Transcript Psychological Therapies

Psychological Therapies
Book authors:
R.H. Ettinger
Chapter 16
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Insight Therapies
 Insight therapies
– Any type of psychotherapy based n the notion that
psychological well-being depends on selfunderstanding
 Psychodynamic therapies
– Therapies that attempt to uncover childhood
experiences that explain a patient’s current
difficulties
– Psychoanalysis
 Freud’s method of psychotherapy; uses free association,
dream analysis, and transference
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Insight Therapies
 Psychodynamic therapies (continued)
– Free association
 A psychoanalytic technique used to explore the
unconscious by having patients reveal whatever thoughts
or images come to mind
– The analyst pieces together the free-flowing
associations, explains their meaning, and helps
patients gain insight into the thoughts and behavior
that are troubling them
– Dream analysis is another technique used by
psychoanalysts
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Insight Therapies
 Psychodynamic therapies (continued)
– Transference
 An intense emotional reaction during psychoanalysis, when
the patient displays feelings and attitudes toward the
analyst that were present in a significant relationship in the
past
– Many therapists today practice brief psychodynamic
therapy in which the therapist and patient decide on
the issues to explore at the outset rather than
waiting for them to emerge in the course of
treatment
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Insight Therapies
 Psychodynamic therapies (continued)
– Crits-Christoph
 Found brief psychodynamic therapy to be as effective as
other psychotherapies
 Humanistic therapies
– Therapies that assume that people have the ability
and freedom to lead rational lives and make rational
choices
– Person-centered therapy
 A nondirective, humanistic therapy in which the therapist
creates a warm, accepting climate, freeing clients to be
themselves and releasing their natural tendency toward
positive growth
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Insight Therapies
 Humanistic therapies (continued)
– Person-centered therapy (continued)
 Developed by Carl Rogers
 According to this view, people are innately good and if
allowed to develop naturally, they will grow toward selfactualization-the realization of their inner potential
– Nondirective therapy
 An approach in which the therapist acts to facilitate growth,
giving understanding and support rather than proposing
solutions, answering questions, or actively directing the
course of therapy
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Insight Therapies
 Gestalt therapy
– A therapy that was originated by Fritz Perls and that
emphasizes that importance of clients’ fully
experiencing, in the present moment, their feelings,
thoughts, and actions and taking personal
responsibility for their behavior
– The goal of Gestalt therapy is to help clients achieve
a more integrated self and become more authentic
and self-accepting
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Insight Therapies
 Gestalt therapy (continued)
– Directive therapy
 An approach to therapy in which the therapist takes an
active role in determining the course of therapy sessions
and provides answers and suggestions to the patient
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Relationship Therapies
 Therapies that attempt to improve patients’
interpersonal relationships or create
relationships in order to provide them with
support
 Interpersonal therapy (IPT)
– A brief psychotherapy designed to help depressed
people better understand and cope with problems
relating to their interpersonal relationships
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Relationship Therapies
 Interpersonal therapy (continued)
– IPT is designed specifically to help patients cope
with four types of problems commonly associated
with major depression:
1.Unusual or severe responses to the death of a loved one
2.Interpersonal role disputes
3.Difficulty in adjusting to role transitions such as divorce,
career change, and retirement
4.Deficits in interpersonal skills
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Relationship Therapies
 Couple and family therapy
– Family therapy
 Therapy involving an entire family, based on the
assumption that an individual’s problem is caused and/or
maintained in part by problems within the family unit
– Couple or family therapy appears to have positive
effects in treating a number of disorders and clinical
problems
– Couples therapy can be helpful in the treatment of
sexual dysfunctions
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Relationship Therapies
 Group therapy
– A form of therapy in which several clients meet
regularly with one or more therapists to resolve
personal problems
– Learning that others also chare their problems
leaves people feeling less alone and ashamed
– A variant of group therapy is the self-help group
– Self-help groups usually are not led by professional
therapists
– They are simply groups of people who share a
common problem and meet to give and receive
support
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Behavior Therapies
 A treatment approach employing the principles
of operant conditioning, classical conditioning,
and/or observational learning theory to
eliminate inappropriate or maladaptive
behaviors and replace them with more
adaptive responses
 Behavior modification
– The systematic application of learning principles to
