Bell Ringer 4.17.2013 Objective: SWBAT define and describe types of psychological therapies. Briefly describe one personality and one developmental disorder

Bell Ringer 4.17.2013

• Objective: SWBAT define and describe types of psychological therapies.• Briefly describe one personality and one developmental disorder in your own words.• Take out your homework to be checked• Remember your last reading assignment!Mod. 47-54 (pgs. 641 – 723)

Unit 14: Treatment of

Abnormal BehaviorMs. Desgrosellier

AP Psychology

KEY IDEAS:

• Mental health practitioners• Brief history of therapy• Insight therapies – psychoanalytic, psychodynamic, humanistic

• Behavioral approaches• Cognitive-behavioral approaches• Biological treatments• Modes of therapy• Community and preventive approaches

Mental Health Practitioners

• Psychiatrists: medical doctors (M.D.) who can prescribe medication and perform surgery.• They generally take a biological approach to treating major disorders.• Their medical training includes an approved residency in a psychiatric section of a hospital.• They are not required to take courses dealing with insight, psychoanalytic, behavioral, cognitive, or humanistic therapeutic approaches.


• Clinical psychologists: have a doctoral degree (Ph.D. or Psy.D.); use different therapeutic approaches depending on training and diagnosis.•Generally CANNOT prescribe medication.


• Counseling psychologists: have a Ph.D., Ed.D., or M.A. in counseling; tend to deal with less severe mental health problems.• They work in college, or marital and family therapy practices.• They try not to assign blame but to provide a supportive ear to all parties and help clarify feelings of each individual to the others.


• Psychoanalysts: may or may not be psychiatrists, but follow the teaching of Freud and practice psychoanalysis or other psychodynamic therapies.•They receive extensive training and self-analysis with a more experienced psychoanalyst before they begin their treatment of patients.


• Clinical or psychiatric social workers: have masters degree in social work (M.S.W.).• Other mental health professionals include psychiatric nurse practitioners and pastoral counselors, who combine spiritual internship, and have taken a certification exam.

Brief History of Therapy

• Trephining: drilling holes in skulls by early humans to release evil spirits they believed to be possessing people with mental health problems.• Over 2,000 years ago, Greek physician Hippocrates proposed that psychological problems have physical causes for which he prescribed rest, controlled diets, and abstinence from sex and alcohol.


• More than 1,500 years ago, Greek physician Galen believed that medicine was needed to treat abnormal behavior, which he thought was a result of an imbalance in the four bodily humors, similar to today’s biomedical approach.


• During the Medieval period, most societies returned to the belief that demons or Satan possessed people suffering from mental problems. Victims were punished with exorcisms or tested by drowning and burning.


• The Enlightenment in the 18th century brought reforms. Phillippe Pinel of France and, in the 19th century, Dorothea Dix, were champions of humane treatment of the mentally ill.• Instead of treating those with mental health problems as sinners or criminals, they created separate institutions for them, and pioneered more individualized and kinder treatment strategies.

Desinstitutionalization

• Serious overcrowding of most mental institutions became a problem by the 1950s. As a result, the needs of many patients were neglected.• When better psychoanalytic drugs were created, a movement for deinstitutionalization began to remove patients who were not considered a threat to themselves or the community from mental hospitals.


• The intent was that patients would improve more rapidly in familiar community settings.• In the 1960s, Congress paired aid bills to establish community mental health facilities in neighborhoods across the United States.


• An unintended problem of deinstitutionalization is today’s homeless population. An substantial proportion of this group is thought to be made up of schizophrenic patients, mostly off their medications and in serious need of care.• Families and communities have failed to meet the needs of these people.

Treatment Approaches

• Multiple approaches can often be more helpful than using one specific approach.

• Meta-analysis: the systematic statistical method for synthesizing the results of numerous research studies dealing with the same kinds of variables to determine the most effective treatments for clients with different disorders.• It indicates that clients who receive psychotherapy are better off than most of those who receive no treatment.

