Overview Therapy refers to how mental disorders are treated, with the help of the knowledge base of psychology. Major types of psychotherapy include psychoanalytic, humanistic, behavior, cognitive, and individual, group, and family psychotherapy. Issues in psychotherapy include culture, gender, values, effective factors and types, and the evaluation of psychotherapy effectiveness. Well also look at biomedical therapies such as drugs, brain stimulation, surgery, and lifestyle change.
Finally, well briefly consider the prevention of psychological disorders. History of Mental Health Treatment When people have displayed unusual behaviors rooted in the mind, these people have often been locked away or treated using old ideas of mental illness. Old ways of getting rid of the evil spirits include: beating them out of people. bleeding them out. letting the spirits out through holes drilled in the skull. Reforms in Treatment This chair was designed to
be an improvement in medical treatment. It was meant to have a calming effect on people with mania. This is working remarkably well. Other Reforms in Treatment Seeing the insane as ill instead of possessed Treating them with tenderness, not harshness Housing them in hospitals rather than locking them up in asylums Developing
psychotherapeutic treatments, medications, and community supports to allow life outside hospitals Current Forms of Therapy Psychotherapy: an interactive experience with a trained professional, working on understanding and changing behavior, thinking, relationships, and emotions Biomedical therapy: the use of medications
and other procedures acting directly on the body to reduce the symptoms of mental disorders Combining Therapies There are various forms of psychotherapy. An eclectic approach uses techniques from various forms of therapy to fit the clients problems, strengths, and preferences. Medications and psychotherapy can be used together, and may help the each other achieve better reduction in symptoms.
Noteworthy Schools of Psychotherapy Psychoanalysis, psychodynamic therapy Sigmund Freuds legacy carried on today Humanistic, client-centered therapy Carl Rogers and Abraham Maslow Behavior therapy, using conditioning B.F. Skinner and Ivan Pavlov applied to people Cognitive therapy, changing thoughts Aaron Beck and Albert Ellis, reducing errors and distress Psychoanalysis: Aims Since psychological problems originate from childhood repressed impulses and conflicts, the aim of psychoanalysis is to bring repressed feelings into conscious
awareness where the patient can deal with them. When energy devoted to id-ego-superego conflicts is released, the patients anxiety lessens. 6 Psychoanalysis Sigmund Freud (1856-1939) found that the unusual symptoms of patients sometimes improved when repressed inner conflicts and feelings were brought into conscious awareness. Psychoanalysis refers to a set of techniques for releasing the tension of repression
and resolving unconscious inner conflicts. Techniques: Free association: the patient speaks freely about memories, dreams, feelings Interpretation: the therapist suggests unconscious meanings and underlying wishes to help the client gain insight and release tension Interpretation in Psychoanalysis The therapist may see unconscious meaning in resistance, dreams, and transference. Resistance: the therapist notices times when the
patient seems blocked in speaking about certain subjects Dreams: there may be themes or latent content behind the plot of a patients dream Transference: the patient may have reactions toward the therapist that are actually based on feelings toward someone from the past Psychodynamic Therapy Less intensive version of psychoanalysis Fewer sessions per week and fewer years Less theory about sex, id,
and superego The focus is on improved self-awareness and insight into unconscious thoughts and feelings which may be rooted in past relationships. In addition to insight, therapists suggest changes in patterns of thinking and relating to others. Interpersonal Therapy A further extension of psychoanalysis The goal is less focused on insight, and more on relational behavior change and symptom relief.
The focus is less on the past, and more on current feelings and relationships including the interaction with the therapist. Assessing the Unconscious Projective Test a personality test, that provides ambiguous stimuli designed to trigger projection of ones inner dynamics TAT Rorschach Assessing the Unconscious Thematic
Apperception Test (TAT) people express their inner feelings and interests through the stories they make up about ambiguous scenes Assessing the Unconscious Rorschach Inkblot Test the most widely used projective test seeks to identify peoples inner feelings by analyzing their interpretations of the blots
Humanistic Therapies Humanistic therapists aim to boost selffulfillment by helping people grow in selfawareness and self-acceptance. Activating the self-actualizing tendency is a primary goal. Reconciling the Real Self and Ideal Self, thereby reducing incongruence, is also a focus. 13 Humanistic Therapies Humanistic psychology (Abraham Maslow and Carl Rogers) emphasizes the human potential for growth, self-actualization, and personal fulfillment. Humanistic therapy attempts to support personal growth by helping people gain
self-awareness and self-acceptance. Client-centered therapy is Carl Rogerss name for his style of humanistic therapy. Style of the ClientCentered Therapist Being non-directive Let insight and goals come from the client, rather than dictating interpretations. Being genuine Be yourself and be truthful; dont put on a therapist faade.
