1. Psychology: From Inquiry to Understanding 2/e
Scott O. Lilienfeld Steven Jay Lynn Laura Namy
Nancy J. Woolf
Prepared by Assoc. Prof. Dr. Bahar Baştuğ
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2. Psychological & Biological Treatments:
Chapter Sixteen
Psychological & Biological Treatments:
Helping People Change

3. Lecture Preview Psychotherapy Insight therapies Behavioral approaches
Is psychotherapy effective?
Biomedical treatments

4. Popular portrayals of psychotherapy have a long history in the media
Popular portrayals of psychotherapy have a long history in the media. (© Cathy Gaines)
Get help: yardım al, getir...

5. CLIENT: PATIENT: COUNSELEE ====MÜŞTERİ: SABIRLI OLAN: DANIŞAN
TERAPIST: DOCTOR: COUNSELOR===DANIŞMAN

6. Psychotherapy Psychotherapy isn’t easy to define.
A psychological intervention designed to help people resolve emotional, behavioral, and interpersonal problems and improve the quality of their lives.
Over 500 “brands” of psychotherapy. Many of these therapies are effective, but many others haven’t been tested.
LO 16.1

7. Who Seeks and Benefits?
20% of Americans have received psychotherapy at some point in their lives.
Females go more than males, Caucasians seek more than other minority groups. Socioeconomic factors are important for seeking therapy. Therapy can be very costly for those without health insurance.
Therapy can benefit all these groups equally.
Culturally sensitive psychotherapists tune their interventions to clients’ cultural values.
PEOPLE CONTEND (YÜZLEŞMEK, COPE, STRUGGLE) FREQUENTLY WITH FEELINGS OF
HELPLESSNESS, SOCIAL ISOLATION, AND A SENSE OF FAILURE. OTHERS TURN TO THERAPY TO EXPAND THEIR SELF-AWARENESS, LEARN BETTER WAYS OF RELATING TO OTHERS, AND CONSIDER LIFESTYLE CHANGES.
İNSANLAR KENDİ ETNİK KÖKENLERİNDEN GELEN TERAPİSTLE ÇALIŞMAYI TERCİH ETSELER DE, YAPILAN ÇALIMALARDA ETNİK KÖKEN YA DA CİNSİYET BENZERLİĞİNİN TERAPİNİN OUTCOME’INDA ARTMAYA YOL AÇTIĞINI GÖSTEREN BULGULARA RASTLANMAMIŞ. DANIŞAN O KÜLTÜRE YENİ GELDİĞİNDE YA DA HENÜZ İYİCE TANIMADIĞINDA ÖNEMLİ OLABİLİR.
THE EFFECTIVENESS OF THERAPY DEPENDS ON A HOST OF INDIVIDUAL DIFFERENCES. ANKSİYETELİ KİŞİLER TERAPİDE DAHA İYİ OLURLAR, STRESLERİ DEĞİŞMEK İÇİN MOTİVASYON SAĞLAR. TIPKI İLİŞKİ ÇIKMAZI GİBİ GEÇİCİ DURUMLAR YAŞAYANLARDA OLDUĞU GİBİ.
TUNE: UYDURMAK, AYARLAMAK

8. The ideal client?
A 1964 study found that many therapists preferred to treat people who were relatively young, attractive, verbal, intelligent, and successful (YAVIS clients). Nevertheless, therapists have recently become more aware of the importance of assisting a broad clientele of all ages and cultural backgrounds.
CLINTELE: MÜŞTERİLER.
WHAT ARE THE CHARACTERISTICS OF IDEAL CLIENT?

9. Who Practices Psychotherapy?
Clinical psychologists, psychiatrists, counselors, and social workers are the mainstays of the mental health profession.
But people with non-advanced degrees also often offer psychological services.
unlicensed religious, vocational, and rehabilitation counselors, art therapists
Social services agencies, crisis intervention centers.
MAINSTAYS: TEMELLERİ

10. PASTORAL COUNSELOR: PAPAZLIĞA AİT

11. Paraprofessionals
Often obtain agency-specific training and attend workshops that enhance their education.
Little to no difference in effectiveness between experienced and novice therapists. Regardless of level of professional training, people who fulfill the role of therapist may provide clients with hope, empathy, advice, support, appreciate complex ethical, professional, and personal issues and opportunities for new learning experiences.
But, professionals know how to operate within system and choose more effective treatments.
PARAPROFESSIONALS HAVE NO FORMAL PROFESSIONAL TRAINING.
NOVICE: ACEMİ ÇAYLAK
PROFESSIONAL HELPERS (1) UNDERSTAND HOW TO OPERATE EFFECTIVELY WITHIN THE MENTAL HEALTH SYSTEM; (2) APPRECIATE COMPLEX ETHICAL, PROFESSIONAL, AND PERSONAL ISSUES; AND (3) CAN SELECT TREATMENTS OF DEMONSTRATED EFFECTIVENESS.
TRAINED AND EXPERIENCED THERAPISTS MAY BE MORE CONFIDENT, LESS DEFENSIVE, AND BETTER ABLE TO APPRECIATE CLIENTS’ WORLD-VIEW THAN LESS EXPERIENCED THERAPISTS.

12. During the first month of treatment, many clients improve considerably
During the first month of treatment, many clients improve considerably. In fact, 40 to 66 percent of clients report improvement even before attending their first session. The act of seeking help—doing something about one’s problems—apparently inspires hope and breeds confidence.
YAPILAN ÇALIŞMALAR GÖSTERMİŞ Kİ TERAPİSTLER HASTALARININ SORUNLARINI ÇÖZMEK İSTİYORLAR, OYSA HASTALAR SADECE DİNLENİLMEK İSTİYORLAR.
RESEARCH SHOWS THAT THERAPISTS WANT TO SOLVE THEIR CLIENTS’ PROBLEMS, WHEREAS CLIENTS WANT TO BE LISTENED.

14. In Treatment, Laura develops sexual feelings for her therapist, Paul
In Treatment, Laura develops sexual feelings for her therapist, Paul. Paul doesn’t have a sexual relationship with her. A sexual relationship with a client is highly unethical. Which of the following behaviors is also unethical?
A) Revealing a client’s plan to commit suicide to a family member to prevent the suicide.
B) Revealing a client’s plan to assault another person to prevent the assault.
C) Informing a client’s elderly father that she harbors hateful feelings toward him.
HARBOR:BREED

15. Effective Therapists Warm and direct.
Establish a positive working relationship.
Tend not to contradict clients.
Select important topics to focus on in session.
Match treatments to needs of clients.
CONTRADICT:DISPUTE

16. Insight Therapies
Psychotherapies where the goal is to expand awareness or insight.
Encompasses psychodynamic, humanistic, and group approaches.
PSYCHOANALYSIS TENDS TO BE EXPENSIVE, LENGTHY (OFTEN LASTING YEARS OR EVEN DECADES), AND OFTEN INVOLVES MEETING MOST DAYS OF THE WEEK, PSYCHODYNAMIC THERAPY IS TYPICALLY LESS COSTLY, BRIEFER—WEEKS OR MONTHS OR OPEN-ENDED—AND INVOLVES MEETING ONLY ONCE OR TWICE A WEEK.
NEO-FREUDIANS ADOPTED FREUD’S PSYCHODYNAMIC PERSPECTIVE BUT MODIFIED HIS APPROACH IN DISTINCTIVE WAYS.

17. Psychodynamic Therapy
Share the following approaches and beliefs:
Causes of abnormal behaviors stem from traumatic or adverse childhood experiences.
Analyze certain things, including avoided thoughts and feelings, wishes and fantasies, significant past events, recurring themes and life patterns and the therapeutic relationship.

