Transcript Chapter 16 pt. 2: Cognitive and Biomedical Therapy

Chapter 17 pt. 2: Cognitive and
Biomedical Therapy
The Most Dominant Therapy is the
Cognitive Approach
Most Common Illnesses Treated in
Cognitive Perspective
 1.
 2.
 3.
 4.
 5.
Depression
Eating Disorders
Chronic Pain
Marital Problems
Anxiety Disorders
Assumption and Goal of
Cognitive Therapy
 Cognitive
Therapy assumes that
thoughts exist between events and
responses. A person’s response
depends on how they interpret the
situation.
 Goal of Cognitive therapy is to
teach people new and more realistic,
helpful, and adaptive patterns of
thinking and acting.
 Want to See glass half-full instead of
half-empty!!
Two Major Therapies where
Cognition Is A Strong Focus
 1.
Aaron Beck’s
Cognitive Therapy
 2.
Albert Ellis’s
Rational Emotive
Therapy
Aaron Beck’s Views on
Depression (NOT IN BOOK)
 Beck
believed the key to
understanding depression was in an
individual’s thought patterns.
 Argued depressed people’s negative
thought patterns and creation of
negative schemas caused them to
misinterpret the world which often
caused them to feel worthless and
incompetent.
 Depressed people tend to view world
with “dark sunglasses.”
Beck’s Examples of Negative
Schemas (NOT IN BOOK)
 Arbitrary
Interference: drawing
negative conclusions from an event
without any evidence.
 Ex: After an argument thinking “that
person hates me.”
 Dichotomous Thinking: irrational all or
nothing thinking.
 Ex: “I can’t be happy unless everyone
likes me.”
Aaron Beck’s Cognitive Triad
Theory of Depression
 Beck
developed a cognitive triad which
looked at what person thinks about:
–1. His/Her Self
–2. His/Her World
–3. His/Her Future
 Depressed people tended to have
negative perceptions in all three areas.
Martin Seligman’s Theory of
Explanatory Styles Effect on Depression
 Depressed people tend to explain negative
external events with a negative
explanatory style.
 Depressed people usually view problems
as: 1. Personal: They caused the
negative events; 2. Pervasive: the
negative events will affect everything they
do; 3. Permanent: and the negative
events will last forever.
 Belief Styles can lead to learned
helplessness.
Pervasive Pessimism Also Tied to
Locus of Control
 If
do good in the stock market it was luck
(don’t have any control) if they do bad it
was their fault (do have control)
 Optimists believe good things happen
because they’re smart and successful
(their own control) and bad things are
isolated occurrences (out of their control)
 Pessimists shrug off the good and
internalize the bad. Optimists do the
opposite.
Rational Emotive Therapy is a Form of
Cognitive-Behavior Therapy
 Cognitive-Behavior
Therapy: aims
to alter the way people think (ex:
irrational thought patterns) and act
(ex: compulsions).
Albert Ellis’s Rational Emotive
Behavior Therapy (NOT IN BOOK)
 Albert
Ellis also believed that people’s
maladaptive thoughts led to maladaptive
emotional responses (behaviors).
 He promoted a form of treatment known
as Rational Emotive Behavior
Therapy: involves getting patients to
recognize the irrationalities within their
thought patterns and helping them create
healthier forms of thinking and behaving.
Effectiveness of Cognitive
Therapy
Effectiveness of Psychotherapy?
How do We Evaluate?
 Is it therapy that helps people get
better or would it occur naturally?
 Regression towards the Mean:
the tendency for for unusual emotions
(depression/sadness) or events to
return (regress) toward their average
state with time.
Effectiveness of Psychotherapy?
How do We Evaluate?
 In
order to test impact of treated vs.
untreated, studies using metaanalysis must be used.
 Meta-analysis: procedure for
statistically combining the results of
many different research studies.
Meta-analysis Illustrates
Success of Psychotherapy
Review: Who Conducts Therapy?
 Clinical
psychologists
–Most are psychologists with a Ph.D. and
expertise in research, assessment, and
therapy, supplemented by a supervised
internship.
–About half work in agencies and
institutions, half in private practice.
–May work in conjunction with a
psychiatrist.
Review: Who Conducts Therapy?
 Counseling
Psychologists
–Marriage and family counselors
specialize in problems arising from
family relations.
–Typically have one of advanced degrees
–Pastoral counselors provide counseling
to countless people.
–Abuse counselors work with substance
abusers and with spouse and child
abusers and their victims.
Review: Who Conducts Therapy?
 Psychiatrists
–Physicians who specialize in the
treatment of psychological disorders.
–Not all psychiatrists have had
extensive training in psychotherapy,
but as M.D.s they can prescribe
medications. Thus, they tend to see
those with the most serious problems.
–Many have a private practice.
Therapies outside of Psychotherapy
Are Often Biomedical
 The
biomedical perspective
focuses on altering body
chemistry.
 Biomedical perspective is
rooted in discoveries of
psychopharmacology:
study of the effect of drugs
on the mind and behavior.
Social Effects of Drug
Treatments
State and county
mental hospital 700
residents, in
600
thousands
500
Introduction of antipsychotic drugs
Rapid decline
in the mental
hospital
population
400
300
200
100
0
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990
Year
Drug Treatments: Antipsychotics
(Neuroleptics)
Antipsychotics are used to treat psychotic
disorders like schizophrenia.
 Antipsychotics helps those experiencing both
positive and negative symptoms.
 Most Common Examples:
– Thorazine: alleviates
delusions/hallucinations (positive symptoms).
– Clozaril: alleviates negative symptoms and
social withdrawal. Also prescribed for those
at risk for suicide.

