Transcript Document

Chapter 13
Therapies
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Chapter Preview
• Biological Therapies
• Psychotherapy
• Sociocultural Approaches and Issues in
Treatment
• The Effectiveness of Psychotherapy
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Biological Therapies
• Also called biomedical therapies
• Treatments that reduce symptoms of
psychological disorders by altering aspects of
body functioning
• Drug therapy
• Electroconvulsive therapy
• Psychosurgery
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Drug Therapy
• Revolutionized mental health care in the 20th century
• Psychotherapeutic drugs used mainly in:
• Anxiety disorders

Antianxiety drugs
• Mood disorders

Antidepressant drugs
• Schizophrenia

Antipsychotic drugs
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Antianxiety Drugs
• Commonly known as tranquilizers
• Bind to receptor sites of neurotransmitters
that become overactive during anxiety
• Benzodiazepines
• Relatively fast acting
• Side effects include drowsiness, loss of
coordination, fatigue, and mental slowing
• Can become addictive
• Nonbenzodiazepines
• Generalized anxiety disorder
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Antidepressant Drugs
• Regulate mood through effects on
neurotransmitters
• Tricyclics
• Increase norepinephrine and serotonin levels
• Monoamine oxidase (MAO) inhibitors
• Block enzyme that breaks down serotonin and
norepinephrine
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Antidepressant Drugs
• Selective serotonin reuptake inhibitors (SSRI)
and serotonin and norepinephrine reuptake
inhibitors.
• Interfere with reabsorption of serotonin and/or
norepinephrine in brain
• Lithium
• Solid element used to treat bipolar disorder
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Antipsychotic Drugs
• Neuroleptics
• Block dopamine’s action in brain
• Side effects include:
• Dysphoria