Being accepting and showing unconditional positive regard Help the client learn to accept themselves despite any weaknesses. Being empathetic Demonstrate careful attention to the clients feelings, partly by reflecting what you hear the client saying. Showing Empathy Through Active Listening Client-centered therapists show that they are tuning in to clients feelings and meanings. 1. Summarize, paraphrase So your father wasnt around much? 2. Invite clarification and
elaboration When you say anxiety, what does that feel like to you? What is going on in your body and thoughts? 3. Reflect Feelings It seems like you are disappointed; am I right? Humanistic vs. Psychoanalytic Therapy Goal Humanistic psychotherapy Promote growth Psychoanalytic
psychotherapy Cure mental illness How to improve Take responsibility for feelings and actions Bring unconscious conflicts into conscious awareness Role of therapist Provide an environment Provide interpretations (e.g. in which growth can of dreams, resistance and occur
transference) Content of Conscious feelings, therapy actual self and ideal self Unconscious conflicts Time focus The present and future The past Behavior Therapy Sometimes, insight is not helpful to recover from some mental health problems. The client might know the right changes to make, but finds that its hard to change actual behavior. Behavior therapy uses the principles of
learning, especially classical and operant conditioning, to help reduce unwanted responses. These might include behaviors such as addictions, or emotions such as panic. Classical Conditioning Techniques Counterconditioning refers to linking new, positive responses to previously aversive stimuli. If you have been conditioned to fear stores because you have had panic attacks there, you could be led into a store and then helped with relaxation exercises. The goal is to associate stores with
relaxation, a state incompatible with fear. Exposure Therapy A conditioned fear can worsen when avoidance of the feared situation gets reinforced by a quick reduction in anxiety. Guided exposure to the feared situation can reverse this reinforcement by waiting for anxiety to subside during the exposure. The person can habituate to (get
used to) the anxiety itself, and then the feared situation. What mistake is Professor Gallagher making here? Hint: systematic desensitization might have been more effective, though less dramatic Versions of Exposure Therapy Sometimes, exposure to the feared situation is too anxietyprovoking or impractical. In those cases, you can use: systematic desensitization. Beginning with a tiny reminder of the feared situation, keep increasing the exposure intensity as
the person learns to tolerate the previous level. virtual reality therapy. This involves exposure to simulations, such as flying (below) or snakes. Systematic Desensitization A type of therapy that associates a pleasant, relaxed state with gradually increasing anxiety-triggering stimuli commonly used to treat phobias. 21 The Bed-Wetting Alarm Example Isnt a bed-wetting alarm a form of operant conditioning? Doesnt the child get a punishment for wetting the bed? Assuming the child is not
wetting on purpose: the bed wetting is not an operant behavior, and the child cannot choose to avoid the alarm. The association that is made is between a biological state (a full and relaxing bladder), and sudden alarming wakefulness. This resembles classical conditioning. 22 Aversive Conditioning When a person has been conditioned to have a positive association with a drug... Aversive conditioning can associate the drug
with a negative response. Operant Conditioning Therapy Operant conditioning refers to the shaping of chosen behavior in response to the consequences of the behavior. Behavior modification refers to shaping a clients chosen behavior to look more like a desired behavior, by making sure that desired behaviors are rewarded and problematic behaviors are unrewarded or punished.
Applications of Operant Conditioning Applied behavioral analysis/ application is used with nonverbal children with autism. It rewards behaviors such as sitting with someone or making eye contact, and sometimes punishes selfharming behaviors. A token economy uses coins, stars, or other indirect rewards as tokens that can be collected and traded later for real rewards. Token Economy In institutional settings therapists may create a token economy in which patients
exchange a token of some sort, earned for exhibiting the desired behavior, for various privileges or treats. 25 Critiques of Behavior Therapy Does it work? And when it does, do the changes stick, without insights and other changes to hold the new behavior in place? It does often work, but extinguished behaviors and reactions do spontaneously reappear. To ensure maintenance of changes, a transition is
needed from artificial rewards to awareness of natural, environmental consequences. Is it ethical? Since conditioning operates below conscious awareness, couldnt peoples choices and reactions be manipulated without their consent? To minimize ethical problems: acquire consent, at least of guardians. develop goals for treatment that are more humane than the alternative. For example, shaping autistic behavior is seemingly better than
institutionalization. Cognitive Therapies: Theory Being depressed and/or anxious involves negative thoughts and interpretations. In the cognitive perspective, the cause of depression are not bad events, but our thoughts about those events. Cognitive Therapies: Practice Cognitive therapy helps people alter the negative thinking that worsens depression and anxiety. Therapists might suggest other thoughts that the clients could
have about their lives, or at least point out when clients jump to conclusions that make them feel worse. Schools of Cognitive Therapy Albert Elliss rational-emotive behavior therapy challenging irrational beliefs and assumptions Aaron Becks cognitive therapy for depression correcting cognitive distortions Donald Meichenbaums stress inoculation training practicing healthier thinking before facing a stressor, disappointment, or frustration Rational-Emotive Behavior Therapy Albert Ellis showed how depression is worsened by irrational beliefs. These include depressing assumptions about the world such as everyone should like me or I should never do anything wrong.
