Transcript SSPVB3- The student will identify abnormal behavior and treatment

PSYCHOLOGY
READ Chapter 17
Therapy,
Psychopharmacology, &
Biomedical Treatments
ESSENTIAL QUESTION:
What techniques do psychologists
and psychiatrists use to treat
psychological disorders?
GPS STANDARD:
SSPVB3- The student will identify abnormal
behavior and treatment.
e.) compare the biomedical, psychoanalytical,
cognitive, and behavioral approaches to the
treatment of psychological disorders.
Therapy
 Psychotherapy
 an emotionally charged, confiding interaction
between a trained therapist and someone
who suffers from psychological difficulties
 this includes talking about the patient’s
problems and exploring new ways of thinking
and acting
Therapy
 Eclectic Approach
 an approach to psychotherapy that,
depending on the client’s problems, uses
techniques from various forms of therapy
 although the eclectic therapist may lean
toward one treatment approach, they borrow
methods from other types of therapy as well
Therapy:
 Basic features of treatment:
 a client (or patient)
 a therapist who is accepted as capable of
helping the client
 the establishment of a special relationship
between the client and therapist that includes
trust and honesty
Therapy:
Basic features of treatment
 Basic features of treatment continued:
 all forms of treatment are based on some
theory about the causes of the client’s
problems
 the theory in turn leads to special
procedures dealing with the client’s
problems
Therapists and their
Training
 Clinical psychologists
 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
 Clinical or Psychiatric Social Worker
 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
 Counselors
 Pastoral counselors provide counseling
to countless people
 Abuse counselors work with substance
abusers and with spouse and child
abusers and their victims
 Marriage and family counselors
specialize in problems arising from
family relations
Therapists and their
Training
 Psychiatrists
 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- antipsychotics/neuroleptics
ESSENTIAL QUESTION:
What drugs are used to treat psychological
disorders? What are some of their negative
side effects?
GPS STANDARD:
SSPVB3- The student will identify abnormal
behavior and treatment.
e.) compare the biomedical, psychoanalytical,
cognitive, and behavioral approaches to the
treatment of psychological disorders.
Psychopharmacology
 Psychopharmacology
study of the effects of drugs
on mind and behavior
Psychopharmacology
 Neuroleptics (or antipsychotics)
 the early 1950s saw the introduction of
a new group of drugs that
revolutionized the treatment of severe
mental disorders
 these drugs dramatically reduced the
intensity of such symptoms as
hallucinations, delusions, paranoid
suspiciousness, and disordered thinking
in many mental patients
Psychopharmacology
 Neuroleptics cont…
 these drugs were especially helpful for
patients with schizophrenia
 as a result of taking these drugs, many
mental patients became better able to
take care of themselves
 thousands of patients were able to
leave the mental hospitals as a result of
these drugs
Psychopharmacology:
antipsychotic medications
 Thorazine
 is used for the reduction of symptoms
of psychotic disorders such as
schizophrenia
 is also used for the short-term
treatment of severe behavioral
disorders in children, including explosive
hyperactivity and combativeness
Psychopharmacology:
antipsychotic medications
 Thorazine cont…
 is also used for the “hyperenergetic” phase of
manic-depressive illness due to its sedative
effects
 has many side effects such as:
 dry mouth
 blurred vision
 urinary retention
 dizziness
 skin pigmentation problems
 may also cause tardive dyskinesia
Psychopharmacology:
antipsychotic medications
 Thorazine cont…
 tardive dyskinesia- has effects similar to
those of Parkinson’s disease such as:
 muscle rigidity
 muscle spasms
 restlessness
 tremors
 slowed movement
 uncontrollable grotesque twitches in the face &
body
 uncontrollable grotesque thrusting of the
tongue
Psychopharmacology:
antipsychotic medications
 Thorazine cont…
 tardive dyskinesia
 this side effect is an irreversible disorder of the
motor system that appears only after years of
neuroleptic use
 it affects 25 percent of patients who take these
drugs
 in some ways tardive dyskinesia can be far
worse than the mental disorder that led to
treatment
Psychopharmacology:
antipsychotic medications
 Clozaril
 is given to people with severe
schizophrenia who have failed to
respond to other drug treatments
 it is not a cure but can help some
people with schizophrenia return to a
more normal life
 does not cause movement disorder
tardive dyskinesia
Psychopharmacology:
antipsychotic medications
 Clozaril
 may cause another disorder called
agranulocytosis in about 2% of the
patients that take it
 Agranulocytosis- is a potentially fatal
disorder characterized by a loss of white
blood cells and the consequent
susceptibility to infectious disease
 weekly blood tests are required to
detect early signs of this disease
Psychopharmacology:
antipsychotic medications
 Haldol
 also used to treat schizophrenia and
other psychotic episodes
 prescribed to control tics
(uncontrollable muscle contractions of
the face arms and shoulders)
 also helps to control uncontrollable
utterances (talking) associated with
Tourette’s syndrome
Psychopharmacology:
antipsychotic medications
 Haldol cont…
 also used to treat children with severe
behavior problems such as hyperactivity
and combativeness
 some doctors also prescribe Haldol to
relieve severe nausea or vomiting
 also used to treat drug problems such
as LSD flashbacks or PCP intoxication
Biomedical Therapies
 The emptying of U.S. mental hospitals
Antidepressants
ESSENTIAL QUESTION:
What drugs are used to treat psychological
disorders? What are some of their negative
side effects?
