Transcript Group Therapy

Treatments for Psychopathology
CORNELL NOTES: WHAT IS “THERAPY” AND WHO RECEIVES IT? WHAT
IS “INSIGHT THERAPY” AND WHAT ARE ITS CHARACTERISTICS?
• Key Points
Summary:
• Notes
Types of Treatment
• Psychotherapy
– Insight therapies
• “talk therapy” Ex. Family and marital therapy
– Behavior therapies
• Changing overt behavior Ex. Phobias and drug
use
– Biomedical therapies
• Biological functioning interventions Ex.
Schizophrenia
• Group Question Minute: Out of all of the people
who receive psychotherapy, how many of them
have mental disorders?
• 15% of U.S. population in a given year, almost half of
which do not have a psychological disorder (Surgeon
General’s report)
• Group Question Minute: What are some reasons to
receive psychotherapy?
Who Seeks Treatment?
Common presenting problems
 Anxiety depression, unsatisfactory interpersonal relations,
troublesome habits, poor self0control, low self-esteem, marital
conflicts, self-doubt, a sense of emptiness, and feelings of personal
stagnation.
Most common presenting problems
› Anxiety and Depression
Women more than men
Medical insurance
Education level
Figure 15.2 Therapy utilization rates
Figure 15.3 Psychological disorders and
professional treatment
Who Provides Treatment?
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Clinical psychologists
Counseling psychologists
Psychiatrists
Clinical social workers
Psychiatric nurses
Counselors
Therapy Skits instructions
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Research your subcategory of research focusing on your key words. You
may use your text and the other available texts in the classroom. Take
notes
Write a school-appropriate skit that includes all key words and/or
represents the concept communicated by each key word. Each person
should have a part. DO NOT JUST IMPROV. Your grade will be based on
preparation, accuracy, and creativity.
Perform your skit.
One group member will remain after the skit to debrief the class on key
words and give explanations and/or examples to clarify any questions.
All students will have a few minutes to summarize each concept in notes
format under the title “Treatment Skits.”
Insight Therapies
• 1. Insight: Psychoanalysis (key words: psychoanalysis, free
association, dream analysis, interpretation, resistance,
transference)
• 2. Insight: Client-Centered Therapy (key words: ClientCentered Therapy, genuineness, unconditional positive
regard, empathy, clarification )
• 3. Insight: Cognitive Therapy (key words: Cognitive Therapy,
negative thoughts, maladaptive behaviors, automatic
thoughts, unrealistic assumptions, detection, reasonable
standards of evaluation, Rational Emotive Behavior Therapy )
• 4. Insight: Group Therapy (key words: Group Therapy,
selection of participants, trading view points, sharing
experiences, coping strategies, acceptance, emotional
support, setting goals, therapist role )
Behavior Therapies
• 5. Behavior Therapies: systematic desensitization (key
words: systematic desensitization, anxiety hierarchy,
deep muscle relaxation, relaxation, working through
the hierarchy, imagination, counterconditioning )
• 6. Behavior Therapies: aversion therapy (key words:
aversion therapy, aversive stimulus, emetic drug,
aversive response, conditioned aversion, troublesome
behaviors )
• 7. Behavior Therapies: social skills training (key
words: social skills training, social ineptitude, social
anxiety, autism, schizophrenia, interpersonal skills,
modeling, behavioral rehearsal, shaping, role-playing )
Biomedical Therapies
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8. Biomedical Therapies: Antianxiety drugs (key words: antianxiety drugs,
anxiety, Valium, Xanax, tranquilizers, side effects, drug dependence,
overdose, Buspar )
9. Biomedical Therapies: Antipsychotic drugs (key words: antipsychotic
drugs, schizophrenia, mood disorders, psychotic symptoms, dopamine
synapses, 70% effective, side effect, tardive dyskinesia, atypical
antipsychotics )
10. Biomedical Therapies: Antidepressant drugs (key words:
antidepressant drugs, tricyclins, MAO inhibitors, beneficial for 2/3 of
patients and 1/3 have complete resolution of symptoms, complete
resolution, selective serotonin reuptake inhibitors, side effects )
11. Biomedical Therapies: Lithium and Stabilizers (key words: lithium,
mood stabilizers, prevention and current treatment of bipolar, side effects,
valproic acid, advantages)
12. Biomedical Therapies: Electroconvulsive Therapy (key words:
electroconvulsive therapy, severe seizures, electrodes, temporal, electrical
current, right hemisphere, controversy, schizophrenia, major depression,
risks)
Insight Therapies: Psychoanalysis
• Sigmund Freud and followers
– Goal: discover unresolved unconscious conflicts
• Free association- clients spontaneously express thoughts
and feelings without censorship
• Dream analysis: discover the unconscious significance of the
client’s dreams. Pay attention to symbols and archetypes.
