Transcript Unit 13 - Therapy PP

SUMMARY of Psych Therapy designs
Refer to chapter 16 to
accompany these notes!
History of treatment
• Attitudes towards and treatment of the mentally ill
have changed significantly over time
• Anciently – believed mentally ill were possessed by
demons – trephining – drilled holes in their skull to
release spirits
• Imprisonment
• Progressive era – call for more humane treatment –
counseling and institutions
– Dorothea Dix in US
– Philippe Pinel in France
Post 1950s
Pharmacology
• MEDS – drugs
De-institutionalization
• Seek to treat mentally
with meds and with outpatient counseling
• Get away from lifetime
institutionalization
• Side effect – increase
mentally ill population in
prison or homeless struggle to function
60 Minutes Clip
• Jan 2014 – Cree Deeds son’s suicide – danger of deinstitutionalization
• http://www.cbsnews.com/news/mentally-ill-youth-incrisis/
Today
• Continue trend in medication and outpatient therapy
• Increased emphasis on
PREVENTION – how……?
– de- stressors
–Stable families
–Emphasize better nutrition, exercise,
sleep, etc.
Summary of different
treatment perspectives
Psychoanalysis
• Issue - Person’s symptoms are outward manifestation
of deeply repressed problems, possibly from childhood
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Freud
Role of Uncon
Developmental fixation
Emphasis on childhood, trauma, repression
Projective tests – free association, hypnosis, dream
analysis, ink blot, TAT
Humanism Summary
• Issue – boost patients self-esteem by helping him realize his
potential, possibilities for growth, and self-actualization
• Maslow and Rogers
• Therapy techniques – unconditional positive regard, client
centered therapy, active listening, show genuine concern for
patient
• People are innately good
• NOT deterministic – you can use your agency to choose your
course in life
• Key terms – hierarchy of needs, free will, self-actualization
Behaviorism Summary
• Issue – abnormal behavior is caused by a dysfunctional
environment. Change the environment – fix the behavior
• 100% nurture – ALL behaviors are learned
• Skinner and operant conditioning (alter reinforcements or
punishments)
• Bandura and social modeling – model healthy behaviors
• Classical Conditioning – Counter Condition – replace
association of anxiety/fear with calm – hierarchy of fears
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Systematic desensitization – proceed step by step by imagining
In vivo desensitization – proceed step by step live
Implosive Therapy – imagine most frightening scenario (top of hierarchy)
Flooding – actually do most frightening scenario – live
– (ultimate goal is always to do it live – but you may do imagination first)
Cognitive - Summary
• Issue – dysfunctional behaviors are caused by dysfunctional
thoughts. Confront the patient’s irrational thoughts
• Albert Ellis – Rational Emotive Therapy – expose irrational
thoughts
• Locus of Control – (internal V. external) be realistic in what you
take credit for or what you take blame for
• Seligman’s – Learned helplessness – do you have control of
your situation – do you take action?
• Aaron Beck’s Cognitive Triad – dysfunctional thoughts about
your 1.) self, 2.) your world, and 3.) your future
Cognitive Summary
Aaron Beck’s Cognitive Triad – dysfunctional
thoughts about your 1.) self, 2.) your world,
and 3.) your future
Cognitive Summary
Dysfunctional Attribution Style
Failures
• Internal – I am a loser
Successes
• External – I got lucky/the
test was easy
• Global – I suck at
everything
• Specific – I only got a
good grade on this one
test
• Stable – I will always
suck at everything
• Unstable – this success
won’t last
Pharmacology –
MEDS
Emphasis on biomedical causes –
Chemical imbalances
Brain abnormalities
Genetic Predispositions
(NATURE)
MEDS
• Anti-Psychotic (Schizophrenia)
– Too much dopamine
– Drugs block receptor sites for dopamine - diminish + symptoms
(hallucinations and delusions)
– Haldol, Thorazine
– Side effect – tardive dyskinesia
Anti-Depressants
- Unipolar depression - Too little serotonin – Prozac and Zoloft block
serotonin reuptake
- Bipolar – lithium
Anti-Anxiety
- Barbiturates – valium, Xanax – depress activity of central nervous system
MEDS
• Risks of all meds
– Finding right med at the right dosage –
often process of trial and error
–ALL meds have some kind of
undesirable side effect
Other Medical Interventions
• Electroconvulsive Therapy (ECT)
– induced medical seizure
– used historically to treat multiple mental
illnesses
–used today as last resort treatment of
depression
–Risk = possible memory loss
Other Medical Interventions
• Psychosurgery – historical prefrontal
lobotomies
• 1950s/60s (JFK’s sister, “One Flew Over the
Cuckoo's Nest”)
60 Minute Clips on Treatment
• Sept 2013 – Untreated Mental illness and connection to mass
shootings:
• http://www.cbsnews.com/video/watch/?id=50156091n