Transcript Chapter 14

Therapy Approaches
• Biomedical Therapy
• Psychotherapy
• Alternative Therapies
• The Power of Forgiveness
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Biomedical Therapies
1. Drug Therapies
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Antipsychotic Drugs
Antianxiety Drugs
Antidepressant Drugs
Mood-Stabilizing Medications
2. Brain Stimulation
- Electroconvulsive Therapy
- Alternative Neurostimulation Therapy
3. Psychosurgery
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Biomedical Therapies
(1) Drug Therapies
• 1-Antipshchotic Drugs
• 2-Antidepressant Drugs
• 3-Tranquilizers
• 4-Mood-Stabilizing Medicines
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1-Antipsychotic Drugs
or Neuroleptics
Good for treating psychosis and schizophrenia
Example: Thorazine
Reduce receptivity to dopamine or increase
serotonin
Reduce positive symptoms of schizophrenia
Do not relieve other negative symptoms
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Antipsychotic Drugs
and Schizophrenia
• Good for reducing:
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• Offers little relief
from:
• Jumbled thoughts
Agitation
• Difficulty
Delusions
concentrating
Hallucinations
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Inability
to
interact
Can shorten
with others
schizophrenic episodes
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After the Introduction of Antipsychotic Drugs
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2-Antidepressant Drugs
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Treat depression, anxiety, phobias, OCD
Example: Prozac, Zoloft, and Paxil
Non addictive but can cause side effects
1-Monoamine oxidase inhibitors (elevate levels of
ser. & nor. by blocking inhibitors)
• 2-Tricyclic antidepressants (boost nor. & ser. by
preventing their reabsorption)
• 3-Selective serotonin reuptake inhibitors
(work on serotonin)
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Serotonin Reuptake
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3-Tranquilizers
• Prescribed for depressed mood, panic, and
anxiety
• Example: Valium
• Increase activity of neurotransmitter GABA
• If overused can result in tolerance and
withdrawal
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4-Mood-Stabilizing Medications
Lithium Carbonate
• Prescribed for bipolar disorder
• Can be dangerous if not given in the right
doze
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Cautions about Drugs
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Placebo effect
Relapse and drop out rates
Dosage problems
Long-term risks
Overprescription
Sometimes they have to be with therapy
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The Placebo Effect
Kirsch and Sapirstein (1998)
• 7315 participants
• 41% of those receiving antidepressants
experienced reduced symptoms.
• 31% of those given placebos also received
reduced symptoms.
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Biomedical Therapies
(2) Brain Stimulation
• Electroconvulsive Therapy
• Alternative Neurostimulation Therapies
- Deep-Brain Stimulation
- Magnetic Stimulation
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Biomedical Therapies
Electroconvulsive Therapy ECT
• After three sessions each week for two or
four weeks, 80% of people receiving ECT
improve markedly, showing no brain
damage.
• ECT reduces suicidal thoughts and is
credited with saving many from suicide.
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Biomedical Therapies
Alternative Neurostimulation Therapy
1. Deep-Brain Stimulation
• Helen Mayberg and her colleagues have been
focusing on a cortex area that bridges the thinking
frontal lobes to the limbic system.
• They have discovered that this area, which is
overactive in the brain of a depressed or
temporarily sad person, becomes calm when
treated by ECT and antidepressants.
• Among 12 patients receiving implanted electrodes
and a pacemaker stimulator, 8 experienced relief.
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Biomedical Therapies
Alternative Neurostimulation Therapy
2- Magnetic Stimulation
• Unlike deep-brain stimulation, the magnetic
energy penetrates only the brain’s surface.
• The painless procedure – called repetitive
transcranial magnetic stimulation (rTMS) – is
performed on wide-awake patients over several
weeks.
• In a study on 67 Israelis with major depression, at
the end of two weeks, half the stimulated patients
showed at least a 50%improvement in their scores
on a depression scale.
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Psychosurgery
• Egas Moniz who developed the Lobotomy in the
1930s found that cutting the nerves connecting the
frontal lobes with the emotion-controlling centers
of the inner brain calmed uncontrollably emotional
and violent people (disconnecting emotion from
thought).
• He was honored with a Nobel Prize for developing
this procedure.
• It produced a permanently lethargic, immature,
and uncreative people.
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Psychotherapy
• Psychodynamic
• Behavioral
• Cognitive
• Humanistic
• Family
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Three Elements Shares by All Forms
of Psychotherapy
• Hope for Demoralized People
• A New Perspective
• An Empathetic, Caring, Trusting
Relationship
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Psychodynamic Therapy
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Probes the past
Doesn’t tackle the immediate problem
The goal is insight
Takes a long time
Explores the unconscious
Methods: free association, interpretation
of dreams, & transference
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• Interpretation
The analyst noting supposed dream meanings,
resistances, and other significant behaviors
in order to promote insight.
• Resistance
In psychoanalysis, the blocking from
consciousness of anxiety-laden material.
• Transference
The patient’s transfer to the analyst of
emotions linked with other relationships
(such as love or hatred for a parent)
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Behavioral Techniques
Learning
Conditioning
Association between
Environmental Stimuli + Response
Classical Conditioning
Association
Stimulus-Response
Operant Conditioning
Reinforcement/
Punishment
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Behavioral Techniques
• There are no mental processes (will,
mind)
• Derived from classical and operant
conditioning
• The focus is on changing the behavior
• Works on the immediate problem
• Focuses on the present
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Classical Conditioning
• Ivan Pavlov
• Conditioning
Learning that involves associations between
environmental stimuli and the organism’s
responses
• Stimulus-response Learning
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Classical Conditioning in
Real Life
• Learning to like
• Learning to fear
• Accounting for Taste
• Reacting to Medical Treatment
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Operant Conditioning
• The behavior is more likely or less likely to
occur based on its consequences.
