1. Therapies
Chapter 14

2. Introduction
The Lobotomist

3. Not to mention your unusually large Dude…Why are my arms so short?
Defining Therapy
Not to mention your unusually large
head…
Psychotherapy is the treatment of emotional and behavioral problems through psychological techniques
Uses psychological rather than exclusively biological approaches to treatment
Involves conversation between an individual with psychological issues and someone trained to help correct the problem known as a therapist.
Dude…Why are my arms so short?

4. History of Treatment
In early Stone Age society, trepanning was used – many did not survive the procedure
During Middle Ages, supernatural forces were blamed for mental illness (demonology) and exorcism was used
During the French Revolution, more humane treatment started with the work of Philippe Pinel
By the mid-19th century, people began to connect abnormal behavior to damage to the brain/central nervous system
Sigmund Freud helped to popularize the “talking cure” in the early 20th century
Since then there has been an explosive growth in available therapies
 3500 BC

5. Insight Therapies

6. Psychoanalysis
Designed to bring repressed feelings and thoughts to conscious awareness developed by Freud
Techniques
Therapist must maintain a neutral relationship with the client so that client may project unresolved feelings/issues upon him/her
Dream analysis
Hypnosis and post-hypnotic suggestions
Free association
Transference and resistance
Analysis of defense mechanisms
Insight and working through

7. Person-Centered Therapy
Developed by Carl Rogers
Goal is to help clients become fully functioning
Therapist expresses unconditional positive regard and empathy
Therapist strives to be authentic, trying to be genuine and real rather than formal
Therapy is nondirective but engages in active listening
Therapist reflects or mirrors clients’ statements

8. Gestalt Therapy Outgrowth of the work of Fritz Perls
Ya, you are in ze hot seat!
Outgrowth of the work of Fritz Perls
Emphasizes the wholeness of personality
Attempts to reawaken people to their emotions and sensations in the here-and-now
Draws attention to what exists rather than what is absent, and draws attention to client’s voice, posture, and movements
Encourages confrontation with issues
Therapist is active and directive
“Empty Chair” and “Hot Seat” technique

9. Recent Developments Short-term psychodynamic psychotherapy
Focused on trying to help people correct the immediate problems in their lives
Forego long process of completely excavating childhood
Virtual therapy
Therapy delivered via chat room, phone or video conference
Client given techniques to use on their own after session ends

10. Behavior Therapies

11. Behavior Therapies
Based on the belief that all behavior – adaptive and maladaptive - is learned
Objective of therapy is to teach people new ways of behaving
Focuses on observable, measurable activities

12. Using Classical Conditioning Techniques
Say hello to Mr. Spider!
Systematic desensitization
Gradually associating relaxation with what was feared
Extinction through counterconditioning
Ending of old fears or reactions through repeated exposure to new stimulus pairs
Flooding
Full-intensity exposure to feared object
Aversive conditioning
Eliminate undesirable behavior by associating it with pain and discomfort
Virtual reality exposure therapy
Expose client to fears in safe, virtual setting

13. Operant Conditioning Behavior contracting Token economy
Client and therapist set behavioral goals and agree on reinforcements the person will receive
Client engages in desired behaviors to attain reinforcement
Token economy
Clients earn tokens for desired behaviors and exchange them for desired items or privileges
Often used in schools and hospitals

14. Modeling
Person learns new behaviors by watching others perform those behaviors
Sometimes used in conjunction with operant conditioning
Therapist him/herself may model desirable behaviors for client

15. Cognitive Therapies

16. Meichenbaum’s Stress-Inoculation Therapy
Type of cognitive therapy that trains people to cope with stressful situations by learning a more useful patterns of self-talk
Taught to suppress negative and anxiety-provoking thoughts in times of stress
Particularly effective for treating anxiety disorders

17. Ellis’ Rational-Emotive Therapy (RET)
A directive, confrontational therapy based on the idea that psychological distress is caused by irrational and self-defeating beliefs
Core problem is belief in “musts” and “shoulds” that leave no room for making mistakes (no more “musterbation”)
Therapist’s job is to challenge client’s irrational beliefs

18. Beck’s Cognitive Therapy
Aimed at identifying and changing inappropriately negative and self-critical patterns of thought
Therapist points out automatic thoughts (instantaneous, habitual, and unconscious thoughts that impact mood and action) and catastrophizing beliefs and forces client to substantiate them
Good treatment for depression

19. Cognitive Distortions List
All or nothing thinking (“always”, “every”, “never”)
Mental filter (focus on negative aspects while ignoring positive aspects)
Disqualifying the positive (shooting down positive experiences for no reason)
Jumping to conclusions (drawing conclusions with little/no evidence)
Overgeneralization (isolated case assumed for all)
Magnification/minimization (making mountains out of molehills, catastrophizing)
Emotional reasoning (decision making based on feelings, not logic)
Personalization (attributing personal responsibility when individual has no control over event)
Should statements (emphasizing what should be rather than what is; what Ellis called “musterbation”)

20. Group Therapies

21. Family Therapy
Form of group therapy that sees the family as at least partly responsible for the individual’s problems
Seeks to change all family members’ behavior to the benefit of the family and the individual

