1 PowerPoint Presentations for Philip G. Zimbardo Robert L. Johnson Vivian McCann Prepared by Beth M. Schwartz Randolph College This multimedia product and its contents are protected under copyright law. The following are prohibited by law: any public performance or display, including transmission of any image over a network; preparation of any derivative work, including the extraction, in whole or part, of any images; any rental, lease, or lending of the program. Seventh Edition Copyright © 2012 Pearson Education, Inc. All rights reserved

2 This multimedia product and its contents are protected under copyright law. The following are prohibited by law: any public performance or display, including transmission of any image over a network; preparation of any derivative work, including the extraction, in whole or part, of any images; any rental, lease, or lending of the program. Chapter 13 Therapies for Psychological Disorders

3 Therapy for psychological disorders takes a variety of forms, but all involve a therapeutic relationship focused on improving a person’s mental, behavioral, or social functioning. What is Therapy? Copyright © 2012 Pearson Education, Inc. All rights reserved

4 What is Therapy? General term for any treatment process In psychology and psychiatry, therapy refers to a variety of psychological and biomedical techniques aimed at dealing with mental disorders or coping with problems of living. Copyright © 2012 Pearson Education, Inc. All rights reserved

5 Components of Therapy Identifying the problem Identifying the cause of the problem or the conditions that maintain the problem Deciding on and carrying out some form of treatment Copyright © 2012 Pearson Education, Inc. All rights reserved

6 Types of Mental Health Care Professionals Counseling Psychologist Clinical Psychologist Psychoanalyst Clinical Social Worker Psychiatrist Psychiatric Nurse Practitioner Pastoral Counselor Copyright © 2012 Pearson Education, Inc. All rights reserved

7 Specialty: Problems of normal living Work setting: Schools, clinics, other institutions Credentials: Master’s in counseling, PhD, EdD, or PsyD Professional Title Counseling Psychologist Clinical Psychologist Psychoanalyst Clinical Social Worker Psychiatrist Psychiatric Nurse Practitioner Pastoral Counselor Copyright © 2012 Pearson Education, Inc. All rights reserved

8 Specialty: Those with severe or less severe disorders Work setting: Private practice, mental health agencies, hospitals Credentials: PhD or PsyD Professional Title Counseling Psychologist Clinical Psychologist Psychoanalyst Clinical Social Worker Psychiatrist Psychiatric Nurse Practitioner Pastoral Counselor Copyright © 2012 Pearson Education, Inc. All rights reserved

9 Specialty: Physician trained to treat mental problems (often by means of drug therapies) Work setting: Private practice, clinics, hospitals Credentials:MD Professional Title Counseling Psychologist Clinical Psychologist Psychoanalyst Clinical Social Worker Psychiatrist Psychiatric Nurse Practitioner Pastoral Counselor Copyright © 2012 Pearson Education, Inc. All rights reserved

10 Specialty: Freudian therapy Work setting: Private practice Credentials: MD or PhD Professional Title Counseling Psychologist Clinical Psychologist Psychoanalyst Clinical Social Worker Psychiatrist Psychiatric Nurse Practitioner Pastoral Counselor Copyright © 2012 Pearson Education, Inc. All rights reserved

11 Specialty: Nursing specialty; licensed to prescribe drugs Work setting: Private practice, clinics, hospitals Credentials: RN plus special training in treating mental disorders and prescribing drugs Professional Title Counseling Psychologist Clinical Psychologist Psychoanalyst Clinical Social Worker Psychiatrist Psychiatric Nurse Practitioner Pastoral Counselor Copyright © 2012 Pearson Education, Inc. All rights reserved

12 Specialty: Social worker with a specialty in dealing with mental disorders Work setting: Often employed by government Credentials:MSW Professional Title Counseling Psychologist Clinical Psychologist Psychoanalyst Clinical or Psychiatric Social Worker Psychiatrist Psychiatric Nurse Practitioner Pastoral Counselor Copyright © 2012 Pearson Education, Inc. All rights reserved

13 Specialty: Combines spiritual guidance with practical counseling Work setting: Religious order or ministry Credentials:Varies Professional Title Counseling Psychologist Clinical Psychologist Psychoanalyst Clinical Social Worker Psychiatrist Psychiatric Nurse Practitioner Pastoral Counselor Copyright © 2012 Pearson Education, Inc. All rights reserved

14 Therapy in Historical Context Medieval Europe: Mental disorder the work of devils and demons Exorcism needed to “beat the devil” out More Modern Times Mentally ill placed in institutions called asylums, which often resulted in neglect Copyright © 2012 Pearson Education, Inc. All rights reserved

15 Modern Approaches to Therapy Modern approaches abandoned demon model and abusive treatments. Therapies based on psychological and biological theories of mind and behavior psychological therapies, often called psychotherapy Biological therapies focus on altering the brain. Copyright © 2012 Pearson Education, Inc. All rights reserved

16 Psychologists employ two main forms of treatment: insight therapies and behavioral therapies. How Do Psychologists Treat Psychological Disorders? Copyright © 2012 Pearson Education, Inc. All rights reserved