Rational-Emotive Behavior Therapy [REBT] helps people: 1) notice that they are operating on selfdefeating assumptions, and 2) reward themselves for replacing these assumptions with realistic beliefs. For example, a more realistic belief might be, some people wont like me, many will have no opinion; it doesnt matter. Aaron Becks Therapy for Depression Aaron Beck helped people see how their depression was worsened by errors in thinking such as catastrophizing, (interpreting current events as signs of the worst possible outcome). For example: Now that Ive made a mistake in my lecture, Ive failed as a professor. Students cant take me seriously, and they cant learn from me. Becks style of therapy helps clients notice and challenge these errors in thinking.
Cognitive Therapy for Depression Rabin et al., (1986) trained depressed patients to record positive events each day, and relate how they contributed to these events. Compared to other depressed patients, trained patients showed lower depression scores. 31 Cognitive Behavioral Therapy Cognitive behavioral therapy [CBT]
works to change both cognitions and behaviors that are part of a mental health disorder. Using cognitive behavioral therapy, people with OCD are led to resist the urge to act on their compulsions, as well as to learn to manage obsessional thinking. Family Therapy Group Therapy Having a session with the whole family, at home or in the office, allows the therapist to work on the family system, that is, the familys patterns of alliances, authority, and communication. A related modality is couples/marital therapy. Group therapy assembles about six to nine
people with related needs into a group, facilitated by a therapist, to work on therapeutic goals together. The benefits include: less cost per person. more interaction, feedback, and support. clients realize others share their problems and they are not alone. Self-Help Groups Self-help groups are led by group members instead of a therapist. They can be much larger than group therapy, with less interaction. The focus is more on support rather than on working on goals during the group session. Is Psychotherapy Effective? There are different measures of the value and effectiveness of
psychotherapy: whether the client is satisfied whether the client senses improvement whether the therapist sees improvement whether there has been an observable, measured change in initial symptoms What Causes Improvement? Even if clients do improve, is the improvement really caused by therapy? It could be: regression to the mean, drifting from initial crisis back to an average state. the clients motivation to appear better in order to please
the therapist or to justify the cost of therapy. Studying Treatment Outcomes To track the effectiveness of an intervention, use a control group not receiving the intervention, or even a placebo group. To measure effectiveness, use objective, observable measures of symptoms rather than relying on client or therapist perceptions. Understanding Outcome Data If we find that even people in a control group (e.g. on a waiting list) showed improvement, is therapy a waste of time? Number of
persons People are more likely to improve with treatment. About 80 percent of untreated people have poorer outcomes than the average treated person. Results of Outcome Research Some forms of psychotherapy have been found to be effective for certain problems: Depression Cognitive-behavioral Anxiety Psychodynamic therapy
Phobias Exposure therapy Bedwetting Behavior conditioning Eye Movement Desensitization and Reprocessing (EMDR) In EMDR therapy, the therapist attempts to unlock and reprocess previous frozen traumatic memories. The therapist waves a finger or light in front of the eyes of the client, in
order to integrate past and present, and left and right hemispheres. Some studies show EMDR is effective and some do not. Studies which did not show effectiveness were critiqued by the founder as being done without adequate training in EMDR. Is this a valid critique of the research? Research suggests that the effectiveness of EMDR, even when it does work, may not depend on the eye movement technique. Light Exposure Therapy Research supports the idea that daily exposure to bright light, especially with a blue tint, is effective in treating the depressive symptoms of
seasonal affective disorder [SAD]. What do effective psychotherapy styles seem to have in common? Hope: therapists assume the client has resources that can be used for recovery, and that improvement is possible A new perspective: new interpretations and narratives (from victim to survivor) can improve mood and motivate change The relationship: empathy, trust, and caring provide an
environment for healthy growth Client-Therapist Differences Therapists differ from clients (and from each other) in beliefs, values, cultural background, conversational style, and personality. Ways to serve diverse clients Therapists should be receptive, respectful, curious, and seek understanding rather than assuming it. The therapist and client do NOT have to have similar backgrounds for effective therapy and a good therapeutic relationship. It is more
important to have similar ideas about the function and style of therapy. Selecting a Psychotherapist People with a variety of different graduate degrees are able to provide psychotherapy. Specific training and experience in the area of your difficulty is worth asking about. What is most important is whether you and the therapist are able to establish an alliance. Some of this is trial and error. If problems arise,
you can try working it out, but switching therapists is okay. Therapists and their Training Psychotherapists psychologists Psychologists (PhD, PsyD) do therapy plus intelligence and personality testing. Psychiatrists (MD, DO) prescribe medicine and sometimes do psychotherapy. Social workers (MSW) as well as counselors, nurses, and other professionals may be trained and licensed to diagnose and treat mental health disorders.