22. Self-Help Groups and Couple Therapy
Small, local gatherings of people who share common problems and provide mutual assistance at very low cost
Alcoholics Anonymous is an example
Good for empathy, but may trigger temptation to relapse
Couple Therapy
A form of group therapy intended to help troubled partners improve their communication and interaction
Empathy training: partners taught to share feelings and listen to and understand partner’s feelings

23. Evaluating Psychotherapies

24. Overall Effectiveness of Psychotherapy
Does Psychotherapy Work?
Psychotherapy helps about 2/3rd of people treated
Approximately 1/3 would improve without therapy
Which Type of Therapy is Best for Which Disorder?
No one type of therapy is better
Key is to match the problem with the appropriate therapy

25. Effectiveness of Insight and Cognitive Therapies
Difficult to judge as spontaneous remission may occur
Who should be asked to judge the effectiveness of therapy? Therapist or client?
Meta-analysis may be the best bet to evaluate these therapies
75-80% result in improvement vs. no therapy at all
Only 10% were worse after therapy
Works best with those who are not severely disturbed

26. Effectiveness of Behavior Therapies
Work well for certain problems such as phobias, compulsive behaviors, impulse control, and learning new social skills to displace maladaptive ones
Criticized for ignoring internal thoughts and expectations and just treating symptoms rather than underlying causes
Not well suited for some types of problems

27. Biological Treatments

28. Biological Treatments: Overall Trends
View abnormal behavior as a symptom of an underlying physical disorder
Typically favor biological therapy (drugs, psychosurgery, ECT, etc.)

29. Drug Therapies
Psychopharmacotherapy is the treatment of mental disorders with medication – also known as drug therapy
Major reasons for widespread use of drugs
Drugs are effective at treating disorders – especially serious disorders
Drug therapies are often less expensive that psychotherapy

30. Antipsychotic Drugs (Neuroleptics)
Used for schizophrenia or psychosis (hallucinations, delusions, paranoia, disordered thinking, incoherence)
All antipsychotics block dopamine receptors in the brain
Side effects include drowsiness, dry mouth, muscular rigidity, and Tardive Dyskinesia
Examples include Thorazine, Haldol, Mellaril, Clozapine, and Risperidone
60-70% show improvement in symptoms when these drugs are used

31. Antidepressant Drugs (Thymoleptics)
Tricyclics and MAO (monoamine oxidase) inhibitors
Most common antidepressants prior to late 1980s
Work by increasing amount of the neurotransmitters serotonin and norepinephrine
Effective, but have serious side effects such as heart complications and weight gain
Examples: Tofranil, Elevil (Tricyclics), Nardil (MAOi)
Selective Serotonin Reuptake Inhibitors (SSRIs)
Work by blocking the reuptake of serotonin
Examples: Prozac, Paxil, Zoloft, Effexor
Side effects: sleepiness, reduced sex drive
60-70% show improvement though it may take two weeks for changes to take effect

32. Action of SSRIs

33. Antimania Drugs: Lithium
A naturally occurring salt (lithium carbonate) that is used to treat bipolar disorder (manic depression) with 80% effectiveness
Nobody knows how lithium works to alleviate symptoms
Problem with establishing proper dosage and with people stopping medication when symptoms ease
Examples: lithium carbonate, Eskalith

34. Antianxiety Drugs (Anxiolytics)
Use to treat anxiety disorders and are often referred to as tranquilizers
Most widely prescribed of all legal drugs
Produce a feeling of calm and mild euphoria
Side effects include physical dependence and withdrawal symptoms is abruptly discontinued
Examples: Valium, Librium, Xanax, Equanil

35. Psychostimulants Used to treat disorders such as AD/HD
Concern that psychostimulants are being overused
Side effects: lethargy, depression, aggression

36. Electroconvulsive Therapy
Commonly known as “shock therapy”
1938 Italian physicians Ugo Cerletti and Lucio Bini created seizures in patients by passing an electric current through their brains
During 1940s and 50s, used as a treatment for depression, schizophrenia and sometimes mania; now used only for severe depression
Causes brief convulsions and temporary loss of consciousness
Side effects include memory loss and difficulty learning following the procedure
Up to 100,000 people receive ECT each year

37. Psychosurgery
Brain surgery performed to change a person’s behavior or emotional state
History of Lobotomy: Egas Moniz and Walter Freeman
Prefrontal lobotomy (EM)
Transorbital lobotomy (WF)
Tragedies
Psychosurgery is rarely used today and removes far less brain tissue

38. Alternatives to Institutionalization

39. Deinstitutionalization
Releasing people with severe psychological disorders into the community
Can cause problems
Some people are ill-prepared to deal with life outside of a hospital
Up to 40% of homeless are mentally ill
Alternative forms of treatment (many)
Half-way houses
Family-crisis interventions
Day-care

40. Prevention Primary prevention Secondary prevention Tertiary prevention
Improve the social environment so that new cases of mental disorders do not develop
e.g. Family planning, Genetic counseling
Secondary prevention
Interventions with high risk groups
e.g., suicide hot-lines, job training in economically depressed areas
Tertiary prevention
Help people adjust after they are released from the hospital in order to help prevent a relapse
e.g. halfway houses, long-term outpatient care
Community psychology attempts to minimize or prevent mental disorders – not just treat them