1. Treatments

2. History of Treatments Early treatments brutal
Transitioned to more humane methods
Dorothea Dix – 1st to transition to gentler treatments in U.S.
Today - Biomedical Drugs and better Psychotherapy has led deinstitutionalization.

3. Categories of Therapy 2 Main Categories
Psychotherapy – interaction between therapist and patient
Example: Psychoanalytic Therapy
Psychotherapist - trained therapist(clinical psych) who uses psychological techniques to assist someone to overcome
Example: psychodynamic therapist who treats an anxiety disorder
2. Biomedical Therapy – prescription meds that act on central nervous system
Example: Antipsychotic drugs to treat Schizophrenia
Ecclectic Approach– uses a variety of psych theories and approaches to treat mental illness
Example: combining medication (anti-depressants) with different types of psychotherapy such as Cognitive Therapy (change feelings of self-blame) and Behavioral (go out and run when feeling depressed)to treat depression

4. Perspectives and Disorders
Psychological School/Perspective
Cause of the Disorder
Treatments
Psychoanalytic/Psychodynamic
Unconscious drives/conflicts and childhood experiences
Psychoanalytic Therapy
Psychodynamic Therapy
Humanistic
Barriers to self-understanding and self-acceptance.
Client Centered Therapy - unconditional positive regard and active listening.
Behavioral
Reinforcement history, the environment.
Behavioral Therapies
Classical – counterconditioning, exposure therapy, flooding, systematic desensitization, virtual reality, aversive
Operant – behavior modification, Token economy
Cognitive
Irrational, dysfunctional thoughts or ways of thinking.
Cognitive Therapy
Sociocultural
Dysfunctional Society & stressful relationships
Group or Family Therapy
Biomedical/Neuroscience
biochemical imbalances, brain abnormalities, genetic predispositions.
Biomedical Drug Therapy

5. Insight Therapies
Insight therapies – try to improve mental state by increasing client’s awareness of underlying motives and defenses
Examples:
Psychoanalytic Therapy
Psychodynamic Therapy
Humanistic Therapy

6. Psychoanalytic Therapy
Psychoanalysis – uncovering childhood experiences to gain insight into the unconscious origins of the disorder
dream analysis – manifest and latent
free association – uncensored reporting of any thoughts that come to mind.
Resistance - blocking from unconsciousness anxiety-laden material during therapy.
Example: stuttering, omitting or forgetting events, pausing, changing the subject, ending a session

7. Psychoanalytic Therapy
Transferring – strong positive or negative feelings patients may feel about the psychoanalyst that reflect similar unconscious feelings repressed from earlier relationships.
Seen as helpful to the therapy process
Example: Hatred toward mother is expressed as hatred toward therapist

8. Psychoanalytic Therapy
Criticisms
Interpretations can’t be proven or disproven
Costly and time consuming (2 or more sessions/week for 2 or more years)

9. Psychodynamic Therapy
Psychodynamic therapy - try to understand patients' current symptoms by focusing on recurring patterns in their interpersonal relationships
Patients gain insight into unconscious conflicts
Face to face, once per week, several months
Interpersonal psychotherapy - effective in treating depression by helping patients improve their interpersonal skills
variation of psychodynamic therapy
14-16 sessions
Example: helping a depressed patient resolve conflicts with friends

10. Humanistic Therapy
Humanistic Therapy - emphasize the importance of self-awareness and take responsibility for own feelings and actions to improve mental state
Focus on present
Focus on Conscious thought
Taking responsibility for own actions
Promote personal growth
Does NOT analyze motive, diagnose or recommend a cure. .

11. Humanistic Psychology
Client-Centered Therapy (Rogers) - patients' discover their own ways of dealing with difficulties
non-directive therapies – therapist listens without judging or giving insight
Genuineness, acceptance and empathy
Unconditional Positive Regard
Active listening – echoing, restating and seeking clarification of clients feelings

12. Geraldo, a high school senior, is so fearful of asking a girl out that he hasn't had a date in over three years. He has recently contacted a psychotherapist for help in overcoming his fear. Describe how a humanistic therapist and a psychoanalyst would treat Geraldo's problem.

13. HUMANISTIC PSYCHOLOGIST
focus on the present rather than the past - what Geraldo can do now to get up the nerve to ask for a date rather than what he failed to do in the past
conscious thoughts - what Geraldo thinks about dating and how he would approach a woman for a date
taking responsibility for his actions - what he can control in asking a woman out on a date rather than what he can't control
PSYCHOANALYST
focus on what unconscious impulses or conflicts are causing Geraldo's fear—Does Geraldo have unconscious feelings of anxiety about his mother that he is transferring to other women?

