1. Therapies Chapter 16 AP Psychology Alice F. Short Hilliard Davidson High School

2. Chapter Preview Biological Therapies Psychotherapy Sociocultural Approaches and Issues Effectiveness of Psychotherapy Therapies and Health and Wellness

3. Biological Therapies Biomedical Approach – reduce/eliminate symptoms by altering body functioning Common Forms of Biological Therapy – drug therapy – electroconvulsive therapy (ECT) – psychosurgery

4. Drug Therapy antianxiety drugs – commonly known as tranquilizers, drugs that reduce anxiety by making the individual calmer and less excitable – benzodiazepines – the antianxiety drugs that generally offer the greatest relief for anxiety symptoms potentially addictive bind to receptor cites of neurotransmitters that become overactive during anxiety examples: Xanax, Valium, Librium – nonbenzodiazepine – buspirone (BuSpar) – used to treat generalized anxiety disorder

5. Drug Therapy antidepressant drugs – drugs that regulate mood – tricyclics – 3-ringed molecular structure believed to work by increasing neurotransmitters, especially serotonin and norepinephrine reduce symptoms of depression in 60-70 percent takes 2-4 weeks to improve mood side effects: restlessness, faintness, trembling, sleepiness, memory difficulties – tetracyclics – 4-ringed molecular structure a.k.a. noradrenergic and specific serotonergic antidepressants (NaSSAs) increases norepinephrine and serotonin example: Remeron (mertazapine) – most effective in reducing depression – monoamine oxidase (MAO) inhibitors block the enzyme monoamine oxidase (which breaks down serotonin and norepinephrine worse side effects: high blood pressure, stroke (esp. with fermented foods, drugs) – selective serotonin reuptake inhibitors (SSRIs) interfere with the reabsorption of serotonin in the brain examples: Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline) fewer side effects, still: insomnia, anxiety, headache, diarrhea, impaired sexual functioning

6. Antidepressant Drugs 1996  2005 – number of Americans prescribed antidepressants doubled anxiety disorders: generalized anxiety disorder, obsessive- compulsive disorder, social anxiety disorder PTSD Bipolar Disorder – lithium – the lightest of the solid elements in the periodic table of elements – effective dosage is precariously close to toxic levels – influences serotonin and norepinephrine (how unknown) – weight gain, going off drug Risks of Antidepressants for Children – FDA hearings on risk of suicide (2004) – “Black Box” warning

7. Drug Therapy antipsychotic drugs – powerful drugs that diminish agitated behavior, reduce tension, decrease hallucinations, improve social behavior, and produce better sleep patterns in individuals with a severe psychological disorder, especially schizophrenia – small dosages over time, may combine with vocation, family and social skills training – neuroleptics (side effect - tardive dyskinesia) most used ability to block dopamine action in the brain tardive dyskinesia – a neurological disorder characterized by involuntary random movements of the facial muscles, tongue and mouth, as well as twitching of the neck, arms and legs – 20% on neuroleptics develop (can develop w/o drugs – atypical antipsychotic medications (introduced 1990s) lower side effects affects dopamine and serotonin (mechanism unknown) examples: Clozaril (clozapine), Risperdal (risperidone)

8. Drug Therapy

9. Biological Therapies electroconvulsive therapy (a.k.a. shock therapy) – small electric current produces a brief seizure – used to treat major depressive disorder which has not responded to other treatments – deep brain stimulation – a procedure for treatment- resistant depression that involves the implantation of electrodes in the brain that emit signals to alter the brains electrical circuitry treatment-resistant depression, OCD nucleus acumbens – improved dramatically, still memory loss and cognitive impairments – for acute depression, great risk of suicide

10. Biological Therapies psychosurgery – a biological therapy, will irreversible effects, that involves removal or destruction of brain tissue to improve the individuals adjustments – prefrontal lobotomies coined by Walter Freemen, “lobotomobile” today: small lesion in amygdala or another part of the limbic system – OCD – major depression – bipolar disorders – not schizophrenia

11. Insight Therapies insight therapies – encourage self-awareness as the key to psychological health – psychodynamic therapies – humanistic therapies

12. Psychotherapy psychotherapy (face-to-face and cybertherapy) a nonmedical process that helps people with psychological disodres recognize and overcome psychological and interpersonal difficulties – 32% in 1996  20% in 2005 Preview of Psychotherapies – psychodynamic therapies – humanistic therapies – behavior therapies – cognitive therapies