• Interpretation: Why is the client saying and thinking what
they are? What do these things say about the influence the
unconscious is exerting on the person’s behavior?
• Common Defense Mechanisms That Turn Up in Therapy:
– Resistance- unconscious defensive maneuvers that help people
save face and hinder progress in therapy.
– Transference- clients unconsciously start relating to their therapist
in ways that mimic critical relationships in their lives
Figure 15.4 Freud’s view of the roots of
disorders
Insight Therapies: Client-Centered Therapy
 Carl Rogers
› Goal: restructure self-concept to better correspond to reality
› Therapeutic Climate
 Genuineness: you are sincere and upfront with the client about their
problem(s), and they are sincere and upfront with you. No posturing. No
acting. No holding back.
 Unconditional positive regard: make the client understand that you will
not judge them and that they’re valuable.
 Empathy: let the client know that you understand the trouble their
problem has caused in their lives. Reflect feelings.
 Clarification: make the person talk so that you can understand them!
Includes paraphrasing.
 Does insight therapy work?
- Homework assignments
mimic behavioral therapies
o -Depends on goals
- Some have doubts, but
research shows it’s superior to
placebo treatments or no
treatments.
Figure 15.5 Rogers’s view of the roots of
disorders
Insight: Cognitive
• Cognitive Therapy: change people’s thought patterns
• Psychologist will help clients get rid of
– negative thoughts: counterproductive
– maladaptive behaviors: deterioration of every-day life
– automatic thoughts: thoughts you don’t know you’re beginning to
have until . . . well . . . you have them!
– unrealistic assumptions: automatic catastrophic thinking
• Psychologists will help clients develop:
– Detection: catch the negative thoughts before they snowball
– reasonable standards of evaluation: realistic thinking
• Albert Ellis Rational Emotive Behavior Therapy
(R.E.B.T.) Also known as “challenge therapy”
• A. Something happens.
B. You have a belief about the situation.
C. You have an emotional reaction to the belief.
• If you want to change your emotional reaction, change your belief.
Insight: Group Therapy
• Also a behavior therapy
• Group Therapy is a form of therapy wherein group members serve as
pseudo-therapists to each other. The therapist’s role is as a
facilitator.
• Processes:
1. selection of participants: all have problem in common
2. trading view points and sharing experiences: empathy and learning
you’re not alone
3. Sharing coping strategies: What works to combat this problem?
4. setting goals: What are we going to accomplish?
• Environment:
1. Acceptance: We all have this problem, so where do we go from
here?
2. emotional support: keep commitment to group and self, but also
receive help for weaknesses
Behavior Therapies: Desensitization
• B.F. Skinner and colleagues
– Goal: unlearning maladaptive behavior and learning
adaptive ones. Counterconditioning.
– Systematic Desensitization – Joseph Wolpe
• Classical and operant conditioning are involved in (1) “unlearning”
associations between fear objects and negative consequences and
(2) “relearning” (counterconditioning) those negative associations
through the presentation of reinforcing stimuli.
• Step #1: Anxiety hierarchy: what are you the most and least afraid
of? Which are real and which are perceived (“imaginary”)?
• Step #2: the client is trained in deep muscle relaxation (physically
relaxing body). Also trained in mental imaging (relaxing mind)
• Step #3: the client tries to work through the hierarchy, learning to
remain relaxed while imagining each stimulus.
• The basic idea: You cannot be anxious and relaxed at the same time.
Behavioral Therapies: Aversion
– Aversion therapy: based upon operant
conditioning (shaping, reinforcement,
punishment). Use on troublesome, maladaptive
behaviors
– Ex. Alcoholism, sexual deviance, smoking, etc.
• aversive stimulus: the thing you learn to hate
• emetic drug: a drug that makes you vomit. Create a taste
aversion on purpose
• aversive response: an undesirable response to the stimulus
• conditioned aversion: the successful training to hate
something that’s not good for you. troublesome behaviors
• The process: Pair an aversive stimulus with the problem
behavior.
