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Managing Stress• we aren’t able to control stressors,
but we do have control over how we respond to it.
• Regressive coping: negative option– sleep to much to avoid/deny prob– take it out on family / friends– exhaustion…give up or lose the battle
• Transformational coping: create something good out of something bad.– admit our anger (address prob more
logically)– adjust our priorities– explore solutions
Problems of labeling Mentally ILL
• stigma attached to label– when label limits up we may become destructive
• its hard enough having an illness– we need to avoid attaching burdens with our own
stereotypes, or irrational fears.
• could arrive at wrong conclusions– influenced by expectations
• could pay too much attention to one source– (parent not kid)
What types of treatments were used to cure the mental
ill throughout history?
Middle Ages (Europe)
• Demonology– Belief that demons caused mental
illness
• Exorcism– Act of removing a demon from an
individual
• Supernatural forces
• Ergotism– rye fields infested with ergot fungus
What was the purpose & end goal?
What did Pillipe Pinel do?
• Changed Bicétre Asylum in Paris from a madhouse insane asylum to a mental hospital (1773).
• Beginning of humane treatment
Shift in inhumane treatment
• Philippe Pinel • Dorothea Dix
Criteria for commitment to state
mental hospital…• does the person harm self or others?
• can the person take care of basic needs?
• easier to get released than admitted.
Biomedical therapiesmedicalization of deviance?
• reduce dopamine levels which reduce + symptoms)– reserpine & chlorpromazine (THORAZINE)
~Thorazine shuffle …like serpents• side effects Tardive Dyskinesia (tics)
– Involuntary repetitive motions
• atypical antipsychotics – Dopamine & serotonin (- symptoms)– Clozapine (clozaril) & risperidone (risperdal)– Less likely to cause tardive dyskinesia
– ~a no tics… I used a rispy clothespin
*combined w/ life-skills programs & family support
Antipsychotic (neuroleptics) Meds
Antianxiety Meds• Benzodiazepines (Valium, Xanax, Ativan) • reduce coordination, alertness, & reaction time.• synergistic effect: intensified with alcohol & other drugs.• Physically addictive • Increase GABA (Works similar to a depressant)
– slows brain activityBenzo valax on the bus and the van…
• Buspar (atypical)- dopamine & serotonin– Less side effects (takes 2-3 wks to kick in)
• All antianxiety drugs must have be take with therapy– “Popping a Xanax” without coping strategies
• Positive reinforcement…leads to addiction• Reduce symptoms without resolving underlying
problems.
Antidepressant Meds• Tricyclics & Monoamine oxidase (MAO) inhibitors
– Increase norepinephrine & serotonin
• Trazodone & bupropion- 2nd generation– same side effects
• Selective Serotonin Reuptake Inhibitors (SSRI)
– Zoloft, Paxil, Prozac
~ Hey SSRI, just ZO ya know, 2 PAX is a PRO
• 4 weeks to kick in
• aerobic exercise & cognitive therapy
Bipolar• Lithium- stabilizes glutamate
– Depakote- (anticonvulsive)– if Lithium doesn’t work
Experiment
• Double blind• Placebo effect• Spontaneous
recovery
Primitive Approach• fear & superstitious
belief in demons witchcraft & magic!– Trepanning
(trephining)
Psychosurgery: Lobotomies
• 1930’s– Egas Moniz cutting the nerves that connect the front lobe
and the limbic system caused patients to become calm Moniz later gets Nobel Prize
• Shock them into a coma Hammer & ice pick like instrument into eye Wiggle it around
• From 1936-1954 10,000’s received lobotomies– Good Decreased person’s misery or tension– Bad Created a permanently lethargic, immature,
uncreative person
• 1950’s medicines came out…no more lobotomies*
• H:\AP PSYCH\video clips\biomedical.wmv
Electric Convulsive Therapy(ECT)
• For those who did not respond to drug treatment• History
– 1st introduced in 1938 Wide awake patient is given 100 volts
• Process– Patient is given muscle relaxant and anesthesia – 30 to 60 seconds of current– 3 sessions each week for 2-4 week
• Controversy• 80% show improvement • Side effects = permanent memory loss• Relapse is common
Repetitive Transcranial Magnetic Stimulation (rTMS)
• Performed on wide awake patients
• Magnetic energy penetrates only person’s skull– Pulses used to stimulate or dampen activity in
various areas of the cerebral cortex• Stimulation energizes depressed patients relatively
inactive left frontal lobe
• Mixed results
Deep Brain Stimulation
Types of Psychotherapy
• Psychoanalytic…FREUD• Humanistic…ROGERS • Behavioral…JONES…WOLPE • Cognitive…ELLIS…BECK• Cognitive-Behavioral• Group & Family Therapy• Biomedical therapy
• What is the goal of each approach?
