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Psychological Therapies Chapter 16 Copyright 2007 Horizon Textbook Publishing This multimedia product and its contents are protected under copyright law. The following are prohibited by law: Any public performance or display, including transmission of any image over a network; Preparation of any derivative work, including the extraction, in whole or in part, of any images; Any rental, lease, or lending of the program Slide authors: Larry D. Thomas Landon O. Thomas Book authors: R.H. Ettinger

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Copyright 2007 Horizon Textbook Publishing All rights reserved Insight Therapies Insight therapies Any type of psychotherapy based n the notion that psychological well-being depends on self- understanding Psychodynamic therapies Therapies that attempt to uncover childhood experiences that explain a patients current difficulties Psychoanalysis Freuds method of psychotherapy; uses free association, dream analysis, and transference

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Copyright 2007 Horizon Textbook Publishing All rights reserved Insight Therapies Psychodynamic therapies (continued) Free association A psychoanalytic technique used to explore the unconscious by having patients reveal whatever thoughts or images come to mind The analyst pieces together the free-flowing associations, explains their meaning, and helps patients gain insight into the thoughts and behavior that are troubling them Dream analysis is another technique used by psychoanalysts

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Copyright 2007 Horizon Textbook Publishing All rights reserved Insight Therapies Psychodynamic therapies (continued) Transference An intense emotional reaction during psychoanalysis, when the patient displays feelings and attitudes toward the analyst that were present in a significant relationship in the past Many therapists today practice brief psychodynamic therapy in which the therapist and patient decide on the issues to explore at the outset rather than waiting for them to emerge in the course of treatment

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Copyright 2007 Horizon Textbook Publishing All rights reserved Insight Therapies Psychodynamic therapies (continued) Crits-Christoph Found brief psychodynamic therapy to be as effective as other psychotherapies Humanistic therapies Therapies that assume that people have the ability and freedom to lead rational lives and make rational choices Person-centered therapy A nondirective, humanistic therapy in which the therapist creates a warm, accepting climate, freeing clients to be themselves and releasing their natural tendency toward positive growth

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Copyright 2007 Horizon Textbook Publishing All rights reserved Insight Therapies Humanistic therapies (continued) Person-centered therapy (continued) Developed by Carl Rogers According to this view, people are innately good and if allowed to develop naturally, they will grow toward self- actualization-the realization of their inner potential Nondirective therapy An approach in which the therapist acts to facilitate growth, giving understanding and support rather than proposing solutions, answering questions, or actively directing the course of therapy

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Copyright 2007 Horizon Textbook Publishing All rights reserved Insight Therapies Gestalt therapy A therapy that was originated by Fritz Perls and that emphasizes that importance of clients fully experiencing, in the present moment, their feelings, thoughts, and actions and taking personal responsibility for their behavior The goal of Gestalt therapy is to help clients achieve a more integrated self and become more authentic and self-accepting

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Copyright 2007 Horizon Textbook Publishing All rights reserved Insight Therapies Gestalt therapy (continued) Directive therapy An approach to therapy in which the therapist takes an active role in determining the course of therapy sessions and provides answers and suggestions to the patient

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Copyright 2007 Horizon Textbook Publishing All rights reserved Relationship Therapies Therapies that attempt to improve patients interpersonal relationships or create relationships in order to provide them with support Interpersonal therapy (IPT) A brief psychotherapy designed to help depressed people better understand and cope with problems relating to their interpersonal relationships

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Copyright 2007 Horizon Textbook Publishing All rights reserved Relationship Therapies Interpersonal therapy (continued) IPT is designed specifically to help patients cope with four types of problems commonly associated with major depression: 1.Unusual or severe responses to the death of a loved one 2.Interpersonal role disputes 3.Difficulty in adjusting to role transitions such as divorce, career change, and retirement 4.Deficits in interpersonal skills

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Copyright 2007 Horizon Textbook Publishing All rights reserved Relationship Therapies Couple and family therapy Family therapy Therapy involving an entire family, based on the assumption that an individuals problem is caused and/or maintained in part by problems within the family unit Couple or family therapy appears to have positive effects in treating a number of disorders and clinical problems Couples therapy can be helpful in the treatment of sexual dysfunctions

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Copyright 2007 Horizon Textbook Publishing All rights reserved Relationship Therapies Group therapy A form of therapy in which several clients meet regularly with one or more therapists to resolve personal problems Learning that others also chare their problems leaves people feeling less alone and ashamed A variant of group therapy is the self-help group Self-help groups usually are not led by professional therapists They are simply groups of people who share a common problem and meet to give and receive support

