PSYCH 101 Chap 16: Therapy

Psychotherapy

Psychotherapy

treatment of psychological problems through psychological techniques

over 500 types

placebo effect

nonspecific improvement as a result of a person’s expectations of change

double-blind technique

the researcher doesn’t know which group has the placebo

demand characteristics

characteristics in environment that may cue a participant to what’s going on

Hans Eysenck

claimed that psychotherapy produced no greater change in maladjustment than natural life experiences

but he took findings across all disorders (systematic research) → problem because some therapies not effective for some disorders
ex. psychoanalysis not appropriate for schizophrenia

eclectic approach

integrating diverse theories and techniques, taking pieces that are evidence based

ex. exercise is good + cognitive therapy with intervention, these come together, but also have own good factors

Client Common Factors

• expect positive outcome

  • exceptions: people with schizophrenia may not because they think those people are against them (no insight so delusions of persecution), teenagers with personal fable, forced into it

• receive attention, which helps maintain positive attitude

• must be willing to make a change

Therapist Common Factors

(CCRMM)

• communicate interest, understanding, respect, tact, maturity, ability to help

• competency in the area

• respect client’s ability to cope

• make suggestions, offer encouragement, provide alternate interpretations and salient examples

• must not engage in other relationships with the client

Rapport - interact well with you via all these things

• must respect multiculturalism and recognize that culture is a powerful influencer of behaviour

Brief Therapy

planned short-term (1-2 sessions)

operational diagnosis: “why is the client here today?”

establish precise goals for the therapy

Psychodynamic Therapy

Freud = insight therapy

2 basic assumptions:

1. becoming aware of one’s motivation helps to change

2. the causes of maladjustment are unresolved unconscious conflicts

• Psychoanalysis

• Neo-Freudian based therapies

Psychoanalysis

developed by Freud, lengthy insight therapy that aims at uncovering unconscious conflicts and using techniques like free association and dream analysis

Goals: address unresolved conflicts then change of behaviour persists

**Primary Components: (F DIRT)

1. Free Association - talk about whatever comes to mind, not directed in any way, unconscious things might then come out, ex. Rorschach inkblot test

2. Dream Analysis - express any dreams, talk about in detail, not with a lot of interpretation at this point, unresolved unconscious things may come out

3. Interpretation - therapist + client provide context, explanation, meaning of some of these things coming out in preconscious

4. Resistance - may resist providing explanation/interpretation, client not working to do this

5. Transference - transfer feelings of love + safety onto therapist, client may think they’re developing real feelings, but really just safe place to share those feelings

6. Working Through - cycle of interpretation, resistance, and transference occurs repeatedly

Neo-Freudian based therapies

use techniques derived from Freud, reject or modify parts of his theory

concerned with conscious aspects of client’s functioning, more optimistic towards functioning, emphasize needs for power, love, status (not just sex + aggression)

Criticisms of Psychoanalysis

• unscientific, imprecise, subjective

• hard to evaluate

• research based on women

• expensive in time + cost (about $200/h, but multiple times a week for years)

• not effective for CBT (Cognitive-Behavioural Treatment)

• have to have certain level of intellectual functioning

Humanistic Therapy

Carl Rogers, Abraham Maslow (hierarchy of needs)

emphasizes development of human potential (people want to be the best they can be), belief that human nature is basically positive, importance of assuming responsibility and living in the present (not blame unconscious, think about the role we play)

not typically for mental health issues, ex. schizophrenia, acute mental health issues

Client/Person-Centred Therapy

(Humanistic)

developed by Carl Rogers

insight therapy that helps people evaluate/gain insight to the world and themselves from their own perspective, when can’t reach full potential, can lead to mental health issues

therapist guides, discover ideal selves, ask lots of questions

therapist must show: (CUE)

• unconditional positive regard - accepting of who the client is right now, shows positive interaction even if they don’t agree

• congruence - therapist themselves must be aware of things that might bias them towards their clients, should be neutral

• empathetic listening - show client that they understand that the client is feeling that way, even if they haven’t felt that way themselves, often paraphrasing what the client tells them

tries to increase awareness and heightened self acceptance, hopes to: (RAT)

1. think more realistically - ex. feel less guilt

2. become more tolerant of others

3. engage in more adaptive behaviours - ex. more productive behaviours

Pos/Neg of Client/Person-Centred Therapy

positives:
- focus on therapeutic relationship

negatives:
- core concepts are difficult to falsity
- not enough to bring about change
- more effective than no treatment, but mixed results compared to other therapies