Insight Therapies

• Their goal is to help clients develop insight about the cause of their problems, and that insight will lead to behavior change; problems will decrease as self-awareness increases.

Psychoanalysis

• Sigmund Freud believed that abnormal behavior was the result of unconscious conflicts from early childhood trauma experienced during the psychosexual stages of development.• He thought that the way to relieve the anxieties is to resolve the unconscious conflicts, which are covered by layers of experience.

Psychoanalysis• Psychoanalysis involves going back to discover the roots of problems, then changing one’s misunderstandings and emotions after identifying the problem.• His treatment plan is to bring the conflict into the conscious mind, enabling the client to gain insight and achieve personality change, includes the techniques of free association and dream analysis.

Psychoanalysis

• In traditional psychoanalysis, the client participates in several sessions every week for 2 or 3 years, during which the therapist sits behind the patient and asks him/her to say whatever comes to mind, called free association.• If clients do not censor what they say, key thoughts will make unconscious conflicts accessible.

Psychoanalysis• Since threatening experiences and feelings can be revealed when controls of the ego and superego are relaxed during sleep, the analyst may ask the client to recall his/her dreams.• The recalled dream – the surface content – is called the manifest content.• The therapist works with the client to find the hidden, underlying meaning (the latent content), by analyzing symbols within the dream.

Psychoanalysis

• Hypnosis and Freudian slips, Freud’s “faulty actions,” may also reveal hidden conflicts.

Psychoanalysis• Hypnosis and Freudian slips, Freud’s “faulty actions,” may also reveal hidden conflicts.• Resistance: blocking of anxiety-provoking feelings and experiences, evidenced by behavior such as talking about trivial issues or coming late for sessions – is a sign that the client has reached an important issue that needs to be discovered.

Psychoanalysis

• Transference: Although the analyst’s behavior is neutral, the client may respond to the analyst as though he/she is a significant person in the client’s emotional life.• This behavior can allow the client to replay previous experiences and reactions, enabling him/her to gain insight about current feelings and behaviors.

Psychoanalysis

• Catharsis: the release of emotional tension after remembering or reliving an emotionally charged experience from the past may ultimately result in relief of anxiety.• Traditional psychoanalysis requires too much time and is too expensive for the vast majority of people seeking help.

Psychodynamic and Interpersonal Psychotherapy

• Influenced by psychoanalysis, it is typically shorter in duration, less frequent, and involves the client sitting up and talking to the therapist.• The more active therapist is likely to point out and interpret relevant associations and help the client uncover unresolved conflict more directly to gain insight into the problem and work through feelings.

Psychodynamic and Interpersonal Psychotherapy

• Although psychodynamic therapists think that anxieties are rooted in past experiences, they do not necessarily assume the problem arose in infancy and early childhood.• Interpersonal therapy: even shorter, aims to enable people to gain insight into the causes of their problems, but it focuses on current relations to relieve present symptoms.

Humanistic Therapies

• Humanists think that problems arise because the clients inherent goodness and potential to grow emotionally have been stifled by external psychosocial constraints.


• The goal of client-centered therapy is to provide an atmosphere of acceptance (unconditional positive regard), understanding (empathy), and sharing that permits the client’s inner strength and qualities to surface so that personal growth can occur and problems can be eliminated, ultimately resulting in self-actualization.


• According to humanist Carl Rogers, the greater the difference between the ideal self and the real self, the greater the problems of the client.• His emphasis on developing a more positive self-concept through unconditional positive regard, active listening, and showing both sensitivity and genuineness is a central focus of nondirective, Rogerian psychotherapy.


• Nondirective therapy encourages the client to take the lead in determining the direction of the therapy.• Rogers’s technique of active listening involves echoing, restating, and seeking clarification of what the client says and does, and acknowledging feelings.


• Objective: SWBAT define and describe types of psychological therapies.• Briefly describe one insight therapy and how they would use it to help treat depression. • Take out your diagnosis homework and reading notes to be checked.


