1. Treatments
Chapter 13…almost done!!

2. Bell ringer
You are a therapist…

3. Statistics 1/3 of people who suffer receive adequate care
41% get treatment in the last year
Least likely to seek treatment…
Elderly, minorities, rural residents
1/3 of those who seek help don’t have a disorder
Most people wait 10 yrs to seek help
Bipolar – 6yrs
Generalized anxiety – 9
ADHD 13
Specific phobias - 20

4. Psychoanalysis - Freud
For success you need…
Motivation – (time and $)
resistance
Interpersonal relationships
Form, maintain, detach
Transferring
Introspection and insight
Curiosity of oneself
Ego Strength
Handle painful interpretation

5. Humanistic Self-fulfillment Present v. Past Conscious v. Unconscious
Immediate responsibility for feelings & actions
Clients not Patients

6. Humanistic Client-Centered (Rogers)
Genuineness, acceptance, empathy (walking in their shoes), self understanding
Active listening
Questions
What you’re telling me is…
An example of that is…
I sense…
ACTIVITY

7. Activity Review
What where your questions for the clients tale?

8. Cognitive-Behavioral
Positivity!
Activity – see if any of the cognitive distortions from “The Feeling Good Handbook” are your own.
How do we “correct” these distortions?

9. Behavior Therapy
Therapy that applies learning principles to the elimination of unwanted behaviors.
To treat phobias or sexual disorders, behavior therapists do not delve deeply below the surface looking for inner causes.
OBJECTIVE 6| Explain how the basic assumption of behavior therapy differs from those of traditional psychoanalytic and humanistic therapies.

10. Classical Conditioning Techniques
Counterconditioning – The patient comes in with a stimuli that triggers unwanted behaviors. This procedure tries to condition new responses to the stimuli
It is based on classical conditioning and includes:
Exposure therapy
Intensive Exposure therapy (flooding)
Aversive conditioning.
OBJECTIVE 7| Define counterconditioning, and describe the techniques used in exposure therapies and aversive conditioning.

11. Can be in real or virtual environments.
Exposure Therapy
Expose patients to things they fear and avoid. Through repeated exposures, anxiety lessens because they habituate to the things feared.
Can be in real or virtual environments.
N. Rown/ The Image Works

12. “Intensive Exposure Therapy” Flooding
Expose patients to things they fear and avoid. Through repeated exposures, anxiety lessens because they habituate to the things feared.
The Far Side © 1986 FARWORKS. Reprinted with Permission. All Rights Reserved.

13. Systematic Desensitization
A method in exposure therapy that associates a pleasant, relaxed state with gradually increasing anxiety-triggering stimuli commonly used to treat phobias.

14. 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.
The behavior therapies—specifically aversive conditioning—
will have some students conjuring up images
of George Orwell’s 1984 and Stanley Kubrick’s A
Clockwork Orange. In the latter, Alex, a young hoodlum,
is apprehended by police after a series of sexual
and violent crimes. While in prison he volunteers for
the “Ludoveck Treatment,” which presumably cures
criminals in a few weeks. Alex is injected with a drug
that makes him violently ill; while under its influence,
he is forced to view films that graphically portray sexual
and aggressive actions. After repeated pairings of the
conditioned stimulus (sexual and violent images) with
the unconditioned stimulus (nausea-producing drug),
sexual and violent thoughts come to make Alex
extremely ill.
Two points are worth making in regard to this fictional
example. First, psychologists do not use aversive
conditioning in this way. Typically, the client knows all
about the procedure and consents to it. Moreover, its
aim—for example, in the treatment of smoking or
drinking—is toward increased self-control rather than
control by others. Second, Kubrick’s account is simplistic.
It overlooks the influences of cognition. After treatment,
Alex would know that sexual and violent actions
would not induce illness. In short, people’s feelings and
behavior cannot be so easily controlled as A Clockwork
Orange implies.

15. At this point you can complete Objective #2
Operant Conditioning
Operant conditioning procedures enable therapists to use behavior modification, in which desired behaviors are rewarded and undesired behaviors are either unrewarded or punished.
At this point you can complete Objective #2
OBJECTIVE 8| State the main premise of therapy based on operant conditioning principles, and describe the views of proponents and critics of behavior modification.

16. Behavior Contracting
Therapist and the client agree on behavior goals and on the reinforcement usually in the form of a contract with punishments and rewards. (Example behavior plans in school)

17. Token Economy
In institutional settings therapists may create a token economy in which patients exchange a token of some sort, earned for exhibiting the desired behavior, for various privileges or treats.

18. Group Therapy Positives:
Group therapy normally consists of 6-9 people attending a 90-minute session If the problems are interpersonal then why not broaden the therapy?
Positives:
behaviors towards others show up quickly in a group setting
client social support, not only one with this problem,
learn new behaviors
seeing others will help insight,
Clients benefit from knowing others have similar problems.
OBJECTIVE 10| Discuss the rationale and benefits of group therapy, including family therapy.