14. Behavioral Therapies
Behavior Therapies – applies learning principles to unwanted behaviors
Classical Conditioning
Maladaptive symptoms are conditioned responses
Operant Conditioning
Maladaptive symptoms are reinforced

15. Behavioral Therapy Classical Conditioning
Counterconditioning (Pavlov)- replaces a negative behavior (anxiety, fear) with a positive behavior (relaxation)
Example: Child wets the bed, condition to wake up when bladder relaxes by using an alarm
2 Types
Exposure Therapies
Flooding
Systematic Desensitization
Virtual Reality Exposure Therapy
Aversive Conditioning

16. Exposure Therapies
Exposure Therapies - Repeatedly introducing people to things they fear and avoid
Flooding – forced exposure to the stimulus that is feared
Example: Putting a Susan who has Arachnophobia in a room full of spiders to show that they have no reason to fear them
Systematic Desensitization – gradual exposure to the actual stimulus by replacing a positive response with a negative response.
Progressive relaxation – imagined scene is repeatedly paired with relaxation and progresses to eventually facing the worst fear
Example: Therapist first asks Susan to relax and imagine a harmless spider climbing up the wall eventually she will face a room full of tarantula spiders, her greatest fear

17. Exposure Therapies
Virtual Reality Therapy – progressively exposing people to simulations of their greatest fears
Examples: exposing Susan to Spiders using a 3 dimensional virtual world with life-like spiders
Fear of flying, heights, animals and public speaking

18. Aversion Therapy
Aversion Therapy – replaces a positive behavior with a negative behavior
Examples: consuming alcohol (euphoria - positive) with a nausea producing drug (negative)
Gambling and shock treatments
Problem: cognition influences conditioning

19. Operant Conditioning
Behavior Modification - reinforcing desired behaviors, giving punishments for undesired behaviors
Example: Punishing aggressive behaviors of children with autism
Token Economy – earning a token for desired behavior that can be traded in for privileges
Example: Given tokens to ADHD students for staying in their seats and allowing them to trade them in for a prize

20. Describe how a therapist might apply operant conditioning techniques to help Rosemary overcome a compulsive habit of eating too much junk food. Be clear about the exact procedures that would be used.

21. behavior modification - reinforcing the desired behavior (e. g
behavior modification - reinforcing the desired behavior (e.g.. encouraging Rosemary to treat herself to a favorite, healthy food [such as an energy drink] if she doesn't eat any chips or candy during the day) or punishing an undesirable behavior (e.g., having to put $5 in a jar each time she has a piece of candy).

22. Cognitive Therapy
Cognitive Therapy – change the way patient thinks (change schemas)
Irrational, Self-blaming, over-generalized thoughts, negative interpretations
Anxiety Disorders, Major Depressive Disorder, Suicide
Example: Dan thinks he can’t get an A in AP Psych because he’s incompetent
Beck’s Therapy for Depression – uses gentle questioning to reveal irrational thinking
Stress Inoculation Training
Teaches to change thinking in stressful events

23. Cognitive-Behavioral Therapy
Cognitive Behavioral - Changes the way we think and act
Example: When Olivia is anxious, her therapist teaches her to attribute her anxiety to a highly reactive sympathetic nervous system and to play Temple Run on her phone instead.
Rational Emotive Behavior Therapy (REBT, Ellis) – helps people change their irrational beliefs by having therapist dispute the client's irrational beliefs and behavioral problems
Example:
"Where is it written that other people must treat you fairly?"

24. One of your best friends feels that he fails at everything he does and that his life isn't worth living. When you suggest that he talk to a psychotherapist, your friend responds, “Talking won't help. The more I talk about myself, the more I think about my problems. The more I think about my problems, the more depressed I get.” What procedures would a cognitive therapist use to help your friend overcome his negative feelings?

25. A cognitive therapist - believes that the emotional reaction (depression) is produced by your friend's thinking about life events, and so would work with the client to change the ways he thinks about life events.

