Transcript Behavior therapies are based on the belief that all

Types of Therapy / Treatment
Insight Therapy
Behavioral Therapy
Cognitive Therapy
Group Therapy
Biological Treatments
Insight Therapies
Psychoanalysis
Client-Centered Therapy
Gestalt Therapy
Short-term psychodynamic
Virtual therapy
Psychoanalysis
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Designed to bring repressed feelings and
thoughts to conscious awareness
Free association
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Transference
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Patient talks about whatever comes to mind
Client’s feelings about authority figures, both
positive and negative, transferred to
therapist
Insight
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Awareness of previously unconscious
feelings and memories and how they
influence present behavior
Client-Centered Therapy
Developed by Carl Rogers
 Goal is to help clients become fully
functioning
 Therapist expresses unconditional
positive regard
 Therapy is nondirective
 Therapist reflects clients’ statements
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Gestalt Therapy
Outgrowth of the work of Fritz Perls
 Emphasizes the wholeness of
personality
 Attempts to reawaken people to their
emotions and sensations in the hereand-now
 Encourages confrontation with issues
 Therapist is active and directive
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Recent Developments
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Short-term psychodynamic
psychotherapy
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Focused on trying to help people
correct the immediate problems in
their lives
Virtual therapy
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Therapy delivered online
Behavior Therapies
Based on the belief that all behavior is
learned
 Objective of therapy is to teach people
new ways of behaving
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Examples:
•Classical Conditioning
•Operant Conditioning
•Modeling
Using Classical Conditioning
Techniques
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Systematic desensitization
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Extinction
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Ending of old fears or reactions
Flooding
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Gradually associating relaxation with what
was feared
Full-intensity exposure to feared object
Aversive conditioning
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Eliminate undesirable behavior by
associating it with pain and discomfort
Operant Conditioning
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Behavior contracting
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Client and therapist set behavioral
goals and agree on reinforcements
the person will receive
Token economy
Clients earn tokens for desired
behaviors and exchange them for
desired items or privileges
 Often used in schools and hospitals
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Modeling
Person learns new behaviors by
watching others perform those
behaviors
 Sometimes used in conjunction with
operant conditioning
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Cognitive Therapies
•Stress Inoculation
•RET
•Beck’s Cognitive Therapy
Stress-Inoculation Therapy
Type of cognitive therapy that trains
people to cope with stressful
situations by learning a more useful
patterns of self-talk
 Taught to suppress negative and
anxiety-provoking thoughts in times of
stress
 Particularly effective for treating
anxiety disorders
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Rational-Emotive Therapy
(RET)
A directive therapy based on the idea
that psychological distress is caused
by irrational and self-defeating beliefs
 Core problem is belief in “musts” and
“shoulds” that leave no room for
making mistakes
 Therapist’s job is to challenge client’s
irrational beliefs
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Beck’s Cognitive Therapy
Aimed at identifying and changing
inappropriately negative and selfcritical patterns of thought
 Good treatment for depression
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Group Therapies
•Family
•Couple
•Self-help
Family Therapy
Form of group therapy that sees the
family as at least partly responsible for
the individual’s problems
 Seeks to change all family members’
behavior to the benefit of the family
and the individual
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Couple Therapy
A form of group therapy intended to
help troubled partners improve their
communication and interaction
 Empathy training
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Partners taught to share feelings and
listen to and understand partner’s
feelings
Self-Help Groups
Small, local gatherings of people who
share common problems and provide
mutual assistance at very low cost
 Alcoholics Anonymous is an example
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Effectiveness of
Psychotherapy
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Does Psychotherapy Work?
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Psychotherapy helps about 2/3rd of people
treated
Approximately 1/3 would improve without
therapy
Which Type of Therapy is Best for Which
Disorder?
