Transcript 1. Behavioral Therapy

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History of Treatment
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Ancient Treatments
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exorcism, caged like animals,
beaten, burned, castrated,
mutilated, blood replaced with
animal’s blood
Trephinated Skulls
History of Treatment
Therapy
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Psychotherapy
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an emotionally charged, confiding
interaction between a trained therapist
and someone who suffers from
psychological difficulties
Eclectic Approach
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an approach to psychotherapy that,
depending on the client’s problems, uses
techniques from various forms of therapy
Psychoanalysis
Developed by Sigmund Freud
based on his theory of personality
Therapy - Psychoanalysis
• Aims
To try to bring repressed feelings into conscious
awareness where the patient can deal with them.
The theory presumes that healthier, less anxious
living becomes possible when patients release
the energy previously devoted to id-egosuperego conflicts.
Why is psychoanalysis a lot quicker for a
man then for a women?
Because when it's time to go back to
childhood, a man is already there.
Psychoanalytic Treatment
In the Freudian system, anxiety is the main
problem people face.
Anxiety is produced when sexual and
aggressive impulses are repressed.
Guilt occurs when the impulses are
partially expressed.
These impulses occur at the unconscious level.
Today psychoanalytic techniques are called
psychodynamic or insight therapy.
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
• Understanding and insight into
repressed conflicts leads to
recognition and resolution
Therapy - Psychoanalysis
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Psychoanalysis - Freud believed the
patient’s free associations, resistances,
dreams, and transferences – and the
therapist’s interpretations of them –
released previously repressed feelings,
allowing the patient to gain self-insight
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use has rapidly decreased in recent
years
Resistance - blocking from
consciousness of anxiety-laden material
Psychoanalytic techniques include:
Free Association
In a safe environment, people say whatever comes to
mind without limiting or censoring thoughts. A
trained therapist can interpret what is said and
provide insights for the client.
food
Reward
Therapy- Psychoanalysis
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Interpretation
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the analyst’s noting supposed dream
meanings, resistances, and other significant
behaviors in order to promote insight
Transference
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the patient’s transfer to the analyst of
emotions linked with other relationships
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e.g. love or hatred for a parent
Transference
Emotional conflicts of earlier years are transferred
onto the therapist. By doing this, unconscious
conflicts become conscious.
Other Dynamic Therapies
Most therapies today are shorter-term
 Based on goals that are specific and
attainable
 Therapists are more directive than
traditional psychoanalysis
 Traditional psychoanalysis is seldom
practiced today
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Humanistic Therapy
People have the power to control their fate, ideas, and
movements as they move towards self-actualization.
This therapy is now known
as person (client) centered
therapy.
Therapist and client are
considered equal partners
in therapy.
In this therapy, the client decides what is to be discussed
and what direction the therapy will take.
Humanistic Therapy
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Client-Centered Therapy
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humanistic therapy developed by Carl Rogers
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therapist uses techniques such as active
listening within a genuine, accepting,
empathic environment to facilitate clients’
growth
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unconditional positive regard for clients
Humanistic Approach in Therapy
Active Listening-empathic listening in which the listener
echoes, restates, and clarifies
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Active Listening-empathic listening in which the listener
echoes, restates, and clarifies
Humanistic Therapy
(continued)
People need to accept themselves as they are, while
working toward fulfilling their potential.
The therapist develops an atmosphere of
trust and understanding.
The therapist acts as a mirror to the client,
reflecting ideas and concepts.
The therapist does not judge the client.
Thoughts, feelings, and ideas represent a
person seeking to grow and seeking to be
understood.
Humanistic Therapies
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Humanistic perspective emphasizes human
potential, self-awareness, and free-will
Humanistic therapies focus on self-perception and
individual’s conscious thoughts and perceptions
Gestalt Therapy
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Gestalt Therapy
Developed by Fritz Perls to combine the psychoanalytic
emphasis on bringing unconscious feelings to awareness
and the humanistic emphasis on getting “in touch with
oneself”
Aims: to help people become more aware of and able to
express their feelings, and to take responsibility for their
feelings and actions.
Emphasizes the importance of encouraging people to
sense and express their own true moment-to-moment
feelings.
