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Therapy: Does it Work? Last Lecture 5/03/04. Trustworthy Testimonials? “My therapist works wonders” “I work wonders”

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Presentation on theme: "Therapy: Does it Work? Last Lecture 5/03/04. Trustworthy Testimonials? “My therapist works wonders” “I work wonders”"— Presentation transcript:

1 Therapy: Does it Work? Last Lecture 5/03/04

2 Trustworthy Testimonials? “My therapist works wonders” “I work wonders”

3 Consumer Reports: 22,000 Rate laundry detergents; Breakfast cereals; home appliances, automobiles… Rate laundry detergents; Breakfast cereals; home appliances, automobiles…AND “If at any time over the past 3 years, you experienced stress of other emotional problems for which you sought help…” “If at any time over the past 3 years, you experienced stress of other emotional problems for which you sought help…” How much did it help? How much did it help? Were you satisfied? Were you satisfied?

4 What percentage of patients? Indicated treatment made things: Indicated treatment made things: A lot worse A lot worse Somewhat worse Somewhat worse No different No different Somewhat better Somewhat better A lot better A lot better Indicated they were: Not satisfied at all Fairly satisfied Highly satisfied 2,900 (40%) sought help from psychologist, psychiatrist, social worker, or marriage counselor 2,900 (40%) sought help from psychologist, psychiatrist, social worker, or marriage counselor

5 Most people… Indicated treatment made things Indicated treatment made things Somewhat better Somewhat better A lot better A lot better Indicated they were Fairly satisfied Highly satisfied 86% 89%

6 So long…

7 Hello Psychotherapy Psychoanalytic Therapy Behavioral Therapy Cognitive Therapy Humanistic Group Biological Therapies Drugs, ECT, Psychosurgery

8 Behavioral Therapy: tell me what you want to change… Behavior = problem, not result Behaviors are learned Therefore, can be unlearned Classical Conditioning Techniques Flooding, Systematic Desensitization, Aversion Therapy Operant-Conditioning Techniques Reward and Punishment, Token Economy, Biofeedback, Social Skills Training

9 Flooding Patient saturated with fear-provoking stimulus until anxiety is extinguished After repeatedly presenting bell without food… Stopped salivating Repeatedly expose phobic to fearful situation w/out negative consequences…

10 Systematic Desensitization Treat anxiety disorders by pairing gradual exposure to anxiety-provoking situation with relaxation Condition to respond to fear w/ calm, not anxiety Relaxation Training Anxiety hierarchy Gradual exposure

11 1. Sit back comfortably, loosen clothing, take shoes off, take a deep breath, let muscles get loose and heavy 2. Wrinkle forehead, tighter, tighter, tighter, clinch jaw, purse lips… 3. Stop tensing and Relax. Picture smooth forehead, open mouth, loosen lips

12 Now that you can relax on cue You see a newspaper ad for discount airfares (0) You see a newspaper ad for discount airfares (0) You look out window as plane leaves ground (100) You look out window as plane leaves ground (100)

13 Close your eyes and imagine… Start with mildest fear-provoking situation Start with mildest fear-provoking situation If you keep your cool, progress If you keep your cool, progress If anxious, stop and relax If anxious, stop and relax Can be imaginal or in vivo… Can be imaginal or in vivo… Phobias, OCD, bulimia, etc. Phobias, OCD, bulimia, etc.OCD

14 Aversion Therapy Technique to react with aversion to harmful substances Calm doesn’t apply to smoking, drinking, overeating and other destructive habits Goal: e.g. get drinkers to feel sick to stomach at sight, smell, and taste of liquor

15 Cognitive Therapy Distorted thoughts produce maladaptive behavior (depression, anxiety, emotional/ mood disorders) Open your minds, think about old problems in new ways, challenge assumptions… Rational-Emotive Behavior Therapy Beck’s Cognitive Therapy Therapist = partner, friend, teacher Sessions focused on concrete problems

16 Rational Emotive Therapy (RET) Distress caused by ways ppl construe events, not upsetting events per se… Distress caused by rigid, maladaptive ways ppl construe events, not upsetting events per se… Irrational beliefs: Irrational beliefs: I have to be perfect at everything I do I have to be perfect at everything I do Everyone must like me Everyone must like me

17 Ellis’ A-B-C Theory of Emotional Distress Activating Event - Beliefs – Consequences “ My approach to psychotherapy is to zero in as quickly as possible on the client’s basic philosophy of life; get him to see exactly what this is and how it’s self-defeating; and to persuade him to work his ass off, cognitively, emotionally, and behaviorally, to profoundly change it”

18 Where is it written that life’s supposed to be fair? Not easy to rid ppl of lifelong assumptions Not easy to rid ppl of lifelong assumptions Blunt, confrontational techniques Blunt, confrontational techniques E.g. shy woman in subway E.g. shy woman in subway Step out of character Step out of character Psychoeducation Psychoeducation “Not just to FEEL better, but to get better” “Not just to FEEL better, but to get better” SHAPE UP ALREADY! SHAPE UP ALREADY!

