Chapter 16: Psychological and Biological Treatments

Insight Therapy

A form of psychotherapy where the goal is to expand awareness → clients gain more knowledge and insight. Encompasses psychodynamic and humanistic approaches

Psychodynamic Therapy

Sharing the following 3 beliefs:

• The causes of abnormal behaviors stem from traumatic or other adverse childhood experiences

• They strive to analyze distressing thoughts and feelings patients avoid, wishes and fantasies, and significant past events

• When insight occurs, the symptoms are more likely to disappear

Psychoanalytic Therapy or Psychoanalysis

Developed by Freud

Goal is to decrease guilt and frustration by bringing the unconscious into the conscious - makes patients aware of previously repressed impulses, conflicts, and memories that generate psychological distress

Typically used for those who have experienced sexual assault

Free Association - Psychoanalysis

Technique in which patients express themselves without censorship of any sort

Resistance - Psychoanalysis

Attempts to avoid confrontation and anxiety associated with uncovering previously repressed thoughts, emotions, and impulses.

Therapists minimize this by making patients aware they’re unconsciously obstructing therapeutic efforts

Transference - Psychoanalysis

Projecting intense, unrealistic feelings and expectations from the past onto the therapist.

This is better than no treatment, but less effective than cognitive-behavioral therapy

Neo-Freudian Tradition

More concerned with conscious aspects of the client’s functioning; acknowledge the impact of other powerful needs, including love, dependence, power, and status (not just sex and aggression).

Interpersonal Therapy

Treatment that strengthens social skills and targets social problems, conflicts, and life transitions (clients are placed in a social setting to gain social skills).

Originally developed for depression (patients learn how to talk to people). Also effective at treating substance abuse and eating disorders

Humanistic Psychotherapy

Therapy that shares an emphasis on the development of potential and the belief that anthropoid nature is basically positive. Stresses the importance of assuming responsibility for our lives and living in the present.

More effective than no treatment, but mixed results compared to other therapies

Person-Centered Therapy

Centers on the client’s goals and ways of solving problems. The therapist doesn’t tell patients how to solve their problems, and patients use the therapy hour however they choose. Patients, not therapists, structure the session.

For example, therapist asks “how do you feel today?” “what would you like to talk about today?” “how did you feel last week after we finished our session?”

Gestalt Therapy

Therapy that aims to integrate different and sometimes opposing aspects of personality into a unified sense of self. Recognizes the importance of awareness, acceptance, and expression of feelings

Two-chair Technique

Client is asked to move between 2 chairs representing different perspectives or parts of the self. For example if you were upset at someone, in one chair you would let out all of your complaints, and in the other chair, you would pretend to be that person and respond to the criticism.

Another example could be that PLL episode (S2E4) where Hanna lets out all her complaints to a pretend Alision while she was in therapy

Group Therapy

Therapy that treats more than one person at a time; makes people feel like they’re not alone (e.g. widows in one therapy session).

Effective for a wide range of problems and about as helpful as individual treatments

Alcoholics Anonymous (AA) - Group Therapy

Twelve-step self-help program that provides social support for achieving sobriety

Controlled Drinking and Relapse Prevention - Group Therapy

Modify and control drinking habits without total abstinence

Family Therapy

See most psychological problems as rooted in a dysfunctional family system. The “patient” is everyone, not just one individual.

Focuses on interaction among members

Strategic Family Intervention

Approach designed to remove barriers to effective communication in families

Structural Family Therapy

The therapist actively immerses herself in the everyday activities of the family to make changes in how they arrange and organize interactions (the therapist manages the conversation)

Behavioral Approaches

Focus on specific problem behaviors and current variables that maintain problematic thoughts, feelings, and attitude.

They use a wide variety of assessment techniques to pinpoint environmental causes of the person’s problem, establish specific and measurable treatment goals, and devise therapeutic procedures

Ecological Momentary Assessment

Assessment of thoughts, emotions, and behaviors that arise in the moment in situations in which they occur in everyday life

Exposure Therapy

Therapy that confronts patients with what they fear, with the goal of reducing that fear

Systematic Desensitization

Patients are taught to relax as they are gradually exposed in a stepwise manner to what they fear. Anxiety-producing stimulus is repeatedly paired with a relaxation response (counter-conditioning)

Relaxation is incompatible with anxiety; eventually the anxiety-producing stimulus stops producing anxiety

Effective for a wide range of phobias and can help people avoid anxiety that contributes to insomnia and speech disorders

Flooding

Repeated exposure to feared stimuli for long periods in a safe environment. The therapist provokes anxiety repeatedly in the absence of actual negative consequences, so the extinction of the fear can occur.

Response prevention - Flooding

Therapists prevent patients from performing their typical avoidance behaviors (patients cannot use normal anxiety-reducing behaviors during the exposure period)

Participant modelling

Technique in which the therapist first models a problematic situation and then guides the patient through steps to cope with it unassisted. Used in assertion and social skills training, along with behavioral rehearsal

Operant and Classical Conditioning Procedures - Token Economies

Reward clients for desirable behaviors with tokens to exchange for items.

Operant and Classical Conditioning Procedures - Aversion Therapies

Treatment that uses punishment to decrease the frequency of undesirable behavior (e.g. antabuse [medication] and alcohol)

Cognitive-Behavioral Therapies

Treatment that attempts to replace maladaptive or irrational cognitions and behaviors with more adaptive, rational ones. Therapists are not trying to change the behavior, they are trying to change the thought process

For example, if a patient is jealous, rather than changing their behavior, a cognitive-behavioral therapist would ask “Why are you jealous? What happened that led you to be jealous? What are the trigger points for you to exhibit certain jealous behaviors?” → in other words, they find out what you are thinking about when you are jealous and change your thought process into something more realistic

More effective than no or placebo treatment. At least or more effective than psychodynamic and humanistic therapies. In general, it's about as effective for most problems

Rational Emotive Behavior Therapy

Ellis argued that we respond to an activating (internal or external) event with a range of emotional and behavioral consequences.

The crucial difference in how we respond to the same activating events stems largely from differences in our belief systems.

Some beliefs are rational and promote self-acceptance and others are irrational and are associated with unrealistic demands about the self, other people, and life conditions.

REBT therapists encourage patients to actively dispute their irrational beliefs and adopt more rational beliefs to increase adaptive responses

Cognitive Therapy

Focuses on identifying and then modifying distorted thoughts and long-held core beliefs. Works best for depression, and evidence for bipolar disorder and schizophrenia

Is Psychotherapy Effective?

Yes. Meta-analysis studies proved that therapy does work in alleviating human suffering.

But there are clear cut exceptions:

• Use of BT and CBT for behavior problems in youth

• BT and CBT for anxiety disorders.

Dodo bird verdict

Suggests that a wide range of psychotherapies are about equal in their effects due to the fact that there is a bit of overlap between all the types of therapies.

Empirically Supported Therapies

Treatments for specific disorders supported by high-quality scientific evidence.

Behavioral therapy and cognitive-behavioral therapy have emerged as ESTs for depression, anxiety, obesity, relationship problems, sexual dysfunction, and alcohol problems

Why are we fooled by ineffective therapies?

Placebo effect !! HA!!

Self-serving biases

You want or desire to get better, but don’t, but you convince yourself that you are