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Chapter 15
Treatment of Abnormal Psych
History of Treatment
Chapter Introduction
Therapeutic drugs and community-based treatments are why many mental health hospitals have been empty since the 1950s.
Therapy
Psychotherapy an emotionally charged,
confiding interaction between a trained therapist and someone who suffers from psychological difficulties
Eclectic Approach an approach to psychotherapy
that, depending on the client’s problems, uses techniques from various forms of therapy
Therapy- Psychoanalysis
Psychoanalysis Freud believed the patient’s
free associations, resistances, dreams, and transferences – and the therapist’s interpretations of them – released previously repressed feelings, allowing the patient to gain self-insight
use has rapidly decreased in recent years
Resistance blocking from consciousness of
anxiety-laden material
Psychoanalytic theory creates less anxious individuals for their conflicted energy is now released
Free association is when you say aloud whatever is on your mind.
Therapy-Psychoanalysis
Therapy-Psychoanalysis
The latent content of a dream is the underlying, but censored meaning.
A dream analysis is a suggestion of a dream’s meaning.
Therapy- Psychoanalysis
Interpretation the analyst’s noting
supposed dream meanings, resistances, and other significant behaviors in order to promote insight
Transference the patient’s transfer to the
analyst of emotions linked with other relationships e.g. love or hatred for a
parent
Psychodynamic Therapy
Therapy deriving from the psychoanalytic tradition that views individuals as responding to unconscious forces and childhood experiences, and that seek to enhance self-insight
The goal is to interpret the patient’s conflict
Humanistic Therapy
Client-Centered Therapy humanistic therapy
developed by Carl Rogers therapist uses techniques
such as active listening within a genuine, accepting, empathic environment to facilitate clients’ growth
Active Listening-empathic listening in which the listener echoes, restates, and clarifies
Humanistic Therapy
Rogers wanted therapists to focus on GENUINENESS, ACCEPTANCE, AND EMPATHY.
Unconditional positive regard: a caring, accepting, nonjudgmental attitude, which Carl Rogers believed to be conducive to developing self-awareness & acceptance
Humanistic Therapy
Insight therapies: aim to improve the psychological functioning by increasing the client’s awareness of underlying motives and defenses.
focuses more on the present and future more than the client’s past
Behavior Therapy
Behavior Therapy therapy that applies learning
principles to the elimination of unwanted behaviors
Counterconditioning procedure that conditions new
responses to stimuli that trigger unwanted behaviors
based on classical conditioning
includes systematic desensitization and aversive conditioning
Behavior Therapy
Exposure Therapy treat anxieties by
exposing people (in imagination or reality) to the things they fear and avoid
Behavior Therapy
Systematic Desensitization type of counterconditioning associates a pleasant, relaxed
state with gradually increasing anxiety-triggering stimuli
commonly used to treat phobias
Aversive Conditioning type of counterconditioning
that associates an unpleasant state with an unwanted behavior
nausea ---> alcohol
Discrimination
Mary Cover Jones did not receive the credit she deserved in psychology because she was a woman.
Systematic Desensitization
Systematic Desensitization: a type of exposure therapy that associates a pleasant relaxed state with gradually increasing anxiety triggering stimuli.
Commonly used to treat phobias.
Progressive Relaxation
Progressive Relaxation: Relaxing one muscle group at a time to receive relaxation and comfort.
Virtual Reality Exposure Therapy
Virtual Reality Exposure Therapy: Anxiety treatment that progressively exposes people to stimulations of their greatest fears such as airplane flying to public speaking.
Virtual Reality Exposure Therapy
This is helpful because your fear is stimulated to help people get through it without a high cost.
Also, using an avatar lets you try out new behaviors in virtual environments for people suffering a social phobia.
Aversive Conditioning
Aversive Conditioning: type of counter-conditioning that associates an unpleasant state with an unwanted behavior.
