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Treating Psychological DisordersThe psychological therapies

Evaluating psychotherapies

The biomedical therapies

Preventing psychological disorders

THE HISTORY OF TREATMENTVisitors to eighteenth-century mental hospitals paid to gawk at patients,as though they were viewing zoo animals. William Hogarth’s (1697–1764) painting captured one of these visits to London’s St. Mary of Bethlehem hospital (commonly called Bedlam).

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Approach Differences

PsychotherapyTherapy in which a trained therapist uses psychological techniques to assist someone seeking to overcome difficulties or achieve personal growth

Biomedical therapyTherapy in which a trained therapist, most often a medical doctor, offers medications and other biological treatments

Eclectic approachUses blend of therapies

The Psychological Therapies

Psychoanalysis and psychodynamic therapy

Humanistic therapies

Behavior therapies

Cognitive therapies

Group and family therapies

The Psychological Therapies

PsychoanalysisGoals: To bring patients’ repressed feelings into conscious awareness; to help patients release energy devoted to id-ego-superego conflicts

Techniques: Historical reconstruction, initially through hypnosis and later through free association; Interpretation of resistance, transference

In psychoanalysis, patients may experience strong feelings for their analyst, which is called ________.

Patients are said to demonstrate anxiety when they put up mental blocks around sensitive memories—showing ________.

The analyst will attempt to offer insight into the underlying anxiety by offering a(n) ________ of the mental blocks.

Psychodynamic Therapy

Goals: To help people understand current symptoms; to explore and gain perspective on defended-against thoughts and feelings

Techniques: Client-centered face-to-face meetings; Exploration of past relationship troubles to understand the origins of current difficulties

FACE-TO-FACE THERAPY In this type of therapy session, the couch has disappeared. But the influenceof psychoanalytic theory may not have, especially if the therapist seeks information from the patient’schildhood and helps the patient reclaim unconscious feelings.

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Humanistic Therapies

Theme: Emphasis on people’s potential for self-fulfillment; to give people new insights

Goals: To reduce inner conflicts that interfere with natural development and growth

Techniques: Client-centered therapy; focus on taking responsibility for feelings and actions and on present and future rather than past

Humanistic Therapies

RogersPerson-centered therapy focuses on a person’s conscious self-perceptions; non-directive; active listening; unconditional positive regard

Most people possess resources for growth

Therapists foster growth by exhibiting genuineness, acceptance, and empathy

ACTIVE LISTENING Carl Rogers (right) empathized with a client during this group therapy session.

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Humanistic Therapies

Strengthening communication: RogersSummarize

Invite clarification

Reflect feelings

Behavior TherapiesClassical conditioning techniques

Counterconditioning: Uses classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors

Exposure therapies: Treat anxieties by exposing people (in imagination or actual situations) to the things they fear and avoid

Systematic desensitization: Associates a pleasant, relaxed state with gradually increasing, anxiety-triggering stimuli

Virtual Reality Exposure Therapy

Treats anxiety by creative electronic simulations in which people can safely face their greatest fears, such as airplane flying, spiders, or public speaking

Within the Within the confines of a confines of a room, virtual room, virtual

reality reality technology technology

exposesexposespeople to vivid people to vivid simulations of simulations of feared stimuli, feared stimuli,

such as walking such as walking across a rickety across a rickety bridge high off bridge high off

the ground.the ground.

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Aversion Therapy for Alcohol Abuse

Therapists gave people with a history of alcohol abuse a mixed drink containing alcohol and Therapists gave people with a history of alcohol abuse a mixed drink containing alcohol and a drug that produces severe nausea. After repeated treatments, some people developed at a drug that produces severe nausea. After repeated treatments, some people developed at

least a temporary conditioned aversion to alcohol. (Classical conditioning terms: US is least a temporary conditioned aversion to alcohol. (Classical conditioning terms: US is unconditioned stimulus, UR is unconditioned response, NS is neutral stimulus, CS is unconditioned stimulus, UR is unconditioned response, NS is neutral stimulus, CS is

conditioned stimulus, and CR is conditioned response.)conditioned stimulus, and CR is conditioned response.)