• B. F. Skinner modified Pavlov’s concept.
• Skinner used reinforcement and punishment
to enhance learning.
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Skinner’s Box
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Behavioral Techniques
• Systematic Desensitization/Counter
Conditioning
• Aversive Conditioning
• Exposure Treatment (Flooding)
• Behavioral Records & Contracts
• Skills Training
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Systematic Desensitization
• Fear of Flying
– Read about safety
– Look at pictures of airplanes
– Visit an airport
– Take a short flight
– Take a long flight
• Fear is extinguished
• Counterconditioning
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Cognitive Therapy
Aeron Beck
• Aaron Beck and his colleagues (1979)
came to believe that cognitive therapy could
reverse people’s catastrophizing beliefs
about themselves, situations, and their
futures
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Cognitive Distortions
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Labeling
Mind Reading
Exaggeration
Unrealistic Expectations
Belief in Entitlement
Belief in Absolute Fairness
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Fighting Dysfunctional Thought
• Hot Thoughts
• He is always mean to
me.
• I did a lousy job.
• I deserve better.
• It’s not fair.
• That jerk!
• They’re driving me
crazy.
• Cool Thoughts
• Maybe he had a bad
day.
• It’ll be better next time
• But people are people
• Life is not fair.
• It’s his problem!
• Just don’t accept the
ride.
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Dysfunctional Thought
Situation
Emotion Automatic Cognitive
Thought Distortion
Rate
1-100%
Fight with
spouse
Angry,
99%
Sad,
50%
-I’ll never
have a
normal
marriage
-I deserve
better
-He’s
stubborn
Rational Outcome
Response Rate
0-100%
Magnificat- -It’s not
ion
the end
of the
world
Entitlement -That’s
normal
-Maybe
Labeling
he had a
bad day
Angry,
50%
Sad,
10%
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Humanistic Therapy
• Works on self-fulfillment and selfactualization
• Does not delve into the past
• Helps the client think about the present and
the future
• Helps people feel good about themselves
• Tackles conscious rather than unconscious
thoughts
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Carl Rogers
Client-Centered Therapy
Person-Centered Therapy
• The therapist uses techniques such as
active listening within a genuine,
accepting, empathetic environment to
facilitate clients’ growth.
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Carl Rogers
Client-Centered Therapy
• Offers unconditional positive regard
• No specific techniques
• Therapist should be warm, genuine and
empathetic
• Client adopts these views and becomes selfaccepting
• Promotes growth instead of curing illness.
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Effective Listening
Client’s
Remark
Closed
Response
Open Response
I can’t do it.
Don’t talk like
that.
It seems very
difficult to you.
I will never be
able to have a
good life.
We’ve discussed It may look very
that before. Stop discouraging
being negative. now.
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Active Listening
• Paraphrase.
Summarize the speakers words in your own
words.
• Invite Clarification.
Encourage the speaker to say more.
• Reflect Feelings.
Reflect what you’re sensing from the speakers
words and body language.
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Family Therapy
• The therapist helps family members
understand how their ways of relating
to one another create problems.
• The treatment’s emphasis is not on
changing the individuals, but on
changing their relationships and
interactions.
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Relative Effectiveness of Different
Therapies
• Behavioral Conditioning Therapies – have
achieved favorable results with specific behavior
problems, such as bed-wetting, phobias,
compulsions, marital problems, and sexual
disorders.
• Studies confirm that Cognitive Therapy is
effective in coping with depression and reducing
suicidal risks
• Biomedical Therapy – is particularly essential for
the treatment of the positive symptoms of
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schizophrenia
Alternative Therapy
(1) Eye Movement Desensitization and
reprocessing (EMDR)
• Francine Shapiro had people imagine
traumatic scenes while she triggered eye
movement by waving her finger in front of
their eyes, supposedly enabling them to
unblock and reprocess previously frozen
memories.
• This therapy helps reduce traumatic
memories.
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Alternative Therapy
(2) Light Exposure Therapy
• It is used to treat people who suffer from
seasonal affecive disorder (SAD).
• After 4 weeks of treatment:
- 61% of those exposed to morning light
greatly improved.
- 50% of those exposed to evening light
greatly improved.
- 32% of those exposed to the placebo greatly
improved.
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When Therapy Helps
• When clients have enough sense of self
• When clients have enough distress to
motivate them to change
• When therapists are warm and empathetic
• When client and therapist establish a good
rapport
• Hostile, negative clients are less likely to
benefit
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When Therapy Harms
• Bias on the therapist’s part because of
gender, religion, or race
• Coercion by the therapist to accept his/her
advice
• Coercion by the therapist to have sexual
intimacy
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The Power of Forgiveness
• Giving up grudges can reduce chronic back pain
• Forgiveness limited the number of relapses among
women battling substance abuse problems.
• Using MRI scans to explore how just thinking
about empathy and reconciliation sparks activity
in the brains left middle gyrus, suggesting we all
have a mental forgiveness center set to be tapped.
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The Power of Forgiveness
• Cortisol’s depressive effect on the immune
system has been linked to serious disorders.
• Forgiveness stops the cortisol and
adrenaline from flowing.
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American Psychosomatic Society
A Study
• 36 male veterans who had coronary artery
disease and who were also burdened by
other war-related issues
• Those who received forgiveness training
showed greater blood flow to the heart.
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