18. Psychodynamic Therapy
When clients achieve insight into unconscious material, the causes and significance of symptoms become evident.
This insight then often causes symptoms to disappear.
INSIGHT: İÇGÖRÜ
INTROSPECTION: İÇEBAKIŞ

19. Psychoanalysis Developed by Freud, one of the first forms of therapy.
Goal is to decrease guilt and frustration and make the unconscious conscious.
Try to bring to awareness previously repressed impulses, conflicts, and memories.
LO 16.3

20. Psychoanalytic Approaches
Free association
Interpretation
Dream analysis
Resistance
Transference
Working through
PSYCHOANALISTS USE FOLLOWING PRIMARY APPROACHES:
AS CLIENTS LIE ON A COACH IN A COMFORTABLE POSITION, THERAPISTS INSTRUCT TO SAY WHATEVER THOUGHTS COME TO MIND, NO MATTER HOW MEANINGLESS THEY MIGHT SEEM. CLIENTS ARE ALLOWED TO EXPRESS THEMSELVES WITHOUT CENCORSHIP.
FROM THE CLIENT’S FREE ASSOCIATIONS, ANALYSTS FORM HYPOTHESES REGARDING THE ORIGIN OF THE CLIENT’S DIFFICULTIES AND SHARE THEM WITH HIM OR HER AS THE THERAPEUTIC RELATIONSHIP DEVELOPS. THERAPISTS FORMULATE INTERPRETATIONS—EXPLANATIONS— OF THE UNCONSCIOUS BASES OF A CLIENT’S DREAMS, EMOTIONS, AND BEHAVIORS. INTERPRETATION İÇİN ZAMANLAMA ÖNEMLİDİR. EĞER TERAPİST HASTA HAZIR OLMADAN INTERPRETATION YAPARSA HASTANIN YAŞAYABİLECEĞİ ANKSİYETE YENİ ÇAĞRIŞIMLARIN AKIŞINI BOZABİLİR.
3. DREAMS EXPRESS UNCONSCIOUS THEMES THAT INFLUENCE THE CLIENT’S CONSCIOUS LIFE. THE THERAPIST’S TASK IS TO INTERPRET THE RELATION OF THE DREAM TO THE CLIENT’S WAKING LIFE AND THE DREAM’S SYMBOLIC SIGNIFICANCE. WE KNOW THE DISTINCTION BETWEEN A DREAM’S MANIFEST (OVERT-OBSERVABLE) AND LATENT (COVERT-HIDDEN) CONTENT. THE THERAPIST MIGHT INTERPRET THE APPEARANCE OF A MONSTER IN A DREAM – THE MANIFEST CONTENT—AS REPRESENTING A HATED AND FEARED PARENT—THE LATENT CONTENT. RÜYALAR BİLİNÇALTINA GİDEN KRAL YOLUDUR.
4. AS TREATMENT PROGRESSES AND PEOPLE BECOME AWARE UNCONSCIOUS AND FEARED ASPECTS OF THEMSELVES, THEY OFTEN EXPERIENCE RESISTANCE: THEY TRY TO AVOID FURTHER CONFRONTATION. CLIENTS EXPRESS RESISTANCE IN MANY WAYS, THEY SKIP THERAPY SESSIONS OR DRAW A BLANK, SAY “I FORGOT” WHEN THE THERAPIST ASKS A QUESTION ABOUT PAINFUL MOMENTS IN THEIR PAST, BUT ALL FORMS OF RESISTANCE STALL (GECİKTİRMEK) THEIR PROGRESS. TO MINIMIZE RESISTANCE, PSYCHOANALYSTS ATTEMPT TO MAKE CLIENTS AWARE THEY’RE UNCONSCIOUSLY BLOCKING THERAPEUTIC EFFORTS AND MAKE CLEAR HOW AND WHAT THEY’RE RESISTING.
5. AS ANALYSIS CONTINUES, CLIENTS BEGIN TO EXPERIENCE TRANSFERENCE: THEY PROJECT INTENSE, UNREALISTIC FEELINGS AND EXPECTATIONS FROM THEIR PAST ONTO THE THERAPIST. THE AMBIGUOUS FIGURE OF THE ANALYST BECOMES THE FOCUS OF EMOTIONS ONCE DIRECTED AT SIGNIFICANT PERSONS FROM THE CLIENT’S CHILDHOOD. FREUD BELIEVED THAT TRANSFERENCE PROVIDES A VEHICLE FOR CLIENTS TO UNDERSTAND THEIR IRRATIONAL EXPECTATIONS AND DEMANDS OF OTHERS, INCLUDING THE THERAPIST.
6. WORK THROUGH (DETAYLI İNCELEMEK) IN THE FINAL STAGE OF PSYCHOANALYSIS, THERAPISTS HELP CLIENTS WORK THROUGH, OR PROCESS, THEIR PROBLEMS. THE INSIGHT GAINED IN TREATMENT IS A HELPFUL STARTING POINT. AS A CONSEQUENCE, THERAPISTS MUST REPEATEDLY ADDRESS CONFLICTS AND RESISTANCE TO ACHIEVING HEALTHY BEHAVIOR PATTERNS AND HELP CLIENTS CONFRONT OLD AND INEFFECTIVE COPING RESPONSES AS THEY REEMERGE IN EVERYDAY LIFE.

21. The Freudian concept of free association is a bit like a magician pulling kerchiefs out of a hat, with one thought leading to the next, in turn leading to the next, and so on.

22. This client began crying after her therapist gently suggested that she takes more risks in life. “That’s exactly what my father used to tell me as a child,” she says, and “now I feel criticized by you the same way I felt criticized by my father.” According to psychoanalysts, the client is experiencing what phenomenon?

23. Neo-Freudian Tradition
More concerned with conscious aspects of the client’s functioning.
Emphasize the impact of cultural and interpersonal influences on behavior.
More optimistic, emphasize needs for power, love, status (not just sex and aggression).
FOR CARL JUNG, THE GOAL OF PSYCHOTHERAPY IS INDIVIDUATION—THE INTEGRATION OF OPPOSING ASPECTS OF THE PERSONALITY INTO A HARMONIOUS “WHOLE,” NAMELY , THE SELF. TO HELP CLIENTS ACHIEVE INDIVIDUATION, JUNG CONSIDERED THEIR FUTURE GOALS AS WELL AS PAST EXPERIENCES.

24. Neo-Freudian Tradition
Sullivan’s influence on interpersonal therapy (IPT).
Short term treatment (12-18 sessions) originally developed for depression to strengthen people’s social skills and assist them in coping with interpersonal problems, conflicts (such as disputes with family members), and life transitions (such as childbirth and retirement).
Also effective at treatment of substance abuse and eating disorders.
SULLIVAN INTERPERSONAL PSYCHOTERAPY’Yİ KURDU. ŞU ANKİ, IPT ÜZERİNDE ETKİSİ VARDIR. For SULLIVAN, psychotherapy is a collaborative WORK between client and therapist. The analyst’s role is participant observeR.

25. Interpersonal therapy aims to resolve interpersonal problems and conflicts and to teach people social skills.

26. Can dostum
BU FİLMLERDE TERAPÖTİK DEĞİŞME İÇİN INSİGHTIN ÖNEMİ VURGULANMIŞTIR.

27. Psychodynamic Therapies
Research, however, shows that insight is not necessary to relieve distress.
In addition, many concepts are difficult to falsify (non-scientific).
Research shows no evidence for repressing hurtful memories either.
To improve, clients typically need to practice new and more adaptive behaviors in everyday life—to engage in working through.
KİŞİNİN RÜYASINDA BABASININ ONA KIZARAK BAKMASININ ÇOCUKLUK ABUSEUNA AİT BASTIRILMIŞ BİR ANI OLDUĞUNU NASIL GÖSTERİRİZ, TERAPİST BÖYLE BİR SONUCA VARSA DA? HASTA “AHA, İŞTE BU” DİYEBİLİR, AMA TERAPİSTİNİ MEMNUN ETMEK İÇİN DİYİP DEMEDİĞİNİ NASIL BİLEBİLİRİZ?
TRAVMATİK ANILAR BASTIRILIR MI? OKULDA SINIFIN EN İYİ 3. NOTUNU ALDIĞINIZ İÇİN UKALA, ÇOK BİLMİŞ OLARAK AKRANLARINIZ TARAFINDAN DALGA GEÇİLDİĞİNİ DÜŞÜNÜN YA DA DERSLERE KATILIMINIZDAN DOLAYI ÖĞRETMENİN SİZİ ÖVDÜĞÜNÜ... BU OLAYLARDAN HANGİSİNİ UNUTMA EĞİLİMİNİZ VARDIR? SIKINTI VERENİ DAHA İYİ HATIRLARIZ. MEMORY CHAPTER 7’DE ÖĞRENDİĞİNİZ GİBİ, RAHATSIZLIK VEREN OLAYLAR DAHA İYİ HATIRLANIR VE DAHA AZ UNUTMAYA MARUZ KALIRLAR. BASTIRILAN ANILARA İLİŞKİN BİLİMSEL DESTEK ZAYIFTIR VE UZAK GEÇMİŞE UZANMIŞ OLAN ÇOĞU ANI ÇARPITILIR.

