Treatments

History of Treatments Early treatments brutal Transitioned to more humane methods Dorothea Dix – 1st to transition to gentler treatments in U.S. Today - Biomedical Drugs and better Psychotherapy has led deinstitutionalization.

Categories of Therapy 2 Main Categories Psychotherapy – interaction between therapist and patient Example: Psychoanalytic Therapy Psychotherapist - trained therapist(clinical psych) who uses psychological techniques to assist someone to overcome Example: psychodynamic therapist who treats an anxiety disorder 2. Biomedical Therapy – prescription meds that act on central nervous system Example: Antipsychotic drugs to treat Schizophrenia Ecclectic Approach– uses a variety of psych theories and approaches to treat mental illness Example: combining medication (anti-depressants) with different types of psychotherapy such as Cognitive Therapy (change feelings of self-blame) and Behavioral (go out and run when feeling depressed)to treat depression

Perspectives and Disorders Psychological School/Perspective Cause of the Disorder Treatments Psychoanalytic/Psychodynamic Unconscious drives/conflicts and childhood experiences Psychoanalytic Therapy Psychodynamic Therapy Humanistic Barriers to self-understanding and self-acceptance. Client Centered Therapy - unconditional positive regard and active listening. Behavioral Reinforcement history, the environment. Behavioral Therapies Classical – counterconditioning, exposure therapy, flooding, systematic desensitization, virtual reality, aversive Operant – behavior modification, Token economy Cognitive Irrational, dysfunctional thoughts or ways of thinking. Cognitive Therapy Sociocultural Dysfunctional Society & stressful relationships Group or Family Therapy Biomedical/Neuroscience biochemical imbalances, brain abnormalities, genetic predispositions. Biomedical Drug Therapy

Insight Therapies Insight therapies – try to improve mental state by increasing client’s awareness of underlying motives and defenses Examples: Psychoanalytic Therapy Psychodynamic Therapy Humanistic Therapy

Psychoanalytic Therapy Psychoanalysis – uncovering childhood experiences to gain insight into the unconscious origins of the disorder dream analysis – manifest and latent free association – uncensored reporting of any thoughts that come to mind. Resistance - blocking from unconsciousness anxiety-laden material during therapy. Example: stuttering, omitting or forgetting events, pausing, changing the subject, ending a session

Psychoanalytic Therapy Transferring – strong positive or negative feelings patients may feel about the psychoanalyst that reflect similar unconscious feelings repressed from earlier relationships. Seen as helpful to the therapy process Example: Hatred toward mother is expressed as hatred toward therapist

Psychoanalytic Therapy Criticisms Interpretations can’t be proven or disproven Costly and time consuming (2 or more sessions/week for 2 or more years)

Psychodynamic Therapy Psychodynamic therapy - try to understand patients' current symptoms by focusing on recurring patterns in their interpersonal relationships Patients gain insight into unconscious conflicts Face to face, once per week, several months Interpersonal psychotherapy - effective in treating depression by helping patients improve their interpersonal skills variation of psychodynamic therapy 14-16 sessions Example: helping a depressed patient resolve conflicts with friends

Humanistic Therapy Humanistic Therapy - emphasize the importance of self-awareness and take responsibility for own feelings and actions to improve mental state Focus on present Focus on Conscious thought Taking responsibility for own actions Promote personal growth Does NOT analyze motive, diagnose or recommend a cure. .

Humanistic Psychology Client-Centered Therapy (Rogers) - patients' discover their own ways of dealing with difficulties non-directive therapies – therapist listens without judging or giving insight Genuineness, acceptance and empathy Unconditional Positive Regard Active listening – echoing, restating and seeking clarification of clients feelings

Geraldo, a high school senior, is so fearful of asking a girl out that he hasn't had a date in over three years. He has recently contacted a psychotherapist for help in overcoming his fear. Describe how a humanistic therapist and a psychoanalyst would treat Geraldo's problem.

HUMANISTIC PSYCHOLOGIST focus on the present rather than the past - what Geraldo can do now to get up the nerve to ask for a date rather than what he failed to do in the past conscious thoughts - what Geraldo thinks about dating and how he would approach a woman for a date taking responsibility for his actions - what he can control in asking a woman out on a date rather than what he can't control PSYCHOANALYST focus on what unconscious impulses or conflicts are causing Geraldo's fear—Does Geraldo have unconscious feelings of anxiety about his mother that he is transferring to other women?