• Gestalt therapy: the therapists goal is to push clients to decide whether they will allow past conflicts to take control their future or whether they will choose right now to take control of their own destiny.


• In contrast to client-centered therapy, Gestalt therapists are directive in questioning and challenge clients to help them become aware of their feelings and problems, and to discard feelings and values that are not their own.


• Similar to psychoanalysts, Gestalt therapists use dream interpretation to help the client gain a better understanding of the whole self.•Through role-playing, the therapist gets the client to express his/her true feelings.


• Like other humanistic therapies, the factors interact to affect his/her whole being.• Insight therapies have been demonstrated to be effective for treating eating disorders, depression, and marital discord.

Behavioral Approaches

• B.F. Skinner and other behaviorists discount the insight therapies. To Skinner, abnormal behavior is a result of maladaptive behavior learned through faulty rewards and punishments.• The goal of behavior therapy is to extinguish unwanted behavior and replace it with more adaptive behavior.

Classical Conditioning Therapies

• Systematic desensitization: a behavior therapy based on the idea that an anxiety response is inhibited by an incompatible relaxation response.• Joseph Wolpe explained it as reconditioning so that the crucial conditioned stimulus elicits the new conditioned response.


• The procedure has three steps:•First the client is taught progressive relaxation.•Next, the therapist and the client create an anxiety hierarchy for all associated fears from the least to the most feared stimulus.


• The procedure has three steps:•Third, the therapist has the student imagine each of the fearful associations beginning with the least feared stimulus. Once the patient can relax with the fear, the process is repeated, finally ascending to the most fear-provoking stimulus.


• Systematic desensitization is typically accomplished within 10 sessions.• Flooding: an exposure technique, a treatment for phobias and other anxiety disorders, that extinguishes the conditioned response.


• As a result of the client directly confronting the anxiety-provoking stimulus, extinction is achieved; the feared stimulus (the CS) is repeatedly presented without the reason for being afraid (the US).


• Aversive conditioning: trains the client to associate physical or psychological discomfort with behaviors, thoughts, or situations he/she wants to stop or avoid.


• One example uses a drug called Antabuse (US) to discourage the use of alcohol. By itself, it has no effect, but when paired with alcohol (CS). the combination causes extreme nausea (CR).• Similar to taste aversions, after very few pairings of Antabuse and alcohol, the client learns to avoid alcohol.


• Without an occasional pairing of the Antabuse with the alcohol again, this new response can easily be extinguished.

Operant Conditioning Therapies

• Rewards are used to target behaviors.• Behavior modification: the client selects a goal and, with each step toward it, receives a small reward until the intended goal is finally achieved.• e.g. Weight Watchers and other weight-reducing programs use this method to keep clients motivated.

Operant Conditioning Therapies

• Token economies: positive behaviors are rewarded with secondary reinforcers (tokens, points, etc.) which can eventually be exchanged for extrinsic rewards, such as food.• They are often used in institutions to encourage socially acceptable behaviors and to discourage socially unacceptable ones.

Other Behavior Therapies

• Social skills training: behavior therapy based on operant conditioning and Bandura’s social learning theory, to improve interpersonal skills by using modeling, behavioral rehearsal, and shaping.• With modeling, the client is encouraged to observe socially skilled people in order to learn appropriate behaviors.


• In behavioral rehearsal, the client practices the appropriate social behaviors through role-playing in structured situations. The therapist helps the client by providing positive reinforcement and corrective feedback.


• Shaping involves reinforcement of more and more complex social situations.• Through social skills training, people with social phobias learn to make friends or date, and former mental patients learn to deal normally with people outside of the hospital.


• Biofeedback training is a widely used behavioral therapy that involves giving the individual immediate information about the degree to which he/she is able to change anxiety-related responses such as heart rate, muscle tension, and skin temperature to facilitate improved control of the physiological process and, therefore, lessen physiological arousal.


