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SUMMARY of Psych Therapy designs Refer to chapter 16 to accompany these notes!
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History of treatment Attitudes towards and treatment of the mentally ill have changed significantly over time Anciently – believed mentally ill were possessed by demons – trephining – drilled holes in their skull to release spirits Imprisonment Progressive era – call for more humane treatment – counseling and institutions –Dorothea Dix in US –Philippe Pinel in France
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Post 1950s Pharmacology MEDS – drugs De-institutionalization Seek to treat mentally with meds and with out- patient counseling Get away from lifetime institutionalization Side effect – increase mentally ill population in prison or homeless - struggle to function
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60 Minutes Clip Jan 2014 – Cree Deeds son’s suicide – danger of de- institutionalization http://www.cbsnews.com/news/mentally-ill-youth-in- crisis/http://www.cbsnews.com/news/mentally-ill-youth-in- crisis/
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Today Continue trend in medication and out- patient therapy Increased emphasis on PREVENTION – how……? – de- stressors –Stable families –Emphasize better nutrition, exercise, sleep, etc.
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Summary of different treatment perspectives
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Psychoanalysis Issue - Person’s symptoms are outward manifestation of deeply repressed problems, possibly from childhood Freud Role of Uncon Developmental fixation Emphasis on childhood, trauma, repression Projective tests – free association, hypnosis, dream analysis, ink blot, TAT
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Humanism Summary Issue – boost patients self-esteem by helping him realize his potential, possibilities for growth, and self-actualization Maslow and Rogers Therapy techniques – unconditional positive regard, client centered therapy, active listening, show genuine concern for patient People are innately good NOT deterministic – you can use your agency to choose your course in life Key terms – hierarchy of needs, free will, self-actualization
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Behaviorism Summary Issue – abnormal behavior is caused by a dysfunctional environment. Change the environment – fix the behavior 100% nurture – ALL behaviors are learned Skinner and operant conditioning (alter reinforcements or punishments) Bandura and social modeling – model healthy behaviors Classical Conditioning – Counter Condition – replace association of anxiety/fear with calm – hierarchy of fears –Systematic desensitization – proceed step by step by imagining –In vivo desensitization – proceed step by step live –Implosive Therapy – imagine most frightening scenario (top of hierarchy) –Flooding – actually do most frightening scenario – live –(ultimate goal is always to do it live – but you may do imagination first)
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Cognitive - Summary Issue – dysfunctional behaviors are caused by dysfunctional thoughts. Confront the patient’s irrational thoughts Albert Ellis – Rational Emotive Therapy – expose irrational thoughts Locus of Control – (internal V. external) be realistic in what you take credit for or what you take blame for Seligman’s – Learned helplessness – do you have control of your situation – do you take action? Aaron Beck’s Cognitive Triad – dysfunctional thoughts about your 1.) self, 2.) your world, and 3.) your future
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Cognitive Summary Aaron Beck’s Cognitive Triad – dysfunctional thoughts about your 1.) self, 2.) your world, and 3.) your future
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Cognitive Summary Dysfunctional Attribution Style Failures Internal – I am a loser Global – I suck at everything Stable – I will always suck at everything Successes External – I got lucky/the test was easy Specific – I only got a good grade on this one test Unstable – this success won’t last
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Pharmacology – MEDS Emphasis on biomedical causes – Chemical imbalances Brain abnormalities Genetic Predispositions (NATURE)
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MEDS Anti-Psychotic (Schizophrenia) –Too much dopamine –Drugs block receptor sites for dopamine - diminish + symptoms (hallucinations and delusions) –Haldol, Thorazine –Side effect – tardive dyskinesia Anti-Depressants -Unipolar depression - Too little serotonin – Prozac and Zoloft block serotonin reuptake -Bipolar – lithium Anti-Anxiety - Barbiturates – valium, Xanax – depress activity of central nervous system
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MEDS Risks of all meds – Finding right med at the right dosage – often process of trial and error –ALL meds have some kind of undesirable side effect
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Other Medical Interventions Electroconvulsive Therapy (ECT) – induced medical seizure – used historically to treat multiple mental illnesses –used today as last resort treatment of depression –Risk = possible memory loss
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Other Medical Interventions Psychosurgery – historical prefrontal lobotomies 1950s/60s (JFK’s sister, “One Flew Over the Cuckoo's Nest”)
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60 Minute Clips on Treatment Sept 2013 – Untreated Mental illness and connection to mass shootings:Sept 2013 – Untreated Mental illness and connection to mass shootings: http://www.cbsnews.com/video/watch/?id=50156091n
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