Behavioral Therapies Behavior Therapies – applies learning principles to unwanted behaviors Classical Conditioning Maladaptive symptoms are conditioned responses Operant Conditioning Maladaptive symptoms are reinforced

Behavioral Therapy Classical Conditioning Counterconditioning (Pavlov)- replaces a negative behavior (anxiety, fear) with a positive behavior (relaxation) Example: Child wets the bed, condition to wake up when bladder relaxes by using an alarm 2 Types Exposure Therapies Flooding Systematic Desensitization Virtual Reality Exposure Therapy Aversive Conditioning

Exposure Therapies Exposure Therapies - Repeatedly introducing people to things they fear and avoid Flooding – forced exposure to the stimulus that is feared Example: Putting a Susan who has Arachnophobia in a room full of spiders to show that they have no reason to fear them Systematic Desensitization – gradual exposure to the actual stimulus by replacing a positive response with a negative response. Progressive relaxation – imagined scene is repeatedly paired with relaxation and progresses to eventually facing the worst fear Example: Therapist first asks Susan to relax and imagine a harmless spider climbing up the wall eventually she will face a room full of tarantula spiders, her greatest fear

Exposure Therapies Virtual Reality Therapy – progressively exposing people to simulations of their greatest fears Examples: exposing Susan to Spiders using a 3 dimensional virtual world with life-like spiders Fear of flying, heights, animals and public speaking

Aversion Therapy Aversion Therapy – replaces a positive behavior with a negative behavior Examples: consuming alcohol (euphoria - positive) with a nausea producing drug (negative) Gambling and shock treatments Problem: cognition influences conditioning

Operant Conditioning Behavior Modification - reinforcing desired behaviors, giving punishments for undesired behaviors Example: Punishing aggressive behaviors of children with autism Token Economy – earning a token for desired behavior that can be traded in for privileges Example: Given tokens to ADHD students for staying in their seats and allowing them to trade them in for a prize

Describe how a therapist might apply operant conditioning techniques to help Rosemary overcome a compulsive habit of eating too much junk food. Be clear about the exact procedures that would be used.

behavior modification - reinforcing the desired behavior (e. g behavior modification - reinforcing the desired behavior (e.g.. encouraging Rosemary to treat herself to a favorite, healthy food [such as an energy drink] if she doesn't eat any chips or candy during the day) or punishing an undesirable behavior (e.g., having to put $5 in a jar each time she has a piece of candy).

Cognitive Therapy Cognitive Therapy – change the way patient thinks (change schemas) Irrational, Self-blaming, over-generalized thoughts, negative interpretations Anxiety Disorders, Major Depressive Disorder, Suicide Example: Dan thinks he can’t get an A in AP Psych because he’s incompetent Beck’s Therapy for Depression – uses gentle questioning to reveal irrational thinking Stress Inoculation Training Teaches to change thinking in stressful events

Cognitive-Behavioral Therapy Cognitive Behavioral - Changes the way we think and act Example: When Olivia is anxious, her therapist teaches her to attribute her anxiety to a highly reactive sympathetic nervous system and to play Temple Run on her phone instead. Rational Emotive Behavior Therapy (REBT, Ellis) – helps people change their irrational beliefs by having therapist dispute the client's irrational beliefs and behavioral problems Example: "Where is it written that other people must treat you fairly?"

One of your best friends feels that he fails at everything he does and that his life isn't worth living. When you suggest that he talk to a psychotherapist, your friend responds, “Talking won't help. The more I talk about myself, the more I think about my problems. The more I think about my problems, the more depressed I get.” What procedures would a cognitive therapist use to help your friend overcome his negative feelings?

A cognitive therapist - believes that the emotional reaction (depression) is produced by your friend's thinking about life events, and so would work with the client to change the ways he thinks about life events.

