Transcript Abnormal Psychology - Solon City Schools

Treatments
History of Treatments
• Early treatments brutal
• Transitioned to more humane
methods
• Dorothea Dix – 1st to
transition to gentler
treatments in U.S.
• Today - Biomedical Drugs and
better Psychotherapy has led
deinstitutionalization.
Categories of Therapy
2 Main Categories
1. Psychotherapy – interaction between therapist and
patient
•
Example: Psychoanalytic Therapy
Psychotherapist - trained therapist(clinical psych) who uses
psychological techniques to assist someone to overcome
–
•
Example: psychodynamic therapist who treats an anxiety disorder
2. Biomedical Therapy – prescription meds that act on
central nervous system
•
Example: Antipsychotic drugs to treat Schizophrenia
Ecclectic Approach– uses a variety of psych theories and
approaches to treat mental illness
Example: combining medication (anti-depressants) with different types
of psychotherapy such as Cognitive Therapy (change feelings of selfblame) and Behavioral (go out and run when feeling depressed)to treat
depression
Perspectives and Disorders
Psychological
School/Perspective
Psychoanalytic/Psychody
namic
Cause of the Disorder
Treatments
Unconscious
drives/conflicts and
childhood experiences
Psychoanalytic Therapy
Psychodynamic Therapy
Humanistic
Barriers to selfunderstanding and selfacceptance.
Client Centered Therapy unconditional positive regard and
active listening.
Behavioral
Reinforcement history, the
environment.
Behavioral Therapies
Classical – counterconditioning,
exposure therapy, flooding,
systematic desensitization, virtual
reality, aversive
Operant – behavior modification,
Token economy
Cognitive
Irrational, dysfunctional
thoughts or ways of
thinking.
Cognitive Therapy
Sociocultural
Dysfunctional Society &
stressful relationships
Group or Family Therapy
Biomedical/Neuroscience biochemical imbalances,
Biomedical Drug Therapy
Insight Therapies
• Insight therapies – try to improve
mental state by increasing client’s
awareness of underlying motives and
defenses
• Examples:
1. Psychoanalytic Therapy
2. Psychodynamic Therapy
3. Humanistic Therapy
Psychoanalytic Therapy
• Psychoanalysis – uncovering
childhood experiences to gain
insight into the unconscious
origins of the disorder
– dream analysis – manifest and
latent
– free association – uncensored
reporting of any thoughts that come
to mind.
• Resistance - blocking from
unconsciousness anxiety-laden
material during therapy.
– Example: stuttering, omitting or
forgetting events, pausing, changing
the subject, ending a session
Psychoanalytic Therapy
– Transferring – strong
positive or negative
feelings patients may feel
about the psychoanalyst
that reflect similar
unconscious feelings
repressed from earlier
relationships.
– Seen as helpful to the
therapy process
• Example: Hatred toward
mother is expressed as
hatred toward therapist
Psychoanalytic Therapy
• Criticisms
– Interpretations can’t
be proven or
disproven
– Costly and time
consuming (2 or more
sessions/week for 2
or more years)
Psychodynamic Therapy
• Psychodynamic therapy - try to
understand patients' current
symptoms by focusing on recurring
patterns in their interpersonal
relationships
– Patients gain insight into unconscious
conflicts
– Face to face, once per week, several
months
• Interpersonal psychotherapy effective in treating depression by
helping patients improve their
interpersonal skills
– variation of psychodynamic therapy
– 14-16 sessions
– Example: helping a depressed patient
resolve conflicts with friends
Humanistic Therapy
• Humanistic Therapy emphasize the importance of
self-awareness and take
responsibility for own feelings
and actions to improve mental
state
– Focus on present
– Focus on Conscious thought
– Taking responsibility for own
actions
– Promote personal growth
– Does NOT analyze motive,
diagnose or recommend a cure. .
Humanistic Psychology
Client-Centered Therapy (Rogers) patients' discover their own ways of
dealing with difficulties
•non-directive therapies – therapist
listens without judging or giving insight
•Genuineness, acceptance and empathy
•Unconditional Positive Regard
•Active listening – echoing, restating and
seeking clarification of clients feelings
• Geraldo, a high school senior, is so fearful of asking
a girl out that he hasn't had a date in over three
years. He has recently contacted a psychotherapist
for help in overcoming his fear. Describe how a
humanistic therapist and a psychoanalyst would
treat Geraldo's problem.
• HUMANISTIC PSYCHOLOGIST
– focus on the present rather than the past - what Geraldo
can do now to get up the nerve to ask for a date rather
than what he failed to do in the past
– conscious thoughts - what Geraldo thinks about dating
and how he would approach a woman for a date
– taking responsibility for his actions - what he can control in
asking a woman out on a date rather than what he can't
control
• PSYCHOANALYST
– focus on what unconscious impulses or conflicts are
causing Geraldo's fear—Does Geraldo have unconscious
feelings of anxiety about his mother that he is transferring
to other women?
