Transcript Review Unit 13 Treatment 2015-2016

Unit 13 Review:
Treatment of Psychological
Disorders
Introduction
• History of treatment-reformers:
– Philippe Pinel
– Dorothea Dix
• Psychotherapy-Trained therapist
uses psychological techniques to assist
someone seeking to overcome
or achieve personal growth.
Refers to all forms of talk therapy
Types of Therapy
• 1. individual
• 2. group-lets one see others have similar
problems, cheaper
• 3. family
• 4. support group/self help groups (grew out of
humanism)
The Relative Effectiveness of Different
Therapies
• Evidence-based practice basing
treatment methods (what tx. To
use for what) on:
Psychotherapy(Talk Therapy) based on the Perspectives:
Psychoanalysis-(*insight therapy) Freud:
Insight into unconscious motives and feelings
1. Psychodynamic Therapy influenced by Freud:
same as above-by identifying themes across important relationships,
including childhood and therapist’s
2. Humanistic Therapy
insight, self acceptance, self acceptance leads to self fulfillment
Both 1 and 2 are Insight Therapy=Helps people reduce inner conflict and
increase self-understanding; assume that psychological problems lessen as
self-awareness grows
3. Behavior Therapy: uses behavior modification (changing) to change
learned behaviors
4. Cognitive Therapy: identifying and changing faulty beliefs that effect
our feelings, thoughts and actions
5. Cognitive Behavior Therapy :
changing faulty thinking and behaviors since our irrational, negative
thinking affects our behavior
Eclectic Approach-using a blend of therapies
Biological/Biomedical perspective:
PERFORMED BY PSYCHIATRIST (MD)
The Biomedical Therapies -changing brain’s functioning
with:
1.Drugs psychopharmacology
2. Electroconvulsive therapy (ECT-shocking brain-used
for SEVERE depression)
3. Psychosurgery (surgery that removes or destroys
brain tissue)
prefrontal lobotomy-for psychosis, violent; impacts
emotions
separating corpus callosum-for epilepsy
The Psychological Therapies
Psychoanalysis
Psychoanalysis (Freud) felt aggression is cathartic
Aims of therapy:
bring repressed feelings to conscious awareness
to gain insight into origins of one’s
issues/problems
Psychoanalysis
Methods
• Methods-takes several times a week for several years
• Currently called Psychodynamic Therapy (1x week-shorter
duration, no couch)
-- Hypnosis (more current)
– Free association
– Resistance Lead to
• Interpretation
Also interpreted are Dreams:
– Dream analysis (manifest/latent
content)
– Transference (strong positive or
Negative feelings towards therapist
that represents past important
relationships)
Humanistic Therapies
• Client-centered therapy Carl Rogers
– Nondirective therapy (listen’s to client’s self-perceptions
without judging, interpreting, or directing towards
feelings), acceptance
(no judging),
and empathy (how world appears
from clients point of view) HOW:
1. Active-Reflective Listening
2. Unconditional Positive
Regard (total acceptance)
GOAL=Therapist accepts you;
You accept you
Behavior Therapies
• Behavior Therapy (assumes Abnormal behaviors are
learned)
– Operant conditioning techniques (changing behaviors
through: 1. rewards-positive or negative, 2. punishmentspositive or negative, 3. ignoring behaviors
– includes Behavior Modification(reinforce desired behaviors and
withholding reinforcement for, or punishing, undesired behaviors)
such as Token Economies
Joseph Wolpe 1915-1997
Systematic Desensitization
(Treatment Choice for Phobia)
Behavior Therapies
Classical Conditioning Therapies-Classical conditioning
Exposure therapies=facing/exposure to fears
Counterconditioning
Counter-conditioning= pairing the unpleasant event/stimulus
(snake, spider, elevator, clown, flying, public speaking, etc…)
with something incompatible with fear, such as in the case of
1.Systematic desensitization-Joseph Wolpe
1. Learn series of Relaxation techniques
2. Anxiety Hierarchy (come up with about a 10 item hierarchy)
3. The person thinks about or experiences each step in the hierarchy, from lowest to
highest, while relaxation
2. Virtual reality exposure therapy
3. Aversive conditioning (opposite of # 1)
Substitute a negative (aversive)response for a positive
response to a harmful stimulus
EX 1. bitter nail polish for nail biters 2. pill to induce vomiting to discourage
alchohol
4. Flooding (extreme exposure, all at once, to demonstrate nothing bad will
occur)
Mary Carver Jones
First to use Classical Conditioning in a positive
way (after Watson-FATHER OF BEHAVIORISM)
to alleviate a child’s fear
of rabbits:
Used favorite food to desensitize- by pairing
food with the rabbit
Cognitive Therapy
The Goal:
Using Thoughts to Change Emotions and behaviors
by teaching clients new ways of thinking
Premise is:
We have Faulty Cognitions (thinking)
We have irrational beliefs and expectations that
distort our behaviors, attitudes and emotions
If I leave the house
Change thinking=Changed Behaviors
Aaron Beck- Cognitive Therapy
Mostly for depression-Goal Is to change
Catastrophizing (Illogical, Maladaptive) beliefs:
•Client’s told to test their thoughts for accuracy
•Example: I never have a good time
•Client may come up with times that were actually good. --An unassertive person may be asked to cut in line or ask
someone for a favor
Cognitive Behavioral Therapy
• Goal=alter the way we think and act since our
irrational, negative thinking affects our
behavior (ex. “I will not die if I leave the
house; it is only fear I feel and no real harm
awaits me.”)
