1. 1 Therapy Chapter 15

2. 2 History: Early Treatment  Abnormal Behavior Caused by?  Treatment?

3. 3 History: Medical Model Movement  Instead of Imprisoning – have Mental Hospitals  More humane movement -- care for the mentally ill.  Diagnosis & Treatments Philippe Pinel (1745-1826)Dorthea Dix (1802-1887) Early treatments

4. 4 Contemporary Therapy It used to be that if someone exhibited abnormal behavior, they were institutionalized. Because of new drugs and better therapy, the U.S. went to a policy of deinstitutionalization. Early treatments

5. 5 Therapy Approaches Today  Psychotherapy = Interaction between a trained therapist and a mental patient/client.  Biomedical therapy = Uses drugs or medical procedures to treat symptoms  Eclectic approach = uses various forms of healing techniques depending upon the client’s unique problems.

6. 6 Psychological Therapies 4 major forms of psychotherapies: 1.Psychoanalytic theory 2.Humanistic theory 3.Behavioral theory 4.Cognitive theory

7. 7 Psychoanalytic Therapy Unconscious Mind – repressed childhood impulses and conflicts creates anxiety (id vs superego) Psychoanalysis (manifest and latent content through…. hypnosis, free association, dream interpretation). Resistance then Transference Other therapies will result in symptom substitution. Criticisms?

8. 8 Psychodynamic Therapy  Influenced by Freud  Face-to-face setting  Focus on Life Stress & Issues  Ex: Interpersonal psychotherapy for treating depression -- focuses on symptom relief here and now, not an overall personality change Psychodynamic

9. 9 Humanistic Therapy Client-Centered Therapy by Carl Rogers These are non-directive therapies and use active listening. Self-actualization, free- will, and unconditional positive regard. Gestalt Therapy by Fritz Perls encourage clients to get in touch with whole self.

10. 10 Behavioral Therapies Counterconditioning Conditions new responses to stimuli that trigger unwanted behaviors Classical Conditioning (Applies learning principles to eliminate unwanted behaviors) 1.Exposure Therapy 2.Aversive Conditioning

11. 11 Behavioral Therapy  Exposure Therapy  Based upon work of Mary Cover Jones & Little Peter Study-- Counterconditioning  Joseph Wolpe  Expose patients to things they fear and avoid (usually phobia therapy). Expose  Through repeated exposures, anxiety lessens because they habituate to the things feared. The Far Side © 1986 FARWORKS. Reprinted with Permission. All Rights Reserved.

12. 12 Behavioral Therapy  Systematic Desensitization  A type of exposure therapy that associates a pleasant, relaxed state with gradually increasing anxiety-triggering stimuli commonly used to treat phobias.  Flooding – Quicker but more traumatic Intense Exposure Therapy OCD & exposure

13. Systematic Desensitization Instructor’s Notes Copyright © Houghton Mifflin Company. All rights reserved. PowerPoint® 2000 or better with Flash® plug-in required to view animations. Right-click on animation for playback controls.

14. 14 Behavioral Therapy  Aversive Conditioning  A type of counterconditioning that associates an unpleasant state with an unwanted behavior.  With this technique, temporary conditioned aversion to alcohol has been reported.

15. 15 Behavioral TherapyTherapy Operant Conditioning Uses behavior modification -- desired behaviors are rewarded and undesired behaviors are either unrewarded or punished Ex: Token Economy

16. 16 Cognitive Therapy It’s all about our thinking Irrational Views Pessimistic Views Change the way we view the world (change our schemas)

17. 17 Cognitive Therapy  Aaron Beck – father of Cognitive Therapy  Pioneer on cognitive treatment for depression  Suggests that depressed patients believe that they can never be happy (thinking) and thus associate minor failings (e.g. failing a test [event]) in life as major causes for their depression  Use of Questioning to change Irrational Views  Teaches people adaptive ways of thinking

18. 18 Cognitive Therapy Albert Ellis – part of cognitive revolution Rational Emotive Therapy (RET) Developed Rational Emotive Behavior Therapy (REBT) – form of Cognitive-Behavior Therapy (CBT) CBT aims to alter the way people act (behavior therapy) and alter the way they think (cognitive therapy). Combines the reversal of self-defeated thinking with efforts to modify behavior. CBT

19. 19 Cognitive Therapy  Stress Inoculation Training  Train people to restructure their thinking in stressful situations. “Relax, the exam may be hard, but it will be hard for everyone else too. I studied harder than most people. Besides, I don’t need a perfect score to get a good grade.”