28. Psychodynamic Therapies
Many are questionable from a scientific standpoint, difficult to research.
Still, brief PD is better than no treatment, but less effective than CBT.
Not effective for psychotic disorders (SCH).
FREUD VE JUNG’UN GÖZLEMLERİNİN DAYANDIĞI UFAK ÖRNEKLEM ZENGİN, BAŞARILI VE İNTELLEKTÜEL KİŞİLERDEN OLUŞMAKTADIR. BU DA EXTERNAL VALİDİTY Yİ DÜŞÜRMEKTEDİR. TERAPİLERİNİN BAŞKALARI TARAFINDAN GÖZLEMLENME VE TEKRAR EDİLME İMKANI YOKTUR.
PSİKOTİKLERDE ETKİSİZ OLDUĞU SÖYLENSE DE HALA BİR GRUP KİŞİ PSİKOZLARDA KULLANMAKTADIR.

29. Humanistic Psychotherapy: Achieving Our Potential
Therapies that share an emphasis on the
Development of human potential.
Emphasis on insight, self-actualization.
Belief that human nature is basically positive.
They reject the interpretive techniques of psychoanalysis. They strive to understand clients’ inner worlds through empathy and focus on clients’ thoughts and feelings in the present moment.
Emphasize importance of assuming responsibility for our lives and living in the present.
HERE AND NOW...

30. Humanistic Psychotherapy
Person-Centered Therapy
Gestalt Therapy

31. Person-Centered Therapy
Developed by Carl Rogers, his therapy is nondirective because therapists don’t diagnose clients’ problems.
Client- centered therapy centers on the client’s goals and ways of solving problems. Clients can use the therapy hour however they choose.
To ensure positive outcome, therapist must
Be authentic and genuine
Express unconditional positive regard
Show emphatic understanding
İSTERLERSE HİÇ KONUŞMADAN DA TERAPİ SEANSINI GEÇİREBİLİRLER.
authentic . Gerçek, hakiki
Client: YARDIM EDİLEMEYECEK DURUMDA OLDUĞUMU DÜŞÜNÜYORUM.
Therapist: HIHI? SANKİ YARDIM EDİLEMEZ DURUMDA GİBİ HİSSEDİYORSUNUZ. ANLIYORUM. TAMAMEN ÇARESİZ HİSSEDİYORSUNUZ. BUNU ANLAYABİLİRİM. BEN ÇARESİZ HİSSETMEM. FAKAT SİZİN HİSSETMENİZİ ANLARIM.
UNCONDITIONAL POSITIVE REGARD IS A NONJUDGMENTAL ACCEPTANCE OF ALL FEELINGS THE CLIENT EXPRESSES. ROGERS WAS CONVINCED THAT UNCONDITIONAL POSITIVE REGARD ELICITS A MORE POSITIVE SELF-CONCEPT.
ROGERS EMPATİYİ ŞÖYLE TANIMLAMIŞTIR: HASTANIN DÜNYASINI SANKİ KENDİ DÜNYAMIZ GİBİ HİSSETMEK, FAKAT BUNU YAPARKEN SANKİ OLDUĞUNU UNUTMADAN YAPMAK. YANİ İÇİNDE KAYBOLMA DEMEK İSTİYOR. To sense the patient’s world as if it were our own, but without ever losing the ‘as if ’ quality. This is empathy” (Rogers, 1957, p. 98).

32. According to Rogers, if a father gives his child love only when he receives a good grade, but not when he receives a poor grade, is the father expressing conditional regard or unconditional regard?
conditional regard
UNCONDITIONAL POSITIVE REGARD: KOŞULSUZ OLUMLU SAYGI

33. Person-Centered Therapy
Tries to increase awareness and heightened self-acceptance.
This hopefully causes people to
Think more realistically.
Become more tolerant of others.
Engage in more adaptive behaviors.
One way to communicate empathy is by way of reflection, that is, mirroring back the client’s feelings
Client: I was small and I envied people who were large. I was—well, I took beatings by boys and I couldn’t strike back (karşılık veremezdim). ...
Therapist: You’ve had plenty of experience in being the underdog (ezilen olma).
Person-centered interviewing techniques, such as warmth and empathy, reflective
listening, unconditional acceptance, and avoiding confrontation, lie at the heart of
motivational interviewing. lives. Motivational interviewing has been shown to be helpful in treating alcohol-related problems and has been successful in modifying a variety of health-related behaviors, including exercise and diet.

34. Gestalt Therapy Fritz Perls founded the Gestalt therapy.
Aim to integrate differing and sometimes opposing aspects of clients’ personalities into a unified sense of self.
The key to personal growth is accepting responsibility for one’s feelings and maintaining contact with the here and now.
Recognizes the importance of awareness, acceptance, and expression of feelings.
He imported some concepts from Gestalt psychology. The word gestalt (configuration) means an organized whole. Gestalt therapists believe that people with psychological difficulties are “incomplete gestalts” because they’ve excluded from their awareness experiences and aspects of their personalities that trigger anxiety (KİŞİLİKLERİNİN BAZI YANLARINI VE YAŞANTILARINI FARKINDALIKLARININ DIŞINDA TUTMUŞLARDIR, BU DA ANKSİYETEYİ TETİKLER. O NEDENLE DE PSİKOLOJİK PROBLEMİ OLANLAR TAMAMLANMAMIŞ GESTALTLARDIR )

35. The Two-Chair Technique
The Two-Chair Technique. Gestalt therapy’s two-chair technique aims to integrate opposing aspects of the client’s personality, such as the “good boy” and the “spoiled brat.”
Utilizes empty-chair technique.
BİR SANDALYEDEN DİĞERİNE OTURARAK, KİŞİLİĞİN BİRBİRİYLE ÇATIŞAN İKİ YANI ARASINDA DİYALOG OLUŞTURULMAYA ÇALIŞILIR.
spoiled brat: ŞIMARIK ÇOCUK

36. Humanistic Therapies Evaluated
Core concepts are difficult to falsify.
But, the conditions for effective therapists have been found to be related to outcome.
More effective than no treatment, but mixed results compared to other therapies.
YAPILAN ÇALIŞMALAR GÖSTERMİŞ Kİ, Establishing a strong alliance is helpful to the ultimate success of therapy. The therapeutic relationship is a stronger predictor of success in therapy than the use of specific Techniques. ROGERS EMPATİ VE POZİTİF REGARD ÜZERİNE AŞIRI ÖNEM VERMİŞ OLMAKLA BİRLİKTE, BUNLAR TERAPİ OUTCOME’YLE İLİŞKİLİDİR.
YİNE YAPILAN BAZI ÇALIŞMALAR, TERAPİSTİN OLMADIĞI SELF HELP PROGRAMLARIN YARARLI OLDUĞUNU GÖSTERMİŞTİR.

37. Group Therapies THE MORE THE MERRIER
In 1920s, Viennese psychiatrist Jacob Moreno introduced the term of group therapy.
Refers to therapies that treat more than one person at a time.
Range from 3-20 people, can be efficient, time-saving, and less costly than individual ones.
Effective for a wide range of problems and about as helpful as individual treatments.
THE MORE THE MERRIER: BİR ŞEYDEN NE KADAR ÇOK OLURSA O KADAR İYİ OLUR.
Participants can provide and receive support, exchange information and feedback, model effective behaviors and practice new skills, and recognize that they’re not alone in struggling with problems.