help a person eliminate undesirable behaviors
and/or acquire more adaptive behaviors; also called
behavior therapy
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Behavior Therapies
 Behavior modification techniques based on
operant conditioning
– Extinction of an undesirable behavior is
accomplished by terminating, or withholding, the
reinforcement that is maintaining that behavior
– Token economies
 A behavior modification technique that reinforces desirable
behaviors with tokens that can be exchanged later for
desired objects, activities, and/or privileges
 For decades mental hospitals have successfully used
token economies with chronic schizophrenics to improve
their self-care skills and social interaction
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Behavior Therapies
 Behavior modification techniques based on
operant conditioning (continued)
– Time out
 A behavior modification technique used to decrease the
frequency of undesirable behavior by withdrawing an
individual from all reinforcement for a period of time
– Monetary reinforcement has been found to be as
effective as nicotine patches for the reduction of
smoking among them
– If you want to modify any of your behaviors, devise
a reward system for desirable behaviors, and
remember the principles of shaping
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Behavior Therapies
 Therapies based on classical conditioning
– Joseph Wolpe
 Reasoned that if he could get people to relax and stay
relaxed while they thought about a feared object, person,
place, or situation, they could conquer their fear or phobia
 Systematic desensitization
– A behavior therapy that is used to treat phobias and
that involves training clients in deep muscle relaxation
and then having them confront a graduated series of
anxiety-producing situations until they can remain
relaxed while confronting even the most feared
situation
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Behavior Therapies
 Causes of mood disorders (continued)
– Flooding
 A behavioral therapy used to treat phobias, during which
clients are exposed to the feared object or event for an
extended period until their anxiety decreases
 Flooding sessions typically last from 30 minutes to 2 hours
and should not be terminated until patients are markedly
less afraid than they were at the beginning of the session
 In vivo flooding, the real-life experience, works faster and is
more effective tan simply imagining the feared object
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Behavior Therapies
 Exposure and response prevention
– A behavior therapy that exposes patients with
obsessive compulsive disorder to stimuli generating
increasing anxiety; patients must agree not to carry
out their normal rituals for a specified period of time
after exposure
– Patients treated with exposure are less likely to
relapse after treatment than those treated with
drugs alone
– Exposure and resistance therapy has proved useful
in the treatment of posttraumatic stress disorder
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Behavior Therapies
 Aversion therapy
– A behavior therapy in which an aversive stimulus is
paired with an undesirable behavior until the
behavior becomes associated with pain and
discomfort
– Alcoholics are sometimes given a nausea-producing
substance such as Antibes, which reacts violently
with alcohol and causes a person to retch and vomit
until the stomach is empty
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Behavior Therapies
 Participant modeling
– A behavior therapy in which an appropriate
response is modeled in graduated steps and the
client attempts each step, encouraged and
supported by the therapist
– In this therapy, not only does the model
demonstrate the appropriate response in graduated
steps, but the client attempts to imitate the model
step by step, while the therapist gives
encouragement and support
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Cognitive Therapies
 Cognitive therapies
– Therapies that assume faulty thinking is the basis of
most psychological difficulties
– Cognitive therapies are also often referred to as
cognitive-behavioral approaches because they
combine the insights into behavior provided by
cognitive psychology with the methodological
approaches of behaviorism
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Cognitive Therapies
 Rational-emotive therapy
– A directive, confrontational therapy developed by
Albert Ellis and designed to challenge and modify
the irrational beliefs thought to cause personal
distress
– Rational-emotive therapy is based on Ellis’s ABC
theory
A refers to the activating event,
B to the person’s belief about the event
C to the emotional consequence that follows
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Use what you have learned about Albert Ellis’s rationalemotive therapy to identify-and perhaps even eliminate-an irrational
belief that you hold about yourself.
First, identify an irrational belief, preferably one that causes
some stress in you life. For example, maybe you feel that you must
earn all A’s in order to think of yourself as a good person
Ask yourself the following questions, and write down your
answers in as much detail as possible.
– Where does this belief come from? Can you identify the time in
your life when it began?
– Why do you think this belief is true? What evidence can you
think of that “proves” your belief?
– Can you think of any evidence to suggest that this belief is
false? What evidence contradicts your belief? Do you know
anyone who does not cling to this belief?