• Tardive Dyskinesia 
Lack of pleasure
Movement disorder
• Atypical antipsychotic medications
• Lower risk of side effects
• Block reuptake of serotonin
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Electroconvulsive Therapy
•
•
•
•
Commonly called shock therapy
Goal is to set off seizure in brain
Used primarily to treat severe depression
Patient receives anesthesia and muscle
relaxants
• Controversial
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Psychosurgery
• Irreversible removal or destruction of brain
tissue to improve adjustment
• Prefrontal lobotomy
• Severing of fibers connecting frontal lobe with
thalamus
• Actual effectiveness questioned
• Ethical concerns
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Psychotherapy
• Nonmedical process that helps individuals
with psychological disorders recognize and
overcome their problems
• Approaches include:
•
•
•
•
Psychodynamic
Humanistic
Behavioral
Cognitive
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Mental Health Professionals
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Psychodynamic Therapies
• Stress importance of:
• Unconscious mind
• Extensive interpretation by therapist
• Role of early childhood experiences
• Psychoanalysis (Freud)
• Contemporary psychodynamic therapies
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Psychoanalysis
• Freud’s therapeutic technique for analyzing
unconscious thoughts
• Goal is to bring unconscious conflicts into
conscious awareness
• Free association
• Interpretation
• Dream Analysis
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Psychoanalysis
• Free association
• Encouraging individuals to say aloud whatever
comes to mind
• Catharsis
• Release of emotional tension when reliving
emotionally-charged or conflicting experiences
• Interpretation
• Search for symbolic, hidden meaning
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Dream Analysis
• Interpreting dreams that contain information
about unconscious thoughts, wishes, and
conflicts
• Manifest content
• Conscious, remembered aspects of dream
• Latent content
• Unconscious, hidden aspects symbolized by
manifest content
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Psychonanalysis
• Transference
• Inevitable – and essential – aspect of therapeutic
relationship
• Relating to analyst in ways that reproduce or relive
important relationships
• Resistance
• Unconscious defense strategies
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Humanistic Therapies
• Encourage people to understand themselves
and to grow personally
• Emphasis on self-healing capacities
• Client-centered therapy (Rogers)
• Warm, supportive atmosphere to improve selfconcept and to encourage insight
• Reflective speech used to mirror feelings
• Therapist must enter into an authentic relationship
with the client
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Behavior Therapies
• Use principles of learning to reduce or
eliminate maladaptive behavior
• Classical conditioning techniques
• Systematic desensitization
• Flooding
• Aversive conditioning
• Operant conditioning techniques
• Applied behavior analysis
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Cognitive Therapies
• Emphasize thoughts as main source of
psychological problems
• Attempt to change feelings and behaviors by
changing cognitions
• Cognitive restructuring
• Changing pattern of thought presumed to be
causing maladaptive behavior or emotion
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Cognitive Therapies
• Albert Ellis’s rational-emotive behavior
therapy
• Aaron Beck’s cognitive therapy
• Cognitive-behavior therapy
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Rational-Emotive Behavior
Therapy
• Emotional reactions to life events as product
of irrational beliefs and expectations
• Central false belief that feelings cannot be
controlled
• Demands (“musterbating”) create
dysfunctional, exaggerated beliefs
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Rational-Emotive Behavior Therapy
• Goal of eliminating self-defeating beliefs by
rationally examining them
• Directive, persuasive, confrontational
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Beck’s Cognitive Therapy
• Problems, such as depression, as result of
illogical thoughts about self, world, future
• Emotions as product of cognitions
• Goal of bringing automatic thoughts to
awareness so they can be changed
• Challenging accuracy of automatic thoughts
• Logical errors  Erroneous beliefs
• More open-ended dialogue with therapist
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Cognitive-Behavior Therapy
• Combination of:
• Cognitive therapy  Reducing self-defeating
thoughts
• Behavior therapy  Changing behavior
• Self-efficacy (Bandura)
• Mastering situation and producing positive
outcomes
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Cognitive-Behavior Therapy
• Self-instructional methods
• Teaching to modify own behavior
• Using reinforcing self-statements to take positive
steps
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Use of Cognitive Therapy
• Anxiety disorders
• Panic disorder
• Post-traumatic stress disorder
• Generalized anxiety disorder, phobias, OCD
• Mood disorders
• Depression
• Schizophrenia
• Personality disorders
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Therapy Comparisons
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Therapy Integrations
• Integrative therapy
• Combination of techniques from different
therapies based on therapist’s judgment
• Dialectical behavior therapy
• Used for borderline personality disorder
• Includes variety of techniques
• Also, treated with psychotherapy and drug
therapy
• Conceptually compatible with biopsychosocial
model
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Sociocultural Approaches &
Issues
• Individual as part of social system of
relationships, influenced by social and cultural
factors
• Group therapy
• Family and couples therapy
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Sociocultural Approaches &
Issues
• Self-help support groups
• Community mental health
• Cultural perspectives on therapy
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Group Therapy
• Individuals sharing psychological disorder
brought together in sessions
• Relationships as key to successful therapy
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Group Therapy
• Features
•
•
•
•
•
•
Information
Universality
Altruism
Experiencing a positive family group
Development of social skills
Interpersonal learning
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Family and Couples Therapy
• Family therapy
• Group therapy among family members
• Couples therapy
• Group therapy with married or unmarried couples
with relationship problems
• Symptoms as function of relationships
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Family Therapy Techniques
• Validation
• Understanding and acceptance of each family
member’s feelings and beliefs
• Reframing
• Problems as family (not individual) problems
• Structural change
• Restructuring coalitions in family
• Detriangulation
• Disentangle situations where scapegoating occurs
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Couples Therapy
• Conflict frequently involves poor
communication
• Attempt to improve communication
• Focus on roles partners play
• Addresses diverse problems
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Self-Help Support Groups
• Voluntary organizations of individuals who get
together to discuss topics
• Conducted by paraprofessionals
• Sympathetic audience for confession, sharing,
and emotional release
• Social support, role modeling, and sharing of
concrete problem-solving strategies
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Self-Help Support Groups
• Alcoholics anonymous (AA)
• Compeer
• Reduce stress and promote adjustment
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Community Mental Health
• Movement born in 1960s
• Individuals with disorders ought to remain in
society
• Deinstitutionalization
• Success depends on resources and commitment
of community
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Community Mental Health
• Training those who directly interact with
community members to offer services
• Explicit goal of helping people who are
disenfranchised from society
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Cultural Perspectives
• Collectivistic cultures
• More importance on group, rather than individual
• Individual psychotherapies may not be as effective
• Ethnicity
• Ethnic match between therapist and client
• Cultural sensitivity and skill
• Gender
• Changing roles affect therapy goals
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Effectiveness of Psychotherapy
• Research  Psychotherapy works
• Meta-analysis
• Statistical combination of results of different
studies
• No therapy is significantly better than the
other
• Therapy benefits during first 6 months
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Health & Wellness Benefits
• Positive effect of therapy on:
• Ability to cope with disease, such as cancer
• Physical health as a result of relieving
psychological disorders such as depression
• Health behavior and physical illness
• May also prevent psychological and physical
problems
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Health & Wellness Benefits
• May enhance positive psychological wellbeing
• Well-being therapy (WBT)
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Common Themes
• Effective psychotherapies have common
elements of:
• Expectations
• Mastery
• Emotional arousal
• Therapeutic alliance
• Relationship between therapist and client
• Client factors
• Quality of participation
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