1. + Treatment of Psychological Disorders Chapter 13

2. + Types of Mental Health Therapy Psychotherapy – trained therapist uses psychological techniques to assist someone seeking to overcome difficulties or achieve personal growth Often used for learning-related disorders (like phobias) Biomedical therapy – prescribed medication or medical procedure that acts directly on a patient’s nervous system Used for biologically influenced disorders (like schizophrenia) Eclectic approach – uses techniques from various forms of therapy

3. + Psychotherapies Psychoanalysis – not used very often Goals – bring repressed feelings into conscious awareness Methods: Free association – saying whatever comes to your mind which indicates resistance – blocking from consciousness of anxiety-laden material Interpretation – analyst notes supposed dream meanings, resistances and other significant behaviors and events in order to promote insight Use of dream analysis Transference – patient's transfer to the analyst of emotions linked with other relationships Involves several years of several sessions a week with therapist traditionally out of view of the patient

4. + Psychotherapies -cont- Psychodynamic therapists – views individuals as responding to unconscious forces and childhood experiences and seeks to enhance self-insight Therapists talks to clients face to face and weekly for a few months Interpersonal psychotherapy – variation to psychodynamic therapy Goal: help people gain insight into the roots of their difficulties and works for symptom relief rather than overall personality change

5. + Psychotherapies -cont- Humanistic Therapies Differences with psychoanalysis Focus on present and future more than past Focus on conscious rather than unconscious feelings Take immediate responsibility for one’s feelings and actions rather than uncovering hidden determinants Promote growth instead of cure illness Use of client-centered therapy – therapists uses active listening within a genuine, accepting, empathic environment to facilitate clients’ growth Uses active listening – echoing, restating and seeking clarification of what the person expresses and acknowledging expressed feelings Developed by Carl Rogers

6. + Psychotherapies -cont- Humanistic therapies -cont- Use of unconditional positive regard – caring, accepting, nonjudgmental attitude to help clients develop self-awareness and self-acceptance Tips for active listening: Paraphrase Invite clarification Reflect feelings

7. + Psychotherapies -cont- Behavior therapies – applies learning principles to the elimination of unwanted behaviors Counterconditioning – uses classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors Exposure therapy – expose people to what they normally avoid Systematic desensitization – associates a pleasant relaxed state with gradually increasing anxiety-triggering stimuli Virtual reality exposure therapy – progressively exposes people to simulations of their greatest fears Aversive conditioning – associates an unpleasant state with an unwanted behavior

8. + Psychotherapies -cont- Behavior therapies -cont- Operant conditioning Behavior modification – reinforcing desired behaviors and withholding reinforcement or enacting punishment for undesired behaviors Token economy – people earn a token for displaying an appropriate behavior which can later be exchanged for privileges or treats Criticisms: Are the conditioned behaviors durable? Is it ethical for one human to control another’s behavior?

9. + Psychotherapies -cont- Cognitive therapies – teaches people new, more adaptive ways of thinking and acting based on the assumption that thoughts intervene between events and our emotional reactions Beck’s therapy for depression – uses gentle questioning to reveal irrational thinking in clients and persuades people to change the lens through which they see life Cognitive-behavioral therapy – aims to change self-defeating thinking and change behavior

10. + Psychotherapies -cont- Group and family therapies Family therapy – treats the family as a system and views an individual’s unwanted behaviors as influenced by or directed at other family members

11. + Psychotherapies -cont- Evaluating Psychotherapies Effectiveness Approximately 90% of clients report feeling better – but keep in mind that clients Enter therapy in crisis May need to believe therapy was worth the effort Generally speak kindly of their therapists Meta-analysis – a procedure for statistically combining the results of many different research studies Has shown that the average therapy clients ends up better off than 80% of untreated individuals on waiting lists Therapy is most effective when the problem is clear-cut APA encourages evidence-based practices – clinical decision- making that integrates the best available research with clinical expertise and patient characteristics and preferences

12. + Treatment vs. No Treatment

13. + Psychotherapies -cont- Commonalities Among Psychotherapies Offer hope for demoralized people Offer people a plausible explanation for their symptoms and an alternative way of looking at themselves or responding to the world Provide an empathic, caring and trusting relationship

14. + Biomedical Therapies Biomedical therapy – physically changing the brain’s functioning by altering its chemistry with drugs or affecting its circuitry with electroconvulsive shock, magnetic impulses or psychosurgery In most cases can only be offered by psychiatrists Drug Therapies Antipsychotic drugs – used to treat schizophrenia and other forms of severe thought disorder Long-term use can promote tardive dyskinesia – involuntary movement of the facial muscles, tongue and limbs

15. + Biomedical Therapies -cont- Drug Therapies -cont- Antianxiety drugs – used to control anxiety and agitation Depress central nervous system activity Can result in psychosocial dependence or withdrawal Antidepressants - used to treat depression Increase norepinephrine or serotonin Research shows that placebos account for about 75% of the effectiveness of antidepressants Mood-stabilizing drugs

16. + Biomedical Therapies -cont- Brain Stimulation Electroconvulsive therapy (ECT) – biomedical therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized patient 80%+ of people show marked improvement after 3 sessions a week for 2-4 weeks Can result in some memory loss Repetitive transcranial magnetic stimulation (rTMS) – application of repeated pulses of magnetic energy to the brain to stimulate or suppress brain activity Only stimulates the brain’s surface and results in no memory loss

17. + Biomedical Therapies -cont- Psychosurgery – surgery that removes or destroys brain tissue in an effort to change behavior Least used Lobotomy – rarely used psychosurgical procedure that cut the nerves connecting the frontal lobes to the emotion-controlling centers of the inner brain Often caused lethargy and reduced creativity Therapeutic Life-Style Change Exercise Sleep Light exposure Social connection Anti-rumination – identifying and redirecting negative thoughts Nutritional supplements

18. + Therapists and Their Training