Operant Conditioning

Operant conditioning therapy: Consequences drive behavior

Behavior modification: The desired behavior is reinforced; undesired behavior is not reinforced and is sometimes ignored or punished

Token economy: People earn a token for exhibiting a desired behavior and can later exchange the tokens for privileges or treats

Quick Comparisons

Insight therapists•Assume self-awareness and psychological well-being are complementary

Psychodynamic therapists

•Expect people’s problems lessen insight into unresolved and unconscious tensions gained

Humanistic therapists•Expect people’s problems to lessen as they get in touch with their feelings

Behavior therapists•Assume problem behaviors are the problems

How do the insight therapies differ from behavior therapies?

Some maladaptive behaviors are learned. What hope does this fact provide?

Exposure therapies and aversive conditioning are applications of ________ conditioning. Token economies are an application of ________ conditioning.

Cognitive Therapies

Cognitive Therapies

Cognitive therapiesTeach people new, more adaptive ways of thinking; Based on the assumption that thoughts intervene between events and our emotional reactions

Beck’s therapy for depressionGentle questioning seeks to reveal irrational thinking and then to persuade people to change their perceptions of their own and others’ actions as dark, negative, and pessimistic

People are trained to recognize and modify negative self-talk

Selected Cognitive Therapy Techniques

Cognitive Therapies

Cognitive-behavioral therapyAn integrative therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior)

Aims to alter the way they act AND they way they think

Helps people learn to make more realistic appraisals

How do the humanistic and cognitive therapies differ?

What is cognitive-behavioral therapy, and what sorts of problems does this therapy address?

Group and Family Therapies

Group therapy Conducted with groups rather than individuals, providing benefits from group interaction

Often used when client problems involve interactions with others

Family therapy Treats the family as a system

Views an individual’s unwanted behaviors as influenced by, or directed at, other family members

FAMILY THERAPY This type of therapy often acts as a preventive mental health strategy.

•The therapist helps family The therapist helps family members understand how their members understand how their ways of relating to one another ways of relating to one another

create problemscreate problems

•The treatment’s emphasis is The treatment’s emphasis is not on changing the not on changing the

individuals, but on changing individuals, but on changing their relationships and their relationships and

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Which therapeutic technique has focused more on the present and future than the past, and has promoted unconditional positive regard and active listening?

Which of the following is NOT a benefit of group therapy?a. more focused attention from the therapistb. less expensivec. social feedbackd. reassurance that others share troubles

Evaluating Psychotherapies

Is psychotherapy effective?

Which psychotherapies work best?

How do psychotherapies help people?

How do culture and values influence psychotherapy?

CLOSE-UP: A consumer’s guide to psychotherapists

Evaluating Psychotherapies

Clients’ perceptionsClient self-reports indicate that psychotherapy is effective

Critics of client self-reportsClients may need to justify their investment of effort and money

Clients generally speak in positive terms of their therapists

Clients often enter therapy in crisis

Evaluating Psychotherapies

Clinicians’ perceptionsTherapists are most aware of the failure of other therapists

Outcome researchWith or without psychotherapy: People improved noticeably over time (Eyenck)

After extensive research review: Those not undergoing therapy often improve, but those undergoing therapy are more likely to improve

Evaluating Psychotherapies

Which Psychotherapies Work Best?

Some forms of psychotherapy work best for particular problems

Behavior therapies: Bed-wetting, phobias, compulsions, marital problems, and sexual dysfunctions

Psychodynamic therapy: Depression and anxiety

Cognitive therapies: Anxiety, depression, and posttraumatic stress disorder

Which Psychotherapies Work Best?

Unsupported approachesEnergy therapies

Recovered memories therapies

Rebirthing therapies

Which Psychotherapies Work Best?

Therapy is more likely to be helpful in those with the ________ (most/least) clearly defined problems.

What is evidence-based practice?

How Do Psychotherapies Help People?

Three basic benefits for all psychotherapies

Hope for demoralized peopleA new perspective for oneself and the worldAn empathic, trusting, caring relationship

A CARING RELATIONSHIP A CARING RELATIONSHIP Effective counselor aboard a ship, Effective counselor aboard a ship,

form a bond of trust with the form a bond of trust with the people they are serving.people they are serving.