Aversive Conditioning vs. Systematic Desensitization
Aversive Conditioning is the opposite of systematic desensitization.
Aversive Conditioning
Aversive Conditioning: to get rid of nail biting, you could paint your nails with a nasty tasting nail polish.
Aversive Conditioning
Aversion is much better in the short term rather than long term.
When coyotes stopped eating sheep because there coats were treated with poison, later they began to eat the sheep again.
Aversive Conditioning
Cognition influences aversive conditioning.
After 3 years people treated with alcohol aversion, only 33% stayed away from alcohol.
Behavior Modification
Behavior Modification: reinforcing behaviors and withholding reinforcement for undesired behaviors or punishing them.
Behavior Modification
Children with disabilities have learned to care for themselves.
People suffering from Schizophrenia have learned to behave more rationally.
Token Economy
Token Economy: an operant conditioning procedure in which people earn a token of some sort for exhibiting a desired behavior and can later exchange the tokens for various privileges or treats.
Token Economy
Criticisms: Will people stop
doing the behaviors when the rewards stop.
Is it right to deprive people of something they desire and decide which behaviors to reinforce.
Cognitive Therapies
Cognitive Therapies: therapy that teaches people new, more adaptive ways of thinking and acting; based on the assumption that thoughts intervene between events and our emotional reactions.
Cognitive Therapies
Cognitive therapists try to teach new, more constructive ways of thinking.
Aaron Beck
Aaron Beck was originally trained Freudian but turned cognitive therapist.
Beck tries to reverse clients’ catastrophizing beliefs about themselves, situations, and future.
Stress Inoculation Training
Meichenbraum’s stress inoculation training teaches people to restructure their thinking in stressful situations.
After learning how to dispute negative thoughts there was a halved rate of future depression.
Cognitive Behavior Therapy
Cognitive Behavior Therapy: a popular integrated therapy that combines cognitive therapy and behavior therapy.
Group Therapy
Economically, group therapy is good because it saves time and money.
It allows people to see problems similar to their own and receive feedback as they try new ways of behaving.
Family Therapy
Family therapy: therapy that treats the family as a system views an individuals unwanted behaviors as influenced by, or directed at, other family members.
Family Therapy
Goals are beneficial because they open up communication within the family or to help family members.
Group Therapy
AIDS, anorexia, alcohol, and hearing loss have successful support groups.
Whereas hypertension, migraines, ulcers, and vision loss don’t really have support groups.
Alcoholics Anonymous
Worldwide, Alcoholics Anonymous has over 2 million members in 114,000 groups.
Their 12 step program, you need to admit powerless, seek help from a higher power, and to share message with others.
Figure 15.1
Psychotherapy
Clients testimonials affirm the use of psychotherapy.
Criticisms: People often enter
therapy in a crisis. Clients may need to
believe therapy was worth the effort.
Clients generally speak highly of their therapists.
Placebo Effect Regarding Therapy
Power or belief in the treatment, whether or not it actually is successful.
Regression Towards the Mean
Regression Towards the Mean: tendency for the extremes to fall back towards the average, or what is normal.
Lack of Psychotherapy
Eysenck said that without psychotherapy, roughly 66% of people with depression improved noticeably.
Time heals. Criticism:
Sample for testing was small.
Research of Therapy
Randomized clinical trials are the best way to study outcome research.
Researchers need to randomly assign people to either a therapy group, or no therapy.
Meta-Analysis
Meta-Analysis: a procedure for statistically combining the results of many different research studies.
Smith’s 1980 Research
Psychotherapists welcomed the first meta-analysis of some 475 psychotherapy outcome studies It showed that the average therapy client ends up better off than 80 percent of the untreated individuals on waiting lists. The claim is modest—by definition, about 50 percent of untreated people also are better off than the average untreated person. Nevertheless, Mary Lee Smith and her colleagues exulted that “psychotherapy benefits people of all ages as reliably as schooling educates them, medicine cures them, or business turns a profit.”