Behaviour Therapy

quick, relatively unexpensive, effective for problem behaviour

focus on what person is doing right now, help replace maladaptive behaviours with effective ones

operant conditioning to establish a new behaviour often depends on a reinforcer, an event or circumstance that increases the probability a response will occur, ex. want to clean room, allowance, positive reinforcement

token economies, extinction, punishment, time out

Token Economies

(Behaviour Therapy)

reward adaptive behaviour: people who display appropriate behaviours receive “tokens”, use tokens to buy or trade in for items

often seen in classrooms, want behaviour to continue, similar to allowance

Extinction

(Behaviour Therapy)

if you don’t reinforce behvaiour or don’t pay attention to it, eventually the behaviour will go away/into extinction

ex. babies cry and their parents come, so as they get older, pull back time going into room and they’ll learn to sleep (sleep training)

Punishment

(Behaviour Therapy)

does not replace with positive behaviour, just aversive stimulus

ex. not put hand up, X on board, but not told how to get rid of it → suppress behaviour, but not increase likelihood of a positive behaviour

punishment is imitated and can bring about generalized aggression → ex. bobo doll, modelling

Time Out

(Behaviour Therapy)

removal of a person from sources of reinforcement to decrease behaviour, takes persistance

ex. kid moved to other area to not get laughs from lots of kids

should only do 1 minute per year of age, good to be in a place nearby, not have ongoing conversations with them

Exposure Therapy

in counterconditioning (reinforces feared situation won’t happen), a person is taught a new, more adaptive response to a stimulus

1. Systematic Desensitization

2. Aversive Conditioning

Systematic Desensitization

(Exposure Therapy)

developed by Joseph Wolpe

based on reciprocal inhibition (can’t be anxious and relaxed at same time)

• taught relaxation first (2 types):

  • progressive muscle relaxation - tightening + relaxing muscle groups (taught then do at home)

  • manual relaxation - picture soothing image in head and think about sensory experiences about that environment, imagining they are there

• hierarchy of fears to then gain mastery of these fears, progressing with each level until anxiety is 0

Dismantling research (look at full procedure) showed that no single component was essential → flooding is without teaching relaxation and the ladder, takes commitment but very effective

Aversive Conditioning

(Exposure Therapy)

a noxious stimulus is paired with a stimulus that elicits an undesireable behaviour, often used to combat addictions

ex. take nausea inducing drug, so if drink or smoke, feel nauseous, then associate drinking/smoking with unpleasant feeling/nausea

Modelling

(Exposure Therapy)

developed by Bandura

used effectively for teaching new behaviour, helping eliminate fears, and enhancing already existing behaviours

ex. kid afraid of dogs, adult pets and talks to dog, show everything is good

Cognitive Behaviour Therapy (CBT)

change client behaviour by changing the person’s thought or perceptions

3 basic assumptions: (IFI)

1. Cognitions are identifiable and measurable (tackle thoughts)

2. Cognitions are key in both healthy and unhealthy psychological functioning

3. Irrational beliefs or thinking can be replaced by more rational and adaptive cognitions (if have unhelpful thought → identify → then change)

Rational Emotive Therapy

emphasizes the importance of logical, rational, thought processes

Albert Ellies, very much in-your-face/directive, same event won’t effect everyone the same

• assumed abnormal behaviour is caused by faulty and irrational thinking patterns

• how we feel about the consequences of an event is determined by our beliefs or opinions

A. Activing event (ex. C on exam)
B. Belief (ex. see as good or bad)
C. Consequences (ex. positive or negative thoughts about self)

Irrational beliefs: product of people’s needs to be liked, to be competent, to be loved, and to feel secure
exaggerated value on needs = abnormal behaviour

Aaron Beck’s Approach

(Cognitive Behaviour Therapy/CBT)

depression is caused by people’s distorted thoughts about reality, lead to negative views of the world, self, and future →
identify this as unhelpful, then can do something to change it, more directive

Shown effective with depression, and also bipolar disorders and schizophrenia

Waves of CBT

First: Behavioural

Second: Cognitive

Third: Acceptance and Commitment Therapy and Dialectical Behaviour Therapy

• highly eclectic, remains to be seen if more effective

Internet Delivered CBT

Dr. Heather H. (Dr. Thomas H’s wife)

message or phone to help guide through therapy, transdiagnostic, designed to treat anxiety + depression together