26. Family and Group Therapy
Offered for: family conflict, stressful relationships, patients with similar problems
Improves communication skills and conflict resolution
Examples: obesity (OA), alcoholism (AA)
Family Therapy – unwanted behaviors are influenced by other family members
Example: rebellious child

27. Evaluating Psychotherapy
Placebo effect – the beneficial consequences of merely expecting that a treatment will be effective.
Regression toward the mean – the tendency for unusual events or emotion to return to their ave. state .
Example: Dan got an unusually high grade on a test, he performed less on the second even though he studied the same amount

28. Evaluating Psychotherapy
Randomized Clinical Trials – compare treatment groups with control groups
Meta-analysis – a procedure for statistically combining the results of many different studies. – gives bottom line results
Psychotherapies bottom line – Those not undergoing therapy often improve, but those undergoing therapy are more likely to improve

29. Comparison of Psychotherapies
Evidence Based Practices - Clinical decision making that integrates the best available research with clinical expertise and an understanding of patient characteristics
**Scientifically Unsupported Therapies - Energy Therapy, Recovered-memory Therapy, Rebirthing Therapies, Facilitated Communication, Crisis Debriefing

30. Alternative Therapies
EMDR (Eye Movement Desensitization and Reprocessing - Rapidly moving one's eyes while recalling traumatic experiences
similar to exposure treatment
Originally developed for anxiety
Value in placebo effect and exposure therapy
Light Exposure Therapy – exposure to intense light that mimics outdoor light
activity in the brain region responsible for arousal
Seasonal Affective Disorder – depression caused by lack of exposure to natural light

31. Biomedical Therapy
Biomedical Therapy – drugs, or treatments that act on the brain’s central nervous system
Examples:
Drugs, electroconvulsive therapy,
Magnetic impulses
Psychosurgery

32. Biomedical Therapy
Psychopharmacology – study of the effects of drugs on the mind and behavior
Antipsychotics (Thorazine,Chlorpromazine, Clozapine)
Anti-anxiety ( Xanax, Ativan d-cycloserine)
Anti-depressants (Paxil, Prozac, Zoloft – SSRI’s)
Mood Stabilizers Bipolar (lithium, Depakote)

33. Anti-Psychotics
Anti-Psychotic Drugs – drugs used to treat schizophrenia that block receptor sites for dopamine
Thorazine – Helps positive symptoms only – hallucinations and paranoia
Tardive dyskinesia –Side effects: sluggishness, tremors, twitches, involuntary movements of face, tongue, limbs from long-term use (
Atypical antipsychotics
Block both dopamine and serotonin receptors
Clozapine –used to treat negative symptoms –apathy and withdrawal

34. Anti-Anxiety Drugs
Anti-anxiety drugs – depress central nervous system activity
Xanax & Ativan
D-cycloserine – acts on receptor site that extinguishes learned fear –helps with PTSD and OCD
Addictive
Withdrawal symptoms – increased anxiety and insomnia

35. Anti-Depressants
Anti-depressants – used to treat depression & anxiety by increasing the availability of serotonin and norepinephrine that elevate arousal and mood
Paxil, Prozac, Zoloft (SSRIs) – blocks serotonin reuptake
Dual Action Drugs – block both the reuptake of serotonin and norepinephrine

36. Alternatives for Depression
Cognitive-Therapy + antidepressants
Cognitive therapy top down
Antidepressant bottoms-up – works on limbic system
Mood Stabilizing Drugs
Lithium – simple salt used to treat Bipolar disorder
Depakote – epilepsy drug used to treat mania
Exercise

37. Brain Stimulation Treatments for Depression
ECT (Electroconvulsive therapy) – electric shock therapy for patients with sever depression
Can trigger seizures and memory loss
rTMS (repetitive transcranial magnetic stimulation)- repeated pulses of magnetic energy to brain’s surface
No seizures or memory loss
Triggers long-term potentiation of inactive left frontal lobe nerve cells.
Deep Brain Stimulation – uses implanted electrodes to inhibit activity in an area of the cortex that triggers negative emotions

38. Psychosurgery Psychosurgery – removes or destroys brain tissue
Lobotomy - cut the nerves connecting the frontal lobes to the emotion controlling centers of inner-brain
Once used to calm severely emotional or violent patients
MRI-guided precision surgery – cut brain circuits of severe OCD

39. Preventing Psychological Disorders
Therapeutic Lifestyle Change – reverses the symptoms of psychological disorders
Aerobic exercise, adequate sleep, light exposure, and social engagement, anti-rumination, nutrition
Resilience – ability to cope with stress and recover from adversity