– How does holding this belief affect your life, both negatively
and positively?
– How would you life be different if you stopped holding this
belief? What would you do differently?
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Cognitive Therapies
 Cognitive therapy
– Aaron T. Beck
 Claims that much of the misery endured by a depressed
and anxious person can be traced to automatic thoughtsunreasonable but unquestioned ideas that rule the person’s
life
 Cognitive therapy
– A therapy designed to change maladaptive behavior by
changing the person’s irrational thoughts, beliefs, and
ideas
– The goal of Beck’s cognitive therapy is to help patients
stop their negative thoughts ass they occur and
replace them with more objective thoughts
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Cognitive Therapies
 Cognitive therapy (continued)
– Cognitive therapy is brief, usually lasting only 10 to
20 sessions
– Cognitive therapy teaches patients to change the
catastrophic interpretations of their symptoms and
thereby prevent the symptoms from escalating into
panic
– Cognitive therapy has proved effective for
generalized anxiety disorder
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Cognitive Therapies
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Biological Therapies
 Biological Therapy
– A therapy that is based on the assumption that most
mental disorders have physical causes
 Drug therapy
– Antipsychotic drugs
 Drugs used to control severe psychotic symptoms, such
as the delusions and hallucinations of schizophrenics; also
known as neuroleptics or major tranquilizers
 The long-term use of typical antipsychotic drugs carries a
high risk of the most severe side effect
 tardive dyskinesia
– almost continual twitching and jerking movements of
the face and tongue, and squirming movements of the
hands and trunk
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Biological Therapies
 Drug therapy (continued)
– Antipsychotics (continued)
 Newer antipsychotic drugs called atypical neuroleptics can
treat not only the positive symptoms of schizophrenia but
the negative symptoms as well, leading to marked
improvement in patients’ quality of life
– Antidepressants
 Drugs that are prescribed to treat depression and some
anxiety disorders
 EEG studies have documented neurological changes in
patients who receive placebos that, while different from
those in patients receiving real drugs, are associated with
improvements in mood
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Biological Therapies
 Drug therapy (continued)
– Antidepressants (continued)
 The first generation of antidepressants are known as the
tricyclics
 The tricyclics work against depression by blocking the
reuptake of norepinephrine and serotonin into the axon
terminals, thus enhancing the action of these
neurotransmitters in the synapses
 The second-generation antidepressants, the selective
serotonin reuptake inhibitors (SSRIs), block the reuptake of
the neurotransmitter serotonin, increasing its availability at
the synapses in the brain
 SSRIs have fewer side effects and are safer in overdose
than tricyclics
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Biological Therapies
 Drug therapy (continued)
– Antidepressants (continued)
 Another line of treatment for depression is the monoamine
oxidase (MAO) inhibitors
 By blocking the action of an enzyme that breaks down
norepinephrine and serotonin in the synapses, MAO
inhibitors increase the availability of norepinephrine and
serotonin
– Lithium and divalproex
 Lithium
– A drug used in bipolar disorder to control the symptoms
in a manic episode and to even out the mood swings
and reduce recurrence of future manic r depressive
states
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Biological Therapies
 Drug therapy (continued)
– Lithium and divalproex (continued)
 Lithium (continued)
– Considered a wonder drug for 40-50% of patients
suffering from bipolar disorder
– A proper maintenance dose of lithium yields reductions
in depressive episodes as well as manic ones
– Recent research suggests that anticonvulsant drugs,
such as Depakote, may be just as effective for
managing bipolar symptoms as lithium with fewer side
effects
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Biological Therapies
 Drug therapy (continued)
– Tranquilizers
 The family of minor tranquilizers called benzodiazepines
includes, among others, the well-known drugs sold as
Valium and Librium and the newer high-potency drug
Xanax
 Used primarily to treat anxiety, benzodiazepines are
prescribed more often than any other class of psychoactive
drugs
 They have been found to be an effective treatment for
panic disorder and generalized anxiety disorder
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Biological Therapies
 Drug therapy (continued)
– Tranquilizers (continued)
 Xanax, the largest selling psychiatric drug, appears to be
particularly effective in relieving anxiety and depression
 Xanax is effective in the treatment of panic disorder, and it
works faster and has fewer side effects than
antidepressants
 If patients discontinue treatment, relapse is likely
 Many patients, once they are panic-free, find themselves