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Copyright 2007 Horizon Textbook Publishing All rights reserved Behavior Therapies A treatment approach employing the principles of operant conditioning, classical conditioning, and/or observational learning theory to eliminate inappropriate or maladaptive behaviors and replace them with more adaptive responses Behavior modification The systematic application of learning principles to help a person eliminate undesirable behaviors and/or acquire more adaptive behaviors; also called behavior therapy

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Copyright 2007 Horizon Textbook Publishing All rights reserved Behavior Therapies Behavior modification techniques based on operant conditioning Extinction of an undesirable behavior is accomplished by terminating, or withholding, the reinforcement that is maintaining that behavior Token economies A behavior modification technique that reinforces desirable behaviors with tokens that can be exchanged later for desired objects, activities, and/or privileges For decades mental hospitals have successfully used token economies with chronic schizophrenics to improve their self-care skills and social interaction

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Copyright 2007 Horizon Textbook Publishing All rights reserved Behavior Therapies Behavior modification techniques based on operant conditioning (continued) Time out A behavior modification technique used to decrease the frequency of undesirable behavior by withdrawing an individual from all reinforcement for a period of time Monetary reinforcement has been found to be as effective as nicotine patches for the reduction of smoking among them If you want to modify any of your behaviors, devise a reward system for desirable behaviors, and remember the principles of shaping

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Copyright 2007 Horizon Textbook Publishing All rights reserved Behavior Therapies Therapies based on classical conditioning Joseph Wolpe Reasoned that if he could get people to relax and stay relaxed while they thought about a feared object, person, place, or situation, they could conquer their fear or phobia Systematic desensitization A behavior therapy that is used to treat phobias and that involves training clients in deep muscle relaxation and then having them confront a graduated series of anxiety-producing situations until they can remain relaxed while confronting even the most feared situation

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Copyright 2007 Horizon Textbook Publishing All rights reserved Behavior Therapies Causes of mood disorders (continued) Flooding A behavioral therapy used to treat phobias, during which clients are exposed to the feared object or event for an extended period until their anxiety decreases Flooding sessions typically last from 30 minutes to 2 hours and should not be terminated until patients are markedly less afraid than they were at the beginning of the session In vivo flooding, the real-life experience, works faster and is more effective tan simply imagining the feared object

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Copyright 2007 Horizon Textbook Publishing All rights reserved Behavior Therapies Exposure and response prevention A behavior therapy that exposes patients with obsessive compulsive disorder to stimuli generating increasing anxiety; patients must agree not to carry out their normal rituals for a specified period of time after exposure Patients treated with exposure are less likely to relapse after treatment than those treated with drugs alone Exposure and resistance therapy has proved useful in the treatment of posttraumatic stress disorder

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Copyright 2007 Horizon Textbook Publishing All rights reserved Behavior Therapies Aversion therapy A behavior therapy in which an aversive stimulus is paired with an undesirable behavior until the behavior becomes associated with pain and discomfort Alcoholics are sometimes given a nausea-producing substance such as Antibes, which reacts violently with alcohol and causes a person to retch and vomit until the stomach is empty

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Copyright 2007 Horizon Textbook Publishing All rights reserved Behavior Therapies Participant modeling A behavior therapy in which an appropriate response is modeled in graduated steps and the client attempts each step, encouraged and supported by the therapist In this therapy, not only does the model demonstrate the appropriate response in graduated steps, but the client attempts to imitate the model step by step, while the therapist gives encouragement and support

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Copyright 2007 Horizon Textbook Publishing All rights reserved Cognitive Therapies Cognitive therapies Therapies that assume faulty thinking is the basis of most psychological difficulties Cognitive therapies are also often referred to as cognitive-behavioral approaches because they combine the insights into behavior provided by cognitive psychology with the methodological approaches of behaviorism

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Copyright 2007 Horizon Textbook Publishing All rights reserved Cognitive Therapies Rational-emotive therapy A directive, confrontational therapy developed by Albert Ellis and designed to challenge and modify the irrational beliefs thought to cause personal distress Rational-emotive therapy is based on Elliss ABC theory A refers to the activating event, B to the persons belief about the event C to the emotional consequence that follows

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Copyright 2007 Horizon Textbook Publishing All rights reserved Use what you have learned about Albert Elliss rational- emotive therapy to identify-and perhaps even eliminate-an irrational belief that you hold about yourself. First, identify an irrational belief, preferably one that causes some stress in you life. For example, maybe you feel that you must earn all As in order to think of yourself as a good person Ask yourself the following questions, and write down your answers in as much detail as possible. Where does this belief come from? Can you identify the time in your life when it began? Why do you think this belief is true? What evidence can you think of that proves your belief? Can you think of any evidence to suggest that this belief is false? What evidence contradicts your belief? Do you know anyone who does not cling to this belief? How does holding this belief affect your life, both negatively and positively? How would you life be different if you stopped holding this belief? What would you do differently? Copyright 2004 Allyn & Bacon All rights reserved