Biomedical Therapies Interventions in the brain and body can affect mood and behavior. Biomedical therapies refer to physically changing the brains functioning by altering its chemistry with medications, or affecting its circuitry with electrical or magnetic impulses or surgery. Drug (Medication) Therapies Psychopharmacology refers to the study of
drug effects on behavior, mood, and the mind. Drug Therapies Psychopharmacology is the study of drug effects on mind and behavior. With the advent of drugs, hospitalization in mental institutions rapidly declined, called deinstitutionalization. 44 Drug Therapies However, many patients are left homeless on the streets due to their illpreparedness to cope independently outside in society. Thus, deinstitionalization was an abysmal failure 45
Types of Medication Antipsychotic Reduces the symptoms of schizophrenia, What they especially positive do symptoms such as hallucinations and delusions How they work
Antianxiety Antidepressant Temporarily reduces worried thinking and physical agitation; might permanently erase traumatic associations Improves mood and control over depressing and anxious thoughts nervous Blocking dopamine Slowing system activity in
receptors the body and brain Obesity, diabetes, and movement problems (sluggishness, Side effects twitching, or eventually tardive dyskinesia--odd facial/tongue and body movements) Slowed thinking, reduced learning, dependence, and withdrawal Increasing levels of
serotonin (sometimes norepinephrine) at synapses by inhibiting reuptake; possible neurogenesis Dry mouth, constipation, and reduced sexual desire and/or response Inhibiting Reuptake Many medications increase synaptic neurotransmitter levels; they stop the sending neuron from taking back its chemical messages. Schizophrenia Symptoms
associated with schizophrenia such as agitation, delusions, and hallucinations byantipsychotics blocking dopamine receptor Atypical [Clozapine (Clozaril)]: Remove negativesites. symptoms associated with schizophrenia such as apathy, jumbled thoughts, concentration difficulties, and difficulties in interacting with others. 49 Atypical Antipsychotic Clozapine (Clozaril) blocks receptors for dopamine and serotonin to remove the
negative symptoms of schizophrenia. 50 Antianxiety Drugs Antianxiety drugs (Xanax, Valium, and Ativan) depress the central nervous system and reduce anxiety and tension by elevating the levels of the Gamma-aminobutyric acid (GABA) neurotransmitter. 51 Antidepressant Drugs Antidepressant drugs like Prozac, Zoloft, and Paxil are Selective Serotonin Reuptake Inhibitors (SSRIs) that improve the mood by elevating levels of serotonin by inhibiting reuptake.
52 Types of Medication Mood Stabilizers Reduce the highs of mania as What they well as reduce the do depressive lows How they
work ADHD Stimulants Help control impulses, and reduce distractibility and the need for stimulation including fidgeting Blocking Under reuptake of investigation dopamine from synapses
Various; blood levels Side effects must be monitored Decreased appetite Electroconvulsive Therapy (ECT) Electroconvulsive therapy [ECT] induces a mild seizure that disrupts severe depression for some people. This might allow neural re-wiring, and might boost
neurogenesis. Repeated Transcranial Magnetic Stimulation Another option is repeated deepbrain stimulation using implanted electrodes. Like ECT, these techniques may disrupt depressive electrochemical brain patterns. Psychosurgery A lobotomy destroys the
connections between the frontal lobes and the rest of the brain. This decreases depression, but also destroys initiative, judgment, and cognition. Microsurgery might work by disrupting problematic neural networks involved with aggression or obsessive-compulsive disorder. Psychosurgery Psychosurgery was
popular even in Neolithic times. Although used sparingly today, about 200 such operations do take place in the US alone. 57 Psychosurgery Modern methods use stereotactic neurosurgery and radiosurgery (Laksell, 1951) that refine older methods of psychosurgery. 58 Psychological Disorders are
Biopsychosocial in Nature 59 Therapeutic Lifestyle Change We can indirectly affect the biological components of mental health problems. Exercise can boost serotonin levels and reduce stress. Changing negative thoughts can improve mood and even rewire the brain. Mental health problems also can be reduced by meeting our basic needs for sleep, nutrition, light,
meaningful activity, and social connection. Preventing Psychological Disorders In addition to treating mental health disorders, some mental health professionals, especially social workers, also work to reduce the risk of mental health disorders. Such prevention efforts include: support programs for stressed families. community programs to provide healthy activities and hope for children. relationship-building communication skills training. working to reduce poverty and discrimination.
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