• What methods do they use to achieve those goals?
PsychoanalysisUnearth the past, unmask the
present~• analysis of the mind…• bring unconscious motivations into consciousness
– Past (unresolved) conflicts & frustrated urges– emotionally charged memories repressed
• How it influences thoughts, behaviors, & dynamics of relationships with others.
• Analyst seeks to reconstruct patient’s personality– Replace maladaptive behaviors– Enable him to deal more effectively in relationships
• The material of the unconscious mind needs to be brought in to the conscious mind so it no longer serves as a source of anxiety and confusion for the patient!
“To make the unconscious conscious”
• Childhood conflicts (residue from psychosexual stages)
• Free Association– “analysis of resistance”
• Insight– Dream Analysis ~ interpret latent content wishes,
feelings, conflicts– How impact current relationships?
– Transference– Counter Transference
• Catharsis (release energy divisions of mind)
• Brief psychodynamic therapy…direct questioning
Psychoanalytic: Projective test
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Psychoanalysis: Criticisms
1. Psychoanalysis is hard to refute because it cannot be proven or disproven.
2. Psychoanalysis takes a long time and is very expensive.
Concept check Psychoanalysis
• 1.) Sudden and dramatic outpouring of emotion that occurs when the trauma is resurrected.• Catharsis
• 2.) When the therapist develops feelings towards the patient.
– Counter transference
• 3.) direct questioning to reveal unconscious conflicts or actively provoke emotional reactions that lowers defenses.
– Brief psychodynamic therapy
Concept check psychoanalysis
• 4.) being aware of the source of the emotion. • insight
• 5.) clients projects emotion to the therapist.
– transference
Interpersonal Psychotherapy
• IPT– Help people gain insight into the roots of their
difficulties• Therapist focuses on current relationships• Help people improve their relationship skills
HUMANISM: Client-centered
• Inherent potential for self fulfillment
• Rogers (Rogerian therapy)– Nondirective
• genuineness • Unconditional positive regard (acceptance)• Empathic understanding (empathy)
– active listening• Paraphrase, invite clarification, reflect feelings
• If I understand you correctly…
• Goal: client reflects & deepens conscious thought– Self awareness– Self acceptance
Humanistic~empathic listening• 1. I wonder if I should help you get started talking?• 2. Why your indecisiveness? What could be its cause?• 3. It’s really hard for you to get started talking.• 4. What is meant by your focus on marriage and family?• 5. The crying and the dam sound as though there must be a great deal of repression.• 6. Decision making just seems impossible to you. • 7. You want marriage, but it doesn’t seem to you to be much of a possibility. • 8. You feel yourself brimming over with feelings reminiscent of your childhood. • 9. At some point, you will probably need to dig into those early unhappy
experiences.• 10. Being very nice to children has somehow had meaning for you.
• Eliza Site• http://www.cyberpsych.org/eliza/#.UXp7AKKceSo• http://www.youtube.com/watch?v=XpaOjMXyJGk
Behaviorism
Classical Conditioning• Counterconditioning
– Mary Cover Jones• Exposure therapy• Virtual reality exposure
• Video• http://www.youtube.com/watch?v=co7BWWoF-5I
• Systematic desensitization– Joseph Wolpe• Progressive relaxation
• Anxiety hierarchy
• visualization
– Aversive conditioning• Antabuse alcoholics
Operant conditioning
• Behavior modification• Token economy• Contingency management
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Systematic Desensitization
exposure therapy that associates a pleasant, relaxed state with gradually increasing anxiety-
triggering stimuli commonly used to treat phobias.