13. Psychodynamic Therapies Emphasis of this Approach – unconscious mind – therapeutic interpretation – early childhood experiences Goals of Therapy – recognize maladaptive coping strategies – identify sources of unconscious conflicts

14. Psychodynamic Therapies Freudian Psychoanalysis – Freud’s therapeutic technique for analyzing an individual’s unconscious thoughts – free association – a psychoanalytic technique that involves encouraging individuals to say aloud whatever comes to mind, no matter who trivial or embarrassing catharsis – the release of emotional tension a person experiences when reliving an emotionally charged and conflicting experience – interpretation – a psychoanalyst’s search for symbolic, hidden meanings in what the client says and does during therapy – dream analysis – a psychoanalytic technique for interpreting a person’s dreams manifest content latent content – transference – a client's relating to the psychoanalyst in ways the reproduce or relive important relationships in the individual’s life – resistance – a client’s unconscious defense strategies that interfere with the psychoanalysts understanding of the individuals problems examples: showing up late/missing sessions, arguing, faking free associations Contemporary Psychodynamic Therapies – still interested in childhood trauma – accord more power to the conscious mind and a person’s current relationships – less emphasis on sex – Heinz Kohut (1977) – therapist replaces unhealthy childhood relationship (empathic, understanding)

15. Humanistic Therapies humanistic therapies – treatments, unique in their emphasis on people’s self-healing capacities, that encourage clients to understand themselves and to grow personally – self healing – conscious thoughts – self-fulfillment goals of therapy – self-understanding – personal growth

16. Roger’s Client-Centered Therapy client-centered therapy – also called Rogerian therapy or nondirective therapy, a form of humanistic therapy, developed by Rogers, in which the therapist provides a warm, supportive atmosphere to improve the client’s self-concept and to encourage the client to gain insight into problems – identify and understand his or her own genuine feelings – warm, supportive atmosphere active listening reflective speech – a technique in which the therapist mirrors the client’s own feelings back to the client – Roger’s 3 essential elements to grow: unconditional positive regard empathy genuineness

17. Behavior Therapies behavior therapies – treatments, based on the behavioral and social cognitive theories of learning, that use principles of learning to reduce or eliminate maladaptive behavior – emphasis: overt behavior change rather than insights into self or into underlying causes – goal: reduce or eliminate maladaptive behaviors – common methods: classical and operant conditioning

18. Behavior Therapies Classical Conditioning Techniques Treating Phobias systematic desensitization – a method of behavior therapy that treats anxiety by teaching the client to associate deep relaxation with increasingly intense anxiety-producing situations (p. 533) – develop hierarchy of fearful scenes – learn relaxation techniques – apply relaxation while imagining fearful scenes Flooding – intense exposure to feared stimuli without allowing avoidance

19. Desensitization for Test Anxiety

20. Aversive Conditioning noxious stimuli paired with conditioned stimulus

21. Behavior Therapies Operant Conditioning Techniques… – unlearning maladaptive behavior (e.g., OCD) through altered consequences. Applied Behavior Analysis – positive reinforcement of adaptive behaviors – extinguish maladaptive behaviors – does not depend on gaining insight

22. Cognitive Therapies cognitive therapies Emphasis of this Approach – thoughts (cognitions) are the primary source of psychological problems – how we think controls how we feel attempt to change the individual’s feelings and behaviors by changing cognitions – focus on overt problems (unlike Freud) – structured analysis and specific guidance (unlike Rogers) Goals of Therapy – cognitive restructuring – a general concept for changing a pattern of thought that is presumed to be causing maladaptive behavior or emotion

23. Cognitive Therapies Albert Ellis’s Rational-Emotive Behavior Therapy – assertion that individuals develop a psychological disorder because of irrational and self-defeating beliefs – directive, persuasive, confrontational – musterbating convert “musts” into realistic and logical thoughts – eliminate beliefs through rational examination Beck’s Cognitive Therapy – illogical automatic negative thoughts – identify and challenge automatic thoughts – reflective, open-ended dialogue, less directive Both are more effective in treating depression than drugs.

