Openstax Psychology Chapter 16

asylums

- institutions created for the specific purpose of housing people with psychological disorders

- focused on ostracizing them from society rather than treating their disorders

- kept in windowless dungeons, beaten, chained to their beds, had little to no contact with caregivers

- typically filthy, offered little treatment, kept people for decades

- submerging in cold baths for long periods of time, electroshock treatment (broke backs)

- electroconvulsive treatment is used but with safeguards and anesthesia - used to produce a generalized seizure

- always cold indoors

aversive conditioning

- counterconditioning technique that pairs an unpleasant stimulant with an

undesirable behavior

- uses unpleasant stimulus to stop an undesirable behavior

- apply to eliminate addictive behaviors (smoking, nail biting, drinking)

- clients engage in a behavior and at the same time are exposed to an unpleasant stimulus like a shock or bad taste (repeating these associations the client can then stop the unwanted behavior)

behavior therapy

- therapeutic orientation that employs principles of learning to help clients change undesirable behaviors, rather than digging into one's unconscious

- principles of learning applied to change undesirable behaviors

- patient learns to overcome fear of elevators through several stages of relaxation techniques

- believe that dysfunctional behaviors (bed wetting) can be changed by teaching clients new and more constructive behaviors (involves classical and operant conditioning)

biomedical therapy

- treatment that involves medication and/or medical procedures to treat psychological disorders (not cure them)

- psychotropic medications are prescribed by medical doctors, including psychiatrists

- depressed: antidepressant

- bipolar: mood stabilizer

- schizophrenic: antipsychotic

cognitive therapy

- form of psychotherapy that focuses on how a person's thoughts lead to feelings of distress, with the aim of helping them change these irrational thoughts

- awareness of cognitive process helps patients eliminate thought patterns that lead to distress

- patient learns not to overgeneralize failure based on single failure

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cognitive-behavioral therapy

- form of psychotherapy that aims to change cognitive distortions and self- defeating behaviors

- work to change cognitive distortions and self-defeating behaviors

- helps clients examine how their thoughts affect their behavior

- attempts to make individuals aware of their irrational and negative thoughts and helps people replace then with new/positive ways of thinking

- uses ABC model

- examines specific maladaptive and automatic thoughts and cognitive distortions (all or nothing thinking, overgeneralization, jumping to conclusions)

comorbid disorder

- individual who has two or more diagnoses, which often includes a substance abuse diagnosis and another psychiatric diagnosis, such as depression, bipolar disorder, or schizophrenia

- fall into a category of mentally ill/chemically addicted as their problems are often chronic and expensive to treat with limited success

- behavior therapies along with psychotropic medications are used along with psychotherapy

confidentiality

- therapist cannot disclose confidential communications to any third party, unless mandated or permitted by law

counterconditioning

- classical conditioning therapeutic technique in which a client learns a new response to a stimulus that has previously elicited an undesirable behavior

- when a client learns a new response to a stimulus that has previously elicited an undesirable behavior

couples therapy

- two people in an intimate relationship, such as husband and wife, who are having difficulties and are trying to resolve them with therapy

- helps them to see how their individual backgrounds, beliefs, and actions are affecting their relationship

- helps resolve the issues, implement strategies that will lead to a healthier and happier relationship (how to listen, how to argue, how to express feelings)

- people go to work out their problems, or to determine whether staying together is the best solution

cultural competence

- therapist's understanding and attention to issues of race, culture, and ethnicity in providing treatment

- must also develop strategies to effectively address the needs of various populations for which Eurocentric therapies have limited application

- Ex. counselor whose treatment focuses on individual decision making may be ineffective at helping a Chinese client with a collectivist approach to problem solving

deinstitutionalization

- process of closing large asylums and integrating people back into the community where they can be treated locally

- part of what occurred was that those released were supposed to go to newly created centers, but the system was not effectively set up (underfunded, staff wasn't correctly trained, high staff burnout

- often ended up homeless

- there are psychiatric hospitals run by state governments and local community hospitals focused on short-term care (insurance coverage limits the time a person can be hospitalized for treatment)

