1. AP Psychology Myers – Chapter 17
Therapy and Treatment
AP Psychology
Myers – Chapter 17

2. Types of Therapy The type of therapy used depends on the problem!
Psychotherapy
Social interaction between a trained therapist and someone who suffers from psychological difficulties
Ex: Using behavior therapies to treat a phobia that psychologically learned
Eclectic Approach
an approach that depending on the client’s problems, uses techniques from various forms of psychotherapy
Ex: using cognitive and behavioral therapies to treat disorders that require changes in thinking and behaviors
Biomedical Therapy
Prescribed medications or medical procedures that act directly on the patient’s brain and/or nervous system.
EX: treating schizophrenia with medication because it is biologically rooted in the brain

3. Psychotherapies Psychoanalysis Humanistic Behavioral Cognitive
Group Therapies

4. Psychoanalysis
“Look into the depths of your own soul and learn first to know yourself, then you will understand why this illness was bound to come upon you and perhaps you will thenceforth avoid falling ill.”
- Sigmund Freud

5. Psychoanalysis Based upon the ideas of Freud Goal Techniques
Criticisms
Try to help patients gain insight into the unconscious origins and roots of their disorders and work through anxiety-ridden feelings.
Free association - patient relaxes and starts talking about anything
Dream interpretation
Interpretation – the analyst’s noting of supposed meanings of dreams, free association, projective tests, etc in order to promote insight into the subconscious
Interpretations cannot be proven or disproven; psychoanalysts say that psychoanalysis is therapy, not a science
Time consuming – years long
Expensive – several sessions a week

6. Psychoanalytic Phenomena
Resistance –the blocking from consciousness of anxiety-laden material
Hints that anxiety exists and you are defending against sensitive material
Transference –the patient’s transfer to the analysts of emotions linked with other relationships
such as love or hatred for a parent
Example Psychoanalytic Session
What About Bob Trailer

7. Psychodynamic Therapy
Influenced by Freud, but not the same as psychoanalysis
Goal
Techniques
Try to understand a patient’s current symptoms by focusing on themes across important relationships
Face-to-face conversation
Once a week for a few weeks/months
Look for patterns in behaviors/relationships

8. Humanistic Therapy
“We have two ears and one mouth that we may listen that more an talk the less.”
- Zeno BC

9. Humanistic Therapy Emphasis on self-actualization and self-fulfillment
Developed largely by Carl Rogers
Goal
Techniques
Criticisms
Aim to boost self-fulfillment by helping people grow in self-awareness and self-acceptance
Focusing on the future instead of the past
Focusing on conscious rather than unconscious thoughts
“Clients” rather than “patients”  client-centered therapy in which the client feels unconditional positive regard and the therapist is nondirective (refrains from offering personal interpretations).
Active listening – therapist echoes, restates, and clarifies
Not scientific enough
Active Listening Example

10. With a neighbor… Think of the last thing recently that: Made you angry
Made you sad
Made you anxious/nervous
For 2-3 minutes, talk about the event and feelings. The active listener should:
Use Active Listening Tips sheet
Paraphrase – check your understanding by summarizing the speaker’s words in your own words and ask if you are correct.
Invite clarification – “What might be an example of that?” may encourage the speaker to say more.
Reflect feelings – “It sounds frustrating” might mirror what you’re sensing from the speaker’s body language and intensity.
Remain unbiased and nonjudgmental
Did you notice any differences when you were active listening compared to how you listen everyday?

11. Behavioral Therapies

12. Behavioral Therapy
Behavioral therapists do not emphasize the mental root of a disorder as they assume that the problem behaviors are the problems
Goal
Techniques
Criticisms
Applies learning principles to the elimination of unwanted behaviors (useful for phobias)
Counter-conditioning - conditions new responses to stimuli that trigger unwanted behaviors, based on classical conditioning.
Exposure therapy (systematic desensitization)
Aversion therapy
Behavior modification - reinforcing desired behaviors and withholding reinforcement or using punishment for undesired behaviors
Token economy
Doesn’t address mental processes behind disorders
When reinforcement disappears/stops, behaviors may come back.
Is it right for one human to control another’s behavior?
Is punishment unethical?