Behavior
Therapy
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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. It had been years
since he had gotten a good night's sleep. Furthermore, his
progress was very poor, and he knew it. So, one day he stops
seeing the psychoanalyst and decides to try something different.
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
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Behavior Therapy
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therapy that applies learning principles to the
elimination of unwanted behaviors
Counterconditioning
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procedure that conditions new responses to
stimuli that trigger unwanted behaviors
based on classical conditioning
includes systematic desensitization and
aversive conditioning
Behavioral Therapy
Behavioral therapy attempts
to change behavior using the
techniques of learning.
Behaviorists assume that
abnormal behaviors are the
result of faulty
(inappropriate) learning.
Behavior Therapy
Behavioristic perspective emphasizes
that behavior (normal and abnormal) is
learned
 Uses principles of classical and operant
conditioning to change maladaptive
behaviors
 Behavior change does not require
insight into causes
 Often called behavior modification
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Behavior Therapy
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Exposure Therapy
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treat anxieties by exposing people (in imagination
or reality) to the things they fear and avoid
Behavior Therapy
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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
Aversive Conditioning
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type of counterconditioning that associates an
unpleasant state with an unwanted behavior
nausea ---> alcohol
Systematic Desensitization
Based on classical conditioning
 Uses three steps:
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Progressive relaxation
Development of anxiety hierarchy and control
scene
Combination of progressive relaxation with
anxiety hierarchy
Behavior Therapy
Systematic Desensitization
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Systematic Desensitization
Systematic Desensitization
Behavior
Therapy
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Aversion
therapy for
alcoholics
Behavior Therapy
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Token Economy
an operant conditioning procedure
that rewards desired behavior
§ patient exchanges a token of some
sort, earned for exhibiting the
desired behavior, for various
privileges or treats
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Cognitive Therapy
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Cognitive Therapy
teaches people new, more
adaptive ways of thinking and
acting
§ based on the assumption that
thoughts intervene between
events and our emotional
reactions
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Cognitive Behavioral Therapy
Cognitive behavioral therapy combines learned behaviors
with conscious thoughts.
Albert Ellis developed rational-emotive therapy. He
believed that emotional upsets occur when people hold
irrational ideas (contrary to logic).
Thus people are disturbed not by things but by the
view we take of them.
The therapist attempts to give
the client a rational or logical
view of reality.
Rational Emotive Therapy
Developed by Albert Ellis
 ABC model
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Activating Event
Beliefs
Consequences
Identification and elimination of core
irrational beliefs
Aaron Beck’s Cognitive
Therapy
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Problems due to negative cognitive bias
that leads to distorted perceptions and
interpretations of events
Recognize the bias then test accuracy of
these beliefs
Therapist acts as model and aims for a
collaborative therapeutic climate
Cognitive Therapy
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The Cognitive
Revolution
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A cognitive perspective on psychological
disorders
Cognitive Therapy
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Cognitive therapy for depression
Cognitive Therapy
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Cognitive-Behavioral Therapy
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a popular integrated therapy that
combines cognitive therapy (changing
self-defeating thinking) with behavior
therapy (changing behavior)
Comparing Cognitive Therapies
Summary Chart
Treatment
Primary Goal
Psychoanalytic
Insight into
childhood conflicts,
motives, and feelings
Methods
Using free association
and transference
Humanistic
Self-acceptance
and self-fulfillment
A safe nonjudgmental
environment to discuss
problems and unconditional
positive regard
Behavioral
Changing behaviors
through learning
Systematic Desensitization,
Aversive Conditioning, and
Token Economies
CognitiveBehavioral
Changing
irrational beliefs
Identification of faulty
belief systems
Group and Family Therapies
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Family Therapy
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treats the family as a system
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views an individual’s unwanted behaviors as
influenced by or directed at other family
members
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attempts to guide family members toward
positive relationships and improved
communication
Group and Family
Therapy
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Group therapy— one or more therapists working
with several people at the same time.
Couple therapy— relationship therapy that helps
with difficulty in marriage or other committed
relationships
Evaluating Psychotherapies
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To whom do people turn for help for psychological
difficulties?