Behavior Therapy: Social Skills Training
B.F. Skinner and colleagues
› Who needs social skills training?
› People with social ineptitude (can’t function in social
situations)
› People lacking interpersonal skills (people skills) for any
reason (like inadequate socialization, for example)
› People with extreme social anxiety (anxiety around other
people).
› People who have other disorders like autism, schizophrenia.
› Social skills training tools:
 Modeling and shaping by therapist and other people in
client’s life
 Behavioral rehearsal and role playing: practice a social
scenario right there in the office
Biomedical therapies: Antianxiety
• Assumption: Certain disorders are caused, at least in part, by
biological malfunctions.
• Psychopharmacotherapy=drug therapy
• 3 Categories:
– Antianxiety - relieve tension, apprehension, and nervousness.
• Mechanism Types Represented by Different Drugs:
• Benzodiazapenes: Depress central nervous system by increasing
sensitivity to GABA (inhibitory neurotransmitter). FAST ACTING!
• Serotonin: increase impact of serotonin by getting rid of inhibition,
which calms you down
• Barbituates: Depress central nervous system by increasing sensitivity
to GABA (inhibitory neurotransmitter), but they also block glutamate
(excitatory neurotransmitter)
• Tranquilizers: Depress central nervous system
– Examples: Valium, Xanax, Buspar
Side Effects of Antianxiety Medications
•Drowsiness, lack of
energy
•Clumsiness, slow
reflexes
•Slurred speech
•Confusion and
disorientation
•Depression
•Dizziness, lightheadedness
•Impaired thinking and judgment
•Memory loss, forgetfulness
•Nausea, stomach upset
•Blurred or double vision
 Do you want a more “natural” method of controlling anxiety?
 Biofeedback
 A bodily function is monitored, and information about the
function is fed back to the person so that they can develop
more control over the physiological process.
 Example: Anxiety attacks
Biomedical Therapies: Antipsychotics
– Antipsychotic - gradually reduce psychotic symptoms,
including hyperactivity, mental confusion, hallucinations,
and delusions.
– Mechanism: Antipsychotics decrease activity at dopamine
synapses by blocking receptors=neurons stop shorting out from
overstimulation
• Side-effects: symptoms of Parkinson’s disease and tardive dyskinesia, an
incurable neurological disorder marked by involuntary writhing and
ticklike movements of the mouth, tongue, face, hands, or feet. ALSO
Blurred vision, Dry mouth, Drowsiness, Muscle spasms or tremors, Weight gain
– Newer drugs, which have a different mechanism of action, such as
clozapine, have fewer motor side effects but are not risk free.
Atypical antipsycholtics, for example, have fewer side effects than
regular antipsychotics and work on patients that have not been
receptive to traditional antipsychotics.
– Examples: Thorazine, Mellaril, Haldol
Biomedical Therapies: Antidepressants
Mechanisms:
• Tricyclins: like Elavil inhibit reuptake at serotonin and norepinephrine synapses,
thus leaving more serotonin (calming neurotransmitter) and norepinephrine
(energy/fight-flight chemical) available for cells. Side Effects: dry mouth, drop in
blood pressure when getting up quickly, constipation, difficulty urinating, blurred
vision, weight gain and drowsiness.
• MAO inhibitors: MAO metabolizes serotonin and norepinephrine. MAO inhibitors
prevents MAO from breaking down these neurotransmitters thus leaving a higher
concentration of them in the body. No major side effects, unless you have high
blood pressure.
• Selective serotonin reuptake inhibitors (SSRIs) – like Prozac, Paxil, Zoloft slow
reuptake at serotonin synapses, thus leaving more serotonin (calming
neurotransmitter) floating around available for cells. Side effects: stomach upset,
nausea, fatigue, headache, fatigue, tremor, nervousness and dry mouth, sexual
dysfunction
Instead of being sucked back up
into the receiving neuron, “happy”
neurotransmitters remain in the
synaptic cleft.
Higher
concentration of
“happy”
neurotransmitters
floating around
Biomedical therapies: Mood Disorders
› Mood stabilizers
 Lithium: chemical used to control mood swings in patients with
bipolar mood disorders
 Very successful at preventing future episodes of mania and
depression, but it can be toxic and requires careful monitoring.
