Chapter 16 – Therapy

Treatment of Psychological Disorders

·      Psychological Therapies

o   Psychoanalytic Therapy

§  Use “talking cure” to achieve two goals:

·      Catharsis or release of bottled-up psychic tension

·      Insight or self-understanding

§  These goals achieved through therapist’s interpretation of free association, resistance, and transference

o   Psychological Therapies

§  More modern version of psychoanalysis

§  Try to understand current thoughts and feelings by looking at important relationships and event such as childhood experiences and client-therapist relationships

§  Clients explore defended-against thoughts and feelings

·      Humanistic Therapies, based on Roger’s Ideas

o   Focus on 3 Things:

§  Growth – helping client grow in self-awareness and self-acceptance

§  The present time is more important than the future or the past

§  The conscious mind as opposed to the unconscious

§  Use “active listening”; interrupt only to restate and confirm feelings or to seek clarification

§  Provide “Unconditional positive regard”, offering understanding and not being judgmental

·      Behavioral Therapies

o   Use classical conditioning and operant techniques

o   Classical Conditioning techniques

§  Exposure therapy – repeatedly expose them to stimuli that trigger unwanted reactions

§  Flooding – person is exposed to (“flooded”) with anxiety-provoking stimulus until the anxiety is extinguished

§  Systematic Desensitization

·      Type of counter conditioning

·      Pairs gradual exposure to an anxiety-provoking situation

§  Aversive Conditioning

·      Used for harmful activities, e.g. drinking, smoking

·      Pairs harmful activity with an aversive stimulus leading to an aversive reaction to the harmful activity

o   Operant Conditioning techniques

§  Reward and Punishment

·      Behavior modification reinforces desirable behaviors and fail to reinforce or even punish undesirable behaviors

·      Token economy

§  Biofeedback

·      People learn to control physiological responses by receiving visual or auditory feedback about internal states

§  Social Skills Training

·      Using modeling and reinforcement to teach interpersonal skills, e.g. assertiveness training

·      Cognitive Therapies

o   Teach people to alter the maladaptive way they think about significant life events

o   Beck’s Cognitive Therapy

§  Helps people restructure the way they interpret events. Learn “you feel the way you think”

§  People are confronted with their irrational, maladaptive beliefs

§  Automatic negative thoughts are challenged

§  Point out “catastrophizing” – relentless, overgeneralized, self-blaming behavior

§  Teach people to restructure their thinking in stressful situations

o   Cognitive-Behavorial Therapy (CBT)

§  Tries to alter way people think and act

§  Trains them to practice what they learn in everyday settings

§  Learn new ways of thinking to tolerate distress and regulate their emotions

·      Group Therapies

o   Simultaneous treatment of several clients in a group setting

o   Benefits include social support, encouragement, modeling, empathy, honest feedback

o   May include Family Therapy

o   Self-help groups, such as A.A.

Is Psychotherapy Effective?

·      A Meta-Analysis of 475 outcome studies showed that average therapy client ends up better off than 80% of untreated individuals

·      Those that don’t get therapy often improve, but those that do are more likely to improve more quickly and with less risk or relapse

Is Psychotherapy Effective? Some are best for specific problems

·      Cognitive and cognitive behavioral therapies are helpful for anxiety, panic, PTSD, insomnia, and depression

·      Behavioral conditioning therapies are helpful for bed-wetting, specific phobias, compulsions, marital problems, and sexual dysfunctions

·      Psychodynamic therapy for depression and anxiety

Is Psychotherapy Effective? Some don't work or are harmful

·      “Conversion Therapy” to change people’s gender identity or sexual orientation

o   These are not mental illnesses and don’t require therapy

·      Initiatives found to be ineffective or harmful:

o   “Scared Straight” for juvenile delinquents

o   DARE

How Does Psychotherapy Help People?

·      It gives hope to discouraged people and gives them expectations that things can and will get better

·      A new perspective, offering plausible explanations for their symptoms

·      An empathic, caring, trusting relationship

Biomedical Therapy

·      Prescribed medications or procedures that act directly on the person’s physiology

·      Drug Therapies

o   How many people recover without treatment? And how soon?

o   How does drug effect compare to psychotherapy?

o   How does drug compare to placebo?

§  Use a double-blind procedure

Antipsychotic Drugs Used to Treat Schizophrenia

·      “Typical Antipsychotics” of First-Generation Antipsychotics

o   Thorazine – receptor blocker at DA synapses; binds D1 and D2

o   Haldol – Blocks D2 receptors

o   Both result in Parkinson’s like side effects – slowness of movements, tremors

o   Both can result in Tardive Dyskinesia – involuntary movements of facial muscles, tongue, and limbs

Antipsychotic Drugs

·      “Atypical Antipsychotics” or Second-Generation Antipsychotics; block dopamine and serotonin

o   Clozapine (Clozaril)

§  Binds D1, D2, D4, and 5-HT Rs

§  Can => agranulocytosis, rare blood disease

o   Olanzepine (Zyprexa)

§  Both of these drugs bind to DA and 5-HT Rs

o   Atypical antipsychotics may not have as high an incidence of “Parkinsonian” side effects, but have other problems – weight gain, diabetes

Drug Treatment of Anxiety Disorders

·      Benzodiazepines

o   E.g. Xanax, Klonopin, Ativan

o   Also used as sleep aids, anticonvulsants, and muscle relaxants

o   Work at GABAa receptors as an agonist, binds to different site than GABA

o   Side effects include sedation and addiction

o   Should not be used with alcohol

Antidepressants

·      E.g. Prozac, Zoloft, Paxil

·      Selective Serotonin Reuptake Inhibitors inhibit reuptake of Serotonin

·      Side effects include increased appetite, fatigue, nausea, reduced sex drive

·      Can take up to 4 weeks to take full effect

Drugs to Treat Mania and Bipolar

·      Anti-depressants can trigger mania in those with Bipolar

·      Mood Stabilizers

o   Lithium Carbonate; metallic ion

§  Blocks rapid transition between depression and mania

§  Can be toxic to thyroid and kidneys

o   Antiepileptic Drugs

§  E.g. Depakote

§  Reduces or prevents manic episodes