Neuroleptics (Antipsychotics) Affect on
Neurotransmitters
 Drugs act as an antagonist and block
dopamine receptors at the synapse to
REDUCE the amount of dopamine in the
brain.
 Side affects are numerous:
– Most worrisome is tardive dyskinesia:
produces an incurable disturbance of motor
controls (shaking, tremors), especially of the
facial muscles.
– Others include general lethargy, possible
increase in negative symptoms, and sexual
dysfunction.
Drug Treatments:
Anti-Anxiety (Anxiolytics)
 Anti-Anxiety
drugs depress nervous
system activity; (often called tranquilizers)
 Drugs reduce stress and suppress anxiety.
 Most common examples are (KNOW
THESE):
–Valium
–Librium
–Xanax
Anti-Anxiety Drugs Affect on
Neurotransmitters
 Most
modern anti-anxiety compounds are
in a prescribed class called
benzodiazepines which include valium
and xanax.
 Work by increasing the activity of the
neurotransmitter GABA (relaxation
neurotransmitter, calming affect)
 Benzodiazepines do have a high risk of
physical and psychological addiction.
Drug Treatments:
Anti-depressants
 Most
anti-depressants increase the
availability of norepinephrine and
serotonin which elevates arousal and
mood.
 Most common examples are (KNOW
THESE):
–Prozac
–Zoloft
–Paxil
Antidepressants Affect on
Neurotransmitters
Most common antidepressants are known as
Selective Serotonin Reuptake Inhibitors
(SSRI’s): which prevent the reuptake of the
neurotransmitter and allow INCREASED
LEVELS OF SEROTONIN. Prolonged effect
often lifts depressed mood.
 Other types of antidepressants also lift
norepinephrine which increases energy levels in
addition to serotonin.
 Drawback: antidepressants take few weeks to
start working.

Drug Treatments:
Mood Stabilizers for Bipolar Disorder
 Most
common is the salt
lithium (carbonate) is
most frequently used to
treat the mood swings of
bipolar disorder.
 Decreases adrenaline and
increases serotonin.
 Often can have dangerous
side effects including being
toxic at high doses
Drug Treatments: Stimulants
 Stimulants
are often used to treat
Attention-Deficit/Hyperactivity
disorder (ADHD): a common problem
for children who have difficulty controlling
their behavior and focusing their
attention.
 Although its exact mechanism is unknown
the stimulants have a calming and
focusing effect in children by increasing
neurotransmitters associated with such
processes.
Electroconvulsive Therapy
(ECT)
 Electroconvulsive
Therapy: used to
treat the severely
depressed after other
treatments have failed.
 Success rate is high.
 Side effects can
include some memory
loss.
Psychosurgery is Most Drastic
Intervention
 Psychosurgery
involves removing or
destroying brain tissue in an effort to
change behavior.
 Best known procedure is a lobotomy:
Ice pick like instrument is put through the
eye sockets cutting the links between the
frontal lobes and the emotional control
centers. Used to be used to “cure”
uncontrollably violent patients but now
very rare.
Lobotomy