5 Subsequent studies
Proved that: Those not undergoing therapy often improve, but those undergoing therapy are more likely to improve.
Psychotherapy-cost effective
Studies show that when people seek psychological treatment, their search for other medical treatment drops—by 16 percent in one digest of 91 studies.
Given the staggering annual cost of psychological disorders and substance abuse—including crime, accidents, lost work, and treatment—this is a good investment.
Both reduce long-term costs. Boosting employees’ psychological well-being, for example, can lower medical costs, improve work efficiency, and diminish absenteeism.
Clinicians experience
There is little if any connection between clinicians’ experience, training, supervision, and licensing and their clients’ outcomes.
Behavioral Benefits from therapy
Behavioral conditioning therapies, for example, have achieved especially favorable results with specific behavior problems, such as bed-wetting, phobias, compulsions, marital problems, and sexual disorders.
Cognitive Therapy
And new studies confirm cognitive therapy’s effectiveness in coping with depression and reducing suicide risk.
Behavioral Optimism
Behavioral change is most optimistic with specific problems (rather than general problems).
Non-recommended therapies
Energy therapies Recovered-memory
therapies Rebirthing therapies Facilitated
communication Crisis debriefing
Psychology’s Civil War
But this question—which therapies get prizes and which do not?—lies at the heart of a serious controversy some call psychology’s civil war.
Evidence Based Practice
Clinical decision-making that integrates the best available research with clinical expertise and patient characteristics and preferences.
EMDR
EMDR (eye movement desensitization and reprocessing) is a therapy adored by thousands and dismissed by thousands more as a sham—“an excellent vehicle for illustrating the differences between scientific and pseudoscientific therapy techniques.”
James Herbert and seven others suggested it
Created when one day while walking in a park and observing that anxious thoughts vanished as her eyes spontaneously darted about.
Francine Shapiro and EMDR
After she tried this on 22 people haunted by old traumatic memories, and all reported marked reductions in their distress after just one therapeutic session, the extraordinary result evoked an enormous response from mental health professionals.
Also noted: To date, nearly 70,000 of them, from more than 75 countries, have undergone training for EMDR.
Does it work?
The treatment need take no more than three 90-minute sessions. The Society of Clinical Psychology task force on empirically validated treatments acknowledges that the treatment is “probably efficacious” for the treatment of nonmilitary post-traumatic stress disorder
Encouraged by their seeming successes, EMDR therapists are now applying the technique to other anxiety disorders, such as panic disorder, and, with Shapiro’s encouragement, to a wide range of complaints, including pain, grief, paranoid schizophrenia, rage, and guilt.
Skeptics
It seems eye movements are not the therapeutic ingredient.
In trials in which people imagined traumatic scenes and tapped a finger, or just stared straight ahead while the therapist’s finger wagged, the therapeutic results were the same.
Seasonal Affective Disorder (SAD)
The wintertime blahs constitute a form of depression (for especially women and those living far from the equator).
Light Exposure Therapy
After four weeks of treatment, 61 percent of those exposed to morning light had greatly improved, as had 50 percent of those exposed to evening light and 32 percent of those exposed to the placebo
Other studies have found that 30 minutes of exposure to 10,000-lux white fluorescent light produced relief for more than half the people receiving morning light therapy and for one-third receiving evening light the
Elements in all forms of psychotherapy
Hope for demoralized people
A new perspective on oneself and the world
An empathic, trusting, caring relationship
Participant’s belief
This belief, apart from any therapeutic technique, may function as a placebo, improving morale, creating feelings of self-efficacy, and diminishing symptoms.
A new perspective
Every therapy also offers people a plausible explanation of their symptoms and an alternative way of looking at themselves or responding to their world. Armed with a believable fresh perspective, they may approach life with a new attitude, open to making changes in their behaviors and their views of themselves.