13. Counter-conditioning
Systematic Desensitization (exposure therapy) - associates a pleasant relaxed state with gradually increasing anxiety- triggering stimuli
commonly used to treat phobias.
Ex: fear of public speaking.
1. Ranked list (high to low anxiety)
2. Relaxed state
3. Induce mild anxiety and indicate too much
4. Return to relaxation
5. Repeat the pairing until the anxiety is replaced by relaxed feelings
6. Move up the anxiety list implementing desensitization each time.
7. Move from imagined situations to real situation.
Based on exposure therapy – touring airports/airplanes/cockpits to over come fear of flying

14. Counter-conditioning
Aversion therapy - associates an unpleasant state with an unwanted behavior
Commonly used to treat addictions
Ex: quitting smoking
1. Therapist shocks a patient when a drag is inhaled
2. Patient smokes rapidly, inducing many shocks
3. Pair together several times
4. Patient associates pain of shock with smoking
5. Quit smoking
Highly successful in the short-run, but has mixed results in the long- run.
Different from systematic desensitization (that induces relaxation) because it aims to induce negative feelings or an uncomfortable state  the reverse of systematic desensitization

15. Behavior Modification
Behaviors are influenced by their consequences
operant conditioning – reinforcement and punishment
Token economy –earn a token of some sort for exhibiting a desired behavior and can later exchange the tokens for various privileges or treats.
Used to help autistic children become more social.
Can teach schizophrenic sufferers or the mentally retarded to care for themselves.

16. Behavioral Therapy
Behavioral therapists do not emphasize the mental root of a disorder as they assume that the problem behaviors are the problems
Goal
Techniques
Criticisms
Applies learning principles to the elimination of unwanted behaviors (useful for phobias)
Counter-conditioning - conditions new responses to stimuli that trigger unwanted behaviors, based on classical conditioning.
Exposure therapy (systematic desensitization)
Aversion therapy
Behavior modification - reinforcing desired behaviors and withholding reinforcement or using punishment for undesired behaviors
Token economy
Doesn’t address mental processes behind disorders
When reinforcement disappears/stops, behaviors may come back.
Is it right for one human to control another’s behavior?
Is punishment unethical?

17. Cognitive Therapy
“Life does not consist mainly, or even largely, of facts and happenings. It consists mainly of the storm of thoughts that are forever blowing through one’s mind.”
- Mark Twain

18. Cognitive Therapy
Best for disorders in which the roots are unclear, like generalized anxiety disorder and major depressive disorder
Goal
Techniques
Tries to change unhealthy or maladaptive patterns in thinking by teaching new healthier ways of thinking
Depressed people do not exhibit the self-serving bias common in nondepressed people.
Instead they attribute their failure to themselves and attribute their successes to external circumstances.  must change that pattern of thinking
Ex: a depressed person writes 3 positive things that happened that day and how they contributed to them
Ex: a person with test-anxiety repeats positive things to themselves before an exam

19. Cognitive-Behavioral Therapy
Useful for disorders that involve maladaptive mental and behavioral elements
Goal
Techniques
Combines changes in thinking (cognitive) and changes in behaviors (behavioral)
Rational-emotive behavior therapy – proposes that unrealistic and irrational beliefs cause maladaptive behaviors; focuses on changing thinking patterns.
Identify the underlying irrational thought patterns/beliefs
Challenge the irrational beliefs
Gain insight and recognize irrationality
Best for OCD, eating disorders, etc (any disorder with cognitive/behavior roots)

20. Other examples of CBT
EX: OCD sufferers – changing thinking patterns concerning obsessive thoughts and changing behaviors concerning compulsions
EX: Anorexia nervosa – changing thinking patterns concerning depression and negative body image and changing behaviors concerning eating.

21. Group Therapies
“The feeling of having shared in a common peril is one element in the powerful cement that binds us.”
- Alcoholics Anonymous member

22. Group Therapy and Support Groups
Except for psychoanalytic therapies, psychotherapy techniques can be used in therapist-led small groups.
Group therapy does not allow for the same degree of individual attention, but it is time and cost effective and has often been found no less effective than individual therapy.
The social context of group therapy often allows client to feel as if they are not alone in their problems. It can be a relief to find that others share your problems and feelings.
EX: AA, cancer or AIDS support groups, online support groups
Rent – “Will I” – AIDS support group
Go On Trailer
More than 10 million Americans belong to small religious, interest, or self-help groups that meet regularly  reflects a longing for community and connectedness.
9 of 10 members in support groups report that members “support each other emotionally.”