Factors in Successful Therapy
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Therapeutic relationship—caring and
mutually respectful
Therapist characteristics—caring attitude,
ability to listen, sensitive
Client characteristics—motivated, actively
involved, emotionally and socially mature
Effectiveness of Psychotherapy
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Most people do not seek help with
problems
Many people report spontaneous
remission
Meta-analyses show that psychotherapy
is more effective than no treatment
Generally no differences among the types
of psychotherapy
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
Meta-analysis
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procedure for statistically combining the
results of many different research studies
Evaluating Psychotherapies
Number of
persons
Average
untreated
person
Average
psychotherapy
client
Text
Poor outcome
80% of untreated people have poorer
outcomes than average treated person
Good outcome
The Relative Effectiveness of
Different Therapies
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The Relative Effectiveness of Different Therapies
Although no one type of therapy can be said to be most effective
overall, some therapies are particularly well-suited to specific
disorders.
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1.Behavioral Therapy— works best when treating specific
behaviors such as phobias, compulsions, or sexual dysfunctions.
2.Cognitive Therapy— best treatment for depression.
3.Psychotherapists— increasingly offer particular treatments for
specific problems.
Evaluating Alternative Therapies
Therapeutic touch
A practitioner moves their hands a few
inches from a patient’s body to push the
energy fields into balance. Advocates say
these manipulations help heal everything
from headaches to burns to cancer.
Skeptics say the evidence shows no
healing power beyond the placebo effect.
Evaluating Alternative Therapies
Eye Movement Desensitization
and Reprocessing (EMDR)
While people imagined traumatic scenes,
Francine Shapiro triggered eye movements
by waving her finger in front of their eyes.
84 to 100% of the trauma victims said it
worked. ...or is it another placebo effect???
Evaluating Alternative Therapies
Light-Exposure Therapy
Treatment for Seasonal Affective
Disorder (SAD) – wintertime depression.
Give SAD people a daily dose of intense
light and it will relieve symptoms associated
with wintertime depression. This does work!
Commonalities Among
Psychotherapies
Hope for Demoralized People
Any therapy offers an expectation that, with
commitment from the patient, things can
and will get better.
Commonalities Among Psychotherapies
A New Perspective
Therapy offers new experiences that help
people change their views of themselves
and their behaviors. They may approach
life with a new attitude.
Commonalities Among Psychotherapies
An Empathic, Trusting, Caring
Relationship
Effective therapists are empathic people
who seek to understand another’s
experience; whose care and concern the
client feels; and whose respectful listening,
reassurance, and advice earn the client’s
trust and respect.
Culture and Values in
Psychotherapy
Culture and Values in
Psychotherapy
Albert Ellis and Allen Bergin disagree about
the value of self-sacrifice and marital
fidelity, they both appear to agree that
psychotherapists’ personal values influence
the process of therapy.
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
§ 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
Biomedical Therapies
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Psychopharmacology
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study of the effects of drugs on mind and
behavior
Antipsychotic Drugs
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Antipsychotic Drugs
The molecules of antipsychotic drugs are
similar enough to molecules of the
neurotransmitter dopamine to occupy its
receptor sites and block its activity.
(Thorazine, Clozapine )
Antianxiety Drugs
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Antianxiety Drugs
Valium, Xanax, Lithium – depress nervous
system activity.
Antidepressant Drugs
Antidepressant Drugs
Most antidepressants work by increasing
the availability of the neurotransmitters
norepinephrine or serotonin, which elevate
arousal and mood and appear scarce
during depression.
Antidepressant Drugs
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Lithium— a chemical that provides an effective
drug therapy for the mood swings of bipolar
(manic-depressive) disorders.
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Prozac— (fluoxetine) blocks the reabsorption
and removal of serotonin from synapses.
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Zoloft— cousin to Prozac; blocks reabsorption of
serotonin.
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Paxil— cousin to Prozac; serotonin-uptakeinhibitor.
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
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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Biomedical Therapies
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The emptying of U.S. mental hospitals
Biomedical Therapies
Biomedical Therapies
Electroconvulsive Therapy
Used for severe depression
 Very effective for quick relief of symptoms
of severe depression (can be used until
medication begins to work)
 May have cognitive side effects such as
memory loss
 Very controversial treatment
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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
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
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Preventing Psychological Disorders
Advocates of preventive mental health
argue that many psychological disorders
could be prevented. Their aim is to
change oppressive, esteem-destroying
environments into more benevolent,
nurturing environments that foster
individual growth and self-confidence