Treatments

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.

Categories of Therapy2 Main Categories1. 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 illnessExample: 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

Perspectives and DisordersPsychological

School/Perspective

Cause of the Disorder

Treatments

Psychoanalytic/Psychodynamic

Unconscious drives/conflicts and childhood experiences

Psychoanalytic TherapyPsychodynamic Therapy

Humanistic Barriers to self-understanding and self-acceptance.

Client Centered Therapy - unconditional positive regard and active listening.

Behavioral Reinforcement history, the environment.

Behavioral TherapiesClassical – 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

Insight Therapies

• Insight therapies – try to improve mental state by increasing client’s awareness of underlying motives and defenses

• Examples: 1.Psychoanalytic Therapy2.Psychodynamic Therapy3.Humanistic Therapy

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

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

Psychoanalytic Therapy

• Criticisms– Interpretations

can’t be proven or disproven

– Costly and time consuming (2 or more sessions/week for 2 or more years)

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

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. .

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

• 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.

• 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?

Behavioral Therapies

Behavior Therapies – applies learning principles to unwanted behaviors

• Classical Conditioning– Maladaptive symptoms are

conditioned responses

• Operant Conditioning– Maladaptive symptoms are

reinforced

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 Types1.Exposure Therapies

– Flooding– Systematic Desensitization– Virtual Reality Exposure Therapy

2.Aversive Conditioning

Exposure Therapies• Exposure Therapies - Repeatedly introducing

people to things they fear and avoid 1. 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

2. 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

Exposure Therapies

3. 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

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

Operant Conditioning

1. Behavior Modification - reinforcing desired behaviors, giving punishments for undesired behaviors

– Example: Punishing aggressive behaviors of children with autism

2. 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

• 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.

• 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).

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

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?"

• 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?

• 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.

Family and Group Therapy• 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

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

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

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

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

Biomedical Therapy

Biomedical Therapy – drugs, or treatments that act on the brain’s central nervous system– Examples: – Drugs, electroconvulsive

therapy,– Magnetic impulses– Psychosurgery

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)

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

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

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

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

Brain Stimulation• Treatments for Depression

1. ECT (Electroconvulsive therapy) – electric shock therapy for patients with sever depression 1. Can trigger seizures and memory loss

2. rTMS (repetitive transcranial magnetic stimulation)- repeated pulses of magnetic energy to brain’s surface1. No seizures or memory loss2. Triggers long-term potentiation of

inactive left frontal lobe nerve cells.

3. Deep Brain Stimulation – uses implanted electrodes to inhibit activity in an area of the cortex that triggers negative emotions

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

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