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No one type of therapy is better
Key is to match the problem with the
appropriate therapy
Biological
Treatments
•Drug therapy
Anti-psychotic, Anti-depressant,
Psycho-stimulants, Anti-anxiety
•Electroconvulsive
•Psychosurgery
Drug Therapies
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Major reasons for widespread use of
drugs
Drugs are effective at treating
disorders
 Drug therapies are often less
expensive that psychotherapy
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Antipsychotic Drugs
Used for schizophrenia or psychosis
 All antipsychotics block dopamine
receptors in the brain
 Phenothiazines (Thorazine)
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Antidepressant Drugs
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Tricyclics and MAO inhibitors
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Most common antidepressants prior to late
1980s
Work by increasing amount of the
neurotransmitters serotonin and
norepinephrine
Effective, but have serious side effects
Selective Serotonin Reuptake Inhibitors
(SSRIs)
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Work by blocking the reuptake of serotonin
Prozac, Paxil, Zoloft, Effexor
Action of SSRIs
Lithium
A naturally occurring salt that is used
to treat bipolar disorder (manic
depression)
 Nobody knows how lithium works to
alleviate symptoms
 Problem with people stopping
medication when symptoms ease
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Other Medications
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Psychostimulants
Use to treat disorders such as AD/HD
 Concern that psychostimulants are
being overused
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Antianxiety medications
Use to treat anxiety disorders
 Produce a feeling of calm and mild
euphoria
 Valium is a common antianxiety
medication
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Electroconvulsive Therapy
Commonly known as “shock therapy”
 Used as a treatment for severe
depression
 Causes brief convulsions and
temporary loss of consciousness
 Memory loss is a side-effect
 Newer techniques minimize effects on
memory
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Psychosurgery
Brain surgery performed to change a
person’s behavior or emotional state
 A prefrontal lobotomy is an example
 Psychosurgery is rarely used today
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Institutionalization and Its
Alternatives
Institutions offer:
•Shelter
•Care
•Therapy / Treatment / Counseling
•Transition training and preparation for real world
living
•Relief for family members
Deinstitutionalization
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Releasing people with severe psychological
disorders into the community
Can cause problems
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Some people are ill-prepared to deal with life
outside of a hospital
Up to 40% of homeless are mentally ill
Alternative forms of treatment (many)
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Half-way houses
Family-crisis interventions
Day-care
Prevention
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Primary prevention
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Improve the social environment so that new
cases of mental disorders do not develop
• Family planning
• Genetic counseling
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Secondary prevention
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Interventions with high risk groups (e.g.,
suicide hot-line)
Tertiary prevention
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Help people adjust after they are released
from the hospital in order to help prevent a
relapse
Gender Differences in
Treatment
More women admit problems and go
to therapy
 Women are more likely to take
medication
 Psychotherapy is seen as more
acceptable for women
 Recent increases in number of males
seeking psychotherapy
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Cultural Difference in
Treatment
Eye contact and body language varies
across cultures and may be
misinterpreted as symptomatic of a
disorder
 Another challenge is treating posttraumatic stress disorder in refugees
 There may be disorders in other
cultures that do not appear in U.S.
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Review
The main goal of insight therapies is to give clients a better
understanding and awareness of their feelings, motivations,
and actions in the hope that this will lead to better adjustment.
Behavior therapies are based on the belief that all behavior,
normal and abnormal, is learned, and that the objective of
therapy is to teach people more satisfying ways of behaving.
Cognitive therapies aim at changing clients' maladaptive
ways of thinking about themselves and the world. Group
therapy is based on the idea that psychological problems are
at least partly interpersonal problems and are therefore best
approached in an interpersonal setting. Group therapy
provides social support and is less costly than individual
therapy.
Psychoanalysis is a therapy based on the belief that
psychological problems stem from feelings and conflicts
repressed during childhood. One way to uncover what has
been repressed is through free association, a process in which
the client discloses whatever thoughts or fantasies come to
mind without editing or otherwise inhibiting them. In classical
psychoanalysis, the patient comes to transfer feelings held
toward authority figures from childhood to the analyst, a
process known as transference. The goal of psychoanalysis is
insight, or awareness of feelings, memories, and actions from
the past that were unconscious but were exerting a strong
influence on the patient's present feelings and behavior.
Client-centered (or person-centered) therapy, founded by
Carl Rogers, is built on the idea that therapy should be
based on the client's view of the world rather than the
therapist's and on the client's responsibility for change. The
therapist's most important task is to provide unconditional
positive regard for clients so that they will learn to accept
themselves. Gestalt therapy grew out of the work of Fritz
Perls and is designed to help people become more aware
of their feelings and more genuine in their day-to-day
interactions. The emphasis in therapy is on making the
person whole and complete.
Behavior therapies are based on the belief that all behavior,
normal and abnormal, is learned, and that the objective of
therapy is to teach people more satisfying ways of
behaving. Classical conditioning therapies attempt to evoke
a new conditioned response to old stimuli. For example, systematic
desensitization is a method for gradually reducing irrational fears by
imagining---or confronting in real life---increasingly fearful situations while
maintaining a relaxed state. Eventually, relaxation replaces fear as a
response, perhaps as a result of extinction. Flooding, which subjects the
person to feared situations at full intensity and for a prolonged time, is a
somewhat harsh but highly effective method of desensitization. Aversive
conditioning has the opposite goal: it conditions a negative rather than a
positive response to a stimulus such as the sight or taste of alcohol. Its
purpose is to eliminate undesirable behaviors by associating them with pain
and discomfort. Operant conditioning techniques work by reinforcing new
behaviors and ignoring or punishing old ones. In one such technique, called
behavior contracting, client and therapist agree on certain behavioral goals
and on the reinforcement the client will receive upon reaching those goals. In
another technique, called the token economy, tokens that can be cashed in
for "rewards" are used to positively reinforce many different kinds of desired
behavior. In modeling, a person learns new behaviors by watching others
perform those behaviors.