17 Copyright © 2012 Pearson Education, Inc. All rights reserved Types of Psychotherapy

18 Insight Therapies Psychotherapies in which the therapists help patients/clients understand (gain insight into) their problems Aim at revealing and changing a patient’s disturbed mental processes through discussion and interpretation Numerous approaches involve this type of therapy. Copyright © 2012 Pearson Education, Inc. All rights reserved

19 Insight Therapies Freudian Psychoanalysis Insight therapies based on the assumption that psychological problems arise from tension created in the unconscious mind by forbidden impulses Major goal: To release conflicts and memories from the unconscious Copyright © 2012 Pearson Education, Inc. All rights reserved

20 Insight Therapies: Psychodynamic Therapies Psychoanalysis The form of psychodynamic therapy developed by Sigmund Freud Access to unconscious material through free association Helps the patient understand the unconscious causes for his or her symptoms Copyright © 2012 Pearson Education, Inc. All rights reserved

21 Insight Therapies Freudian Psychoanalysis Copyright © 2012 Pearson Education, Inc. All rights reserved

22 Insight Therapies: Psychodynamic Therapies Psychoanalysis The ego blocks unconscious problems from consciousness through defense mechanisms. e.g., displacement and repression Analysis of Transference Analyzing and interpreting the patient’s relationship with the therapist, based on the assumption that this relationship mirrors unresolved conflicts in the patient’s past Copyright © 2012 Pearson Education, Inc. All rights reserved

23 Insight Therapies: Psychodynamic Therapies Neo-Freudian Psychodynamic Therapies Therapies developed by psychodynamic theorists who embraced some but not all of Freud’s ideas emphasis on conscious motivation significance of the self experiences throughout life the role of interpersonal relationships abandoned the psychoanalyst’s couch see patients once a week Copyright © 2012 Pearson Education, Inc. All rights reserved

24 Insight Therapies: Humanistic Therapies Humanistic Therapies Mental problems arise from low self-esteem, misguided goals, and unfulfilling relationships. Client-Centered Therapy: Carl Rogers Emphasizes healthy psychological growth through self-actualization Reflection of feeling: paraphrasing client’s words to capture the emotional tone expressed Copyright © 2012 Pearson Education, Inc. All rights reserved

25 Insight Therapies: Cognitive Therapies Cognitive Therapy Emphasizes rational thinking as the key to treating mental disorder Helps patients confront destructive thoughts Copyright © 2012 Pearson Education, Inc. All rights reserved

26 Insight Therapies: Group Therapies Group Therapy Psychotherapy with more than one clien t Self-Help Support Groups Groups that provide social support and an opportunity for sharing ideas about dealing with common problems; typically organized/run by laypersons (not professional therapists) Copyright © 2012 Pearson Education, Inc. All rights reserved

27 Insight Therapies: Group Therapies Couples and Family Counseling Intended to help clients learn about relationships Can be more effective than individual therapy with one member of the relationship at a time Copyright © 2012 Pearson Education, Inc. All rights reserved

28 Systematic Desensitization Token Economies Contingency Management Aversion Therapy Participant Modeling Behavior Therapies Behavior Therapy Any form of psychotherapy based on the principles of behavioral learning: operant conditioning and classical conditioning Copyright © 2012 Pearson Education, Inc. All rights reserved

29 Classical Conditioning Therapies Systematic Desensitization Technique in which anxiety is extinguished by exposing the patient to an anxiety- provoking stimulus Exposure Therapy Desensitization therapy in which patient directly confronts the anxiety-provoking stimulus (as opposed to imagining it) Copyright © 2012 Pearson Education, Inc. All rights reserved

A Sample Anxiety Hierarchy 30 Copyright © 2012 Pearson Education, Inc. All rights reserved

31 Classical Conditioning Therapies Aversion Therapy Involves presenting individuals with an attractive stimulus paired with unpleasant stimulation in order to condition a repulsive reaction Copyright © 2012 Pearson Education, Inc. All rights reserved

32 Operant Conditioning Therapies Contingency Management Approach to changing behavior by altering the consequences of behaviors Effective in numerous settings e.g., families, schools, work, and prisons Copyright © 2012 Pearson Education, Inc. All rights reserved

33 Operant Conditioning Therapies Token Economies Applied to groups (e.g., classrooms or mental hospital wards) Involves distribution of “tokens” contingent on desired behaviors Tokens can later be exchanged for privileges, food, or other reinforcers. Copyright © 2012 Pearson Education, Inc. All rights reserved

34 Participant Modeling: An Observational-Learning Therapy Participant Modeling The therapist demonstrates and encourages a client to imitate a desired behavior. Draws on concepts from both operant and classical conditioning Copyright © 2012 Pearson Education, Inc. All rights reserved

35 Cognitive-Behavioral Therapy: A Synthesis Cognitive-Behavioral Therapy Combines cognitive emphasis on thoughts with behavioral strategies that alter reinforcement contingencies Assumes irrational self-statements cause maladaptive behavior Seeks to help the client develop a sense of self-efficacy Copyright © 2012 Pearson Education, Inc. All rights reserved