• Behavior therapies have been found effective for treating anxiety disorders, alcohol and drug addictions, bed-wetting, sexual dysfunctions, and autism.• Psychoanalysts discount the quick cure offered by behaviorists. They are unconcerned with the cause of the anxiety, and analysts believe that it will resurface in a new form.

Cognitive-Behavioral Approaches

• Cognitive (sometimes Cognitive-Behavioral) therapists think that abnormal behavior is the result of faulty thought patterns.• It is sometimes considered an insight theory.

Cognitive-Behavioral Approaches

• It helps clients change both the way they think and the way they behave.• Through cognitive restructuring, or turning the faulty, disordered thoughts into more realistic thoughts, the client may change abnormal behavior.

Rational Emotive Behavior Therapy

• Albert Ellis developed Rational Emotive Therapy (RET), based on the idea that anxiety, guilt, depression, and other psychological problems result from self-defeating thoughts.


• The therapist has the client confront irrational thoughts by using the ABCs of treatment: discussing his/her action, beliefs about those actions, and finally the consequences of those beliefs.


• Ellis believed that much of his thinking involves the tyranny of the “shoulds,” what we believe we must do, rather than what is actually realistic or necessary.

Cognitive Triad Therapy

• Aaron Beck also developed a cognitive therapy to alleviate faulty and negative thoughts.• Cognitive triad: looks at what a person thinks about his/her Self, World, and Future.•Depressed individuals tend to have negative perceptions in all three areas.


• Beck suggests specific including evaluating the evidence the client has for and against automatic thoughts, reattributing the blame to situational factors rather than the client’s incompetence, and discussing alternative solutions to the problem.


• As noted by Martin Seligman, depressed individuals tend to think they caused the negative events, the negative events will affect everything they do, and the negative events will last forever.•Such thoughts lead to low self-esteem, depression, and anxiety.


•The goal of therapy is to help them change these irrationally negative beliefs into more positive and realistic views.•Failures are attributed to things outside their control and successes are seen as personal accomplishments.


• Cognitive therapies have been demonstrated to be effective in treating depression, eating disorders, chronic pain, marital discord, and anxiety disorders.

Biological/Biomedical Treatments

• Biological psychologists believe that abnormal behavior results from neurochemical imbalances, abnormalities in brain structures, or possibly some genetic predisposition.• Psychopharmacotherapy: the use of psychotropic drugs to treat mental disorders.


• Treatments also include electroconvulsive therapy and psychosurgery.• Medical doctors, psychiatric nurse practitioners, and a limited number of clinical psychologists can prescribe psychoactive drugs.


• Four major classifications of psychotropic drugs are anxiolytics (antianxiety medication), antidepressants, stimulants, and neuroleptics (antipsychotics).

Tranquilizers

• Also known as anxiolytics or antianxiety drugs, include:•Quick acting benzodiazepines:• Valium (diazepam)• Librium (chlordiazepoxide)• Xanax (alprazolam)•Slow acting BuSpar (busprione)

Tranquilizers

• Benzodiazepines increase the availability of the inhibitory neurotransmitter GABA to the limbic system and reticular activating system where arousal is too high, reducing the anxiety felt by the patient.

Tranquilizers

• Other therapies such as visualization, relaxation, and time management can be used in conjunction with drugs so that the drugs may be tapered off over time, because patients can develop unpleasant side effects and build up a tolerance to these compounds.

Tranquilizers

• Anxiolytics are helpful in the treatment of post-traumatic stress disorder, panic disorder, agoraphobia, and generalized anxiety disorder.

Antidepressants

• Antidepressants elevate mood by making monoamine neurotransmitters including serotonin, norepinephrine, and/or dopamine more available at the synapse to stimulate postsynaptic neurons.