Family and Group Therapy Offered for: family conflict, stressful relationships, patients with similar problems Improves communication skills and conflict resolution Examples: obesity (OA), alcoholism (AA) Family Therapy – unwanted behaviors are influenced by other family members Example: rebellious child

Evaluating Psychotherapy Placebo effect – the beneficial consequences of merely expecting that a treatment will be effective. Regression toward the mean – the tendency for unusual events or emotion to return to their ave. state . Example: Dan got an unusually high grade on a test, he performed less on the second even though he studied the same amount

Evaluating Psychotherapy Randomized Clinical Trials – compare treatment groups with control groups Meta-analysis – a procedure for statistically combining the results of many different studies. – gives bottom line results Psychotherapies bottom line – Those not undergoing therapy often improve, but those undergoing therapy are more likely to improve

Comparison of Psychotherapies Evidence Based Practices - Clinical decision making that integrates the best available research with clinical expertise and an understanding of patient characteristics **Scientifically Unsupported Therapies - Energy Therapy, Recovered-memory Therapy, Rebirthing Therapies, Facilitated Communication, Crisis Debriefing

Alternative Therapies EMDR (Eye Movement Desensitization and Reprocessing - Rapidly moving one's eyes while recalling traumatic experiences similar to exposure treatment Originally developed for anxiety Value in placebo effect and exposure therapy Light Exposure Therapy – exposure to intense light that mimics outdoor light activity in the brain region responsible for arousal Seasonal Affective Disorder – depression caused by lack of exposure to natural light

Biomedical Therapy Biomedical Therapy – drugs, or treatments that act on the brain’s central nervous system Examples: Drugs, electroconvulsive therapy, Magnetic impulses Psychosurgery

Biomedical Therapy Psychopharmacology – study of the effects of drugs on the mind and behavior Antipsychotics (Thorazine,Chlorpromazine, Clozapine) Anti-anxiety ( Xanax, Ativan d-cycloserine) Anti-depressants (Paxil, Prozac, Zoloft – SSRI’s) Mood Stabilizers Bipolar (lithium, Depakote)

Anti-Psychotics Anti-Psychotic Drugs – drugs used to treat schizophrenia that block receptor sites for dopamine Thorazine – Helps positive symptoms only – hallucinations and paranoia Tardive dyskinesia –Side effects: sluggishness, tremors, twitches, involuntary movements of face, tongue, limbs from long-term use ( Atypical antipsychotics Block both dopamine and serotonin receptors Clozapine –used to treat negative symptoms –apathy and withdrawal

Anti-Anxiety Drugs Anti-anxiety drugs – depress central nervous system activity Xanax & Ativan D-cycloserine – acts on receptor site that extinguishes learned fear –helps with PTSD and OCD Addictive Withdrawal symptoms – increased anxiety and insomnia

Anti-Depressants Anti-depressants – used to treat depression & anxiety by increasing the availability of serotonin and norepinephrine that elevate arousal and mood Paxil, Prozac, Zoloft (SSRIs) – blocks serotonin reuptake Dual Action Drugs – block both the reuptake of serotonin and norepinephrine

Alternatives for Depression Cognitive-Therapy + antidepressants Cognitive therapy top down Antidepressant bottoms-up – works on limbic system Mood Stabilizing Drugs Lithium – simple salt used to treat Bipolar disorder Depakote – epilepsy drug used to treat mania Exercise

Brain Stimulation Treatments for Depression ECT (Electroconvulsive therapy) – electric shock therapy for patients with sever depression Can trigger seizures and memory loss rTMS (repetitive transcranial magnetic stimulation)- repeated pulses of magnetic energy to brain’s surface No seizures or memory loss Triggers long-term potentiation of inactive left frontal lobe nerve cells. Deep Brain Stimulation – uses implanted electrodes to inhibit activity in an area of the cortex that triggers negative emotions

Psychosurgery Psychosurgery – removes or destroys brain tissue Lobotomy - cut the nerves connecting the frontal lobes to the emotion controlling centers of inner-brain Once used to calm severely emotional or violent patients MRI-guided precision surgery – cut brain circuits of severe OCD

Preventing Psychological Disorders Therapeutic Lifestyle Change – reverses the symptoms of psychological disorders Aerobic exercise, adequate sleep, light exposure, and social engagement, anti-rumination, nutrition Resilience – ability to cope with stress and recover from adversity