• Rational Emotive Therapy or Rational Emotive
Behavioral Therapy(RET or REBT)-Developed
by Albert Ellis
His ABCs:
Activating Event (say being criticized)
Belief (I must be loved by everyone to be happy)
Consequent Emotions (unhappiness)
The goal of RET is to change B=FALSE, SELF-DEFEATING
BELIEFS
Comparison of Psychotherapies
Is Psychotherapy Effective?
• Regression toward the mean
• Client’s perceptions (very positive)
• Therapist’s perspective:
Very positive
Why Clients Remain Positive
• 1. enter tx. In crisis and may mis-attribute
improvement to tx.
• Clients have a “stake” in believing the therapy
was worth it (similar to belief perseverence)
• Clients generally speak highly of their
therapist even if symptoms remain
Is Psychotherapy Effective?
• Outcome research-2/3 of those treated for
non-psychotic disorders improved
markedly
– Meta-analysis-putting a bunch of studies
together and evaluating
Placebo treatments
Placebo Effect=I get better with therapy
b/c I think it will help (not due to
therapy itself)
Evaluating Alternative Therapies
• light exposure therapy helps with
–Seasonal
affective
disorder
(SAD)
Types of Therapists
Biological / Biomedical Therapies
Drug Therapies
(Agonists or Antagonists)
Drug Therapies
Antipsychotic Drugs
• Antipsychotic drugs (neuroleptics)
– Psychoses (some loss of
reality contact with
delusions and hallucinations)
– Chlorpromazine
(sold as Thorazine or Haldol)-
Antipsychotic drugs similar to molecules in neurotransmitter
Dopamine –they block receptor sites for dopamine
– Tardive dyskinesia (involuntary movements of facial muscles,
tongue, and limbs from antipsychotic medications)
Drug Therapies
Antipsychotic Drugs
– Atypical antipsychotics –Clozaril- are best to
alleviate
negative symptoms of schizophrenia and
cause “awakenings” in these individuals
Overall, antipsychotic drugs are effective
Drug Therapies
Antianxiety Drugs
• Antianxiety drugs
– Xanax, Ativan,
– Draw back:
1.Physiological
Dependence
2. Worsening symptoms
When stopped
Drug Therapies
Antidepressant Drugs
• Antidepressant drugs-increase activity of serotonin
– Use with mood and anxiety disorders increase levels of
norepinephrine or serotonin, neurotransmitters that elevate mood
– Fluoxetine (common name Prozac), Zoloft and Paxil block removal
of serotonin from synapses and are called:
Selective-serotonin-reuptake
Inhibitors (SSRIs)
Serotonin promotes Neurogenesis
(birth of new brain cells)
May be why the drugs take up to 4 week to
work
Drug Therapies
Mood-Stabilizing Medications
• Mood-stabilizing medications
– Lithium Carbonate for the highs and lows of bipolar
– unsure
why these drugs
Are effective
Psychosurgery
• Psychosurgery (surgery that removes or destroys brain
tissue)
– Lobotomy (not used after introduction of antipsychotic
meds in 1950s)
• Procedure-cut nerves connecting frontal lobe with emotion
centers-used for uncontrollably emotional and violent patients
• Side effects: lethargic, immature, uncreative-Permanent
Lobotomy abandoned when drugs available
Psychosurgery used in rare instances with epilepsy by cutting
corpus coliseum