- most suffering from mental illnesses are not even hospitalized

dream analysis

- technique in psychoanalysis in which patients recall their dreams and the psychoanalyst interprets them to reveal unconscious desires or struggles

electroconvulsive therapy (ECT)

- type of biomedical therapy that involves using an electrical current to induce seizures in a person to help alleviate the effects of severe depression

- the memory loss associated with repeated sessions has led to this being a last resort option

exposure therapy

- counterconditioning technique in which a therapist seeks to treat a client's fear or anxiety by presenting the feared object or situation with the idea that the person will eventually get used to it

- via reality, imagination, virtual reality

- first reported by Mary Cover Jones

- Joseph Wolpe refined Jones' techniques

family therapy

- special form of group therapy consisting of one or more families

-family is viewed as an organized system and each individual is a contributing member who creates and maintains processes within the system that shape behavior

- each member of the family is influenced and influences each other

- the goal is to enhance the growth of each family member as well as the family as a whole

free association

- technique in psychoanalysis in which the patient says whatever comes to mind at the

moment

- patient relaxes and says whatever comes to mind at the moment (Freud felt that the ego would try to block/repress unacceptable urges or painful conflicts

- the patient would demonstrate resistance to recalling these thoughts/situations

group therapy

- treatment modality in which 5-10 people with the same issue or concern meet together with a trained clinician

- can help decrease a client's shame/isolation about a problem when offering needed support, both form therapist/other members of the group (you're not alone type of deal)

- can confront each other about their patterns

- entire group could reflect on an individual's problems or difficulties and others might disclose what they have done in that situation

- the focus is to make sure everyone benefits and participates in the group and that no one person is the focus of the entire session

- some sessions could have a theme, be time-limited, open membership, or closed

- no specific plan; the group themselves will decide how the group will spend its time and on what goals it will focus

- there are limitations: afraid to speak in front of others, confidentiality issues, complete strangers being stressful/overwhelming, personality clashes

humanistic therapy

- therapeutic orientation aimed at helping people become more self-aware and accepting of themselves

- increase self-awareness and acceptance through focus on conscious thoughts

- patient learns to articulate thought that keep her from achieving her goals

- focuses on helping people achieve their potential

individual therapy

- treatment modality in which the client and clinician meet one-on-one usually for 45 minutes to 1 hour

- occur weekly/every other week

- work with clients to help explore feelings, work through life challenges, and identify aspects of themselves and their lives that they wish to change, and set goals to help them work towards these changes

intake

- therapist's first meeting with the client in which the therapist gathers specific information to

address the client's immediate needs

involuntary treatment

- therapy that is mandated by the courts or other systems

- therapy that is not the individual's choice

nondirective therapy

- therapeutic approach in which the therapist does not give advice or provide interpretations but helps the person identify conflicts and understand feelings

play therapy

- therapeutic process, often used with children, that employs toys to help them resolve psychological problems

- psychoanalytical therapy wherein interaction with toys is used instead of talk; used in child therapy

- patient (child) acts out family scenes with dolls

- therapist observes how the child plays with the toys in an effort to understand the roots of the child's disturbed behavior

- can be directive/non directive

psychoanalysis

- developed by Sigmund Freud; believed that most of our psychological problems are the result of repressed impulses and trauma experienced in childhood

- believed that this would help uncover long-buried feelings

- employs free association, dream analysis, and transference to uncover repressed feelings

- first form of psychotherapy

- dominant therapeutic technique in the 20th century

- therapists help their patients look into their past to uncover repressed feelings

psychotherapy

- (also, psychodynamic psychotherapy) psychological treatment that employs various methods to help someone overcome personal problems, or to attain personal growth

- has evolved into what is known as psychodynamic therapy

rational emotive therapy (RET)

- form of cognitive-behavioral therapy

- founded by Albert Ellis

relapse

- repeated drug use and/or alcohol use after a period of improvement from substance abuse

Rogerian (client-centered therapy)