38. Group therapy procedures are efficient, timesaving, and less costly than many individual treatment methods.

39. Alcoholics Anonymous
Self-help groups like AA have become very popular and widespread. AA provides social support for achieving sobriety.
Composed of peers with similar problems, often no professional therapists.
Sobriety: AYIKLIK
THERE ARE SOME ASSUMPTIONS THAT ALCOHOL IS A PHYSICAL DISEASE AND “ONCE AN ALCOHOLIC, ALWAYS AN ALCOHOLIC,” WHICH REQUIRE THAT MEMBERS NEVER DRINK ANOTHER DROP AFTER ENTERING TREATMENT. TEDAVİYE GİRDİKTEN SONRA ÜYELERİN BİR DAMLA DAHİ ALMAMALARINI BEKLER.

40. Alcoholics Anonymous has been in existence since the 1930s, and provides self-help to people of all ages and backgrounds.

41. AA Alternatives
Controlled drinking programs encourage people to set limits and drink moderately.
Can be effective for many people.
Relapse prevention treatment assumes people will “slip up” and plans accordingly.
abstinence violation effect
Lapse does not equal relapse.
%68İ İLK ÜÇ AY İÇİNDE AA’DAN AYRILIR. TEDAVİDE KALANLAR İSE DÜZELMİŞ OLANLARDIR.
AA’NIN FELSEFESİNİ AKSİNE KONTROLLÜ İÇMEYİ DESTEKLEYENLER AŞIRI İÇMENİN ÖĞRENİLMİŞ BİR DAVRANIŞ OLDUĞUNU VE ABSTİNENS OLMADAN TERAPİSTLERİN KONTROL EDEBİLECEĞİNİ İLERİ SÜRER.
slip up: HATA YAPMAK.
RELAPS PREVENTİON TEDAVİSİNE GÖRE ALKOL KULLANAN İNSANLAR BİR YERDE HATA YAPAR, SÜRÇER VE İÇMEYE YENİDEN BAŞLARLAR. İNSANLARA BİR KEZ İÇTİKLERİNDE HEMEN SUÇLU, UTANMIŞ HİSSETMEMELERİNİ ÖĞRETİR, ÇÜNKÜ BU TÜR OLUMSUZ DUYGULAR İÇMEYİ DEVAM ETTİRMEYE YOL AÇAR BUNA DA ABSTINENCE VIOLATION EFFECT DENİR. THEY LEARN THAT A LAPSE DOESN’T MEAN A RELAPSE. ARAŞTIRMALAR BU YAKLAŞIMIN DAHA ETKİLİ OLDUĞUNU GÖSTERMİŞTİR.
CİDDİ ALKOL BAĞIMLILIĞI OLAN YA DA KONTROLLÜ İÇMEYİ BAŞARAMAYANLAR İÇİN
ASLINDA EN İYİSİ TOTAL ABSTİNENSDİR.

42. Family Therapies
See most psychological problems as rooted in a dysfunctional family system.
The “patient” is the whole family system, not one individual.
Focus on interactions among family members.
LO 16.6

43. Family Therapies
Strategic family interventions are designed to remove barriers to effective communication.
For Virginia Satir, Jay Haley, and Paul Watzlawick, families often scapegoat one family member as the identified patient with the problem.
They identify the family’s unhealthy communication patterns.

44. Where’s the Problem? According to the strategic family therapy, families often single out one family member as “the problem” when the problem is actually rooted in the interactional patterns of all family members.
single out :BELİRLEMEK BİRİNİ SEÇMEK
scapegoat:GÜNAH KEÇİSİ.

45. Family Therapies
Structural family therapy has the therapist immerse herself in the everyday activities of the family to make changes in how they arrange and organize interactions.
Salvatore Minuchin
Both are more effective than no treatment and at least as effective as individual therapy.

46. In structural family therapy, the therapist immerses herself in the family’s everyday activities. Having observed what goes on in the family, the therapist can then advocate for changes in how the family arranges and organizes its interactions.

47. Behavioral Approaches
Behavior therapists focus on specific problem behaviors.
Assume that behavior change results from the operation of basic principles of learning, especially classical conditioning, operant conditioning, and observational learning.
Use behavioral assessment techniques, such as direct observations, verbal descriptions of the nature and dimensions of the problem, scores on paper-and-pencil tests, standardized interviews, and physiological measures.
LO 16.7

48. A behavior therapist treating a bad habit, like nail biting, trichotillomania, would try to determine the situations in which nail-biting occurs, as well as the consequences of nail-biting for the person—such as distraction from anxiety.

49. Exposure Therapies
Confronts clients with what they fear with the goal of reducing the fear.
Earliest was systematic desensitization, developed by psychiatrist Joseph Wolpe in 1958 to help clients manage phobias.
SD gradually exposes clients to anxiety producing situations through the use of imagined scenes.

50. Systematic Desensitization
Based on principle of reciprocal inhibition - we can’t be anxious and relaxed at the same time because relaxation inhibits anxiety.
Uses counterconditioning by repeatedly pairing an incompatible relaxation response with anxiety, so we condition a more adaptive response to anxiety-arousing stimuli.
Can use imaginal and in vivo exposure to the fear situations listed on the created hierarchy.
reciprocal inhibition :KARŞILIKLI KET VURMA
İncompatible: çelişkili, uyumsuz..
Teaching the client how to relax. She might imagine pleasant scenes, focus on breathing and maintaining a slow breathing rate, and alternately tense and relax her muscles.
Helping to construct an anxiety hierarchy— a “ladder” of situations that climbs from least to most anxiety provoking.
The therapist asks the client to relax and imagine the first scene, and moves to the next, more anxiety producing scene only after the client reports feeling relaxed while imagining the first scene.
If the client reports anxiety at any point, the therapist interrupts the process and
helps her relax again. Then, the therapist reintroduces the scene that preceded the one that caused anxiety. This process continues until the client can confront the most frightening scenes without anxiety.

51. In vivo desensitization: Clients gradually approach and handle any fears, as these clients are doing as they overcome their fear of flying.
in vivo means, in “real life”. In vivo SD involves gradual exposure to what the client actually fears, rather than imagining the anxiety-provoking situation.

52. Systematic Desensitization
Dismantling research showed that no single component (relaxation, imagery, an anxiety hierarchy) was essential. Maybe the credibility of the treatment creates a strong placebo effect.
FLOODİNG Very effective for many anxiety disorders, like phobias, OCD, and PTSD.
Led to development of exposure with response prevention therapies like flooding. In response prevention, therapists prevent clients from performing their typical avoidance behaviors.
Dismantling APPROACH enables researchers to examine the effectiveness of isolated components of a broader treatment.
FLOODİNG: TAŞIRMA KAYGI NESNESİ İLE UZUN SÜRELİ YÜZYÜZE BIRAKMA. Flooding therapies provide a vivid contrast to SD. FLOODİNGDE HİYERARŞİNİN EN ÜSTÜNE ATLARLAR VE KORKULAN UYARANIN İMGESİNE UZUN SÜRELER EXPOSE OLURLAR.
ONLAR İÇİN FEARS are maintained by avoidance. İNSANLAR KORKTUKLARI ŞEYDEN SÜREKLİ KAÇTIKLARI İÇİN KARŞILAŞTIKLARINDA NE OLACAĞINI, SONUCU BİLMEZLER.
FLOODİNG’İN ÖNEMLİ BİR UNSURU RESPONSE PREVENTİON, OKB’DA RITUEL PREVENTİONDIR. ELLERİNİ HASTANIN KİRLETİP YIKAMASINA ENGEL OLMAK. KANALİZASYONDAN KAÇAN HASTAM...
Some therapists have applied exposure + response prevention to clients with bulimia
by having them eat large amounts of food, but preventing them from purging, exercising, or otherwise trying to lose weight.

53. FLOODİNG

54. With high-tech equipment, virtual reality exposure provides a “virtually lifelike” experience of fear provoking situations, therapists can treat many anxiety-related conditions, including height phobia, storm phobia, flying phobia and posttraumatic stress disorder. Virtual reality exposure provides repeated exposure to situations that often aren’t feasible in real life, like flying in airplanes.