23. Family Therapy
Treats the family as a system in which undesirable behaviors are influenced by and affect other members
tries to foster healthier relationships within the family.
Ex: A family might attend therapy if one member is addicted to drugs/medication during which the therapist would evaluate relationships in the family that could contribute to conflict and possible drug abuse.
Crash Course - Psychotherapy
Help family members discover the role they play within their family’s social system and to open communication by discovering new ways of preventing or resolving conflicts.

24. Evaluating Psychotherapies

25. Is Therapy Effective? Clinicians… Clients… YES
Self-justification – rationalize the time and money spent.
Confirmation bias and selective recall
Enter therapy in troubled state, when we return to a “normal” state, we attribute this to whatever we have done in the interim.
Placebo effect?
YES
More aware of the failures of other therapists.
The same person with the same recurring problems could be considered a “success story” for several therapists.
Although treatments have varied widely, every generation of therapists view its own approach as the most enlightened and effective.
Self-serving bias
Clients:
People often enter therapy in crisis. – when the crisis passes, people may attribute their improvement to the therapy.
Clients may need to believe the therapy was worth it. – Self-justification is a powerful human motive to justify or rationalize spending time and money on therapy.
Clients generally speak kindly of their therapists. – Even if the client’s problems are not solved or lessened, they still seem to say kind things about the therapist so the therapy doesn’t appear as a failure.
Testimonials can be misleading because we are prone to selective and biased recall and to making judgments that confirm our beliefs.
Clinicians…
Clients justify entering psychotherapy due to their unhappiness, justify leaving psychotherapy by emphasizing their well-being to the therapist (even if they are unhappy or unchanged)
Therapists are more aware of the failures of other therapists, whose clients are no seeking a new therapist for their recurring problems. The same person with the same recurring problems could be considered a “success story” for several therapists.
Although treatments have varied widely, every generation of therapists view its own approach as the most enlightened and effective.

26. Outcome Research Controlled experiments!
Outcome studies are randomized clinical trials in which people on a waiting list receive therapy or no therapy.
Meta-analysis – a procedure for statistically combining the results of many different research studies
People who remain untreated often improve (2/3)
People who receive psychotherapy are more likely to improve.
People who receive psychological treatment spend less time and money later seeking other medical treatments, compared with those on the waiting list.

27. Evaluating Pseudotherapies
As critical thinkers, exploring and evaluating pseudotherapies requires a scientific attitude -- being skeptical but not cynical, and open to surprise but not gullible.

28. Pseudotherapies
Every therapy, based on testimonials, will seem effective for some people.
Placebo effect? Regression toward the mean?
For many pseudotherapies, little/no scientific evidence about the effectiveness exists (uncontrolled exp., unreliable results)
Hypnotherapy
Anger-release therapists
Reflexologists
Aromatherapists
Massage therapy
Herbal medicines

29. Eye Movement Desensitization and Reprocessing (EMDR)
A therapist attempts to unlock and reprocess previously frozen traumatic memories by waving a finger/flashing a light in front of the eyes of a person imagining a traumatic scene.
EDMR has its believers and also its critics.
Combination of exposure therapy (repeatedly reliving traumatic memories in a safe and reassuring context) and the placebo effect?
EMDR

30. Light Exposure Therapy
Light exposure therapy – exposure to daily timed doses of light that mimics outdoor light.
Seasonal affective disorder – (SAD) a form of depression linked to periods of decreased sunlight.
Light comes out of manufactured light boxes that can be bought or rented from health supply and lighting stores.
Research and controlled experiments suggest that light exposure therapy diminishes symptoms associated with SAD.

31. Relative Effectiveness of Different Therapies
Is there a “best” therapy?

32. Relative Effectiveness
Consumer Reports readers reported being equally satisfied…
Regardless of therapy type
Regardless of training level of therapist (psychiatrist, psychologist, or social worker)
With both group vs. individual sessions

33. Relative Effectiveness
Therapy is most effective when the problem is clear-cut and specific.
Phobias or panic can hope for improvement.
Less-focused problems, such as depression and anxiety, usually benefit in the short-run but often relapse later.
Those who have chronic schizophrenia or who wish to change their personality are unlikely to benefit from psychotherapy alone.