- non-directive form of humanistic psychotherapy developed by Carl Rogers that emphasizes unconditional positive regard and self-acceptance

- Rogers emphasized the importance of the person taking control of his own life to overcome life's challenges

strategic family therapy

- therapist guides the therapy sessions and develops treatment plans for each family member for specific problems that can addressed in a short amount of time

- therapist would guide what happens in the therapy session and design a detailed approach to resolving each member's problem

structural family therapy

- therapist examines and discusses with the family the boundaries and structure of the family: who makes the rules, who sleeps in the bed with whom, how decisions are made, and what are the boundaries within the family

- helps resolve issues and communicate more effectively

systematic desensitization

- form of exposure therapy used to treat phobias and anxiety disorders by exposing a person to the feared object or situation through a stimulus hierarchy

- wherein a calm/pleasant state, is gradually associated with increasing levels of anxiety-induced stimuli

- the idea is that you can't be nervous and relaxed at the same time, so you can learn to relax when faced with environmental stimuli that make one nervous/fearful

- eventually you can eliminate your unwanted fear response

token economy

- involves a controlled setting where individuals are reinforced for desirable behaviors with tokens (e.g., poker chip) that be exchanged for items or privileges

- often used in psychiatric hospitals to increase patient cooperation and activity levels

transference

- process in psychoanalysis in which the patient transfers all of the positive or negative emotions associated with the patient's other relationships to the psychoanalyst

- Ex. girl goes to therapy, over years she sees the therapist as a father figure, transfers feelings about father onto therapist perhaps in an effort to gain the love and attention she did not receive from her own father

unconditional positive regard

- fundamental acceptance of a person regardless of what they say or do; term associated with humanistic psychology

- involves not judging clients and simply accepting them for who they are

virtual reality exposure therapy

- uses a simulation rather than the actual feared object or situation to help people conquer their fears

- used to effectively treat anxiety disorders such as public speaking, claustrophobia, aviophobia, and post-traumatic stress disorder

voluntary treatment

- therapy that a person chooses to attend in order to obtain relief from her symptoms

Treatment in the past

- was believed that mental illness was caused by demonic possession, witchcraft, or an angry god

- exorcism was treatment, prayers (etc.), medicinal drinks

- trephining (small hole in skull to release spirit from body, most died)

- execution/imprisonment

- many mentally ill people were killed from being accused for being a witch, etc.

Philippe Pinel

- argued for more humane treatment of the mentally ill

- suggested they be unchained/talked to

Dorothea Dix

- led reform efforts for mental health care in the U.S.

- investigated how those who are mentally ill/poor were cared for

- discovered an underfunded/unregulated system that perpetuated abuse of this population

- efforts to lobby various state legislatures and the U.S. congress for change led to the creation of the first mental asylums in the U.S.

Where can psychological treatment occur?

- community mental health centers

- private practitioner/community practice

- school counselors/psychologists, social worker

- group therapy in prison

- there are clinical social workers, marriage and family therapists, and even trained religious personnel who perform counseling/therapy

What about funding sources for mental health treatment?

- health insurance, government, and private pay

- past: even when people had health insurance, the coverage would not always pay for mental health services

- this changed: eventually was required of group health plans and insurers to make sure there is parity of mental health services (co-pays, total number of visits, deductibles for mental health and substance abuse treatment need to be equal to and cannot be more restrictive or harsher than those for physical illnesses/medical and surgical problems

What is the goal of therapy?

- it is to help a person stop repeating and reenacting destructive patterns and to start looking for better solutions to difficult situations

psychodynamic psychotherapy

- talk therapy based on belief that the unconscious and childhood conflicts impact behavior

- patient talks about past

psychoanalytical perspective

- remains centered on the role of people's internal drives and forces

- treatment is less intensive than Freud's original model

non directive play therapy

- children are encouraged to work through their problems by playing freely while the therapist observes

directive play therapy

- the therapist provides more structure and guidance in the play session by suggesting topics, asking questions, and even playing with the child

What is Antabuse?