GPS STANDARD:
SSPVB3- The student will identify abnormal
behavior and treatment.
e.) compare the biomedical, psychoanalytical,
cognitive, and behavioral approaches to the
treatment of psychological disorders.
Psychopharmacology:
antidepressants
 soon after antipsychotic drugs
appeared, antidepressants were
developed
 these drugs were designed to relieve
the symptoms of depression
Psychopharmacology:
antidepressants
 about 60 to 70 percent of patients
who take these drugs show:
 improved mood
 greater physical activity
 increased appetite
 more deep sleep
Psychopharmacology:
antidepressants
 although these drugs have an
immediate effect on
neurotransmitters (usually increasing
serotonin or norepinephrine) their
effects on depressive symptoms do
not occur until one to three weeks
after the dosage begins
Psychopharmacology:
antidepressants
 MAO-I (monoamine oxidase inhibitors)
 effective for depression and panic disorder
 serious side effect of severe hypertension
(high blood pressure) if mixed with foods
containing tyramine:
 aged cheeses
 red wine
 chicken livers
Psychopharmacology:
antidepressants
 Tricyclics
 work better than MAO-I(s)in reducing depression
 tricyclics have fewer side effects and do not raise
the blood pressure
 Side effects of tricyclics include:
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Sleepiness
Dry mouth
Dizziness
Blurred vision
Hypotension (lower blood pressure)
Constipation
Urinary retention
Psychopharmacology:
antidepressants
 Tricyclics cont….
 An extreme side effect of tricyclics is that
when they are combined with alcohol it
increases the effects of both and the
combination of the two can potentially
result in the death of the patient
Psychopharmacology:
antidepressants
 SSRIs (selective serotonin reuptake
inhibitors)
 Prozac is the most popular drug among the
SSRIs
 it affects serotonin rather than
norepinephrine
 Prozac was introduced in 1986 and is the
most widely prescribed antidepressant in
the United States
Psychopharmacology:
antidepressants
 SSRIs (selective serotonin reuptake
inhibitors) cont….
 Its popularity is due to the fact that it is as
effective as the tricyclics and in most cases
has fewer side effects
 60 to 80 percent of the depressed patients
that use Prozac get significant relief from
their depression
Psychopharmacology:
antidepressants
 OTHER SSRIs (selective serotonin
reuptake inhibitors)
 Anafranil
 Luvox
 Effexor
 Celexa
 Paxil
 Zoloft
 Wellbutrin
Biomedical Therapies
Biomedical Therapies
Psychopharmacology:
herbal remedies
 St. John’s Wort
 The most recent development in the pharmacological treatment
of depression is the use of the herbal remedy St. John’s Wort
 In Germany, where this treatment is paid for by health
insurance, it is more popular than Prozac
 The active ingredient in St. John’s Wort is hypericin
 Hypericin is a substance thought to enhance serotonin activity in
the brain and possibly act just like an MAO-I
Psychopharmacology:
herbal remedies
 St. John’s Wort cont…
 it has multiple uses:
 Soothes the digestive system
 Relieves ulcers and gastritis
 Treats diarrhea and nausea
 Works as a sedative, painkiller, a topical analgesic
Psychopharmacology:
herbal remedies
 St. John’s Wort cont…
 one major side effect is that it causes
photosensitivity
 If a light-skinned animal or human eats the
plant exposure to direct sunlight may cause:
 Dermatitis
 Inflammation of the mucous membranes
 Or more toxic reactions
Bipolar drugs, anti-anxiety drugs, electroconvulsive therapy
ESSENTIAL QUESTION:
What drugs are used to treat psychological
disorders? What are some of their negative
side effects?