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Those who undergo psychotherapy are ________ (more/less) likely to show improvement than those who do not undergo psychotherapy.

How Do Culture and Values InfluencePsychotherapy?

Psychotherapists’ personal beliefs and values influence their practice

Differences in cultural and moral diversity and religious values can create a mismatch

The Biomedical Therapies

Drug therapies

Brain stimulation

Psychosurgery

Therapeutic lifestyle change

The Biomedical Therapies

Drug therapiesAre the most widely used biomedical treatments

Include prescribed antidepressants for 27 million Americans

Involve placebo and double-blind techniques to evaluate drug effectiveness

The Biomedical Therapies

Most common drug treatments for psychological disorders

Antipsychotic drugs

Antianxiety drugs

Antidepressant drugs

Mood-stabilizing medications

Let’s take a closer look at each of these.

Drug Therapies

Antipsychotic drugsMimic certain neurotransmitters (e.g., block or increase activity of dopamine); reduce overreaction to irrelevant stimuliMay produce sluggishness, tremors, twitches, and tardive dyskinesia; ThorazineSuccessfully used with life-skills programs and family support to treat schizophrenia

Antianxiety drugsDepress CNS activity; Xanax or AtivanUsed in combination with psychological therapyMay reduce symptoms without resolving underlying problems; withdrawal linked to increased anxiety and insomnia

Drug Therapies

Antidepressant drugsIncrease availability of norepinephrine or serotonin; promote birth of new brain cells

Slow synaptic vacuuming up of serotonin (SSRIs)

Effectiveness sometimes questioned due to spontaneous recovery and placebo effect

Mood-stabilizing medicationsDepakote: Controlling manic episodes

Lithium: Levels emotional highs and lows of bipolar disorder

How do researchers evaluate the effectiveness of particular drug therapies?

The drugs given most often to treat depression are called ________. The drugs that are now often given to treat anxiety disorders are called ________. Schizophrenia is often treated with ________ drugs.

Brain Stimulation

Electroconvulsive therapyManipulates the brain by shocking it

Involves the administration of a general anesthetic and muscle relaxation to prevent convulsions

Causes less memory disruption than earlier versions

AMA concluded that ECT methods among most positive treatment effects; reduces suicidal thoughts

Involves several theories about the reason for effectiveness

Brain Stimulation

Brain Stimulation

Alternative neurostimulation therapiesVagus nerve stimulation: Stimulates neck nerve that sends signals to limbic system; increases available serotonin by increasing firing rate of some neuronsDeep brain stimulation: Manipulates depressed brain via pacemaker; stimulates inhibition activity related to negative emotions and thoughtsRepetitive transcranial magnetic stimulation (rTMS): Sends magnetic energy to brain surface through coiled wire held close to brain; fewer side effects; modest effectiveness

Severe depression that has not responded to other therapy may be treated with ________, which can cause memory loss. More moderate neural stimulation techniques designed to help alleviate depression include ________ stimulation, ________ stimulation, and ________ magnetic stimulation.

Brain Stimulation

PsychosurgeryInvolves surgery that removes or destroys brain tissue in an effort to change behaviorIs irreversible; is the least used biomedical therapy

LobotomyPsychosurgical procedure once used to calm uncontrollably emotional or violent patients Procedure cut the nerves connecting the frontal lobes to the emotion-controlling centers of the inner brain (Moniz)Today less invasive techniques are used; MRI-guided surgery in severe disorders

Therapeutic Lifestyle Change

Training seminarsHuman brains and bodies were designed for physical activity and social engagement

Our ancestors hunted, gathered, and built in groups with little evidence of disabling depression

12-week training with the following goalsAerobic exercise, adequate sleep, light exposure, social connection, antirumination, nutritional supplements

Comparing Therapies

What are some examples of lifestyle changes we can make to enhance our mental health?

Preventing Psychological Disorders

ResilienceInvolves personal strength that helps most people cope with stress and recover from adversity and trauma

Can be seen in New Yorkers after 9/11, spinal cord injury patients, Holocaust survivors, and others

PreventionThrough identification and elimination of conditions that cause psychological casualties

Through support of programs and providers that control or eliminate stress

What is the difference between preventive mental health and psychological or biomedical therapy?