 Valproic acid: same result as lithium, but has fewer averse side
effects.
• Side Effects of Lithium: Nausea, vomiting, and diarrhea, Trembling,
Increased thirst and increased need to urinate, Weight gain in the first few
months of use, Drowsiness, A metallic taste in the mouth, Abnormalities in
kidney function, Abnormalities in thyroid function.
• Side Effects of Valporic Acid: weight gain, drowsiness, low energy,
stomach upset, changes in liver function, and problems with platelet
functioning . Uncommon side effects can include temporary hair loss,
headaches, and confusion
Biomedical therapies: ECT
Electroconvulsive therapy (ECT)
Electroconvulsive therapy (ECT) is a
biomedical treatment in which electric
shock channeled through the temporal
lobes is used to produce a cortical seizure
accompanied by convulsions. While the use
of ECT peaked in the 40s and 50s to treat
schizophrenia, there has been a recent
resurgence in this therapy as applied to
depressive disorders.
Traumatic. Can be emotionally scarring.
Example: In A Beautiful Mind a version of
ECT is used on a schizophrenic patient.
Therapy Analysis Activity Ctd.
• Reflection Paragraph: What is the origin of
the increase for the need for mental health
professionals in the late 20th Century? In other
words, why do so many people need therapy
in our day? According to your personal view
and your knowledge of the world, write a
RACE paragraph naming one or a few reasons
for this increase. Please explain your reasons
and cite evidence.
Example: Joe Jensen is currently a happy husband and a flight
attendant. He loves his family and his work, and has now been
married and flying for 25 years. However, earlier on in his adult life,
he almost lost his wings and his new family. Joe was diagnosed with
histrionic personality disorder at the age of 23. He found himself
overreacting to small events in order to get attention. No matter how
juvenile he knew this behavior to be, he couldn’t stop himself from
laughing hysterically, throwing tantrums, and staging accidents to
draw the attention of his wife and the plane passengers. Finally,
passengers began complaining to the company about Joe’s behavior
on flights. A pilot with whom Joe worked pulled him aside and gave
him the card of a competent psychiatrist. Joe saw this doctor for
several years, and he was finally able to master his impulsiveness
through a combination of behavioral and cognitive treatments. His
wife came near to leaving him, but decided to hang in there when she
saw Joe’s determination to control his problem. Joe still visits the
psychiatrist, but much less frequently than at the beginning. With the
help of caring coworkers and an understanding wife, and with his
determination to control his behavior, Joe was able to keep his family
and job.
Cornell Notes: What are the current trends
and issues in psychological treatment?
• Key Points
Summary:
• Notes
Current Trends and Issues in Treatment
• Managed care through Health Insurance:
• Are HMOs negatively impacting psychological care? Many say
“yes.”
• + Consumers pay lower prices (copays)
• - Consumers give up freedom to choose providers and obtain
whatever treatments they believe necessary.
• - In the mental health domain, the question of what is
“medically necessary” is more ambiguous.
Current Trends and Issues in Treatment
• Empirically validated treatments
• Psychologists have increased research efforts to validate the efficacy of
specific treatments for specific problems.
• + Insurance companies will pay for “research based” treatments.
• - Concerns about the inability of empirical studies to capture the
complexity of the real world or the flexibility with which therapists
must practice their craft.
• - Some argue that the movement toward empirically supported
treatment runs counter to the eclectic blending of therapeutic
approaches, which current studies suggest has merit.
Current Trends and Issues in Treatment
• Blending approaches to treatment
• Most mental health professionals use a mixture of treatments
• Multicultural sensitivity
• Western cultures view “the self” as independent, reflective, rational,
and capable of self-improvements. Not all cultures hold these beliefs.
• Ethnic minorities are undertreated.
Current Trends and Issues in Treatment
• Deinstitutionalization
– Definition: the movement away from inpatient treatment in
mental hospitals to more community based treatment.
– The negative effects of mental hospitals have fueled this
movement, as has the ability to treat serious mental problems
with effective drug therapy. Long-term hospitalization for
mental disorders is almost non-existent.
– + Fewer people are being hospitalized long-term, because
other treatments are available.
– - Revolving door problem: people who really do need longterm treatment spend their lives coming and going from the
psych. ward.
– - Homelessness: 1/3 of homeless people are mentally ill.