55. Exposure therapies provide clients with cutting-edge virtual reality technology to confront their fears of spiders and other frightening stimuli. Does this virtual reality scene cause you extreme anxiety?
cutting-edge: EN SON, EN İLERİ VIRTUAL: SANAL, GERÇEK OLMAYAN

56. In EMDR, the client focuses on the therapist’s fingers as they move back and forth. Nevertheless, studies indicate that such eye movements play no useful role in EMDR’s effectiveness.
CALLAHAN TARAFINDAN GELİŞTİRİLMİŞ THOUGHT FIELD THERAPY DE HASTA STRES VEREN DÜŞÜNCESİNİ DÜŞÜNÜRKEN TERAPİST ÖNCEDEN BELİRLENEN BEDEN PARÇALARINA HAFİFÇE VURUR, BU SIRADA HASTA AMERİKA MİLLİ MARŞINI SÖYLER. BU YAKLAŞIMI HAYVANLARDA DA KULLANDIKLARI SÖYLENİYOR. KORKUYLA İLİŞKİLİ ENERJİ BLOKLARINI ORTADAN KALDIRDIĞINA İNANILIYOR. UNFALSİFİABLE.
EMDR:EYE MOVEMENT DESENSİTİZATION ABD REPROCESSING ANKSİYETE BOZ.NDA VE ÖZELLİKLE PTSDDE BÜYÜK BULUŞ DİYE ORTAYA ATILDI. TRAVMATİK BİR ANI DÜŞÜNÜRKEN GÖZLERİN YANLARA HAREKETİNİN ACILI ANILARIN İŞLENMESİNİ ARTIRDIĞINI İDDİA ETMİŞLERDİR.

57. Modeling in Therapy
Modeling is one form of observational or vicarious learning.
Bandura’s participant modeling has the therapist
Model a calm encounter with the client’s feared object or situation.
Guide the client through the steps of the encounter until she can cope unassisted.
Used in assertion and social skills training, along with behavioral rehearsal.
ASSERTİVENESS TRAINING’DE AMAÇ BAŞKALARININ MANTIKSIZ TALEPLERİNE BOYUN EĞİCİ YA DA SALDIRGAN OLMADAN AŞIRI TEPKİ VERMEKTEN KAÇINARAK SOSYAL AÇIDAN UYGUN TARZDA TEPKİ VERMEYİ ÖĞRETMEKTİR.
behavioral rehearsal: DAVRANIŞSAL TEKRAR. ASSERTİVENESS TRAINING YA DA DİĞER MODELING TEKNİKLERDE KULLANILIR. ROLE PLAYING YAPARLAR. HASTA TERAPİSTİN OYNADIĞI KİŞİYE TEPKİLERİNİ VERİR, TERAPİST DE SIRASIYLA KOÇLUK VE FEEDBACK VERİR. ASSERTİVENESS TRAININGDE TERAPİST DANIŞANIN ROLÜNÜ OYNAR. BÖYLECE TERAPİST DANIŞANA MODEL OLARAK YALNIZCA NE SÖYLEYECEĞİ DEĞİL, NASIL SÖYLEYECEĞİ KONUSUNU DA ÖĞRENİR. ÖĞRENDİKLERİNİ GÜNLÜK YAŞAMA TRANSFER ETMESİ İÇİN CESARETLENDİRİLİR. schizophrenia, autism, depression, attention-deficit/hyperactivity disorder (ADHD), and social anxiety TEDAVİSİNDE ASSERTİVENESS TRAINING VE SOCIAL SKILL TRAININGLER KULLANILIR.

58. Operant Procedures
Applied behavior analysis procedures to treat autistic children.
Token economies reward clients for desirable behaviors with tokens to exchange for items.
Aversion therapies use punishment to decrease the frequency of undesirable behaviors.
Mixed support for the use of aversion therapies (e.g., Antabuse and alcohol)
TOKEN ECONOMIES USED IN INSTITUTIONAL AND RESIDENTIAL SETTINGS. CERTAIN BEHAVIORS, LIKE HELPING OTHERS, ARE REWARDED WITH TOKENS (FİŞ, JETON) THAT CLIENTS CAN LATER EXCHANGE FOR MORE TANGIBLE (MADDİ, SOMUT) REWARDS, WHEREAS OTHER BEHAVIORS, LIKE SCREAMING AT HOSPITAL STAFF, ARE PUNISHED. TOKEN ECONOMIES HAVE SHOWN SOME SUCCESS IN TREATING CHILDREN WITH ADHD, AND IN TREATING CLIENTS WITH SCHIZOPHRENIA WHO REQUIRE LONG-TERM HOSPITALIZATION.
WHILE A PERSON ENGAGES IN A PROBLEM BEHAVIOR, THERAPISTS INTRODUCE STIMULI THAT MOST PEOPLE EXPERIENCE AS PAINFUL, UNPLEASANT, OR EVEN DİSGUSTING. THERAPISTS HAVE USED MEDICATIONS, SUCH AS ANTABUSE—TO MAKE PEOPLE VOMIT AFTER DRINKING ALCOHOL.

59. Cognitive-Behavioral Therapies: Learning to Think Differently
Beliefs play the central role in our feelings and behaviors.
All share three core assumptions
Cognitions are identifiable and measurable.
Cognitions are key in both healthy and unhealthy psychological functioning.
Irrational beliefs or catastrophic thinking can be replaced by more rational and adaptive cognitions.
Such as “I’m worthless, and will never succeed at anything,”

60. Rational Emotive Behavior Therapy
Developed by Albert Ellis starting in 1950s. Its first name is rational emotive therapy (RET).
Emphasizes changing how we think, but also how we act.
How we feel about the consequences of an event is determined by our beliefs or opinions.
that’s the “cognitive” part, that’s the “behavioral” part..
Ellis argued that we respond to an unpleasant activating (internal or external) event
with a range of emotional and behavioral consequences (C). belief systems (B).
Some beliefs are rational: They’re flexible, logical, and promote self-acceptance. Others are irrational: They’re associated with unrealistic demands about the self (“I must be perfect”), others (“I must become worried about other people’s problems”), and life conditions (“I must be worried about things I can’t control.”).

61. LO 16.8

63. Albert Ellis wrote a number of humorous song lyrics to demonstrate REBT principles (Ellis even recorded them commercially, although it’s unlikely that he’d make it to the finals of American Idol). This song, set to the tune of Yankee Doodle, pokes fun at the widespread but irrational belief that all romantic relationships should be characterized by promises of complete, unconditional, and never-ending love. (Adapted from “Love Me, Love Me, Only Me!” by Albert Ellis. Reprinted with permission of Albert Ellis Institute)

64. Rational Emotive Behavior Therapy
Our vulnerability to psychological disturbance is a product of the frequency and strength of our irrational beliefs.
To the ABC, Ellis added D (dispute the beliefs) and E (adopt more effective ones) to describe how therapists treat clients.
To modify clients’ irrational beliefs, the therapist encourages them to rethink their assumptions and personal philosophy. REBT therapists assign “homework” designed to falsify clients’ maladaptive beliefs.

65. Other CBT Approaches
Aaron Beck developed cognitive therapy around the same time as Ellis’ REBT.
Cognitive therapy focuses on identifying and modifying distorted thoughts and core beliefs.
Works very well with depression, some evidence for bipolar disorder and SCH.
LO 16.8

66. Two pioneers of CBT, Aaron Beck (left; 1921– ) and Albert Ellis (1913–2007).

67. Each of the three statements below typical of a different psychotherapy. Match each statement with the therapy:
1. You’re being irrational and jumping to
conclusions. Even if someone were following you, why conclude that he’s contacted your friends just because they’re more distant?
2. You’ve told me that during childhood, your father constantly judged you; and when he stared at you, it brought about tremendous guilt. Perhaps this man you can’t escape symbolizes your father?
3. Starting nine months ago, you became
suspicious of a man you’re now pretty sure
will damage relationships you prize.How
terrible it must feel to think he’s telling lies
about you!
(A. client-centered, B. Freudian, C. REBT)
1-C; 2-B; 3-A

68. Donald Meichenbaum’s stress inoculation training
Therapists teach clients to prepare for and cope with future stressful events.
Therapists “inoculate” them against an upcoming stressor and develop cognitive skills to minimize its harm, much as a vaccine (inoculation). Clients fearful of giving a speech may learn to say things to themselves like, “Even though it’s scary, the outcome probably won’t be as bad as I fear.”
It is applied to children and adults facing medical and surgical procedures, public speaking, and exams.