20. 20 Group Therapies  Consists of 6-9 people attending (a 90-minute session)  Help more people and Costs less.  Clients benefit from knowing others have similar problems.

21. 21 Family Therapy  Treats the family as a system.  Therapy guides family members toward positive relationships and improved communication.

22. 22 The Relative Effectiveness of Different Therapies Which psychotherapy would be most effective for treating a particular problem? DisorderTherapy DepressionBehavior, Cognition, Interpersonal/PA AnxietyCognition, Exposure, Stress Inoculation BulimiaCognitive-behavior PhobiaBehavior, CBT Schizophrenia? OCD treatment

23. 23 Who do people turn to for help with psychological difficulties?

24. 24 The Biomedical Therapies These include physical, medicinal, and other forms of biological therapies. 1.Drug Therapies 2.Brain Stimulation 3.Psychosurgery

25. 25 Somatic/Biomedical Therapies Psychopharmacology Study of drug effects on mind and behavior Use Double-Blind Procedures to test effectiveness of drugs

26. 26 Schizophrenia Medication Antipsychotic Drugs (Neuroleptics) First introduced in 1950s Typical (Classical) Antipsychotics blocks receptors for dopamine to remove the symptoms of schizophrenia (stops delusions and hallucinations) Chlorpromazine (Thorazine) – low potency & Haloperidol (Haldol) – high potency Side Effects -- Tardive dyskinesia (have difficulty not moving body parts -- repetitive, involuntary, purposeless movements), Tremors, Weight Gain, Muscle Stiffness & Cramping, Dry Mouthmovingrepetitive

27. 27 Atypical (2 nd Generation) Antipsychotics Clozapine (Clozaril), Abilify Less likely to cause motor control disabilities (Parkinson’s), body rigidity, & involuntary tremors May remove some negative symptoms

28. 28 Antianxiety Drugs Depress the central nervous system and reduce anxiety and tension by elevating the levels of the Gamma-aminobutyric acid (GABA) neurotransmitter. Valium, Barbiturates, Xanax, Ativan

29. 29 Antidepressant Drugs Selective Serotonin Reuptake Inhibitors (SSRIs) Improve the mood by elevating levels of serotonin by inhibiting reuptake. Prozac, Zoloft, and Paxil Serotonin-Norepinephrine Reuptake Inhibitors ( SNRIs) – Cymbalta Monoamine Oxidase Inhibitor (MAOIs) SSRI drugs

30. 30 SAD Treatment Seasonal Affective Disorder (SAD) Treated by light exposure therapy. This form of therapy has been scientifically validated.

31. 31 Bipolar Medications Mood Stabilizers Lithium, a common salt, has been used to stabilize manic episodes in bipolar disorders (decreases norepinephrine & increases serotonin). Moderates levels of norepinephrine and glutamate neurotransmitters Suppress Mood Swings Anticonvulsants

32. 32 Somatic Therapy Electroconvulsive Therapy (ECT)- for severe depression & form of brain stimulation. Psychosurgery 1.Prefrontal lobotomy (20 / YR today) Early treatments

33. 33 Brain Stimulation Electroconvulsive Therapy (ECT)ECT ECT is used for severely depressed patients who do not respond to drugs. The patient is anesthetized and given a muscle relaxant. Patients usually get a 100 volt shock that relieves them of depression. 80% of severely depressed show improvement

34. 34 Alternatives to ECT Repetitive Transcranial Magnetic Stimulation (rTMS) In rTMS, a pulsating magnetic coil is placed over prefrontal regions of the brain to treat depression with minimal side effects.

35. 35 Trepanation Acupuncture