Psychological Therapies

AP 604-628

Therapy

• It used to be that if someone exhibited abnormal behavior, they were institutionalized.

• Because of new drugs and better therapy, the U.S. went to a policy of deinstitutionalization.

2 Major Types of Therapy• 1. Psychological Therapies:

employ interaction (usually verbal) between trained professional and a client with a problem

• 2. Biomedical: therapies directed at a patient’s nervous system.

VS.

Eclectic Approach Takes a Smorgasbord Approach

• Eclectic Approach: uses a variety of different techniques from various theories of therapy depending on the problem of the individual.

• More than half of therapists take this approach.

Behavior Therapies• View psychological disorders

as learned behaviors to be fixed by learning new behaviors (not searching for underlying causes)

• Based upon Behaviorist and Social-Cognitive approaches to personality/disorder

Behavior TherapiesBehavior Therapy – applies learning principles to the elimination of unwanted learning

Utilizes both classical and operant conditioning

Classical ConditioningCounterconditioning – uses classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors.

1. Exposure Therapy

2. Systematic Desensitization

Exposure Therapies – behavioral techniques that treat anxieties by exposing people to things they may fear and avoid.

Exposure Techniques

• “Flooding” – Based on extinction– Keeps people in feared (but

harmless) situation and prevents them from normally rewarding pattern of escape

– Association between feared stimulus and fear response gradually weakens

Classical ConditioningSystematic Desensitization – a type of counter conditioning that associates a pleasant relaxed state with gradually increasing anxiety-triggering stimuli (Developed by Joseph Wolpe)

Used to treat phobias

Virtual reality exposure therapy progressively exposes people to their greatest fears

• Step 1: Learn relaxation techniques

• Step 2: Create a hierarchy of what you fear

• Step 3: Engage each level of the hierarchy while using relaxation techniques

Behavioral Therapies: Counterconditioning/Exposure Therapy

Less Aggressive Exposure Therapy (Not in Book)

• Implosion: patient imagines stimulus rather than being exposed to actual negative stimulus…hopes to reduce anxiety.

• Usually used as first step in systematic desensitization.

Behavioral Therapies: Counterconditioning

Aversive Conditioning: a type of counterconditioning that associates an unpleasant state (such as nausea) with an unwanted behavior (such as drinking alcohol)

Will eventually lead to extinction

Operant ConditioningOperant Conditioning therapy has been used to help those with Autism

Token economy – conditioning procedure that attempts to modify behavior by giving rewards for desired behaviors. The tokens can later be exchanged for privileges or treats.

Parents, schools, daycares, hospitals all use this token economy idea

Behavior Affects Biology• Biofeedback: uses a system

that records physiological processes such as heart rate, muscle tension, and skin temperature.

• Patient can use immediate information to see degree which they can change anxiety-related responses to lessen physiological arousal.

Biomedical Therapy• Prescribed medications

or medical procedures that act directly on the patients nervous system.– Drugs that alter brain

chemistry– Affecting brain circuitry

with electric shock, magnetic impulses, or psychosurgery.

Drug Therapies

• Psychopharmacology = study of the effects of drugs on mind and behavior.– Drugs have minimized

involuntary hospitalization.

• Why is this a good thing?• Why is this a bad thing?

Antipsychotic Drugs

• Antipsychotics are drugs used to treat people with psychoses– Psychoses is a break in reality

where people experience hallucinations or delusions.

– Dampen responsiveness to irrelevant stimuli.

– Antagonist for Dopamine– Can cause sluggishness,

tremors, and twitches because of the low dopamine levels.

Drug Treatments: Antipsychotics (Neuroleptics)

• Antipsychotics are used to treat psychotic disorders like schizophrenia.

• Antipsychotics helps those experiencing both positive and negative symptoms.

• Most Common Examples:– Thorazine: alleviates delusions/hallucinations

(positive symptoms).– Clozaril: alleviates negative symptoms and social

withdrawal. Also prescribed for those at risk for suicide.

Long Term Use of Antipsychotics• Tardive Dyskinesia = Involuntary movements of the facial muscles

tongue and limbs.• Negative side effects

– Nausea– Headaches – Exacerbation of other medical problems

Antianxiety Drugs• Drugs used to control

anxiety and agitation.– Depress central nervous

system activity by increasing the amounts of GABA in the brain.

– Xanax• Can become

physiologically dependent.

Antidepressant Drugs• Drugs used to treat depression or anxiety. Different types work by

altering the levels of various neurotransmitters.– Norepinephrine– Serotonin

• SSRI: Prozac, Zoloft, Paxil– Can have serious side effects– Full effect of the drug may take up to four weeks

Drug Treatments:Mood Stabilizers for Bipolar Disorder

• Most common is the salt lithium (carbonate) is most frequently used to treat the mood swings of bipolar disorder.

• Decreases adrenaline and increases serotonin.

• Often can have dangerous side effects including being toxic at high doses

Drug Treatments: Stimulants• Stimulants are often used to treat Attention-

Deficit/Hyperactivity disorder (ADHD): a common problem for children who have difficulty controlling their behavior and focusing their attention.

