1. Copyright McGraw-Hill, Inc. 2010 1 Chapter 13 Therapies

2. Copyright McGraw-Hill, Inc. 2010 2 Chapter Preview Biological Therapies Psychotherapy Sociocultural Approaches and Issues in Treatment The Effectiveness of Psychotherapy

3. Copyright McGraw-Hill, Inc. 2010 3 Biological Therapies Also called biomedical therapies Treatments that reduce or eliminate symptoms of psychological disorders by altering aspects of body functioning Drug Therapy Electroconvulsive Therapy Psychosurgery

4. Copyright McGraw-Hill, Inc. 2010 4 Drug Therapy Revolutionized mental health care in the 20 th century Psychotherapeutic drugs used mainly in... Anxiety disorders  Antianxiety drugs Mood disorders  Antidepressant drugs Schizophrenia  Antipsychotic drugs

5. Copyright McGraw-Hill, Inc. 2010 5 Antianxiety Drugs Commonly known as tranquilizers Bind to receptor sites of neurotransmitters that become overactive during anxiety Benzodiazepines Relatively fast acting Side effects include drowsiness, loss of coordination Can become addictive Non-benzodiazepines

6. Copyright McGraw-Hill, Inc. 2010 6 Antidepressant Drugs Regulate mood through effects on neurotransmitters Tricyclics Increase norepinephrine and serotonin levels Monoamine Oxidase (MAO) Inhibitors Block enzyme that breaks down serotonin and norepinephrine Selective Serotonin Reuptake Inhibitors (SSRI) Interfere with reabsorption of serotonin in brain Lithium Solid element used to treat bipolar disorder

7. Copyright McGraw-Hill, Inc. 2010 7 Antipsychotic Drugs Neuroleptics Block dopamine’s action in brain Side effects include... Dysphoria  Lack of pleasure Tardive Dyskinesia  Movement disorder Atypical Antipsychotic Medications Lower risk of side effects Block reuptake of serotonin

8. Copyright McGraw-Hill, Inc. 2010 8 Drug Therapy

9. Copyright McGraw-Hill, Inc. 2010 9 Electroconvulsive Therapy Commonly called shock therapy Goal is to set off seizure in brain Used primarily to treat severe depression Patient receives anesthesia and muscle relaxants Controversial Side effects

10. Copyright McGraw-Hill, Inc. 2010 10 Psychosurgery Irreversible removal or destruction of brain tissue to improve adjustment Prefrontal Lobotomy Severing of fibers connecting frontal lobe with thalamus Actual effectiveness questioned Ethical concerns

11. Copyright McGraw-Hill, Inc. 2010 11 Psychotherapy Nonmedical process that helps individuals with psychological disorders recognize and overcome their problems Approaches include... Psychodynamic Humanistic Behavior Cognitive

12. Copyright McGraw-Hill, Inc. 2010 12 Mental Health Professionals

13. Copyright McGraw-Hill, Inc. 2010 13 Psychodynamic Therapies Stress importance of... Unconscious mind Extensive interpretation by therapist Role of early childhood experiences Psychoanalysis (Freud) Contemporary Psychodynamic Therapies

14. Copyright McGraw-Hill, Inc. 2010 14 Psychoanalysis Freud’s therapeutic technique for analyzing unconscious thoughts Goal is to bring unconscious conflicts into conscious awareness Free Association Interpretation Dream Analysis

15. Copyright McGraw-Hill, Inc. 2010 15 Psychoanalysis Free Association Encouraging individuals to say aloud whatever comes to mind Catharsis Release of emotional tension when reliving emotionally-charged or conflicting experiences Interpretation Search for symbolic, hidden meaning

16. Copyright McGraw-Hill, Inc. 2010 16 Dream Analysis Interpreting dreams, which contain information about unconscious thoughts, wishes, and conflicts Manifest Content Conscious, remembered aspects of dream Latent Content Unconscious, hidden aspects symbolized by manifest content

17. Copyright McGraw-Hill, Inc. 2010 17 Psychonanalysis Transference Inevitable – and essential – aspect of therapeutic relationship Relating to analyst in ways that reproduce or relive important relationships Resistance Unconscious defense strategies

18. Copyright McGraw-Hill, Inc. 2010 18 Contemporary Psychodynamic Therapies Accord more power to... Conscious mind Current relationships Kohut’s view Early social relationships with attachment figures as critical Internalized relationships as basis for self

19. Copyright McGraw-Hill, Inc. 2010 19 Humanistic Therapies Encourage people to understand themselves and to grow personally Emphasis on self-healing capacities Client-Centered Therapy (Rogers) Warm, supportive atmosphere to improve self-concept and to encourage insight Reflective speech used to mirror feelings Unconditional positive regard, empathy, genuineness Therapist’s role as non-directive

20. Copyright McGraw-Hill, Inc. 2010 20 Behavior Therapies Use principles of learning to reduce or eliminate maladaptive behavior Classical Conditioning Techniques Systematic Desensitization Flooding Aversive Conditioning Operant Conditioning Techniques Applied Behavior Analysis