GPS STANDARD:
SSPVB3- The student will identify abnormal
behavior and treatment.
e.) compare the biomedical, psychoanalytical,
cognitive, and behavioral approaches to the
treatment of psychological disorders.
Biomedical Therapies
 Electroconvulsive Therapy (ECT)
 therapy for severely depressed patients in
which a brief electric current is sent through
the brain of an anesthetized patient
 Psychosurgery
 surgery that removes or destroys brain tissue
in an effort to change behavior
 lobotomy
 now-rare psychosurgical procedure once used to
calm uncontrollably emotional or violent patients
Electroconvulsive
Therapy
Psychopharmacology:
bipolar disorder
 Eskalith (lithium bicarbonate)
 around 1970, a mineral salt of the
element lithium was found to calm
manic patients
 if taken regularly, it prevents both the
depression and the mania associated
with bipolar disorders
Psychopharmacology:
bipolar disorder
 Lithium bicarbonate (Eskalith) cont…
 lithium is effective for 80% of manic
patients
 Without lithium, the typical bipolar
patient has a manic episode about
every 14 months and a depressive
episode about every 17 months
Psychopharmacology:
bipolar disorder
 Lithium cont…
 With lithium attacks of mania
occur as rarely as every 9 years
Psychopharmacology:
bipolar disorder
 Lithium cont…
 The lithium dosage must be exact and
carefully controlled
 Too much lithium causes:
 Vomiting
 Nausea
 Tremors
 Fatigue
 Slurred speech
 With severe overdoses Coma OR Death
Psychopharmacology:
bipolar disorder
 Lithium cont…
 lithium cannot treat a manic episode in
progress because it takes a week or two
or regular use before its effects are
seen
 So just like with antidepressants,
lithium’s effects probably occur through
some long-term adaptation as the
nervous system adjusts to the presence
of the drug
Psychopharmacology:
anxiety disorders
 Anti-anxiety drugs- used for the
treatment of anxiety or insomnia
 Ativan
 Valium
 Librium
 Rohypnol
 Klonopin
 Xanax
Anxiety Drugs
 Many anxiety drugs are in a class of
drugs called benzodiazepines
 Benzodiazepines are dangerous when
mixed with alcohol
 the benzodiazepines became the
worldwide drug treatment of choice for
anxiety
 these and the more modern drugs of
this drug class continue to be the most
widely prescribed and used of all legal
drugs
Psychopharmacology:
anxiety disorders
 benzodiazepines cont…
 benzodiazepines have an immediate
calming effect on anxiety and are quite
useful in the treatment of generalized
anxiety disorder (GAD) and
posttraumatic stress disorder (PTSD).
 one of the newest of the
benzodiazepines is Xanax
ESSENTIAL QUESTION:
How do humanistic therapists help
their clients overcome the obstacles
that prevent them from achieving
their full human potential and
experience…..
self-actualization?
GPS STANDARD:
SSPVB3- The student will identify abnormal behavior and
treatment.
e.) compare the biomedical, psychoanalytical, cognitive,
and behavioral approaches to the treatment of psychological
disorders.
Humanistic Therapy
 Client-Centered Therapy
 humanistic therapy developed by Carl
Rogers
 therapist uses techniques such as active
listening within a genuine, accepting,
empathic environment to facilitate
clients’ growth
Humanistic Therapy
 Carl Rogers
 Carl Rogers was trained in
psychoanalytic methods but he began
to question their value and usefulness
 Rogers disliked being a detached expert
observer in the therapy process whose
job is to figure out what is wrong with
the client
Humanistic Therapy
 Carl Rogers cont…
 Rogers became convinced that a less formal
approach would be more effective for the
client and more comfortable for the therapist
 Rogers developed a non-directive form of
therapy which depends on the client’s own
drive toward growth or personal actualization
Humanistic Therapy
 Carl Rogers cont…
 Rogers allowed his clients to decide
what to talk about and when, without
direction, judgment, or interpretation by
the therapist which is the main idea
behind client-centered therapy
Humanistic Therapy
 Carl Rogers developed client-centered therapy
Humanistic Therapy
 Unconditional Positive Regard
 treating the client as a valued person
no matter what they say or what they
have done
 the therapist listens without interrupting
and accepts everything the client says
without evaluating it
Humanistic Therapy
 Unconditional Positive Regard cont…
 The therapist need not approve of
everything the client says but he or she
must accept statement as reflecting a
part of the person
 because they trust their clients to solve
their own problems, Rogerian therapists
rarely give advice
Humanistic Therapy
 Unconditional Positive Regard cont…
 If the therapist gives advice, Rogers believed
that this would undermine the human growth
potential of the client by subtly implying that
they are incompetent to solve their own
problems
 They must be confident that they can solve
their own problems and not become
dependent on others for help
Humanistic Therapy
 Empathy
 Client-centered therapists try to appreciate
how the world looks from the client’s point of
view
 This involves far more than saying, “I know
what you mean.”