• Although its exact mechanism is unknown the stimulants have a calming and focusing effect in children by increasing neurotransmitters associated with such processes.

Antidepressants and the Placebo Effect• 75% of antidepressants effects

can be contributed to the placebo effect.

• The placebo effect was less for those who had sever depression.– Evidence many use to make

the argument we should only be using antidepressants in sever cases after other therapies have failed.

• 1 in 4 people do not respond to a particular antidepressant and switching to another usually brings relief.

Electroconvulsive Therapy (ECT)

• Electroconvulsive Therapy: used to treat the severely depressed after other treatments have failed.

• Success rate is high.

ECT• Introduced in 1938• 100 volts of electricity

for 30-60 seconds.• Today patients receive

general anesthetic and muscle relaxants.

• Some memory loss is common.

• We do not know why or how it works.

Biomedical Therapy

• Repetitive Transcranial Magnetic Stimulation: the application of repeated pulses ofmagnetic energy to the brain; used to stimulate or suppress brain activity

Alternative Neurostimulation Therapies

• Deep-Brain Stimulation: Focuses on stimulation an area of the brain that connects the frontal lobes and the limbic system.

Psychosurgery• Surgery that removes or

destroys brain tissue in an effort to change behavior.

• Lobotomy = A procedure that cut the nerves connecting the frontal lobes to the emotion-controlling centers of the inner brain.– Created permanently

lethargic personality.

http://www.npr.org/templates/story/story.php?storyId=5014080

Psychosurgery is Most Drastic Intervention

lobotomy: Ice pick like instrument is put through the eye sockets cutting the links between the frontal lobes and the emotional control centers. Used to be used to “cure” uncontrollably violent patients but now very rare.

Lobotomy

•

Therapeutic Life-Style Change

• Aerobic Exercise helps to calm those with anxiety disorders and energize those who feel depressed.

• Adequate sleep (7-8 hours a day) can increase energy and alertness.

• Light exposure amplifies arousal and influences hormones.

• Social connections helps to satisfy the human need to belong.

• Positive Thinking• Nutritional supplements helps with healthy

brain functioning.

Cognitive Therapy• Change the way we

view the world (change our schemas)

• Based on work by Aaron Beck and Albert Ellis

Cognitive TherapyCognitive Therapy – teaches people new, more adaptive ways of thinking and acting; based on the assumption that thoughts intervene between events and our emotional reactions.

Our thinking affects how we feel

Try to teach people to think constructively as opposed to destructively.

Cognitive Therapy Cont’dCognitive Behavior Therapy – therapy that combines cognitive and behavior therapies.

Attempts to alter thoughts as well as the actions

Especially effective in treating OCD. This is used as a method to treat most psychological disorders.

Cognitive Therapies

Rational-Emotive Behavior Therapy (REBT)– Albert Ellis

• Assumes psychological problems like anxiety, guilt, depression are caused by how people think about events (not the events themselves)

• Aims to identify and change self-defeating thoughts

– (i.e. “shoulds” and “musts”)

Cognitive Therapies• Cognitive Therapy

– Aaron Beck• Certain disorders (esp. depression & anxiety) can

be traced to “cognitive distortions” (errors in logic)

– “catastrophizing”– “all-or-none thinking”– “personalization”– Some have a pessimistic outlook, tendency

to blame bad events on themselves• Help identify distorted thoughts/beliefs• Treat these as hypotheses to be tested

– Often given “homework”– Provides evidence to challenge distortions

Most Common Illnesses Treated in Cognitive Perspective

• 1. Depression• 2. Eating Disorders• 3. Chronic Pain• 4. Marital Problems• 5. Anxiety Disorders

Family and Group Therapy

Family Therapy – view’s an individual’s behavior as guided by or directed at other family members; tries to improve communication and relationships.

This focuses on relationships and can be used quite often when a child is dealing with a neurological disorder

Family and Group Therapy Cont’d

Advantages of group therapy:1. Help more people in

less time2. Lower cost3. Allows people to

discover that others are dealing with similar troubles to their own. This can bring relief

4. Foster a sense of community

Humanistic Therapy• Insight Therapy: a

therapy which aims to improve psychological functioning byincreasing the client’s awareness of underlying motives and defenses

Humanistic Therapy

• People are capable of consciously controlling own actions, taking responsibility for decisions– Behavior is motivated by drive for

personal growth/improvement, guided by way they perceive their world

– Disorder comes from blocked growth due to distorted perceptions or lack of awareness of feelings

Client-Centered Therapy(aka Person-Centered Therapy)

• Developed by Carl RogersAllows client to decide what

to talk about without direction (non-directive therapy), judgment, or

interpretation• Less popular model today,

but still influences therapy

Client-Centered Therapy• Attitudes of therapist:

– Unconditional Positive Regard (Acceptance)

• Convey caring/value for client as a person, no matter what

– Help overcome “conditions of worth”– Listen without interrupting, making

judgments, or offering advice– Empathy

• Attempt to understand how world looks from client’s point of view (need not approve of everything)