Stress-inoculation therapy teaches clients new and positive
patterns of self-talk they can use to support themselves
through stressful situations. Rational-emotive therapy (RET) is
based on the idea that people's emotional problems derive
from a set of irrational and self-defeating beliefs they hold
about themselves and the world. The therapist vigorously
challenges these beliefs until the client comes to see just how
irrational and dysfunctional they are. Aaron Beck believes that
depression results from negative patterns of thought that are
strongly and inappropriately self-critical. His cognitive therapy
tries to help clients think more positively about themselves
and the world.
Group therapy is based on the idea that psychological
problems are at least partly interpersonal problems and are
therefore best approached in an interpersonal setting. Group
therapy provides social support and is less costly than
individual therapy. Family therapy is based on the idea that an
individual's psychological problems are to some extent family
problems. Therefore, the therapist treats the family unit rather
than the isolated individual, with the goal of improving
communication and empathy among family members and
reducing intrafamily conflict. Couple therapy concentrates on
improving patterns of communication and interaction.
Most researchers agree that psychotherapy helps about
two-thirds of the people treated. Most kinds of therapy are
more effective than no treatment at all, but researchers
have found few major differences in the effectiveness of
various forms of therapy. The general trend in
psychotherapy is toward eclecticism, the use of a broad
treatment package rather than one single form of therapy.
Biological treatments, including medication,
electroconvulsive therapy, and psychosurgery, are
sometimes used when psychotherapy does not work or
when a client has a disorder for which biological treatment
is known to be safe and effective. Medication, especially, is
very often used in conjunction with psychotherapy
Drugs are the most common biological therapies.
Antipsychotic drugs are valuable in the treatment of
schizophrenia; they do not cure the disorder, but they do
reduce its symptoms. Side effects can be severe, however.
Antidepressant drugs alleviate depression, though some
have serious side effects. Often the effectiveness of
antidepressants such as Prozac seems to be due to the
patient's belief that the drug will work (the placebo effect).
Many other types of medication are used to treat
psychological disorders, including antianxiety drugs,
sedatives, and psychostimultants for children with attentiondeficit/hyperactivity disorder.
Electroconvulsive therapy (ECT) is used for cases of severe
depression that do not respond to other treatments. An electric
current briefly passed through the brain of the patient
produces convulsions and temporary coma.
Psychosurgery is brain surgery performed to change a
person's behavior and emotional state. It is rarely done
today, and then only as a last desperate measure on
patients with intractable psychoses.
Large mental hospitals offer people with severe mental
disorders shelter and a degree of care, but a number of
problems are linked with institutionalization, including
inadequate care and the tendency of patients to become
lethargic and accept a permanent "sick role." With the advent
of antipsychotic drugs in the 1950s, many patients were
released from large public hospitals to be cared for in a
community setting, in the policy of deinstitutionalization. But
community mental-health centers and other support services
proved inadequate to the task. As a result, many former
patients stopped taking their medication, became homeless,
and ended up suffering from psychosis and living on the
street.
Alternatives to hospitalization range from living in the family
home, with training to cope with daily activities for the mentally
ill individual and crisis therapy for the family, to small homelike
facilities in which residents and staff share responsibilities.
Most alternative treatments involve some medication of the
troubled individual and skillful preparation of the
family/community. The majority of studies have found more
positive outcomes for alternative treatments than for
hospitalization.
Prevention refers to efforts to reduce the incidence of mental
illness. Primary prevention refers to improving the social
environment through assistance to parents, education,
and family planning. Secondary prevention refers to
identifying high-risk groups and directing service to them.
The object of tertiary prevention is to help hospitalized
patients return to the community.
Reference:
Psychology, an Introduction, 12th ed. ; Morris, Charles & Maisto, Albert
Pearson Publishers, 2010 (chapter 14)
Psychology, a Journey, 2nd ed.; Coon, Dennis
Thomson/Wadsworth Publishers, 2005 (chapter 13)
Let the sunshine...let the
sunshine in, the sun, shine
in...