50% reduction of symptoms

Group Therapy

3-20 clients meeting on a regular basis with therapist, group members selected on the basis of what they can gain and offer to the group, group members encouraged to role play new behaviours

led by a therapist, there is an agenda

social anxiety disorder would be good for this → garner skill set just exposed to the group, focused on anxiety disorder, already exposed because showed up

Family Therapy

two or more people who are committed to each other’s well-being are treated together, therapists attempt to change the family systems (what is going on), the dynamic social system of the marriage or family (focus on interactions)

ex. not just focusing on the anxious child, but also behvaiours of the other family members maybe inciting or maintaining that anxiety

Biologically Based Therapies

include medication, hospitalization, physicians

often used in combination with traditional forms of psychotherapy

Drugs

(Biologically Based Therapies)

- will not permanently cure (garner skillset, symptoms reduce, then look to get off them)
- start on low dosage typically then move up
- side effects may deter people
- began with development of Thorazine (antipsychotic) in 1954
- 15% of population on antidepressants

Anti-Anxiety Drugs

(Biologically Based Therapies)

reduce physiological symptoms of stress, calms them so able to think more rationally about thigns

Benzodiazephines - modulate GABA, modifies these inhibitory receptors so serotonin can move more freely

• used for seizures in a hospital

• abusable, not prescribed long term

• may be given a few if have bad panic attacks

• colonoxopy to help sleep

• fast affects

Selective Serotonin Reuptake Inhibitors (SSRIs) - modulates serotonin

• able to be prescribed long term

• take longer to exhibit change

Anti-Depressant Drugs

(Biologically Based Therapies)

work by altering levels of brain chemicals

3 major categories:

1. Tricyclics - oldest types

   • insomnia, chronic headaches

   • blocks reuptake of multiple neurochemicals, not as specific → serotonin, norepinephrine

   • because of that, more side effects, allows for more of these neurochemicals to be available in that synapse

2. Monoamine Oxidase (MAO) Inhibitors

   • works by breaking down monoamine oxidase (enzyme that destroys neurotransmitters), then allows for more neurochemicals to be available which results in change of mood

   • not prescribed often, food restrictions

3. SSRIs

Mood Stabilizing Drugs

(Biologically Based Therapies)

often used for bipolar disorder, careful monitoring required, too much will produce noxious side effects, too little will have no effect

• lithium carbonate - harsh on system, can impact immune system, very effective but hard on body

• anticonvulsant agents - more likely for stabilization in younger patients, sometimes used for epilepsy

Anti-Psychotic Drugs

(Biologically Based Therapies)

antipsychotics are a group of drugs commonly but not exclusively used to treat psychosis and schizophrenia

Chlorpromazine (Thorazine) was the first antipsychotic, 1st gen

• only affected dopamine (D-2) receptors, blocking them

• effect was primarly seen on positive symptoms (hallucinations + delusions)

Atypical antipsychotic (newer/2nd gen)

• Clozapine, Olanzapine, Risperidone

• affected both dopamine + serotonin, so both positive + negative symptoms

major side effect is tardive dyskinesia:

• central nervous system disorder

• involuntary, spasmodic movements of upper body, leg jiggling, tongue protrusions, facial tics and involuntary movement of mouth + shoulder

• more risk with older types of anti-psychotics

• because dopamine is so restricted, mimics Parkinson’s disease

Psychosurgery

brain surgery, common type in 1940s-50s was prefrontal lobotomy:

• removal of parts of brain frontal lobes thought to alleviate mental disorder symptoms

• made some people unnaturally calm and completely unemotional

• used today as absolute last resort with conditions like severe OCD, depression, bipolar disorders, done very small and precisely

Electroconvulsive Therapy (ECT)

electric current is briefly applied to the head to produce a generalized seizure (convulsion), affecting negative mood symptoms

sparingly now, once widely used for depression, was used willy-nilly in psych hospitals

now used for treatment resistant depression (late measure), all that shows is a toe moving, under control of physicians with anesthesia/pain meds

50% relapse within six months, clouded memory

Deinstitutionalization

transitioning of treatment for mental health problems from inpatient facilities to outpatient or community-based facilities, while in would be engaged in work, activities, and therapies

benefits must be weighted against number of untreated individuals and homeless with mental illness

problem: transitioned out, but there was no community support for them when let out, many homeless or into the criminal justice system