Effective therapists
Normally have the qualities of: Empathetic Caring Trusting Willing to gain insight Communicate well
Similarities between psychologists
Similar characteristics of cognitive, psychodynamic, and interpersonal psychologists: At key moments, the
empathic therapists of both persuasions would help clients evaluate themselves, link one aspect of their life with another, and gain insight into their interactions with others.
Therapeutic Alliance
The emotional bond between therapist and client (is a key aspect of effective therapy).
Paraprofessional
That all therapies offer hope through a fresh perspective offered by a caring person is what also enables paraprofessionals (briefly trained caregivers) to assist so many troubled people so effectively.
People who don’t need therapy
They empathize, reassure, advise, console, interpret, or explain. Such qualities may explain why people who feel supported by close relationships—who enjoy the fellowship and friendship of caring people—are less likely to need or seek therapy.
What therapy wants to enhance
Sensitivity Openness Personal Responsibility
Culture
Clients who are immigrants from Asian countries, where people are mindful of others’ expectations, may have trouble relating to therapies that require them to think only of their own well-being.
Such differences help explain the reluctance of some minority populations to use mental health services.
Asian-American view points
Asian-American clients matched with counselors who shared their cultural values (rather than mismatched with those who did not) perceived more counselor empathy and felt a stronger alliance with the counselor.
Albert Ellis
Rational-Emotive Therapy Assumed that “no one and
nothing is supreme,” that “self-gratification” should be encouraged, and that “unequivocal love, commitment, service, and… fidelity to any interpersonal commitment, especially marriage, leads to harmful consequences.”
Bergin and Ellis
Bergin and Ellis disagreed more radically than most therapists on what values are healthiest. In so doing, however, they agreed on a more general point: Psychotherapists’ personal beliefs influence their practice.
Assumed that “no one and nothing is supreme,” that “self-gratification” should be encouraged, and that “unequivocal love, commitment, service, and… fidelity to any interpersonal commitment, especially marriage, leads to harmful consequences.”
Bio Medical Therapy
Bio Medical Therapy: Prescribed medications or medical procedures that act directly on the patient’s nervous system
Psychotherapy is to psychological disorders and biomedical therapy is to serious disorders
Only psychiatrists (as medical doctors) offer biomedical therapies.
The study of the effects of drugs on mind and behavior.
Psychopharmacology
Diminishing Enthusiasm
Almost any new treatment, including drug therapy, is greeted by an initial wave of enthusiasm as many people apparently improve.
Decline in enthusiasm is due to: (1) normal recovery among
untreated persons (2) recovery due to the placebo
effect, which arises from the positive expectations of patients and mental health workers alike.
Testing the drug
To test the legitimacy of a drug, scientists use the double blind procedure.
Double Blind: Half the patients get the drug, and the other half get a similar-appearing placebo. Neither the staff nor the patients know who gets which.
Psychoses
Disorders in which hallucinations or delusions indicate some loss of contact with reality
When drugs were found for this it was accidental
Antipsychotic Drugs Drugs used to treat
schizophrenia and other forms of severe thought disorder
Examples: Chlorpromazine which dampened responsiveness to irrelevant stimuli
Mimics dopamine; goal of molecule is to occupy its receptor sites and block its activity
This finding reinforces the idea that an overactive dopamine system contributes to schizophrenia. Antipsychotics are powerful drugs
Tardive Dyskinesia
Involuntary movements of the facial muscles, tongue, and limbs; a possible neurotoxic side effect of long-term use of antipsychotic drugs that target certain dopamine receptors.
Treating Positive vs. Negative symptoms
Positive: antipsychotic drugs such as Thorazine are used to dampen responsiveness to irrelevant stimuli and aiding is the prevention of hallucinations and delusions
Negative: atypical antipsychotics are used such as Clozaril. These drugs target both dopamine and serotonin receptors this helps alleviate negative symptoms and “ awakens” patients.