19 Get real, get smart, get going!

20 Beck: It’s my fault, I can’t do anything right, It’s the story of my life… Same idea, gentler, more collaborative approach Same idea, gentler, more collaborative approach Restructure interpretations by questioning Restructure interpretations by questioning “Is there another way to look at the sitch.?” “Is there another way to look at the sitch.?” “What’s the worst thing that could happen?” “What’s the worst thing that could happen?” Distress in therapy Distress in therapy Keep diary: situation, felt, thinking, rational? Keep diary: situation, felt, thinking, rational? Bibliotherapy: You feel the way you think Bibliotherapy: You feel the way you think

21 The Bottom Line: Does Psychotherapy Work? Based on the results of 475 studies (Smith et al., 1980), the average psychotherapy client shows more improvement than 80% of those in the no-treatment control group.

22 BUT: Untreated ppl improve Untreated ppl improve Ppl who receive therapy are somewhat more likely to improve regardless of kind Ppl who receive therapy are somewhat more likely to improve regardless of kind All approaches are equally effective All approaches are equally effective For some disorders, certain types of therapy tend to be more successful. For some disorders, certain types of therapy tend to be more successful. Placebo treatments also improve Placebo treatments also improve

23 What are the Active Ingredients? Common, nonspecific factors apparent in all types of psychotherapy: Common, nonspecific factors apparent in all types of psychotherapy: Supportive Relationship Supportive Relationship A Ray of Hope A Ray of Hope Opportunity to Open Up Opportunity to Open Up

24 On opening up… Preventative medicine?

25 Writing Paradigm: Overview For the next four days, I would like for you to write your very deepest thoughts and feelings about the most traumatic experience of your life. In your writing, I’d like you to really let go and explore your very deepest emotions and thoughts. You might tie your topic to your relationships with others, including parents, lovers, friends, or relatives. You may also want to link your experience to your past, your present, or your future, or to who you have been, who you would like to be, or who you are now. You may write about the same general issues or experiences on all days of writing, or on different traumas each day. All of your writing will be completely confidential.

26 Monthly Health Center Visits: ( Across four studies)

27 Samples of Participants Students (undergraduates, medical students, adolescents) Students (undergraduates, medical students, adolescents) Maximum security prisoners Maximum security prisoners Unemployed engineers Unemployed engineers Holocaust survivors Holocaust survivors University staff members University staff members Chronic pain, arthritis, and asthma patients Chronic pain, arthritis, and asthma patients Recently bereaved adults Recently bereaved adults PTSD samples PTSD samples

28 Objective Health Improvements following writing Reduced physician visits for illness Reduced physician visits for illness Fewer absentee days among university staff Fewer absentee days among university staff Reduced medication use among pain patients Reduced medication use among pain patients Reduced alcohol consumption (older, non- college samples only) Reduced alcohol consumption (older, non- college samples only) Reduced blood pressure, skin conductance, muscle tension Reduced blood pressure, skin conductance, muscle tension Long-term physiological markers (e.g. NK cell activity, CD-4 (t-lymphocyte) levels) Long-term physiological markers (e.g. NK cell activity, CD-4 (t-lymphocyte) levels)

29 Emotional Expression: NO WORDS? Dance study (Krantz, 1993) Dance study (Krantz, 1993) Conditions: Conditions: Dance only Dance only Dance + write Dance + write Exercise Exercise

30 Changes in Handwriting

31 Linguistic Inquiry and Word Count LIWC A computer-based text analysis program

32 LIWC Dimensions I. Standard linguistic dimensions I. Standard linguistic dimensions Word count, pronouns, articles, prepositions II. Psychological processes II. Psychological processes EmotionsSensory Processes Cognitive processesSocial Processes III. Relativity III. Relativity Time, space, motion IV. Personal concerns IV. Personal concerns OccupationReligion LeisurePhysical states (illness, sex, sleeping) Money

33 Language Dimensions Predicting Health

34 To Health Personal upheavals cause havoc by: Personal upheavals cause havoc by: disrupting normal cognitive activity disrupting normal cognitive activity undermining social interactions and relationships undermining social interactions and relationships Writing about an upheaval: Writing about an upheaval: reduces the need to inhibit thoughts, emotions, behaviors reduces the need to inhibit thoughts, emotions, behaviors brings about cognitive resolution, freeing up working memory brings about cognitive resolution, freeing up working memory allows for more open social relationships allows for more open social relationships

35 The End


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