69. Third Wave of CBT
After behavioral (first) and cognitive (second), these therapies focus on acceptance.
Includes Acceptance and Commitment Therapy (ACT) and Dialectical Behavior Therapy (DBT). ACT practitioners teach clients that negative thoughts such as “I’m worthless” are merely thoughts, not “facts.” Linehan’s DBT used with borderline personality disorder. Linehan encourages clients to accept their intense emotions while actively attempting to cope with these emotions by making changes in their lives.
Highly eclectic, remains to be seen if these are superior to accepted CBT methods.
Their aim is to assist clients with accepting all aspects of their experience—thoughts, feelings, memories, and physical sensations—they’ve avoided or suppressed. Avoiding and suppressing disturbing experiences, rather than accepting or confronting them, often backfires (GERİ TEPER), creating even greater emotional turmoil (KARMAŞA).
eclectic approaches ARE treatments that integrate techniques and theories from more than one existing approach. The large proportion of clinical psychologists calls themselves eclectic/integrative.

70. CBT Evaluated Scientifically
More effective than no or placebo treatment.
At least or more effective than psychodynamic and humanistic therapies.
At least as effective as drug therapies for depression.
In general, CBT and BT are about as effective for most problems.
LO 16.8

71. Is Psychotherapy Effective?
Dodo bird effect: “All have won, and all must have prizes.”
Prior to 1970s, considerable controversy on it.
Meta-analysis studies proved that therapy does work in alleviating human suffering.
But which therapy? And for whom?.
ALİCE HARİKALAR DİYARINDA KİTABINDAKİ DODO KUŞUNDAN ESİNLENİLMİŞTİR.
A meta-analysis, meaning “analysis of analysis,” is a statistical method that helps researchers to interpret large bodies of psychological literature.
Studies with experienced therapists who’ve practiced behavioral, psychodynamic, and person-centered approaches have found that all are more successful in helping clients compared with no treatment, but no different from each other in their effects.

72. The Effectiveness of Psychotherapy
This graph shows two normal distributions derived from nearly 500 studies of psychotherapy outcomes. The distribution on the left shows people who haven’t received psychotherapy, and the distribution on the right shows people who’ve received psychotherapy. 80 percent of people who receive therapy do better than people who don’t.

73. Is Psychotherapy Effective?
Some researchers claim the dodo bird verdict
“All have won, and all must have prizes”. Some researchers that Dodo bird verdict is extinct.
But there are clear cut exceptions, like
Use of BT and CBT for behavior problems in youth.
BT and CBT for anxiety disorders.
Some therapies may actually be harmful.
Extinct: nesli tükenmiş.
Çoğu psikoterapi İYİ ÇALIŞMAKLA BİRLİKTE bazılarının etkisi eşittir diyen araştırmacılar var.
%5-10 GİBİ BİR ORANDA İNSANLAR TERAPİYİ TAKİBEN YA DA TERAPİDEN DOLAYI DAHA KÖTÜ OLABİLMEKTE. CRİSİS DEBRİEFİNG TRAVMAYA MARUZ KALMIŞ KİŞİLERİN PTSD OLMA OLASILIĞINI ARTIRMAKTA.

74. Some Potentially Harmful Therapies
Facilitated communication
Scared Straight Programs
Crisis debriefing
DARE programs
Coercive restraint therapies
POPÜLASYONUN BELLİ KISIMLARININ TERAPİYE NASIL TEPKİ VERDİĞİNE İLİŞKİN BİLGİLERDE DE EKSİKLİK VARDIR. SOSYOEKONOMİK DURUM, YAŞ, CİNSİYET, IRK İLE TERAPİ SONUCU ARASINDA ÇOK AZ İLİŞKİ VAR.

75. Common Factors
Many therapies may be comparable due to common factors that cut across therapies. Common factors :
empathic listening,
instilling hope,
establishing a strong emotional bond with clients,
providing a clear theoretical rationale for treatment,
implementing techniques that offer new ways of thinking, feeling, and behaving.
Specific factors are those that characterize only certain therapies, such as exposure, challenging irrational beliefs, and social skills training.
Most psychologists agree that both matter, but are divided over the degree of each.
As Jerome Frank noted in his classic book, Persuasion and Healing, these common factors include....BU COMMON FAKTÖRLER İNANÇLA İYİLEŞTİRME, DİNİ KONUŞMALAR VE İKNADA DA KULLANILAN VE YÜZYILLARDIR HEMEN HER KÜLTÜRDE İŞE YARAYAN YÖNTEMLER.

76. Good psychotherapists keep up with the current state of the research literature, staying informed about which therapies do and don’t have strong scientific support.

77. Empirically Support Therapies
Name for interventions for specific disorders supported by high-quality scientific evidence.
Most therapists do not use ESTs in practice.
Many BT, CBT, acceptance, and interpersonal therapies have been found to be useful.
TERAPİSTLER TEDAVİLERİNİ SUBJEKTİF DENEYİM VE SEZGİYE Mİ DAYANDIRMALILAR YOKSA DİKKATLE YAPILMIŞ KONTROLLÜ ÇALIŞMALARA MI? BİLİMADAMI UYGULAMACI UÇURUMU FARKI DENİLEN ŞEY BUDUR. BİR KISMI PSİKOTERAPİYE BİR SANAT OLARAK BAKARKEN BİR KISMI İYİ REPLİKE EDİLMİŞ BİLİMSEL BULGULARI YANSITMALIDIR DEMEKTEDİR.
CBT HAVE EMERGED AS ESTs FOR DEPRESSION, ANXIETY DISORDERS, OBESITY, MARITAL PROBLEMS, SEXUAL DYSFUNCTION, AND ALCOHOL PROBLEMS. INTERPERSONAL THERAPY HAS SUPPORT FOR DEPRESSION AND BULIMIA, ACCEPTANCE-BASED APPROACHES FOR BORDERLINE PERSONALITY DISORDER.