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Copyright 2007 Horizon Textbook Publishing All rights reserved Cognitive Therapies Cognitive therapy Aaron T. Beck Claims that much of the misery endured by a depressed and anxious person can be traced to automatic thoughts- unreasonable but unquestioned ideas that rule the persons life Cognitive therapy A therapy designed to change maladaptive behavior by changing the persons irrational thoughts, beliefs, and ideas The goal of Becks cognitive therapy is to help patients stop their negative thoughts ass they occur and replace them with more objective thoughts

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Copyright 2007 Horizon Textbook Publishing All rights reserved Cognitive Therapies Cognitive therapy (continued) Cognitive therapy is brief, usually lasting only 10 to 20 sessions Cognitive therapy teaches patients to change the catastrophic interpretations of their symptoms and thereby prevent the symptoms from escalating into panic Cognitive therapy has proved effective for generalized anxiety disorder

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Copyright 2007 Horizon Textbook Publishing All rights reserved Cognitive Therapies

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Copyright 2007 Horizon Textbook Publishing All rights reserved Biological Therapies Biological Therapy A therapy that is based on the assumption that most mental disorders have physical causes Drug therapy Antipsychotic drugs Drugs used to control severe psychotic symptoms, such as the delusions and hallucinations of schizophrenics; also known as neuroleptics or major tranquilizers The long-term use of typical antipsychotic drugs carries a high risk of the most severe side effect tardive dyskinesia almost continual twitching and jerking movements of the face and tongue, and squirming movements of the hands and trunk

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Copyright 2007 Horizon Textbook Publishing All rights reserved Biological Therapies Drug therapy (continued) Antipsychotics (continued) Newer antipsychotic drugs called atypical neuroleptics can treat not only the positive symptoms of schizophrenia but the negative symptoms as well, leading to marked improvement in patients quality of life Antidepressants Drugs that are prescribed to treat depression and some anxiety disorders EEG studies have documented neurological changes in patients who receive placebos that, while different from those in patients receiving real drugs, are associated with improvements in mood

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Copyright 2007 Horizon Textbook Publishing All rights reserved Biological Therapies Drug therapy (continued) Antidepressants (continued) The first generation of antidepressants are known as the tricyclics The tricyclics work against depression by blocking the reuptake of norepinephrine and serotonin into the axon terminals, thus enhancing the action of these neurotransmitters in the synapses The second-generation antidepressants, the selective serotonin reuptake inhibitors (SSRIs), block the reuptake of the neurotransmitter serotonin, increasing its availability at the synapses in the brain SSRIs have fewer side effects and are safer in overdose than tricyclics

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Copyright 2007 Horizon Textbook Publishing All rights reserved Biological Therapies Drug therapy (continued) Antidepressants (continued) Another line of treatment for depression is the monoamine oxidase (MAO) inhibitors By blocking the action of an enzyme that breaks down norepinephrine and serotonin in the synapses, MAO inhibitors increase the availability of norepinephrine and serotonin Lithium and divalproex Lithium A drug used in bipolar disorder to control the symptoms in a manic episode and to even out the mood swings and reduce recurrence of future manic r depressive states

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Copyright 2007 Horizon Textbook Publishing All rights reserved Biological Therapies Drug therapy (continued) Lithium and divalproex (continued) Lithium (continued) Considered a wonder drug for 40-50% of patients suffering from bipolar disorder A proper maintenance dose of lithium yields reductions in depressive episodes as well as manic ones Recent research suggests that anticonvulsant drugs, such as Depakote, may be just as effective for managing bipolar symptoms as lithium with fewer side effects

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Copyright 2007 Horizon Textbook Publishing All rights reserved Biological Therapies Drug therapy (continued) Tranquilizers The family of minor tranquilizers called benzodiazepines includes, among others, the well-known drugs sold as Valium and Librium and the newer high-potency drug Xanax Used primarily to treat anxiety, benzodiazepines are prescribed more often than any other class of psychoactive drugs They have been found to be an effective treatment for panic disorder and generalized anxiety disorder