unable to discontinue the drug because they experience
moderate to intense withdrawal symptoms, including
intense anxiety
 Valium seems to be just as effective as Xanax for treating
panic disorder, and withdrawal is easier
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Biological Therapies
 Drug therapy (continued)
– Disadvantages of drug therapy
 It’s important to not that drugs do not cure psychological
disorders, so patients usually experience a relapse if they
stop taking the drugs when their symptoms lift
 Maintenance doses of antidepressants following a major
depression reduce the probability of recurrences
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Biological Therapies
 Electroconvulsive Therapy (ECT)
– A treatment in which an electric current is passed
through the brain, causing a seizure; usually
reserved for severely depressed patients who are
either suicidal or unresponsive to other treatment
– For many years, ECT involved passing an electric
current through both cerebral hemispheres, a
procedure known as bilateral ETC
– Today electric current is administered to the right
hemisphere only, and the procedure is called
unilateral ETC
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Biological Therapies
 Electroconvulsive Therapy (continued)
– Rapid transcranial magnetic stimulation
 Performed on patients who are not sedated; it causes no
seizures, no memory lose, and has no known side effects
 Psychosurgery
– Brain surgery to treat some severe, persistent, and
debilitating psychological disorder or severe chronic
pain
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Biological Therapies
 Psychosurgery (continued)
– Egas Moniz
 Developed the first experimental brain surgery for human
patients to treat severe phobias, anxiety, and obsessions
 His technique, the lobotomy, surgeons severed the neural
connections between the frontal lobes and the deeper brain
centers involved in emotion
 Eventually it became apparent that this treatment left
patients in a severely deteriorated condition
– Modern psychosurgery procedures result in less
intellectual impairment
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Biological Therapies
 Psychosurgery (continued)
– Cingulotomy
 Electrodes are used to destroy the cingulum, a small
bundle of nerves connecting the cortex to the emotional
centers of the brain
 Several procedures have been helpful for some extreme
cases of obsessive compulsive disorder
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Evaluating the Therapies
 Smith, Glass, and Miller
– Reanalyzed the results of 475 studies, which
involved 25,000 patients
– Revealed that psychotherapy was better than no
treatment, but no one type of therapy was more
effective than another
 Hans Eysenck
– Showed a slight advantage for behavioral therapies
over other types
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Evaluating the Therapies
 Holloa, These, and Marches
– Found an advantage for cognitive and interpersonal
therapies over psychodynamic approaches for
depressed patients
 Regardless of training or theoretical
orientation, all therapists are bound by ethical
standards established by professional
organizations and, in most cases, codified in
state laws
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Evaluating the Therapies
 Informed consent
– Therapists must inform clients of the cost and
expected duration of therapy prior to beginning any
actual interventions
– Clients must be informed of the legal limits of
confidentiality
 Therapists are forbidden to engage in any kind
of intimate relationships with clients or with
other who are close to them
 Therapists are ethically obligated to use tests
that are reliable and valid
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Culturally Sensitive and Gendersensitive Therapy
 Culturally sensitive therapy
– Kleinman and Cohen
 Believes that people experience and suffer from
psychological disorders within a cultural context that may
dramatically affect the meaning of symptoms, outcomes,
and responses to therapy
– Therapeutic alliance
 The bond between therapist and client that is known to be
a factor in the effectiveness of psychotherapy
– Culturally sensitive psychotherapy
 An approach to therapy that considers cultural variables in
the diagnosis and treatment of psychological disorders
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Culturally Sensitive and Gendersensitive Therapy
 Culturally sensitive therapy (continued)
– Culturally sensitive therapists recognize the
language differences between therapists and
patients can pose problems
– Culturally sensitive therapists also attempt to
address group differences that can affect the results
of therapy
 Gender-sensitive therapy
– An approach to therapy that takes into account the
effects of gender on both the therapist’s and the
patient’s behavior
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Culturally Sensitive and Gendersensitive Therapy
 Gender-sensitive therapy (continued)
– Advocates of gender-sensitive therapy point out that
knowledge of real sex differences is important to the
practice of gender-sensitive therapy
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