Behavioral Therapies
Behavior Therapies – applies
learning principles to
unwanted behaviors
• Classical Conditioning
– Maladaptive symptoms are
conditioned responses
• Operant Conditioning
– Maladaptive symptoms are
reinforced
Behavioral Therapy
• Classical Conditioning
– Counterconditioning (Pavlov)- replaces a
negative behavior (anxiety, fear) with a
positive behavior (relaxation)
• Example: Child wets the bed, condition to
wake up when bladder relaxes by using an
alarm
– 2 Types
1. Exposure Therapies
– Flooding
– Systematic Desensitization
– Virtual Reality Exposure Therapy
2.Aversive Conditioning
Exposure Therapies
• Exposure Therapies - Repeatedly introducing
people to things they fear and avoid
1. Flooding – forced exposure to the stimulus that
is feared
•
Example: Putting a Susan who has Arachnophobia in a room full of
spiders to show that they have no reason to fear them
2. Systematic Desensitization – gradual exposure to
the actual stimulus by replacing a positive
response with a negative response.
•
Progressive relaxation – imagined scene is repeatedly
paired with relaxation and progresses to eventually
facing the worst fear
•
Example: Therapist first asks Susan to relax and imagine a
harmless spider climbing up the wall eventually she will face a
room full of tarantula spiders, her greatest fear
Exposure Therapies
3. Virtual Reality Therapy –
progressively exposing
people to simulations of
their greatest fears
–
–
Examples: exposing Susan to
Spiders using a 3 dimensional
virtual world with life-like spiders
Fear of flying, heights, animals and
public speaking
Aversion Therapy
• Aversion Therapy – replaces
a positive behavior with a
negative behavior
– Examples: consuming alcohol
(euphoria - positive) with a
nausea producing drug
(negative)
– Gambling and shock treatments
• Problem: cognition influences
conditioning
Operant Conditioning
1. Behavior Modification - reinforcing
desired behaviors, giving punishments
for undesired behaviors
–
Example: Punishing aggressive behaviors
of children with autism
2. Token Economy – earning a token for
desired behavior that can be traded
in for privileges
–
Example: Given tokens to ADHD students
for staying in their seats and allowing
them to trade them in for a prize
• Describe how a therapist might apply operant
conditioning techniques to help Rosemary overcome
a compulsive habit of eating too much junk food. Be
clear about the exact procedures that would be
used.
• behavior modification - reinforcing the desired
behavior (e.g.. encouraging Rosemary to treat
herself to a favorite, healthy food [such as an
energy drink] if she doesn't eat any chips or candy
during the day) or punishing an undesirable
behavior (e.g., having to put $5 in a jar each time
she has a piece of candy).
Cognitive Therapy
• Cognitive Therapy – change the way
patient thinks (change schemas)
– Irrational, Self-blaming, over-generalized
thoughts, negative interpretations
– Anxiety Disorders, Major Depressive
Disorder, Suicide
– Example: Dan thinks he can’t get an A in AP
Psych because he’s incompetent
• Beck’s Therapy for Depression – uses
gentle questioning to reveal irrational
thinking
• Stress Inoculation Training
– Teaches to change thinking in stressful events
Cognitive-Behavioral Therapy
• Cognitive Behavioral - Changes the
way we think and act
– Example: When Olivia is anxious, her
therapist teaches her to attribute her
anxiety to a highly reactive sympathetic
nervous system and to play Temple Run
on her phone instead.
– Rational Emotive Behavior Therapy
(REBT, Ellis) – helps people change their
irrational beliefs by having therapist
dispute the client's irrational beliefs and
behavioral problems
– Example:
– "Where is it written that other people
must treat you fairly?"
• One of your best friends feels that he fails at
everything he does and that his life isn't worth
living. When you suggest that he talk to a
psychotherapist, your friend responds, “Talking
won't help. The more I talk about myself, the more I
think about my problems. The more I think about
my problems, the more depressed I get.” What
procedures would a cognitive therapist use to help
your friend overcome his negative feelings?
• A cognitive therapist - believes that the emotional
reaction (depression) is produced by your friend's
thinking about life events, and so would work with
the client to change the ways he thinks about life
events.
Family and Group Therapy
• Group Therapy
– Offered for: family
conflict, stressful
relationships, patients with
similar problems
– Improves communication
skills and conflict resolution
• Examples: obesity (OA),
alcoholism (AA)
– Family Therapy – unwanted
behaviors are influenced by
other family members
Example: rebellious child
Evaluating Psychotherapy
• Placebo effect – the beneficial
consequences of merely expecting
that a treatment will be effective.
