Transcript Chap 16 slides

-be as it may,
I’m gonna impose a schedule,
anyway.
APRIL important schedules
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4/21 Monday
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4/23-4/24 block day
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2 free response
4/28-4/29 Mon-Tues
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Ch 15 & 16 test (no comprehensive)
Review activities
4/30-5/1 block day
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Final exam (multiple choice)
MAY important schedules
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5/5 Monday
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5/6 Tuesday
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Careers in psychology project due
5/13-5/16 Tues-Fri
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class potluck
5/7-5/8 block day
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AP exam
Work on final project
5/19-5/30 Mon-Fri
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Present final projects
HW of the week 4/14-4/18
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Monday
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Tuesday
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Ch 16 p. 679-683
Block day
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Ch 16 p.673-679 ½
Ch 16 p.684-685
Study for vocab quiz
Friday
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Lunch review for Monday test
Agenda Monday 4/14
Return free response
 Therapy
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Approaches (handout)
Objectives
1.
2.
3.
4.
5.
6.
7.
8.
Describe psychoanalytic therapeutic techniques (e.g., free
association, interpretation)
Discuss Roger’s client-centered therapy
Identify counterconditioning techniques
Describe the goals of cognitive therapies
Discuss the benefits of group therapy and family therapy
Differentiate between antianxiety, antidepressant and
antipsychotic medication
Describe electroconvulsive therapy and lobotomies
Discuss the effectiveness of the psychotherapies
Things we will learn
Treatment approaches
 Modes of therapy (individual, group,
community, preventive)
 Effectiveness
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THERAPY
Therapy
Psycho(logical) therapy : an emotionally charged,
confiding interaction between a therapist and patient
(treats learned behaviors; phobia)
Biomedical therapy: use drugs or other procedures that
act directly on the patient’s nervous system.
Eclectic approach: combination of various techniques.
Psychological Therapies
We will look at four major forms of psychotherapies
based on different theories of human nature:
1.
2.
3.
4.
Psychoanalytical theory
Humanistic theory
Behavioral theory
Cognitive theory
Psychoanalysis
The first formal psychotherapy to emerge was
psychoanalysis, developed by Sigmund Freud.
Edmund Engleman
Sigmund Freud's famous couch
Therapy- Psychoanalysis
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Psychoanalysis
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Aims to gain awareness/insight
of repressed feelings
Therapist interprets patient’s
free associations, resistances,
dreams, and transferences
use has rapidly decreased in
recent years
Causes of Psychological
Problems
Undesirable urges and conflicts are
“repressed” or pushed to the unconscious
 Unconscious conflicts exert influence on
behaviors, emotions, and interpersonal
dynamics
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Psychoanalysis: Aims
Now the patient can deal with the issue (recognition,
resolution); when energy devoted to id-ego-superego
conflicts is released, anxiety lessens.
Psychoanalysis: Methods
Free association: saying aloud
anything that comes to mind.
Analyst watches for “resistance”
Analyst interprets resistance,
dreams, other behaviors (e.g.,
transference) and provides insight
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Resistance: the defensive
blocking of anxiety-laden
material from the conscious
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Transference: transferring to
the therapist the strong feelings
harbored against a family
member or other significant
person
Criticism
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relied on after-the fact interpretations and
repressed memories
it is time-consuming and very costly.
Other Dynamic Therapies
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Psychodynamic/interpersonal therapies
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Focus: current symptoms (e.g., depression),
recurring patterns in interpersonal relations
Goal: insight. client’s self awareness and
understanding of past on present behavior
Shorter-term, less expensive
Humanistic Therapies
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People have the power to control their fate, ideas, and
movements as they move towards self-actualization.