21. Copyright McGraw-Hill, Inc. 2010 21 Cognitive Therapies Emphasize thoughts as main source of psychological problems Attempt to change feelings and behaviors by changing cognitions Cognitive Restructuring Changing pattern of thought presumed to be causing maladaptive behavior or emotion Albert Ellis’s Rational-Emotive Behavior Therapy Aaron Beck’s Cognitive Therapy Cognitive-Behavior Therapy

22. Copyright McGraw-Hill, Inc. 2010 22 Rational-Emotive Behavior Therapy Emotional reactions to life events as product of irrational beliefs and expectations Central false belief that feelings cannot be controlled Demands (“musterbating”) create dysfunctional, exaggerated beliefs Goal of eliminating self-defeating beliefs by rationally examining them Directive, persuasive, confrontational

23. Copyright McGraw-Hill, Inc. 2010 23 Beck’s Cognitive Therapy Problems, such as depression, as result of illogical thoughts about self, world, future Emotions as product of cognitions Goal of bringing automatic thoughts to awareness so they can be changed Challenging accuracy of automatic thoughts Logical errors  Erroneous beliefs More open-ended dialogue with therapist

24. Copyright McGraw-Hill, Inc. 2010 24 Cognitive-Behavior Therapy Combination of... Cognitive therapy  Reducing self-defeating thoughts Behavior therapy  Changing behavior Self-Efficacy (Bandura) Mastering situation and producing positive outcomes Self-Instructional Methods Teaching to modify own behavior Using reinforcing self-statements to take positive steps

25. Copyright McGraw-Hill, Inc. 2010 25 Use of Cognitive Therapy Anxiety Disorders Panic Disorder Post-Traumatic Stress Disorder Generalized Anxiety Disorder, Phobias, OCD Mood Disorders Depression Schizophrenia Personality Disorders

26. Copyright McGraw-Hill, Inc. 2010 26 Therapy Comparisons

27. Copyright McGraw-Hill, Inc. 2010 27 Therapy Integrations Integrative Therapy Combination of techniques from different therapies based on therapist’s judgment Dialectical Behavior Therapy Used for borderline personality disorder Includes variety of techniques Also, treating with psychotherapy and drug therapy Conceptually compatible with biopsychosocial model

28. Copyright McGraw-Hill, Inc. 2010 28 Sociocultural Approaches & Issues Individual as part of social system of relationships, influenced by social and cultural factors Group Therapy Family and Couples Therapy Self-Help Support Groups Community Mental Health Cultural Perspectives on Therapy

29. Copyright McGraw-Hill, Inc. 2010 29 Group Therapy Individuals sharing psychological disorder brought together in sessions typically led by mental health professional Relationships as key to successful therapy Features: Information Universality Altruism Experiencing positive family group Development of social skills Interpersonal learning

30. Copyright McGraw-Hill, Inc. 2010 30 Family and Couples Therapy Family Therapy Group therapy among family members Couples Therapy Group therapy with married or unmarried couples with relationship problems Symptoms as function of relationships

31. Copyright McGraw-Hill, Inc. 2010 31 Family Therapy Techniques Validation Understanding and acceptance of each family member’s feelings and beliefs Reframing Problems as family (not individual) problems Structural Change Restructuring coalitions in family Detriangulation Disentangle situations where scapegoating occurs

32. Copyright McGraw-Hill, Inc. 2010 32 Couples Therapy Conflict frequently involves poor communication Attempt to improve communication Focus on roles partners play Addresses diverse problems

33. Copyright McGraw-Hill, Inc. 2010 33 Self-Help Support Groups Voluntary organizations of individuals who get together regularly to discuss topics in common Conducted by paraprofessionals Sympathetic audience for confession, sharing, and emotional release Social support, role modeling, and sharing of concrete problem-solving strategies Alcoholics Anonymous (AA) Compeer Reduce stress and promote adjustment

34. Copyright McGraw-Hill, Inc. 2010 34 Community Mental Health Movement born in 1960s Individuals with disorders ought to remain in society Deinstitutionalization Success depends on resources and commitment of community Training those who directly interact with community members to offer services Explicit goal of helping people who are disenfranchised from society

35. Copyright McGraw-Hill, Inc. 2010 35 Cultural Perspectives Collectivistic Cultures More importance on group, rather than individual Individual psychotherapies may not be as effective Ethnicity Ethnic match between therapist and client Cultural sensitivity and skill Gender Changing roles affect therapy goals

36. Copyright McGraw-Hill, Inc. 2010 36 Effectiveness of Psychotherapy Research  Psychotherapy works. Meta-analysis Statistical combination of results of different studies No one therapy significantly better than others Therapy benefits during first 6 months

37. Copyright McGraw-Hill, Inc. 2010 37 Health & Wellness Benefits Positive effect of therapy on... Ability to cope with disease, such as cancer Physical health as result of relieving psychological disorders, such as depression Health behavior and physical illness May also prevent psychological and physical problems May enhance positive psychological well-being Well-Being Therapy (WBT)

38. Copyright McGraw-Hill, Inc. 2010 38 Common Themes Effective psychotherapies have common elements of... Expectations Mastery Emotional arousal Therapeutic Alliance Relationship between therapist and client Client Factors Quality of participation