Side effects of Antipsychotic drugs
Antipsychotic drugs can increase one’s risk of obesity and diabetes
Benefits
Combined with life skill programs and family support, the most positive gain form antipsychotic drugs ate that thousands of schizophrenics have returned to near normal life
Anti-anxiety drugs
Anti anxiety drugs: drugs that are used to control anxiety and agitation
Example: Xanax or Ativan
These drugs depress central nervous system activity
Negative side effects
“popping” Xanax can lead to… Psychological dependence Reinforce repeated behavior Physiological dependence Anxiety Insomnia Other withdrawal symptoms
Antidepressants
Antidepressant drugs: drugs used to treat depression; also increasingly prescribed for anxiety. Different types alter different neurotransmitters.
Antidepressants can workon obsessive compulsive disorder
Antidepressants
Work on increasing the availability of nor epinephrine and serotonin, neurotransmitters that elevate arousal and mood and appear scarce during depression
Prozac
Prozac blocks the reabsorbsion and removal of serotonin from synapses
SSRI’s
SSRI: selective serotonin reuptake inhibitors Zoloft Paxil Prozac
Administering drugs
Most successful method: administering by a patch or bypassing the intestines and liver; helps to reduce side effects.
Prevalence
After SSRI’s were introduced in 1987, 70% of depressed patients received them
In 2001, this jumped to 89% 11% of women and 5% of men take an SSRI
Other ways to relieve depression
Aerobic exercise can often lift our spirits and gradually cure us of depression due to the release of endorphins
Cognitive therapy can also help depressed patients sort through their thoughts in order to beat depression
Effects of SSRI’s
Full effects do not take place for a few weeks; you do not wake up the next morning saying “it’s a beautiful day!” This is because increase
of serotonin promotes neurogenesis
Side effects may include diminished sexual desire
Relieving depression
Attacking depression from above and below Use antidepressants
along (bottom up) with cognitive therapy (top down)
Antidepressant Facts
Only the most severe patients should be treated using antidepressants
Adolescent SSRI use has no effect on suicide rates
There is no link between antidepressants and suicide rates
Mood stabilizing drugs
Lithium A simple salt that is an
effective mood stabilizer for those with emotional highs and lows of bipolar disorder
7 in 10 people benefit from the long term use of lithium
The suicide rate of those with bipolar disorder taking lithium is about 1/6 the rate of those who are not
Electroconvulsive Therapy
ECT: a biomedical therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized person
Introduced in 1938 Patient remembers nothing
of the treatment after 80% of patients reported
improved moods
Repetitive Transcranial Magnetic Stimulation
rTMS: the application of repeated pulses of magnetic energy to the brain; used to stimulate of suppress brain activity
No memory loss or other detrimental side effects
Half of depressed Israelis that received rTMS showed improvement
ECT Study
Mayberg found that a brain region overactive in a depressed patient becomes calm after the administration of ECT or antidepressants
This area became known as the “depression switch”
Psychosurgery
Psychosurgery: surgery that removes or destroys brain tissue in an effort to change behavior
Not used frequently Used in the most
extreme cases as a last resort
Lobotomies
Lobotomy: a now-rare psychosurgical procedure once used to calm uncontrollably emotional or violent patients. The procedure cuts the nerves connecting the frontal lobes to the emotion-controlling centers of the inner brain
Rosemary Kennedy : Famous recipiant of a lobotomy
Characteristics of a lobotomy
Decreased a person’s misery and tension
Produced lethargic, immature, uncreative people
Became more obsolete 1950’s when new drugs were developed and perfected
Therapeutic lifestyle change
Includes one with strenuous physical activity, strong community ties, sunlight exposure, and plenty of sleep
The Amish are a good example of people who live a therapeutic lifestyle
Reducing depression
The Llardi team believes that depression can be reduced by Aerobic exercise Adequate sleep Light exposure Social connections Anti-rumination Nutritional supplements
“It is better to prevent than cure”
What do you think?