19. Family Therapy
Goal: To change all family members’ behavior to the benefit of the family unit as well as the troubled individual.
Method:
If one person is having problems, then it is likely the whole family is.
Must improve communication, empathy, responsibility, and reduce conflict.
Requires that all family members see the benefits.
Focus on changing self not others.
Concerns: Key person won’t come or monopolizes the sessions.

20. Couple Therapy
Goal: To improve a couple’s problems in communication, interaction, and mutual expectations.
Method:
Empathy Training – each is taught to share the inner feelings and to listen to and understand the partner’s feelings before responding.
Behavioral Techniques – schedule for caring actions
Cognitive Techniques – tries to dispel the cognitive distortions that disrupt communication
Concerns: Much more affective when it is two instead of one (56% vs. 29%)

21. Self-Help Groups
Goal: Low cost support and social network for a disorder
Method:
Since 40 million Americans suffer from some form of psychological disorder there are not enough psychologists to go around and they are expensive.
These small local gatherings of people share a common problem and provide mutual assistance at a very low cost.
AA is the best known.
At this point you can complete Objective # 3

22. Evaluating Psychotherapies
Within psychotherapies cognitive therapies are most widely used, followed by psychoanalytic and family/group therapies.

23. Outcome Research
Research shows that treated patients were 80% better than untreated ones.

24. The Relative Effectiveness of Different Therapies
Which psychotherapy would be most effective for treating a particular problem? – Objective #4
Disorder
Therapy
Depression
Behavior, Cognition, Interpersonal
Anxiety
Cognition, Exposure, Stress Inoculation
Bulimia
Cognitive-behavior
Phobia
Behavior
Bed Wetting
Behavior Modification
OBJECTIVE 14| Summarize the findings on which psychotherapies are most effective for specific disorders.

25. The Biomedical Therapies
These include physical, medicinal, and other forms of biological therapies.
Drug Treatments
Surgery
Electric-shock therapy
Used if:
The client is too agitated, disoriented, or unresponsive for psychotherapy.
The disorder has a strong biological component.
Dangerous to themselves or others.

26. Antipsychotic Drugs
Classical antipsychotics [Chlorpromazine (Thorazine)]: Remove a number of positive symptoms associated with schizophrenia such as agitation, delusions, and hallucinations.
Atypical antipsychotics [Clozapine (Clozaril)]: Remove negative symptoms associated with schizophrenia such as apathy, jumbled thoughts, concentration difficulties, and difficulties in interacting with others.
OBJECTIVE 19| Describe the characteristics of antipsychotic drugs, and discuss their use in treating specific disorders.

27. Atypical Antipsychotic
Clozapine (Clozaril) blocks receptors for dopamine and serotonin to remove the negative symptoms of schizophrenia.

28. Antianxiety Drugs
Antianxiety drugs (Xanax and Valium) depress the central nervous system and reduce anxiety and tension by elevating the levels of the Gamma-aminobutyric acid (GABA) neurotransmitter. GABA is the chief inhibitory neurotransmitter in the CNS
OBJECTIVE 20| Describe the characteristics of antianxiety drugs, and discuss their use in treating specific disorders.

29. Antidepressant Drugs
Antidepressant drugs like Prozac, Zoloft, and Paxil are Selective Serotonin Reuptake Inhibitors (SSRIs) that improve the mood by elevating levels of serotonin by inhibiting reuptake. MAO Inhibitors increase the concentration of serotonin
OBJECTIVE 21| Describe the characteristics of antidepressant drugs, and discuss their use in treating specific disorders.

30. Mood-Stabilizing Medications
Lithium Carbonate, a common salt, has been used to stabilize manic episodes in bipolar disorders. It moderates the levels of norepinephrine and glutamate neurotransmitters.
OBJECTIVE 22| Describe the use and effects of mood-stabilizing medications.

31. Electroconvulsive Therapy (ECT)
Brain Stimulation
Electroconvulsive Therapy (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.
OBJECTIVE 23| Describe the use of electroconvulsive therapy (ECT) in treating severe depression, and describe some possible alternatives to ECT.

32. 200 such operations do take place in the US alone.
Psychosurgery
Psychosurgery was popular even in Neolithic times. Although used sparingly today, about
200 such operations do take place in the US alone.
OBJECTIVE 24| Summarize the history of the psychosurgical procedure known as lobotomy, and discuss the use of psychosurgery today.

33. Psychosurgery
Psychosurgery is used as a last resort in alleviating psychological disturbances. Psychosurgery is irreversible. Removal of brain tissue changes the mind.
Prefrontal lobotomy – The frontal lobes of the brain are severed from the deeper centers of the brain.

34. Psychosurgery
Modern methods use stereotactic neurosurgery and radiosurgery (Laksell, 1951) that refine older methods of psychosurgery.

35. Psychological Disorders are Biopsychosocial in Nature

36. Objectives and Quiz on Wednesday
This will be the first grade of the fourth quarter.