 The therapist tries to replace their external
frame of reference- looking at the patient
from the outside- with an internal frame of
reference.
Humanistic Therapy
 Empathy cont….
 The therapist tries to replace their external
frame of reference- looking at the patient
from the outside- with an internal frame of
reference.
 The internal frame of reference is
characterized by empathy
 Empathy- the emotional understanding of
what the client might be thinking and feeling
Humanistic Therapy
 Client-centered therapy conveys empathy
to the client by active listening
 The therapist:
 makes eye contact with the client
 nods in recognition as the client speaks
 gives other signals of careful attention
Humanistic Therapy
 Active Listening-empathic listening in which the
listener echoes, restates, and clarifies
Humanistic Therapy
 Client-centered therapists also use
reflection (or mirroring)
 Reflection- is a paraphrased summary of
the client’s words and especially the
feelings and meanings that appear to
accompany those words
 Reflection confirms that real
communication is going on between the
therapist and client
Humanistic Therapy
 Reflection cont….
 reflection shows the therapist’s level of interest
 reflection helps the client perceive and focus on the
thoughts and feelings that they are expressing
 This method helps the client bring important material
into the open without the therapist asking disruptive
questions which interfere with the client’s thinking
process
Humanistic Therapy
 Congruence (a.k.a.- genuineness)
 congruence shows consistency between the
therapist’s feelings and actions
 when the therapist’s unconditional positive
regard and empathy are genuine, the client is
able to see that relationships between people
can be built on openness and honesty
 this will hopefully help the client to become
more congruent or genuine in their other
relationships
ESSENTIAL QUESTION:
What techniques does
psychoanalysis use to treat and
resolve conflicts?
GPS STANDARD:
SSPVB3- The student will identify abnormal
behavior and treatment.
e.) compare the biomedical, psychoanalytical,
cognitive, and behavioral approaches to the
treatment of psychological disorders.
TherapyPsychoanalysis
 Psychoanalysis
(Freud’s method of treatment)
 the field of psychotherapy began when
Sigmund Freud established the psychoanalytic
approach in the late 1800s
 central to his approach is the assumption that
personality and behavior reflects the efforts
of the ego (the self) to resolve internal
conflicts between our unconscious desires for
pleasure and the rules and values of society
which tell us what we should and should not
do
TherapyPsychoanalysis
 Psychoanalysis
(Freud’s method of treatment)
 Psychoanalysis is aimed at understanding the
unconscious conflicts and how they affect the
client
 a one-to-one method of studying and treating
people
 a systematic search for relationships between an
individual’s life history and their current problems
 an emphasis on thoughts and emotions during
treatment
 a focus on the patient-therapist relationship
TherapyPsychoanalysis
 Psychoanalysis cont…
 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
 classical psychoanalytic treatment aims to help clients
gain insight into their problems by recognizing
unconscious thoughts and emotions and then
discover, or work through, the many ways in which
those unconscious elements affect their everyday life
TherapyPsychoanalysis
 Interpretation
 the analyst’s noting supposed dream meanings,
resistances, and other significant behaviors in order
to promote insight
 Transference
 the patient’s transfer to the analyst of emotions
linked with other relationships
 e.g. love or hatred for a parent
 Resistance
 blocking from consciousness of anxiety-laden
material
TherapyPsychoanalysis
 Psychoanalysis cont…
 the use of psychoanalysis has
rapidly decreased in recent years
ESSENTIAL QUESTION:
What techniques do behavioral
psychologists use to treat
psychological disorders?