36 Cognitive-Behavioral Therapy: A Synthesis Rational-Emotive Behavior Therapy (REBT) Albert Ellis Based on the idea that irrational thoughts and behaviors are the cause of mental disorders Attempts to eliminate the self-defeating thoughts Positive Psychotherapy (PPT) Positive emphasis on growth Emphasis on research Copyright © 2012 Pearson Education, Inc. All rights reserved

37 Evaluating the Psychological Therapies Eysenck (1952) proposed that people with nonpsychotic problems recover just as well with or without therapy. Reviews of evidence since have shown that: Eysenck overestimated the improvement rate in the group without therapy. Therapy is better than no therapy. It appears advantageous to match specific therapies with specific conditions. Copyright © 2012 Pearson Education, Inc. All rights reserved

Comparing the Different Types of Therapy 38 Copyright © 2012 Pearson Education, Inc. All rights reserved

39 How Is the Biomedical Approach Used to Treat Psychological Disorders? Biomedical therapies seek to treat psychological disorders by changing the brain’s chemistry with drugs, its circuitry with surgery, or its patterns of activity with pulses of electricity or powerful magnetic fields. Copyright © 2012 Pearson Education, Inc. All rights reserved

40 Drug Therapy Antipsychotic Drugs E.g., chlorpromazine, haloperidol, and clozapine Usually affect dopamine pathways May have side effects tardive dyskinesia: incurable disorder of motor control resulting from long-term use of antipsychotic drugs Copyright © 2012 Pearson Education, Inc. All rights reserved

41 Drug Therapy Antidepressant Drugs Three major categories: tricyclic compounds (e.g., Tofranil and Elavil) SSRIs (e.g., Prozac) Monoamine oxidase (MOA) inhibitors and lithium carbonate (effective against bipolar disorder) Mood Stabilizers E.g., Lithium and Depakote: effective for bipolar disorders Copyright © 2012 Pearson Education, Inc. All rights reserved

42 Drug Therapy Antianxiety Drugs Include barbiturates and benzodiazepines May include some antidepressant drugs that work on certain anxiety disorders Should not be used to relieve the ordinary anxieties of everyday life Should not be taken for more than a few days at a time Should not be combined with alcohol Copyright © 2012 Pearson Education, Inc. All rights reserved

43 Drug Therapy Stimulants (e.g., caffeine, nicotine, cocaine) Produce excitement or hyperactivity Suppress activity level in persons with attention-deficit/hyperactivity disorder (ADHD) Controversy exists concerning the use of these stimulants for children. side effects growth slowed concern regarding overdiagnosis of ADHD Copyright © 2012 Pearson Education, Inc. All rights reserved

44 Psychosurgery The general term for surgical intervention in the brain to treat psychological disorders The infamous prefrontal lobotomy is no longer performed. Severing the corpus callosum, however, can reduce life-threatening seizures. Copyright © 2012 Pearson Education, Inc. All rights reserved

45 Brain-Stimulation Therapies Used to treat severe depression Electroconvulsive Therapy (ECT) Apply an electric current to temples briefly Patient is put to “sleep.” Memory deficits are a side effect. Transcranial Magnetic Stimulation (TMS) High-powered magnetic stimulation to the brain Also effective for bipolar disorder Deep Brain Stimulation Surgical implants of a micro electrode directly in the brain Still highly experimental Copyright © 2012 Pearson Education, Inc. All rights reserved

46 Hospitalization and the Alternatives Therapeutic Community Designed to bring meaning to patients’ lives Hospital setting to help patients cope with the world outside Higher costs Deinstitutionalization Removing patients, whenever possible, from mental hospitals Community Mental Health Movement Effort to deinstitutionalize mental patients and to provide therapy from outpatient clinics Copyright © 2012 Pearson Education, Inc. All rights reserved

How do the Psychological Therapies and Biomedical Therapies Compare? While a combination of psychological and medical therapies is better than either alone for treating some (but not all) mental disorders, most people who suffer from unspecified “problems in living” are best served by psychological treatment alone. Copyright © 2012 Pearson Education, Inc. All rights reserved 47

48 Depression Psychological vs. Medical Treatment Both are equally effective ways to treat depression in the short run. Cognitive behavioral therapy is more effective in the long run. A combination of both is most effective. Copyright © 2012 Pearson Education, Inc. All rights reserved

49 Anxiety Disorders Psychological vs. Medical Treatment Both can be effective. Most effective is a combination of both. Copyright © 2012 Pearson Education, Inc. All rights reserved

50 Empirically Supported Therapy (EST) Therapies validated by research evidence showing that they actually work This research raises interesting questions about whether counselors/therapists should be limited to these therapies. Can this guideline help practitioners to avoid harmful therapies? Can practitioners still meet individual needs? How will the insurance companies be involved? Copyright © 2012 Pearson Education, Inc. All rights reserved