– “active listening”– “reflection” – paraphrase client’s

statements and note feelings– Genuineness (Congruence)

• A consistency between way therapists feel and way they act toward clients

– Shows relationships can be built on openness/honesty

Humanistic Therapy

• Assumptions:1. Treatment is an encounter between

equals (not “cure” by “expert”)2. Clients improve on own given right

conditions (conditions promote awareness, acceptance, emotional expression)

3. Ideal conditions established by feeling fully accepted/supported as human beings

4. Clients remain responsible for choosing how they think/behave

Humanistic TherapyTherapy that aims to promote self-fulfillment by increasing self-acceptance and self awareness

Differ from the psychoanalytic perspective in 3 ways:1. Focus on fostering growth

instead of relieving illness2. Focus on the present and

future instead of the past3. Emphasize conscious thought

as opposed to the unconscious

PsychoanalysisSigmund Freud – Founder of psychoanalysis

Psychoanalysis – Theory of personality and therapeutic technique that attributes our thoughts and actions to unconscious motives and conflicts

Classic Psychoanalysis• Freud developed methods in

medical work with “hysteria” (conversion disorder) patients– Initially tried hypnosis – not very

successful– Came to focus on unconscious and

conflicts raging within it• Gain insight to unconscious

thoughts/emotions• Interpret and work through ways it

motivates maladaptive thoughts/behavior

– May take 3-5 sessions per week over several years

PsychoanalysisPsychoanalysis is attempting to make a “historical reconstruction”

Psychoanalysis tries to find past events that help understand the present

1.Freud used dream interpretation

2. Free association was used by Freud to explore the unconscious mind

PsychoanalysisResistance – In psychoanalysis, the blocking from consciousness of anxiety-laden material

Interpretation – In psychoanalysis, the analyst’s noting supposed dream meanings, resistances, and other significant behaviors in order to promote insight

Psychoanalysis

You will work through the past issues through Freud’s idea of transference with the psychologist

Transference – the patient’s transfer to the analyst of emotions linked with other relationships

Classic Psychoanalysis• Methods:

– Eventually asked patients to lie on couch and report whatever thoughts, memories, or images came to mind (free association)

• Resistance – when block sensitive material from free association

– therapist needs to explore

– “Freudian slips”– Latent content of dreams – wishes,

impulses, fantasies kept out of consciousness while awake by defense mechanisms

– Transference – patients express dependence, hostility, even love toward therapist

• seen as unconscious process of transferring childhood feelings/conflicts

• analysis of this provides insight

Contemporary Psychodynamic Therapy

• Very few Freudian psychoanalysts left• Forms of “short-term psychodynamic

therapy” more common now– Interpersonal therapy, Object relations

therapy, etc.

• May involve less time and money, meet face-to-face, de-emphasize the past & id, stress social/interpersonal relationships

– Still focus on unconscious and conscious, internal conflicts, and transference analysis

Psychodynamic Therapists

Psychodynamic therapy – deriving from psychoanalysis

• focuses on themes across important relationships, including childhood experiences, and the therapist relationship

Criticism of Psychoanalytic Therapy

• 1. Built on assumption that repressed memories exist.

• 2. Interpretations cant be proven right or wrong.

• 3. Is very time-consuming and costly…usually takes several years to achieve insight.

Is Psychotherapy Effective?

Some researchers believe that two phenomena make psychotherapy seem more effective than it is.

1. The Placebo Effect2. Regression toward the

mean• Tendency for

extreme or unusual scores to fall back to the average

Effectiveness of Psychotherapy? How do We Evaluate?

• Is it therapy that helps people get better or would it occur naturally?

• Regression towards the Mean: the tendency for for unusual emotions (depression/sadness) or events to return (regress) toward their average state with time.

Effectiveness of Psychotherapy? How do We Evaluate?

• In order to test impact of treated vs. untreated, studies using meta-analysis must be used.

• Meta-analysis: procedure for statistically combining the results of many different research studies.

Ineffective TherapiesResearch has shown us that some therapies are ineffective

• Energy therapies• Recovered-memory

therapies• Rebirthing therapies• Facilitated

communication• Crisis debriefing

Alternative Therapies

There are many alternative types of therapy

Therapeutic Touch Therapy• Move their hands around a person to push their energy fields into balance.• Many skeptics including James Randi• Not currently accepted as a medical practice

Alternative Therapies Cont’dLight Exposure Therapy to treat SAD – Seasonal Affective Disorder

This is an accepted practice that appears to give some benefit.

The Most Dominant Therapy is the Cognitive Approach

Review: Who Conducts Therapy?

• 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.

–May work in conjunction with a psychiatrist.

Review: Who Conducts Therapy? • Counseling Psychologists

–Marriage and family counselors specialize in problems arising from family relations.

–Typically have one of advanced degrees–Pastoral counselors provide counseling to

countless people.–Abuse counselors work with substance

abusers and with spouse and child abusers and their victims.

Review: Who Conducts Therapy? • 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.