• Objective: SWBAT define and describe types of psychological therapies.• On your bell ringer, briefly describe ONE of the following types of therapy:• Cognitive Biological• Behavioral


• Objective: SWBAT define and describe types of psychological therapies.• Take out your diagnosis worksheet!• On your bell ringer, briefly describe ONE of the following types of therapy:• Cognitive Biological• Behavioral

Antidepressants

• Types of antidepressants:•Monoamine Oxidase Inhibitors (MAOIs)•Selective serotonin reuptake inhibitors (SSRIs)•Atypical antidepressants (sometimes called non-SSRIs)

Antidepressants

• Types of SSRIs:•Paxil•Prozac•Zoloft•Celexa•Fluvoxamine

Antidepressants

• Non-SSRIs include:•Bupropion (Wellbutrin)•Velafaxine HCL (Effexor XR)

Antidepressants

• They have been found to be effective for treating depression, as well as anxiety disorders.• For treatment of bipolar disorder, lithium has been widely used to stabilize mood, alone or with antidepressants.• Anti-seizure medicines used to treat epilepsy have also been used.

Stimulants

• Stimulants are psychoactive drugs, like Ritalin and Dexedrine, that active the motivational centers and reduce activity in inhibitory centers of the central nervous system by increasing serotonin, dopamine, and norepinephrine systems.• They are used to treat people with narcolepsy and ADHD.

Antipsychotics

• Neuroleptics are powerful medicines that lessen agitated behavior, reduce tension, decrease hallucinatiosn and delusions, improve social behavior, and produce better sleep behavior, especially in schizophrenic symptoms.•They block dopamine receptors.

Antipsychotics

• Examples:•Thorzine•Haldol•Clozaril

Antipsychotics

• Unfortunately, these can have serious side effects, such as• Tardive dyskinesia: problems with walking, drooling, and involuntary muscle spasms which result from the clocking of dopamine at other sites.• These problems can cause some patients to abandon the medication after hospitalization, which results in a return of psychotic symptoms.

Other Biological Treatments

• Electroconvulsive shock treatment (ECT): used as a last resort to treat severely depressed patients•ECT is administered humanely, with the patient under anesthetic and given a muscle relaxant to prevent injury from convulsions.


•Typically the procedure is repeated six times over 2 weeks.•The patient typically experiences some (often temporary) memory loss, but no apparent brain damage.


•Repetitive transcranial magnetic stimulation (rTMS): a new painless treatment in which pulses surge through a magnetic coil positioned above the right eyebrow of patients.•It may work by stimulating the depressed patient’s left frontal lobe.


• Psychosurgery: the removal of brain tissue• Can be used to treat certain organic problems that lead to abnormal behavior.


• Prefrontal lobotomy: cutting the main neural tracts connecting lower brain regions to the frontal lobes• It was performed on thousands of schizophrenic patients, especially violent ones, to reduce the intensity of their emotional responses. Unfortunately, following lobotomies, many patients were left as emotional zombies, with extensive brain damage.


• Today, psychosurgery is very limited.• One successful example is cutting the corpus callosum between left and right hemispheres to treat severe epilepsy.

Modes of Therapy

Group Therapy

• Another way that psychological services can be delivered is in groups.•Group therapy•Couples and family therapy•Self-help groups

Community and Preventive Approaches

• With deinstitutionalization came the problem of how to help other people in need of aid in local communities.•e.g. homeless schizophrenics

Community and Preventive Approaches

• Community psychologists aim to promote psychosocial change to prevent psychological disorders, as well as to treat people with psychopathologies in their local communities.

Community and Preventive Approaches• In the 1960s local clinics

cropped up with the goal of treating people with psychological problems to prevent them from getting worse and helping them recover.•They address unemployment, poverty, overcrowding, and other stressful social problems that can affect mental health.


• Objective: SWBAT review social and abnormal psychology topics.• SIT WITH A TEAM FOR REVIEW• On your bell ringer, briefly describe ONE of the following terms:• antipsychoticsantidepressants• ECT rTMS• psychosurgery

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Bell Ringer 4.17.2013 Objective: SWBAT define and describe types of psychological therapies. Briefly describe one personality and one developmental disorder