• Regression toward the mean – the
tendency for unusual events or
emotion to return to their ave. state .
– Example: Dan got an unusually high grade
on a test, he performed less on the
second even though he studied the same
amount
Evaluating Psychotherapy
• Randomized Clinical Trials –
compare treatment groups with
control groups
• Meta-analysis – a procedure for
statistically combining the results
of many different studies. – gives
bottom line results
• Psychotherapies bottom line – Those
not undergoing therapy often
improve, but those undergoing
therapy are more likely to improve
Comparison of Psychotherapies
Evidence Based Practices - Clinical decision making that integrates the
best available research with clinical expertise and an understanding of
patient characteristics
**Scientifically Unsupported Therapies - Energy Therapy, Recovered-memory
Therapy, Rebirthing Therapies, Facilitated Communication, Crisis Debriefing
Alternative Therapies
• EMDR (Eye Movement Desensitization
and Reprocessing - Rapidly moving one's
eyes while recalling traumatic
experiences
– similar to exposure treatment
– Originally developed for anxiety
– Value in placebo effect and exposure
therapy
• Light Exposure Therapy – exposure to
intense light that mimics outdoor light
– activity in the brain region responsible for
arousal
– Seasonal Affective Disorder – depression
caused by lack of exposure to natural light
Biomedical Therapy
Biomedical Therapy – drugs, or
treatments that act on the brain’s
central nervous system
– Examples:
– Drugs, electroconvulsive
therapy,
– Magnetic impulses
– Psychosurgery
Biomedical Therapy
Psychopharmacology – study of
the effects of drugs on the
mind and behavior
– Antipsychotics
(Thorazine,Chlorpromazine,
Clozapine)
– Anti-anxiety ( Xanax,
Ativan d-cycloserine)
– Anti-depressants (Paxil,
Prozac, Zoloft – SSRI’s)
– Mood Stabilizers Bipolar
(lithium, Depakote)
Anti-Psychotics
• Anti-Psychotic Drugs – drugs used to
treat schizophrenia that block
receptor sites for dopamine
– Thorazine – Helps positive symptoms only –
hallucinations and paranoia
• Tardive dyskinesia –Side effects:
sluggishness, tremors, twitches,
involuntary movements of face, tongue,
limbs from long-term use (
• Atypical antipsychotics
– Block both dopamine and serotonin
receptors
– Clozapine –used to treat negative
symptoms –apathy and withdrawal
Anti-Anxiety Drugs
• Anti-anxiety drugs – depress
central nervous system activity
– Xanax & Ativan
– D-cycloserine – acts on receptor
site that extinguishes learned
fear –helps with PTSD and OCD
– Addictive
• Withdrawal symptoms – increased
anxiety and insomnia
Anti-Depressants
• Anti-depressants – used to
treat depression & anxiety by
increasing the availability of
serotonin and norepinephrine
that elevate arousal and mood
– Paxil, Prozac, Zoloft (SSRIs) –
blocks serotonin reuptake
– Dual Action Drugs – block both
the reuptake of serotonin and
norepinephrine
Alternatives for Depression
• Cognitive-Therapy +
antidepressants
– Cognitive therapy top down
– Antidepressant bottoms-up
– works on limbic system
• Mood Stabilizing Drugs
– Lithium – simple salt used to
treat Bipolar disorder
– Depakote – epilepsy drug
used to treat mania
• Exercise
Brain Stimulation
• Treatments for Depression
1.
ECT (Electroconvulsive therapy) –
electric shock therapy for patients
with sever depression
1.
Can trigger seizures and memory loss
2. rTMS (repetitive transcranial
magnetic stimulation)- repeated
pulses of magnetic energy to brain’s
surface
1.
2.
No seizures or memory loss
Triggers long-term potentiation of
inactive left frontal lobe nerve cells.
3. Deep Brain Stimulation – uses
implanted electrodes to inhibit
activity in an area of the cortex
that triggers negative emotions
Psychosurgery
• Psychosurgery – removes
or destroys brain tissue
– Lobotomy - cut the nerves
connecting the frontal lobes
to the emotion controlling
centers of inner-brain
• Once used to calm severely
emotional or violent patients
– MRI-guided precision
surgery – cut brain circuits
of severe OCD
Preventing Psychological
Disorders
• Therapeutic Lifestyle Change
– reverses the symptoms of
psychological disorders
– Aerobic exercise, adequate
sleep, light exposure, and social
engagement, anti-rumination,
nutrition
– Resilience – ability to cope with
stress and recover from
adversity