24. Cognitive Therapy Techniques challenge idiosyncratic meanings question the evidence reattribution examine options and alternatives decatastrophize fantasize consequences examine advantages and disadvantages turn adversity to advantage guided association scaling thought stopping distraction labeling of distortions Table on p. 357

25. Cognitive Therapy Techniques

26. Cognitive-Behavior Therapy Albert Bandura and Self Efficacy – self-efficacy – concept that one can master a situation and produce positive outcomes cognitive-behavior therapy – a therapy that combines cognitive therapy and behavior therapy with the goal of developing self-efficacy – self-defeating thoughts – incorporates behavior therapy – self-instructional methods

27. Therapy Integrations Techniques from different therapies are combined for the benefit of the client (e.g., dialectical behavior therapy).

28. Comparing Psychotherapies integrative therapy – a combination of techniques from different therapies based on the therapist’s judgment of which particular methods will provide the greatest benefit for the client – most therapists use an eclectic approach

29. How Does Therapy Affect the Brain? Brain Imaging Studies – use of functional magnetic resonance imaging (fMRI) – shows that brain function can be normalized (e.g., cognitive remediation therapy increases prefrontal cortex activity in schizophrenics)

30. Sociocultural Approaches Emphasis – influence of various social/cultural factors – views the individual as a part of a system of relationships that are influenced by various social and cultural factors Approaches to Therapy – group therapy – a sociocultural approach to the treatment of psychological disorders that brings together individuals who share a particular psychological disorders in sessions that are typically led by a mental health professional information universality – others feel the same altruism – others provide advice, sympathy and support experiencing a positive family group – resembles (or is) a family development of social skills – corrective feedback (accept from group) interpersonal learning – training new behaviors

31. Sociocultural Approaches Approaches to Therapy – family therapy – group therapy with a family validation – understanding and acceptance of each family member (validates); finds positives reframing – as family problems (not individual) structural change - restructure coalitions and roles detriangulation – shift attention away from scapegoat – couples therapy – group therapy with married or unmarried couples whose major problem lies within their relationship communication = most common problem

32. Sociocultural Approaches Approaches to Therapy – self-help support groups – voluntary organizations of individuals who get together on a regular basis to discuss topics of common interest paraprofessionals relatively cheap Example: Alcoholics Anonymous (AA) online support groups – problems: pro-ana (pro-anorexia) Web sites – community mental health (1960s) changes in attitudes toward people with psychological disorders involves training teachers, ministers, family physicians, nurses, and others who directly interact with community members to offer lay counseling and workshops Community Mental Health Act of 1963 – deinstitutionalization – transferred from mental institutions to community-based facilities (rise in homelessness)

33. Sociocultural Approaches and Issues Cultural Perspectives – individualistic v. collectivistic cultures collectivist – group therapy may be more effective – ethnicity match between client and therapist ethnic-specific service – gender balance between independence and relatedness feminist therapies

34. Effectiveness of Psychotherapy Research results show that all therapies are “winners”. – dodo bird hypothesis Common Themes in Successful Psychotherapy – expectations of help – increased sense of competence – emotional arousal is a motivator – therapeutic alliance - the relationship between the therapist and client—an important element of successful psychotherapy – client factors (active engagement)

35. Effectiveness of Psychotherapy

36. Effects of Therapy on Health and Wellness stress reduction in cancer patients reduces physical health risks in those who are depressed not only reduces symptoms, but enhances psychological wellness well-being therapy (WBT) – short-term, problem-focused, directive – notice and celebrate positive experiences

37. Chapter Summary Describe the biological approaches to therapy. Define and characterize four types of psychotherapy. Explain the sociocultural approaches and issues in treatment. Discuss the effectiveness of psychotherapy. Discuss the impact that therapy has on health and wellness.

38. Chapter Summary Biological Therapies – drug therapy – electroconvulsive therapy – psychosurgery Psychodynamic Therapies – Freud’s psychoanalysis Humanistic Therapies – Rogers’s client-centered therapy

39. Chapter Summary Behavior Therapies – systematic desensitization and flooding – aversive conditioning Cognitive Therapies – Ellis’s rational-emotive behavior therapy – Beck’s cognitive therapy – cognitive-behavior therapies

40. Chapter Summary Sociocultural Approaches and Issues – group, family, and couples therapy – self-help groups and community mental health – cultural perspectives Effectiveness of Psychotherapy Therapies and Health and Wellness – physical health and preventing disorders