chapter 16 psychtx basic
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Treatment of
PsychologicalDisorders
Chapter 16
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Basic features
Psychotherapy talking about problems
and exploring new ways of thinking and
acting
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Features
Professional relationship between client and therapist
Inpatients treatment in hospital or residential institution
Outpatients receive tx and drugs while living incommunity
Psychiatrists Doctors who have extra training in
psychology
Psychologists Holders of doctorate degree whoconcentrate on psychotherapy
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Psychodynamic psychotherapy
Classical psychoanalysis The talking cure using free association to cure
hysteria, which is also conversion disorder
Focus of treatment the unconscious becoming
conscious sexual and aggressive impulses goneunderground cause symptoms
Dream analysis Manifest content obvious meaning
Latent content hidden meaning, exploring theunconscious
Transference unconscious childhood feelings andwishes towards parents transferred towards therapist.Analysis of this transference is an importantpsychoanalytic method
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Psychodynamic psychotherapy
Contemporary psychodynamic therapy
Short-term psychodynamic therapy
Object relations most of the problems come
from relationship with others, especially parents
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Humanistic psychotherapy
Basic assumptions
Treatment is an encounter between equals
help clients restart growth
Clients will improve on their own, given the right
conditions
Ideal condition of therapy client feels fully
accepted and supported, no matter how horribletheir behaviour is
Client fully responsible for their choices
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Humanistic psychotherapy
Client-centered therapy Unconditional positive regard accept the client, so that
the client can overcome conditions of worth
Conditions of worthI am accepted because I am
worthy (intelligent, successful, attractive, etc.) and notbecause I am a human being and has INHERENTWORTH.
Empathy feelings WITH the client
Reflectionparaphrased summary of clients feelings,so that the client would feel heard
Congruence therapists need to be honest with theirfeelings. I am confused by what youre saying. Nopretensions
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Humanistic psychotherapy
Gestalt therapy
Goal so that clients could become more self-
aware, self accepting, and unified.
Use dramatic techniques client talk to an
imaginary person, therapist points out
difference between what they say and how they
act (eg. Smiling while talking about a sad
event).
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Behavior therapy
Psychological problems are LEARNED
behaviors and therefore can be
UNLEARNED
Basic assessment:
Identify signals / triggers
What are the rewards for continuing behavior
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Behavior therapy
Principles
Develop rapport with client client should haveconfidence that change is possible
Careful listing of bx and thoughts to be changed Therapist is a teacher, giving homework
assignments, active planning on how toovercome the problem, etc
Continuous monitoring and adjustment of plan
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Behavior therapy
Behavior modification
Systematic desensitization
Progressive relaxation training
Imagine thing that is scary from least scary to
most scary (desensitization hierarchy)
Virtual reality graded exposure replaces in vivo
therapy
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Behavior therapy
Exposure techniques
Flooding keeps people in feared but harmless
situations, at the same time preventing them from
escaping (their rewarding behavior). Modelling
Follow what the therapist does
Social skills training
Assertiveness training
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Behavior therapy
Positive reinforcement
Token economy system get coincs or tokens that
could be exchanged for video game time, snacks,
etc. Extinction, punishment, aversion conditioning
Aversion therapy when you think of what you
should not think of, you get electric shocks,
nauseated, etc.
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Cognitive behavioral therapy (CBT)
Rational Emotive Behavioral Therapy Ellis
All problems are caused by how people think about
events, not the events themselves
shoulds and musts. Replace upsetting thoughts with new thoughts which are
more adaptive cognitive restructuring
Meichenbaums stress inoculation training
imagine being in a stressful situation, then use newly
learned cognitive skills to remain calm
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Zick Rubin, Lelitia Anne Peplau, and Peter Salovey, Psychology.
Copyright 1993 by Houghton Mifflin Company. Reprinted by permission.
Ellis Model of
Maladaptive Behavior
Continue
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Cognitive behavioral therapy (CBT)
Cognitive therapy Beck
Cognitive distortions like
catastrophizing
all-or-none thinking
personalization
recognizing and correcting distortions
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Group therapy therapy with
unrelated clients
Benefits:
Therapist see clients interacting with one another
Clients discover they are not alonelift clients
expectation for improvement Boost self confidence and self acceptance
Learn from one another how they come across to
others
Try out new skills assertiveness
Self-help groups AA
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Family therapy therapy with
related family members
Identified patient of the family black sheep
VS. Seeing the problem as resulting from
the interactions among ALL family
members.
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Couples therapy husband and
wife
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Effectiveness of therapy
Eysenck (1952) those who received therapy
are worse than those who received no
treatment
Empirically supported therapies (ESTs) Use experimental research to evaluate result you
can choose them with confidence
Criticism:
Some studies have not yet been validated Experimental studies not the same as real-life clinical
settings
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Rules and rights of therapeutic
relationship
Confidentiality (dont tell anyone)
maintained EXCEPT
Client so disturbed and suicidal that
hospitalization is needed
client uses mental condition to defend in court
therapist sued by client
client talks about sexual/physical abuse of child Therapist believes client will harm others
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Rules and rights of therapeutic
relationship
Patients rights
Cannot be committed unless there is clear and
convincing reason that they are an imminent harm to
others and themselves, and gravely disabled
Have the right to receive treatment, and the right not to
receive treatment, EXCEPT hospital patients who are a
danger to themselves and others
Subjected to minimal restriction to their freedom
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Biological treatments
Psychosurgery lobotomy 1940s, 1950s
Electroconvulsive therapy
Patients anesthesized, administered to half the
brain
Used for patients who are deeply depressed
but do not respond to medication.
Cure temporarily, but relapse soon afterwards
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Biological treatments
Psychoactive drugs
Neuroleptics/antipsychotics reduce
hallucinations, delusions
Old generation Thorazine and Haldol
New generationatypical neuroleptics
Clorazil, Risperdal, Zyprexa, Seroquel, Geodon,
Abilify
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Biological treatments
Antidepressants reduce depression, obsessivethoughts, panic
Effective only after 2 weeks
Monoamine oxidase inhibitors MAOIs
Tricyclic antidepressants (TCAs) SSRIs Prozac, Zoloft, Anafranil
Lithium mood stabilizer control manic &depressive episodes
Anticonvulsants alternative to lithium
Depakote, Lamictal Anxiolytics reduce anxiety
Benzodiazepines Highly addictive
Buspirone alternative to benzodiazepines
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Biological treatments
Choosing between psychotherapy vs. drugs
Psychotherapy and drugs both useful
Psychotherapy superior when
Dropout rate lower
long-term benefits
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Biological treatments
Combination
Recommended for patients who are too
distressed to receive psychotherapy initially
Effective for long-term depression, ADHD,OCD, panic disorder, alcoholism.
For those who are not exhibiting psychotic
symptoms, CBT first, then medication + CBT
when CBT is not effective
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