GPS STANDARD:
SSPVB3- The student will identify abnormal
behavior and treatment.
e.) compare the biomedical, psychoanalytical,
cognitive, and behavioral approaches to the
treatment of psychological disorders.
Behavior Therapy
 Behavior Therapy
 therapy that applies learning principles to the
elimination of unwanted behaviors
 behavior therapists help clients view their
psychological problems as learned behaviors
 these learned behaviors can be changed
without understanding the hidden meanings
or underlying processes
Behavior Therapy
 Behavior Therapy
 for instance, panic attacks can be reduced
without looking for the meaning of the
underlying behavior
 Behavior therapy would discover the
underlying learning principles that caused the
fear and then would teach the person new
learned responses in fearful situations
Behavior Therapy
 Counterconditioning
 procedure that conditions new responses to
stimuli that trigger unwanted behaviors
 based on classical conditioning
 includes exposure therapy, systematic
desensitization, and aversive conditioning
Behavior Therapy
 Exposure Therapy
 treat anxieties by exposing people (in imagination
or reality) to the things they fear and avoid
Behavior Therapy
 Systematic Desensitization
 type of counterconditioning
 it is a method in which the client visualizes a
series of anxiety-provoking stimuli while
maintaining a state of relaxation
 it associates a pleasant, relaxed state with
the stimuli that once caused the anxiety
 commonly used to treat phobias
Behavior Therapy
 Aversive Conditioning
 many unwanted behaviors are so habitual
and temporarily rewarding that they must be
made less attractive if the client is to have
any chance of learning alternatives
 type of counterconditioning that associates an
unpleasant state with an unwanted behavior
 Nausea producing drug Antabuse ---> makes
you sick when you drink alcohol
Behavior Therapy
 Systematic Desensitization
Behavior Therapy
 Aversion
therapy
for
alcoholics
Behavior Therapy
 Punishment
 sometimes the only way to eliminate a
dangerous or disruptive behavior is to
punish it with an unpleasant but harmless
stimulus, such as shouting “No!” or a mild
electric shock
 punishment presents the unpleasant
stimulus after the undesirable response
occurs
Behavior Therapy
 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
ESSENTIAL QUESTION:
What techniques do cognitive
psychologists use to treat
psychological disorders?
GPS STANDARD:
SSPVB3- The student will identify abnormal
behavior and treatment.
e.) compare the biomedical, psychoanalytical,
cognitive, and behavioral approaches to the
treatment of psychological disorders.
Cognitive Therapy
 Cognitive Therapy
 it assumes that our thinking affects our feelings
 somewhere between the event and our response to it
lies the human mind which interprets the event and
creates an emotional response
 if we can control our reaction to the event we can
also control our response
 cognitive teaches people new, more adaptive ways of
thinking and acting
Cognitive Therapy
 Cognitive Therapy & Depression
 self-blaming and over-generalized explanations of
“bad” events are often part of the vicious cycle of
depression
 the person experiencing depression interprets
 a suggestion such as criticism
 disagreement as dislike
 friendliness as pity
 dwelling on negative thoughts sustains a bad mood
Cognitive Therapy
 Cognitive Therapy & Depression
 if depressed thinking patterns can be learned
then they can also be replaced
 cognitive therapists teach people new, more
constructive ways of thinking
 If people are miserable they can be helped to
change their minds
Cognitive Therapy
 The
Cognitive
Revolution
Cognitive Therapy
 A cognitive
perspective
on
psychological
disorders
Cognitive Therapy
 Cognitive
therapy for
depression
Cognitive Therapy
 Cognitive-Behavioral Therapy
 a popular integrated therapy that
combines cognitive therapy
(changing self-defeating thinking)
with behavior therapy (changing
behavior)
Group and Family
Therapies
 Family Therapy
 treats the family as a system
 views an individual’s unwanted
behaviors as influenced by or directed
at other family members
 attempts to guide family members
toward positive relationships and
improved communication
Evaluating
Psychotherapies
 To whom do
people turn
for help for
psychological
difficulties?
Evaluating
Psychotherapies
 Regression toward the mean
 tendency for extremes of unusual
scores to fall back (regress) toward
their average
 Meta-analysis
 procedure for statistically combining the
results of many different research
studies
Evaluating
Psychotherapies
Number of
persons
Average
untreated
person
Poor outcome
80% of untreated people have poorer
outcomes than average treated person
Average
psychotherapy
client
Good outcome
Evaluating
Psychotherapies