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Copyright 2007 Horizon Textbook Publishing All rights reserved Biological Therapies Drug therapy (continued) Tranquilizers (continued) Xanax, the largest selling psychiatric drug, appears to be particularly effective in relieving anxiety and depression Xanax is effective in the treatment of panic disorder, and it works faster and has fewer side effects than antidepressants If patients discontinue treatment, relapse is likely Many patients, once they are panic-free, find themselves unable to discontinue the drug because they experience moderate to intense withdrawal symptoms, including intense anxiety Valium seems to be just as effective as Xanax for treating panic disorder, and withdrawal is easier

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Copyright 2007 Horizon Textbook Publishing All rights reserved Biological Therapies Drug therapy (continued) Disadvantages of drug therapy Its important to not that drugs do not cure psychological disorders, so patients usually experience a relapse if they stop taking the drugs when their symptoms lift Maintenance doses of antidepressants following a major depression reduce the probability of recurrences

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Copyright 2007 Horizon Textbook Publishing All rights reserved Biological Therapies Electroconvulsive Therapy (ECT) A treatment in which an electric current is passed through the brain, causing a seizure; usually reserved for severely depressed patients who are either suicidal or unresponsive to other treatment For many years, ECT involved passing an electric current through both cerebral hemispheres, a procedure known as bilateral ETC Today electric current is administered to the right hemisphere only, and the procedure is called unilateral ETC

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Copyright 2007 Horizon Textbook Publishing All rights reserved Biological Therapies Electroconvulsive Therapy (continued) Rapid transcranial magnetic stimulation Performed on patients who are not sedated; it causes no seizures, no memory lose, and has no known side effects Psychosurgery Brain surgery to treat some severe, persistent, and debilitating psychological disorder or severe chronic pain

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Copyright 2007 Horizon Textbook Publishing All rights reserved Biological Therapies Psychosurgery (continued) Egas Moniz Developed the first experimental brain surgery for human patients to treat severe phobias, anxiety, and obsessions His technique, the lobotomy, surgeons severed the neural connections between the frontal lobes and the deeper brain centers involved in emotion Eventually it became apparent that this treatment left patients in a severely deteriorated condition Modern psychosurgery procedures result in less intellectual impairment

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Copyright 2007 Horizon Textbook Publishing All rights reserved Biological Therapies Psychosurgery (continued) Cingulotomy Electrodes are used to destroy the cingulum, a small bundle of nerves connecting the cortex to the emotional centers of the brain Several procedures have been helpful for some extreme cases of obsessive compulsive disorder

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Copyright 2007 Horizon Textbook Publishing All rights reserved Evaluating the Therapies Smith, Glass, and Miller Reanalyzed the results of 475 studies, which involved 25,000 patients Revealed that psychotherapy was better than no treatment, but no one type of therapy was more effective than another Hans Eysenck Showed a slight advantage for behavioral therapies over other types

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Copyright 2007 Horizon Textbook Publishing All rights reserved Evaluating the Therapies Holloa, These, and Marches Found an advantage for cognitive and interpersonal therapies over psychodynamic approaches for depressed patients Regardless of training or theoretical orientation, all therapists are bound by ethical standards established by professional organizations and, in most cases, codified in state laws

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Copyright 2007 Horizon Textbook Publishing All rights reserved Evaluating the Therapies Informed consent Therapists must inform clients of the cost and expected duration of therapy prior to beginning any actual interventions Clients must be informed of the legal limits of confidentiality Therapists are forbidden to engage in any kind of intimate relationships with clients or with other who are close to them Therapists are ethically obligated to use tests that are reliable and valid

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Copyright 2007 Horizon Textbook Publishing All rights reserved Culturally Sensitive and Gender- sensitive Therapy Culturally sensitive therapy Kleinman and Cohen Believes that people experience and suffer from psychological disorders within a cultural context that may dramatically affect the meaning of symptoms, outcomes, and responses to therapy Therapeutic alliance The bond between therapist and client that is known to be a factor in the effectiveness of psychotherapy Culturally sensitive psychotherapy An approach to therapy that considers cultural variables in the diagnosis and treatment of psychological disorders

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Copyright 2007 Horizon Textbook Publishing All rights reserved Culturally Sensitive and Gender- sensitive Therapy Culturally sensitive therapy (continued) Culturally sensitive therapists recognize the language differences between therapists and patients can pose problems Culturally sensitive therapists also attempt to address group differences that can affect the results of therapy Gender-sensitive therapy An approach to therapy that takes into account the effects of gender on both the therapists and the patients behavior

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Copyright 2007 Horizon Textbook Publishing All rights reserved Culturally Sensitive and Gender- sensitive Therapy Gender-sensitive therapy (continued) Advocates of gender-sensitive therapy point out that knowledge of real sex differences is important to the practice of gender-sensitive therapy