Steps of Systematic Desensitization…hierarchy example
For a fear of public speaking:
1. Seeing a picture of a person giving a speech2. Watching another person give a speech3. Preparing a speech to give4. Having to introduce oneself to a large group5. Waiting to be called upon to speak at a meeting.6. Being introduced as a speaker to a group7. Walking to the podium to make a speech8. Making a speech to a large group
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Aversive Conditioning (classical)
counterconditioning that associates an
unpleasant state with an unwanted
behavior.
With this technique, temporary conditioned
aversion to alcohol has been reported.
Cognitive• Remember cognitive bias?
– Confirmation bias– In-group bias– Anchoring bias
Cognitive Therapy
Albert Ellis
• Rational-Emotive Therapy• Change irrational beliefs• A = activating experience
• rejection
• B = Irrational beliefs• I must be loved
• C = Emotional consequences• Confused, hurt, assumes cause
Aaron Beck
• Unrealistic beliefs• Cognitive distortions• Awfulize• Catastrophisizing
Irrational ideas…lead to anxiety & hostility
• I must be loved & approved by everyone in my community, especially by those who are most important to me.
• I must be perfectly competent, adequate, &successful in achieving before I can think of myself as worthwhile.
• I have no control over my own happiness. My happiness is completely in the control of external circumstances.
• My past experiences & the events of by live have determined my present life & behavior. Therefore, the influence of the past cannot be eradicated.
• There is one right & perfect solution to each of my problems. If this is not found it will be devastating for me.
• Dangerous or fearsome things are causes for great concern. I must be prepared for the worst by constantly dwelling on & agonizing over the possible calamities.
• I should be dependent on others &must have someone stronger than myself on whom I can rely.
• If my life does not work out the way I had planned, it will really be terrible. • It is easier to avoid certain difficulties & responsibilities than to face them. • Some people are bad, wicked, villainous. They should be blamed & punished. • One should become upset over the problems & disturbances of other people.
“The Way I Think”1. I often worry that I _________. (fill in the blank)
2. If this worry of yours was indeed true, what does it mean to you & why does it bother you so much?
3. What's the worst thing that could possibly happen? What do you fear most of all?
4. When you think of the worst thing that could happen, do you really think that it's likely to happen? If so, how could you learn to cope with it?
5. What do you (perhaps "secretly") get out of thinking like this? How does it work to your advantage?
6. Persuade a friend…
7. Positive imagery anecdotes
8. I accept myself even though I ______ (do not use the word "am")
Eclectic Cognitive Behavioral
Therapist & client work together •to modify irrational self-talk•set attainable behavioral goals •develop realistic strategies for attaining them
Goal of CBTPeople change the way they approach problems & gradually
develop new skills & a high sense of self-efficacy.
Who Seeks Treatment?
• Women more than men
• Most common presenting problems– Anxiety and Depression
• 15% of U.S. population in a given year
• Medical insurance If you have it you are more likely to get treatment
• Education level If you have it you are more likely to get treatment
• Biggest reason not to get treatment? …Negative stigma surround mental health
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Commonalities Among Psychotherapies
Three commonalities shared by all forms of psychotherapies are the following:
1. A hope for demoralized people.
2. A new perspective.
3. An empathic, trusting and caring relationship.
© M
ary Kate D
enny/ PhotoE
dit, Inc.
Comparison of Psychotherapies
46
Evaluating PsychotherapiesWithin psychotherapies cognitive therapies are most widely used, followed by psychoanalytic and family/group therapies.
Group Therapy
• Group therapy is a form of psychotherapy in which a small, carefully selected group of individuals meets regularly with a therapist.
• The purpose of group therapy is to assist each individual in emotional growth and personal problem solving.
• All utilize the power of the group.• Group therapy offers multiple relationships to assist the
individual in growth and problem solving.
Family Therapy
• Help families deal with important issues that may interfere with the functioning of the family and the home environment.
• The goal of family therapy is to help family members improve communication, solve family problems, understand and handle special family situations (death, serious physical or mental illness, or child and adolescent issues), and create a better functioning home environment.
END of Chapter Review QUIZ
1. B 6. C 11. C
2. E 7. A 12. C
3. A 8. C 13. D
4. D 9. B 14. A
5. A 10. E 15. D