34. Effective Therapy Depends on the Problem
Psycho-dynamic
Humanisitc/ CCT Therapy
Behavioral
Therapies
Cognitive
Therapy
Depression X
Anxiety
Phobias
OCD
Reducing suicide risk

35. When Should You Consider Therapy?
The APA suggests considering seeking a mental health profession if you display:
Feelings of hopelessness
Deep and lasting depression
Self-destructive behaviors
Disruptive fears
Sudden mood shifts
Thoughts of suicide
Compulsive rituals

36. The Biomedical Therapies
“Medicine, the only profession that labors incessantly to destroy the reason for its existence,”
- James Bryce

37. Biomedical Therapies Physically change the brain’s functioning…
Altering chemistry with medication
Overloading its circuits with electroconvulsive shock
Using magnetic impulses to stimulate or dampen activity
Altering its circuits through psychosurgery

38. Psychopharmacology
The study of the effects of drugs on mental processes and behaviors.
Led to more independent lives for sufferers of psychological disorders
Reduced hospitalization of many people
To evaluate the effectiveness of new drugs, researchers use the double-blind experimental technique to reduce researcher bias.

39. Antipsychotic Drugs Tardive Dyskenesia Goal Useful for… Examples
Negative Effects
Lessen responsiveness to random stimuli by blocking dopamine receptors
Dopamine hypothesis - schizophrenia is related to overactivity of dopamine.
Schizophrenia (regulates dopamine by blocking it at the synapse)
Lessens positive symptoms
Thorazine
Clozapine
Risperdal
Zyprexa
AKA - Neuroleptics
Tardive dyskenesia – involuntary mov’ts of facial muscles, tongue, and limbs
Increased risk of obesity and diabetes
= Dopamine
= Antipsychotic drug

40. Anti-anxiety Drugs Goal Useful for… Examples Negative Effects
Depress central nervous system reactivity
Anxiety
Phobias
Can help a person learn to cope with frightening situations and fear-triggering stimuli.
Xanax
Ativan
Can be used as a crutch, without actually solving the root of the anxiety.
Users can become tolerant, addicted, and dependent on the medication.

41. Anti-depressant Drugs
Goal
Useful for…
Examples
Negative Effects
Regulate levels of neurotransmitters in the brain (serotonin and norepinephrine) that can elevate mood
Depression
Anxiety
Selective-serotonin-reuptake-inhibitors (SSRIs) – slow/block the reabsorption or reuptake of serotonin
Zoloft
Prozac
Paxil
Full effects take 4 weeks – high suicide risk when starting medication

42. Mood Stabilizing Drugs
Goal
Useful for…
Examples
Negative Effects
Stabilize fluctuating moods
Bipolar Disorder
Lithium
Unclear how it works – maybe strengthens nerve connections in brain that regulate mood?
Increased thirst
Headaches
Memory loss
Some tremors or twitches

43. Brain Stimulation “Shock” Trailer Goal Useful for… Examples
Negative Effects
Send an electric current through the brain while the patient is anesthetized
Severe depression that does not respond to meds
Electroconvulsive therapy (ECT)
Not exactly sure how it works – maybe calms the area of the brain that is over active and causing depression?
Memory loss
Stigmatized (bad reputation)
repeated pulses of magnetic energy to the brain
Alternative to ECT
Repetitive transcranial magnetic stimulation (rTMS) - used to stimulate or suppress brain activity
Does not penetrate surface of brain
Painless, wide-awake
No memory loss
No seizures

44. Psychosurgery
Goal
Useful for…
Examples
Negative Effects
Remove or destroy brain tissue to change behavior
Epilepsy
Cutting the corpus callosum
Lobotomy – NOT performed anymore
Irreversible – least used therapy
Lobotomy – a now-rare psychosurgical procedure that cut the nerves that connect the frontal lobes to the emotion-controlling centers of the inner brain.
Developed in the 1930s
Shock the patient into a coma
Hammer an ice pick-like instrument through each eye socket into the brain, then wiggle it to sever connections running up to the frontal lobes.

45. Lobotomies Crude but easy and inexpensive (10 minutes)
Tens of thousands of severely disturbed people were lobotomized during the 1940s-50s
The lobotomy usually produced a permanently lethargic, immature, impulsive personality.
In the 1950s, calming drugs were introduced and lobotomized fell out of favor in the US.
Other early therapies
Crash Course – Biomedical Therapies