

4. Psychotherapy Effectiveness  Q: Does psychotherapy work?  A: Yes.*  *Need to think critically about why studies say it works, and how effectiveness is measured

5. Effectiveness: Key Points  Most problems usually get better on their own…but they’re likely to improve faster with psychotherapy.  Two key ingredients of successful psychotherapy are:  Quality of relationship with the therapist  The client’s belief that s/he will improve  In general, no particular therapeutic approach is superior  However, certain therapies work much better for specific problems

6. Outline: Therapy  Does Therapy Work?  Approaches  Psychoanalytic Therapy  Humanistic Therapy  Cognitive-Behavioral Therapy  Treatment for Mood Disorders  Treatment for Anxiety Disorders

7. Approaches  Q: How should we treat psychological disorders?  A: Depends on our assumptions about etiology (what causes the disorders)

8. Approaches: Theoretical Perspectives  What causes psychological disorders?  Is it…  …unconscious conflicts stemming from childhood relationships with parents (psychodynamic perspective)?  …not living to one’s full potential (humanistic)?  …learned behaviors and responses (behavioral)?  …thinking a certain way (cognitive)?  …neurochemistry and biology (biological)?

9. Outline: Therapy  Does Therapy Work?  Approaches  Psychoanalytic Therapy  Humanistic Therapy  Cognitive-Behavioral Therapy  Treatment for Mood Disorders  Treatment for Anxiety Disorders

10. Psychoanalytic therapy (psychoanalysis)  Assumes conflicts are unconscious  Free association = allowing the client to verbalize everything that comes to mind without censoring anything  Sessions are often frequent over a long period of time  Expensive!

11. Psychoanalytic therapy (psychoanalysis) cont’d  Therapist looks for signs of transference (client acts toward the therapist in ways suggestive of unconscious conflicts)  http://www.youtube.com/watch? v=yTHM2o3dvao http://www.youtube.com/watch? v=yTHM2o3dvao  Countertransference is also an issue  A therapist’s own conflicts can change how s/he acts toward the client

12. Outline: Therapy  Does Therapy Work?  Approaches  Psychoanalytic Therapy  Humanistic Therapy  Cognitive-Behavioral Therapy  Treatment for Mood Disorders  Treatment for Anxiety Disorders

13. Humanistic Therapy  Sometimes called client- centered therapy  Therapist provides unconditional positive regard  Therapist is empathic  Encourages client to be genuine  Most therapists – regardless of orientation – employ these humanistic principles Carl Rogers (1902-1987)

14. Outline: Therapy  Does Therapy Work?  Approaches  Psychoanalytic Therapy  Humanistic Therapy  Cognitive-Behavioral Therapy  Treatment for Mood Disorders  Treatment for Anxiety Disorders

15. Cognitive-Behavioral Therapy (CBT)  Integrates assumptions from both the behavioral and cognitive perspectives  Basic model: CognitionsEmotionsBehaviors

16. Using a CBT model, how might a therapist treat depression?

17. CBT model of depression Cognitions Emotions Behaviors “I’m no fun…nobody wants to hang out with me.” Avoiding friends, avoiding social events, staying home alone Feeling lonely, depressed “If I go out I won’t have a good time...people will think I’m such a jerk”

18. Treatment for depression: Changing attribution styles  Depressed people tend to attribute events in ways that are inaccurate and maladaptive (Beck’s Cognitive Triad of Depression)  Beliefs about the self – negative events are attributed to internal causes  Beliefs about the world – negative events are seen as having global effects  Beliefs about the future – negative events are seen as stable and unchanging

19. Treatment for depression: Changing attribution styles Depressive Non-Depressive Internal “It’s all my fault” Global “Everything is going wrong” Stable “Things will always be lousy” External “That was just bad luck” Specific “This is just one lousy situation” Unstable “This won’t last forever”

20. Some Maladaptive Cognitions  Overgeneralization = arbitrarily concluding that an event will happen to you over and over again  All-or-nothing thinking = tendency to evaluate personal qualities in black/white categories  Mind-reading = assuming you know what others are thinking of you (inaccurately)  Mental filter = dwelling on the negative and ignoring the positive  Magnification = exaggerating the importance of a negative action

21. Using a CBT model, how might a therapist treat a Specific Phobia?

22. Treatment of phobias: Systematic Desensitization  Feeling relaxed is incompatible with feeling anxious  The therapist helps the client construct a ‘fear hierarchy’  The client is asked to practice coping by using relaxation strategies in the presence of fearful stimuli  Exposure to the feared stimulus lasts until the fear level drops to a very low level

23. Sample fear hierarchy  Sitting on Santa’s lap – 10  Touching Santa’s beard – 9  Talking to Santa 5 ft away – 8  Hearing Santa say “Ho Ho Ho!” – 6  Seeing a red Santa suit on a hanger – 4  Touching a toy Santa - 4  Seeing a chubby man with a bushy white beard – 3  Hearing “Jingle Bells” - 2

24. Using a CBT model, how might a therapist treat OCD?

25. Treatment of OCD: Exposure and Response Prevention  Compulsions (behaviors) are negatively reinforcing because they decrease anxiety  Client with OCD is exposed to a situation that triggers obsessions (thoughts) and is prevented from performing compulsions  Client learns that anxiety will eventually decrease over time without performing the compulsion  Client is negatively reinforced for doing other things, like distracting self or relaxing)

26. Stress Inoculation  Combination of systematic desensitization (classically conditioning relaxation response with anxiety-provoking stimuli) with cognitive responses  Use of self-talk to facilitate relaxation and coping (“I can get through this OK”, “Just one step at a time”, “Fear is natural, it won’t always be this bad and I can get through this.”)  Coping skills (self-talk and relaxation) are practiced prior to encountering the stressors

27. Questions?