80. Fooled by Ineffective Therapies
Five reasons can help explain why bogus therapies can gain a dedicated public following
1.Spontaneous remission
2.Placebo effect
3.Self-serving biases
4.Regression to the mean
5.Retrospective rewriting of the past
YUNUS BALIĞI TEDAVİSİ, GÜLME TEDAVİSİ HATTA UZAYLILAR TARAFINDAN KAÇIRILMAYA TERAPİ GİBİ SAHTE TERAPİLER NASIL MÜŞTERİ TOPLUYOR? NLP (NÖROLİNGUİSTİK PROGRAMMING DE TERAPİSTLER KENDİ SÖZEL OLMAYAN DAVRANIŞLARINI ÖRNEĞİN SES TONU, GÖZ HAREKETİ VE YÜZ MİMİKLERİ GİBİ DANIŞANLARINKİYLE EŞLEYEREK TEDAVİ ETMEYE ÇALIŞIRLAR) VE TEMEL ÇIĞLIK TERAPİSİ (DOĞUM TRAVMASINDAN KAYNAKLI ÖFKE GİBİ SİNİR SİSTEMİNDE HAPSOLMUŞ ÖFKEYİ SALARAK SORUNLARDAN KURTULMAYI ESAS ALAN) GİBİ TERAPİLERİ DESTEKLEYEN ÇALIŞMALAR YOKTUR.
İNSANLAR ASLINDA ETKİLİ OLMAYAN TERAPİLERİ NASIL YARARLI OLARAK GÖRÜRLER???
HEPİMİZİN İNİŞ ÇIKIŞLARI “UPS AND DOWNS” VARDIR. HİÇBİR TEDAVİ OLMADAN İYİLEŞEBİLİRİZ ,BU DEPRESYON İÇİN OLDUĞU KADAR KANSER İÇİN DE GEÇERLİDİR. EN SON AŞKINIZ BİTTİĞİNDE YAŞAMADINIZ MI?
2. PLASEBO ETKİSİ SEMPTOMLARDA ANLAMLI AZALMAYA YOL AÇAR. UMUT AŞILAYARAK VE İKNA İLE DEMORALİZASYONUN AZALMASINDA TEDAVİLER YARARLI OLUR.
3. DÜZELMEDİKLERİNDE BİLE DANIŞANLAR PSİKOTERAPİYE ÇOK YATIRIM YAPTIKLARINDA VE ÇOK PARA DÖKTÜKLERİNDE KENDİLERİNE YARDIM EDİLDİĞİ ŞEKLİNDE KENDİLERİNİ İNANDIRABİLİRLER. BİR KİŞİNİN ÇOK ZAMAN, ENERJİ VE ÇABA HARCADIĞINI KENDİ KENDİNE KABUL ETMESİ ÇOK SIKINTILI BİR DURUMDUR. DANIŞANLAR SELF ESTEEMLERİNİ SÜRDÜRMENİN BİR YOLU OLARAK, BAŞARILARINI ABARTABİLİRLER, BAŞARISIZLIKLARINI GÖRMEZDEN GELEBİLİRLER.
AŞIRI PUANLAR RETESTİNG DE DAHA AZ AŞIRI OLMA EĞİLİMİ GÖSTERİR. BU NE DEMEK??? İLK İNTRO EXAMINDE 0 ALMIŞSANIZ İKİNCİ EXAMDE KESİNLİKLE DAHA İYİ YAPACAKSINIZDIR. TAM TERSİNE İLKİNDE 100 ALMIŞSANIZ İKİNCİSİNDE KESİNLİKLE BU KADAR YÜKSEK OLMAZ. AYNI ŞEKİLDE PSİKOTERAPİ İÇİN DE GEÇERLİDİR. BİR DANIŞAN “REGRESSİON TO THE MEAN” TERAPİSTLERİ VE DANIŞANLARI YARARSIZ BİR TERAPİNİN ETKİLİ OLDUĞU KONUSUNDA KANDIRABİLİR. NERMİN HANIMI ÖRNEK VER.
5. BAZI DURUMLARDA, HİÇBİR İLERLEME OLMADIĞINDA BİLE İLERLEDİĞİMİZE İNANIRIZ, ÇÜNKÜ TEDAVİ ÖNCESİ UYUM DÜZEYİMİZİ OLDUĞUNDAN DAHA KÖTÜ OLARAK YANLIŞ HATIRLARIZ. WE EXPECT TO CHANGE AFTER TREATMENT, MAY ADJUST OUR MEMORIES TO FIT THIS EXPECTATION. BİR ÇALIŞMADA BİR GRUP ÖĞRENCİ RANDOMLY OLARAK ÇALIŞMA BECERİ KURSUNA ALINIRKEN BİR GRUP WAITING LISTTE ALINDI. OBJEKTİF ÖLÇÜMLERDE KURSUN HİÇBİR İŞE YARAMADIĞI GÖRÜLDÜĞÜ HALDE KURSU ALAN ÖĞRENCİLER İLERLEDİKLERİNİ DÜŞÜNDÜLER. ÇÜNKÜ BAŞTAKİ ÇALIŞMA BECERİLERİNİ YANLIŞ OLARAK GERÇEKTE OLDUĞUNDAN DAHA KÖTÜ OLARAK BELİRLEMİŞLERDİ.

81. Some therapists claim that contact with dolphins can treat a variety of psychological problems, including autism. However, research does not support the idea that dolphin therapy is effective for any problem.

82. Self-help books???
80 percent of therapists recommend them to their clients.
Bibliotherapy
Use books that have research support and are based on valid psychological principles of change
Evaluate the author’s credentials
Be wary of books that make far-fetched promises, such as curing a phobia in five minutes.
Beware of books that rely on a “one size fits all” approach.
Serious problems warrant professional help rather than self-help alone.
SELF HELP BOOKLAR ÜZERİNE YAPILMIŞ ÇOK AZ SAYIDA ÇALIŞMA BİBLİOTERAPİ VE PSİKOTERAPİNİN DEPRESYON VB HASTALIKLAR ÜZERİNDE ETKİLİ OLDUĞUNU GÖSTERMİŞSE DE BUNU TÜM KİTAPLARA GENELLEYEMEYİZ. BU ARAŞTIRMADA GÖNÜLLÜ OLAN KİŞİLER BELKİ SELF HELP BOOK OKUMAYA AŞIRI MOTİVEDİR VE DAHA FAZLA FAYDA SAĞLAMIŞ OLABİLİR. AYRICA BU KİTAPLAR ÇOK CİDDİ HASTALIKLAR İÇİN YAZILMIŞ OLMAYIP DAHA GÜNLÜK BASİT SORUNLARI İÇERİR.
far-fetched: ŞİŞİRİLMİŞ
“one size fits all” : HERKESE UYAN

83. Biomedical Treatments
Attempt to directly alter the brain’s chemistry or physiology to treat psychological disorders. They include medications, electrical stimulation techniques, and brain surgery.
Psychopharmacotherapy – use of medications – is the most widespread.
Began with use of Thorazine (chlorpromazine) in 1954 to ease the symptoms of SCH; today almost 15% of Americans are on antidepressants.
Chlorpromazine: LARGACTİL

84. Psychopharmacology
Today, medications are available to treat most psychological disorders
Antianxiety, antidepressants, mood stabilizers, antipsychotics, psychostimulants.
Unfortunately, we don’t know exactly why most of these work.
attention problems (psychostimulants, which stimulate the nervous system yet paradoxically treat symptoms of attention-deficit/hyperactivity disorder).
İLAÇ ŞİRKETLERİNİN İDDİASI BEYİNDEKİ KİMYASAL DENGESİZLİĞİ DÜZELTTİKLERİ ŞEKLİNDEDİR. BİRÇOK İLAÇ ÇOKLU NÖROTRANSMİTTER ÜZERİNDE ETKİLİDİR. BEYİNDEKİ SEROTONİN YA DA DİĞER NÖROTRANSMİTTERLERİN OPTİMAL DÜZEYİNİN NE OLDUĞU KONUSUNDA KESİN BİR BİLGİ YOKTUR. ANTİDEPRESANLAR NÖROTRANSMİTTERLERİN DÜZEYİNDEN ZİYADE NÖRON RESEPTÖRLERİNİN DUYARLILIĞINI ETKİLEYEREK ETKİLERİNİ ORTAYA ÇIKARABİLİR.
İLAÇLARI SADECE PSİKİYATRİSTLER VE PSİKİYATRİK HEMŞİRELER YAZARKEN New Mexico in 2002 and Louisiana in 2004 BU İKİ EYALETTE FİZYOLOJİ, ANATOMİ VE FARMAKOLOJİ DERSLERİNİ ALAN PSİKOLOGLAR DA İLAÇ REÇETE ETMEYE BAŞLAMIŞLARDIR. AMA BU KONU BÜYÜK ÖLÇÜDE TARTIŞMALIDIR.