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Instead of curing a disorder, seeks to promote growth,
fulfillment and self-acceptance
Humanistic Therapy
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Client-Centered Therapy
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Carl Rogers
active listening and unconditional positive
regard within a genuine, non-judgmental,
empathic environment
Therapist and client are equal partners
Client directs the topic and direction of the
discussion
http://www.youtube.com/watch?v=Ew8CAr1v48M
Humanistic Therapy
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Active Listening-empathic listening in which the listener
echoes, restates, and clarifies
http://www.youtube.com/watch?v=TA-RaDNVKpw
http://www.youtube.com/watch?v=4VOubVB4CTU
QW #1
Compare psychoanalytic and humanistic
theories in terms of their:
1) understanding of the source of the
problem, 2) treatment techniques, and 3)
therapy goals.
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Joe has been seeing a psychoanalyst for four years for treatment of
the fear that he had monsters under his bed. His progress was very
poor, and he knew it. So, one day he stops seeing the
psychoanalyst and decides to try something different.
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A few weeks later, Joe's former psychoanalyst meets his old client in
the supermarket, and is surprised to find him looking well-rested,
energetic, and cheerful. "Doc!" Joe says, "It's amazing! I'm cured!"
"That's great news!" the psychoanalyst says. "you seem to be doing
much better. How?"
"I went to see another doctor," Joe says enthusiastically, "and he
cured me in just ONE session!"
"One?!" the psychoanalyst asks incredulously.
"Yeah," continues Joe, "my new doctor is a behaviorist."
"A behaviorist?" the psychoanalyst asks. "How did he cure you in
one session?"
"Oh, easy," says Joe. "He told me to cut the legs off of my bed."
Behavior Therapy
Applies learning principles to eliminate/change behaviors.
To treat phobias or sexual disorders, behavior therapists
do not seek to explain the origin of a behavior
(psychoanalytic), or to promote self-acceptance and
awareness (humanistic)
Classical Conditioning
Techniques
Behaviorists assume that abnormal behaviors are
the result of faulty (inappropriate) learning.
Counterconditioning: pairs new response
with old stimuli (that used to trigger
maladaptive behaviors)
Example: exposure therapy,
aversive conditioning
Exposure Therapy
The Far Side © 1986 FARWORKS. Reprinted with Permission. All Rights Reserved.
Expose patients to things
they fear and avoid. Through
repeated exposures, anxiety
lessens because they
habituate to the things
feared.
Exposure Therapy
Exposure therapy involves exposing people to fear-driving
objects in real or virtual environments.
*arachnophobia
Both Photos: Bob Mahoney/ The Image Works
N. Rown/ The Image Works
Behavior Therapy:
classical conditioning
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Systematic Desensitization
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type of counterconditioning
associates a pleasant, relaxed state with gradually
increasing anxiety-triggering stimuli
commonly used to treat phobias
Uses three steps:
1.
2.
3.
Progressive relaxation
Development of anxiety hierarchy and control
the scene
Combination of progressive relaxation with
anxiety hierarchy
http://www.youtube.com/watch?v=lMZ5o2uruXY
http://www.youtube.com/watch?v=omYECykyQWE
Behavior Therapy
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Aversive Conditioning
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type of counterconditioning that associates an
unpleasant state with an unwanted behavior
nausea ---> alcohol
Agenda Tuesday 4/15
• Behavior and cognitive therapies
• Effectiveness of psychotherapies
Behavior Therapy
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Aversion
therapy for
alcoholics
Operant Conditioning
Operant conditioning (rewarded or punished)
procedures enable therapists to use behavior
modification.
* Success in training 3 year old autistic children
Behavior Therapy
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Token Economy
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an operant conditioning procedure that
rewards desired behavior
client exchanges a token for various
privileges or treats
Cognitive Therapy
Cognitive Therapy
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Cognitive Therapy
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Source: emotional disturbance comes
from cognitive bias and distorted
perceptions (e.g., self-blame)
Goal: new, more adaptive ways of
thinking
Cognitive Therapy for Depression
Aaron Beck believes that cognitions such as “I can never
be happy” need to change in order for depressed patients
to recover. This change is brought about by gently
questioning patients.
Cognitive Therapy for Depression
Rabin et al., (1986) trained
depressed patients to record
positive events each day, and
relate how they contributed to
these events.