- a chemically based substance that inflicts uncomfortable side effects such as nausea, vomiting, increased heart rate, heart palps., severe headaches and shortness of breath when combined with alcohol

Mary Cover Jones

- considered the mother of behavior therapy

- worked with a boy named Peter who was afraid of rabbits

- wanted to replace fear with conditioned response of relaxation

- placed a caged rabbit on the other side of a room while Peter ate his after school snack

- over the course of a few days, the cage moved closer

- once two months passed, Peter was eventually able to hold the rabbit and pet it while eating

Joseph Wolpe

- gave us the behavior therapy technique of exposure therapy that is used today

applied behavior analysis

- include operant conditioning techniques that are designed to reinforce positive behaviors and punish unwanted behaviors

- child-specific reinforcers (stickers, bubbles, etc.) are used to reward and motivate the autistic children when they demonstrate desired behaviors (sitting when requested, speaking a greeting)

- punishment like a timeout or a sharp no might be used to discourage undesirable behaviors like pinching, scratching, and pulling hair

What is the ABC Model?

- Action: (activating event)

- Belief: (about the event)

- Consequences (of this belief)

Client-centered therapy

- therapist uses the technique of active listening where the therapist acknowledges, restates, and clarifies what the client expresses

According to the American Psychological Association, what are the 3 factors that work together to produce successful treatment?

- 1: use of evidence based treatment that is deemed appropriate for your particular issue

- 2: the clinical expertise of the psychologist or therapist

- 3: your own characteristics, values, preferences, and culture

antipsychotics

- schizophrenia/thought disorders

- haldol, mellaril, prolixin, thorazine

- treat positive psychotic symptoms; visual hallucinations, delusions, paranoid (blocks neurotransmitter dopamine)

- long term use can lead to tardive dyskinesia, involuntary movement of arms, legs, tongue, face muscles (Parkinson's like tremors)

atypical antipsychotics

- schizo/thought disorders

- abilify, risperdal, clozaril

- treat negative symptoms; withdrawal, apathy, target dopamine and serotonin receptors

- can increase risk of obesity/diabetes and elevate cholesterol levels, constipation, dry mouth, blurred vision, drowsiness, dizziness

anti-depressants

- depression/increasingly for anxiety

- paxil, prozac, zoloft, SSRIs, tofranil, elavil

- alter levels of neurotransmitters such as serotonin and norepinephrine

- give headaches, nausea, weight gain, drowsiness, reduced sex drive, dry mouth, constipation, etc.

anti-anxiety agents

- anxiety, OCD agitation, PTSD, panic disorder, social phobia

- xanax, valium, ativan

- depress central nervous system activity

- drowsiness, dizziness, headaches, fatigue, lightheadedness

mood stabilizers

- bipolar disorder

- lithium, depakote, lamictal, tegretol

- treat episodes of mania/depression

- excessive thirst, irregular heartbeat, itching/rash, swelling, nausea, loss of appetite

stimulants

- ADHD

- adderall, ritalin

- improve ability to focus on a task and maintain attention

- decreased appetite, difficulty sleeping, stomachache, headache

trans-cranial magnetic stimulation

- uses magnetic fields to stimulate nerve cells int he brain to improve depression symptoms

- used when other treatments have not worked

addiction

- viewed as a chronic disease

- the choice to use a substance is voluntary, but because chronic substance use can permanently alter the neural structure in the prefrontal cortex (associated with decision making/judgment), a person becomes driven to use drugs/alcohol

sociocultural perspective

- looks at you, your behaviors, your symptoms in the context of your culture and background

multicultural counseling

- aims to offer a helping role and process that uses modalities and defines goals consistent with the life experience and cultural values of clients

- strives to recognize client identities to include individual, group, and universal dimensions, advocate the use of universal/culture specific strategies and roles in the healing process, and balances the importance of individualism and collectivism in the assessment/diagnosis, and treatment of client/client systems

therapeutic perspective

- integrates the impact of cultural/social norms, starting at the beginning of treatment

- obtain and integrated information about thei cultural patterns into a unique treatment approach based on their particular situation