85. anxiolytics or antianxiety drugs
SERTRALINE: LUSTRAL

86. Table 16.9 (continued) Commonly Used Medications for Psychological Disorders, Mechanisms of Action, and Other Uses.
CLOZAPINE: LEPONEX
CHLORPROMAZINE: LARGACTIL

87. Cautions to Consider
Psychopharmacotherapy not a cure-all, as most medications have numerous side effects.
Most dissipate after discontinuing the drug, but not all (tardive dyskinesia).
Weight, age, and even racial differences often affect drug response.
CURE-ALL: HER DERDE DEVA
Weighed: hesap edilmiş
Most adverse reactions SIDE EFFECTS, including nausea, drowsiness, weakness, fatigue, and impaired sexual performance, are reversible when medications are discontinued or when their dosage is lowered.
Tardive dyskinesia (TD), a serious side effect of some older antipsychotic medications,
those used to treat schizophrenia and other psychoses. TARDİF DİSKİNEZİNİN BELİRTİLERİ AĞIZ VE YÜZ KASLARINDA KABA İSTEMSİZ HAREKETLER, OMUZ BACAK VE KOLLARDA TİTREME. ÇOĞUNLUKLA UZUN YILLAR YÜKSEK DOZ İLAÇ KULLANIMINDAN SONRA BAŞLAR, BU NEDENLE TARDİF YANİ GEÇ GÖRÜNEN DENİR. RİSPERDAL GİBİ YENİ KUŞAK ANTİPSİKOTİKLER DE ŞİZOFRENİNİN ÖZELLİKLE NEGATİF BELİRTİLERİNİ TEDAVİ EDERLER VE ANİ KARDİYAK ÖLÜMLERE NEDEN OLUR.

88. Cautions to Consider
Questions about efficacy and safety of SSRIs in children and adolescents.
Overprescription is also a concern for many, especially of psychostimulants for ADHD.
Polypharmacy is prescribing many medications —sometimes five or more— at the same time can be hazardous. Certain medications may interfere with the effects of others or interact with them in dangerous ways. Polypharmacy is a particular problem among the elderly.
BAZI İNSANLAR BENZODİAZEPİNLERE FİZİKSEL VE PSİKOLOJİK BAĞIMLILIK GELİŞTİRİRLER O NEDENLE HEKİMLERİN SONUCA ULAŞMAK İÇİN EN DÜŞÜK DOZU BELİRLEMELERİ GEREKİR. YİNE BAZI İLAÇLARI KESERKEN DERECELİ KESMEK GEREKİR, BİRDEN KESİLDİĞİNDE ANKSİYETE VB ORTAYA ÇIKABİLİR.
PROZAC VE SUİCİD İLİŞKİSİ HAKKINDA SORULAR VAR.
Critics of psychostimulants (RİTALİN) have pointed to their potential for abuse. Moreover,
their adverse effects include insomnia, irritability, heart-related complications.
MİCHAEL JACKSON VE WHİTNEY HOUSTON POLYPHARMACYDEN DOLAYI ÖLMÜŞ OLABİLİRLER...

89. Evaluating Psychopharmacotherapy
In many cases, therapy alone can produce as great or better benefits for many disorders.
Clear advantages to combining meds and therapy when
Symptoms interfere greatly with functioning.
Therapy alone hasn’t worked for a 2 month period.
Meds + Therapy is warranted for SCH, bipolar disorder, longterm major depression, and major depression with psychotic symptoms.
CBT is at least as effective as antidepressants, even for severe depression, and perhaps more effective than antidepressants in preventing relapse.
When patients benefit from psychotherapy, this change is reflected in the workings of their brains. Psychotherapy and medication produce similar brain changes. OCDLİ HASTALARDAN BEHAVİOR THERAPY ALANLAR İLE SSRI ALANLAR (Prozac) AYNI BEYİN DEĞİŞİKLİKLERİNİ GÖSTERMİŞLERDİR. CAUDATE NUCLEUS OCD’DE AŞIRI AKTİF OLAN BEYİN BÖLGESİDİR, HER İKİ TEDAVİ SONRASINDA BURADAKİ METABOLİK FAALİYETLERDE AZALMA GÖRÜLMÜŞ. AYNI ŞEKİLDE CBT VE CITALOPRAM ALAN SOSYAL FOBİK HASTALARDA DA GÖRÜLMÜŞ. TEHDİTLE İLİŞKİLİ BEYİN BÖLGESİ OLAN LİMBİK SİSTEMDE HER İKİ TEDAVİ SEÇENEĞİNDE AZALMIŞ AKTİVİTE SAPTANMIŞ.
EĞER HASTALIĞIN NEDENİ BİYOLOJİKSE SCH’DA OLDUĞU GİBİ İLAÇ TEDAVİSİ, EĞER NEDENİ PSİKOLOJİKSE SOSYAL FOBİDE OLDUĞU GİBİ PSİKOLOJİK TEDAVİ YAPALIM DİYE BİR YANLIŞ İNANÇ VARDIR. ÇÜNKÜ PSİKOLOJİK TEDAVİLER BİYOLOJİMİZİ ETKİLER, BİYOLOJİK TEDAVİLER PSİKOLOJİMİZİ ETKİLER.

90. Electrical Stimulation
Electroconvulsive therapy (ECT) -informally called “shock therapy” involves patients receiving brief electrical pulses to the brain that produce a seizure about a minute, similar to epilepsy.
Used to treat severe problems (intractable depression, bipolar disorder, SCH, and severe catatonia) as a last resort.
6-10 treatments given three times a week.
as a last resort: SON BİR ÇARE OLARAK.
intractable : İNATÇI

91. A team of professionals administer ECT.

92. Electrical Stimulation
Most people who undergo ECT would do so again, and report improvements after ECT.
Must weigh benefits against problems
Over 50% relapse in six months. ECT isn’t a cure-all.
It can create short-term confusion and cloud memory. Memory loss is restricted to events that occur right before the treatment. Memory and attention problems persisted in some patients for six months after ECT.
ECT may be helpful because it increases the levels of 5-HT in the brain and stimulates growth of brain cells in the hippocampus and serves as an “electrical placebo.”
THE Erroneous beliefs that ECT is painful or dangerous and produces long-term memory loss, personality changes, and even brain damage.
YAPILAN ÇALIŞMALARDA ect ALMIŞ OLAN KİŞİLER İYİ Kİ ALDIKLAIRNI, EĞER YENİDEN HASTALANIRLARSA ECT OLMAK İSTEDİKLERİNİ DİLE GETİRMİŞLERDİR.
UNDERGO: EXPERİENCE
CURE-ALL: HER DERDE DEVA
BELKİ DE ECT’NİN İYİ GELDİĞİNİ SÖYLEYENLER BUNA KENDİLERİNİ İNANDIRMIŞ VE ÇOK MOTİVE OLMUŞ KİŞİLER OLABİLİR.
AYRICA SÖYLEDİKLERİ İYİLEŞME, İŞLEVSELLİK VE SEMPTOM ÖLÇÜMLERİNDE DÜZELME İLE PARALEL DEĞİLDİR.

93. A small vagus nerve stimulator can be implanted under the breastbone in cases of serious treatment-resistant depression.
VAGUS NERVE: AKCİĞER MİDE SİNİRİ
Electrical pulses to this nerve may stimulate 5-HT and increase brain blood FLOW.

94. Electrical Stimulation
Vagus nerve and transcranial magnetic stimulation are both FDA approved for treatment-resistant depression.
No large-scale studies on effectiveness, side effects similar to or greater than ECT.
LO 16.13

95. Psychosurgery
Brain surgery to treat psychological disorders, like prefrontal lobotomies.
“dehumanized zombies”
In the past, lobotomies were performed on violent sexual criminals, homosexual child abusers, and aggressive prison inmates.
Used today as an absolute last resort with a handful of conditions
Severe OCD, depression, bipolar disorders
1950LERİN ORTASINDA FARMAKOLOJİNİN GELİŞMESİ VE İNSANLIKTAN ÇIKMIŞ ZOMBİLER OLARAK İNSANLARIN BELİRLENMESİNDEN SONRA PSİKOŞİRJÜRİYE OLAN İLGİ AZALDI. PSİKOŞİRÜRJİYE YAPILAN ELEŞTİRLERDEN BİRİSİ DE İNSANLARIN YARARINA DEĞİL DE ONLARI CEZALANDIRMAK İÇİN KULLANILDIĞI ŞEKLİNDE.
HaNdful: az miktarda, avuç dolusu

96. Operations
Trepanation
The photographs have been taken in Samsun Archaeological Museum by Bahar Baştuğ.

97. It’s ensured that
(a) there’s a clear rationale for the operation,
(b) the patient has received an appropriate preoperative and postoperative evaluation,
(c) the patient has consented to the operation, and
(d) the surgeon is competent to conduct the procedure