Stress Inoculation Training
Meichenbaum (1977, 1985) trained people to
restructure their thinking in stressful situations.
“Relax, the exam may be hard, but it will be hard for
everyone else too. I studied harder than most people.
Besides, I don’t need a perfect score to get a good
grade.”
Cognitive Behavioral Therapy
The pioneering form is Rational-Emotive therapy,
developed by Albert Ellis.
CBT therapists believe that emotional upsets occur
when people hold irrational/negative ideas.
The treatment is directive and structured; involves a
therapist who challenges/changes clients’ thinking
• https://www.youtube.com/watch?v=95SNt21Jyyk
Cognitive Therapy
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The
Cognitive
Revolution
QW #2
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Compare and contrast behavior therapy,
cognitive therapy, and cognitive
behavioral (rational-emotive) therapy in
terms of their:
1) origin/source of the problem
 2) treatment techniques
 3) goals
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Group Therapy
Group therapy normally consists of 6-9 people attending
a 90-minute session that can help more people and
costs less. Clients benefit from knowing others have
similar problems.
© Mary Kate Denny/ PhotoEdit, Inc.
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Group treatment is especially helpful when
members share similar (stigmatized)
problems. https://www.youtube.com/watch?v=uxeR95aYer0 (~ 1:00)
p. 604
Group and Family Therapies
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Family Therapy
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Focus: family as a system
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Origin of problem: behavior is influenced by
or directed at other family members
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Goal: positive relationships and improved
communication
Group and Family Therapy
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Couple therapy— relationship therapy that helps
with difficulty in marriage or other committed
relationships
Is Psychotherapy Effective?
Who can sense improvement?
Patient/client
Therapist
Family
and friends
Client’s Perceptions
Clients often overestimate effectiveness of therapies.
1.
2.
3.
We enter therapy in crisis, but crisis subsides
over time (regression toward the mean).
Clients may need to believe the therapy was
worth the effort.
Clients generally speak kindly of their
therapists.
Evaluating Psychotherapies
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Regression toward the mean
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tendency for extremes of unusual scores to
fall back (regress) toward their average
Outcome Research
Randomized
clinical trials
Meta-analysis
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procedure for statistically combining the
results of many different research studies
Meta-analysis results
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Untreated people improve
Treated people more likely to improve
People who received psychotherapy spent less time
and money later on medical treatment
Which psychotherapy?
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Do not write on the paper!
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Solve the sheet with a partner
Factors in Successful Therapy
Therapeutic relationship—caring and respectful
 Therapist characteristics—caring, active listener,
sensitive, shared values (**no connection to
training, experience, supervision, licensing)
 Client characteristics—motivated, actively
involved, mature
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Common Benefits of
Psychotherapies
1.
2.
3.
New hope.
A fresh perspective.
An empathic, trusting and caring
relationship.
© Mary Kate Denny/ PhotoEdit, Inc.
Therapists and their Training
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Clinical psychologists
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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
Therapists and their Training
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Clinical or Psychiatric Social Worker
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A two-year Master of Social Work graduate
program plus postgraduate supervision
prepares some social workers to offer
psychotherapy, mostly to people with
everyday personal and family problems
About half have earned the National
Association of Social Workers’ designation of
clinical social worker
Therapists and their Training
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Counselors
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Marriage and family counselors specialize in
problems arising from family relations
Pastoral counselors provide counseling to
countless people
Abuse counselors work with substance
abusers and with spouse and child abusers
and their victims
Therapists and their Training
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Psychiatrists
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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
Agenda block day 4/16-4/17
Biomedical therapies
 Cinderella’s therapist
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The Relative Effectiveness of
Different Therapies
Which psychotherapy would be most effective for
treating a particular problem?
Disorder
Therapy
Depression
Behavior, Cognition, Interpersonal
Anxiety
Cognition, Exposure, Stress Inoculation (CBT)
Bulimia
CBT
Phobia
Behavior (counterconditioning)
Bed Wetting
Behavior Modification
Eye Movement Desensitization
and Reprocessing (EMDR)
Therapist attempts to unlock and reprocess
clients’ traumatic memories by triggering eye
movements (waving a finger in front of the
eyes).
https://www.youtube.com/watch?v=GTLLfdcJE0Q
*EMDR has not held up under scientific testing.
Placebo effect?
Light Exposure Therapy
For Seasonal Affective
Disorder (SAD), light
exposure therapy has
valid effect.
Courtesy of Christine Brune
Biomedical Therapies
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Psychopharmacology
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study of the effects of drugs on mind and
behavior
Antipsychotics => schizophrenia
Occupies dopamine receptor sites and dampens
responsiveness to irrelevant stimuli
*
side effects: Tardive dyskinesia
On the news: http://health.usnews.com/healthnews/articles/2014/04/10/too-many-foster-kids-with-adhd-treated-
Antianxiety Drugs
Antianxiety Drugs
Depress nervous system activity.
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Valium, Xanax, Lithium
*side effect: drowsiness, depression, dependence
Antidepressants=> depression,
anxiety
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Increases the availability of the scarce
neurotransmitters (serotonin), which elevate
arousal and mood
Anti-Depressant Medication
• First generation—tricyclics and MAO inhibitors
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Effective for about 75% of patients
Produce troubling side effects
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MAO inhibitors can have serious physiological side
effects when taken with some common foods
Tricyclics caused weight gain, dry mouth, dizziness,
sedation
https://www.youtube.com/watch?v=m4PXHe
HqnmE
Anti-Depressant Medication
Second generation—chemically different but no
more effective than earlier drugs (Wellbutrin,
Desyrel)
 Selective serotonin reuptake inhibitors (SSRI)—
have fewer undesirable side effects than earlier
drugs
(Prozac, Paxil, Zoloft)
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Fig. 15-12, p. 612
Biomedical Therapies
Antidepressant Drugs
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Lithium— a chemical that provides an effective drug
therapy for the mood swings of bipolar (manicdepressive) disorders.
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Prozac—blocks the reabsorption and removal of
serotonin from synapses.
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Zoloft— cousin to Prozac; blocks reabsorption of
serotonin.
https://www.youtube.com/watch?v=6vfSFXKlnO0
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Paxil— cousin to Prozac; serotonin-uptake-inhibitor.
https://www.youtube.com/watch?v=Wt7Xq4TwOjg
Biomedical Therapies
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The emptying of U.S. mental hospitals
Biomedical Therapies
Biomedical Therapies
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Electroconvulsive Therapy (ECT)
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therapy for severely depressed patients in which a
brief electric current is sent through the brain of an
anesthetized patient
Side effects: memory loss
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https://www.youtube.com/watch?v=TvXlxW-JP6Y
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Psychosurgery
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surgery that removes or destroys brain tissue in an
effort to change behavior
lobotomy
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now-rare psychosurgical procedure
once used to calm uncontrollably
emotional or violent patients
Preventing Psychological Disorders
Problem source: disorders result from stressful
social situations
 Aim: change oppressive, esteem-destroying
environments into more nurturing ones.
 Strategies: reduce abuse and illiteracy. Alleviate
poverty, increase parenting and teaching skills
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Cinderella therapists activity
Form groups of 5 people
 Decide who will take which role
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Moderator, therapist (team of 2; divvy up
script), Cinderella, fairy
Each group will be reading their script. As
you hear other groups, write down: (1)
the correct therapy approach (2) the
specific treatment technique
Activity continued- your turn
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http://www.buzzfeed.com/leonoraepstein/
disney-characters-who-really-need-to-seea-psychiatrist
Select a character
 Write a short script with a moderator,
therapist, characters (2~3) based on one
of the therapy approaches and treatment
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If time
 Anti-depressant:
Makes shrimps too calm
https://www.youtube.com/watch?v=D1WFfTVmmOM
During pregnancy
http://www.cbsnews.com/videos/antidepressants-duringpregnancy-linked-to-new-risks/
Friday agenda
Vocab quiz
 Practice disorder and treatment
 Placebo effect
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Lunch review today