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Chapter 13Therapies
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Biological Therapies
Psychotherapy
Sociocultural Approaches and Issues in Treatment
The Effectiveness of Psychotherapy
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Biological Therapies
Also called biomedical therapies Treatments that reduce or eliminate
symptoms of psychological disorders by altering aspects of body functioning
Drug Therapy Electroconvulsive Therapy Psychosurgery
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Drug Therapy
Revolutionized mental health care in the 20th century
Psychotherapeutic drugs used mainly in . . . Anxiety disorders Antianxiety drugs
Mood disorders Antidepressant drugs
Schizophrenia Antipsychotic drugs
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Antianxiety Drugs
Commonly known as tranquilizers Bind to receptor sites of neurotransmitters that
become overactive during anxiety
Benzodiazepines Relatively fast acting Side effects include drowsiness, loss of coordination Can become addictive
Non-benzodiazepines
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Antidepressant Drugs
Regulate mood through effects on neurotransmitters
Tricyclics Increase norepinephrine and serotonin levels
Monoamine Oxidase (MAO) Inhibitors Block enzyme that breaks down serotonin and norepinephrine
Selective Serotonin Reuptake Inhibitors (SSRI) Interfere with reabsorption of serotonin in brain
Lithium Solid element used to treat bipolar disorder
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Antipsychotic Drugs
Neuroleptics Block dopamine’s action in brain Side effects include . . .
Dysphoria Lack of pleasure Tardive Dyskinesia Movement disorder
Atypical Antipsychotic Medications Lower risk of side effects Block reuptake of serotonin
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Drug Therapy
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Electroconvulsive Therapy
Commonly called shock therapy Goal is to set off seizure in brain
Used primarily to treat severe depression Patient receives anesthesia and muscle
relaxants
Controversial Side effects
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Psychosurgery
Irreversible removal or destruction of brain tissue to improve adjustment
Prefrontal Lobotomy Severing of fibers connecting frontal lobe
with thalamus
Actual effectiveness questioned Ethical concerns
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Psychotherapy
Nonmedical process that helps individuals with psychological disorders recognize and overcome their problems
Approaches include . . . Psychodynamic Humanistic Behavior Cognitive
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Mental Health Professionals
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Psychodynamic Therapies
Stress importance of . . . Unconscious mind
Extensive interpretation by therapist
Role of early childhood experiences
Psychoanalysis (Freud) Contemporary Psychodynamic Therapies
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Psychoanalysis
Freud’s therapeutic technique for analyzing unconscious thoughts
Goal is to bring unconscious conflicts into conscious awareness
Free Association Interpretation Dream Analysis
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Psychoanalysis
Free Association Encouraging individuals to say aloud whatever
comes to mind Catharsis
Release of emotional tension when reliving emotionally-charged or conflicting experiences
Interpretation Search for symbolic, hidden meaning
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Dream Analysis
Interpreting dreams, which contain information about unconscious thoughts, wishes, and conflicts
Manifest Content Conscious, remembered aspects of dream
Latent Content Unconscious, hidden aspects symbolized by manifest
content
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Psychonanalysis
Transference Inevitable – and essential – aspect of therapeutic
relationship Relating to analyst in ways that reproduce or relive
important relationships
Resistance Unconscious defense strategies
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Contemporary Psychodynamic Therapies
Accord more power to . . . Conscious mind Current relationships
Kohut’s view Early social relationships with attachment
figures as critical Internalized relationships as basis for self
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Humanistic Therapies
Encourage people to understand themselves and to grow personally
Emphasis on self-healing capacities
Client-Centered Therapy (Rogers) Warm, supportive atmosphere to improve self-concept and
to encourage insight Reflective speech used to mirror feelings Unconditional positive regard, empathy, genuineness Therapist’s role as non-directive
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Behavior Therapies
Use principles of learning to reduce or eliminate maladaptive behavior
Classical Conditioning Techniques Systematic Desensitization Flooding Aversive Conditioning
Operant Conditioning Techniques Applied Behavior Analysis
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Cognitive Therapies
Emphasize thoughts as main source of psychological problems
Attempt to change feelings and behaviors by changing cognitions
Cognitive Restructuring Changing pattern of thought presumed to be causing
maladaptive behavior or emotion
Albert Ellis’s Rational-Emotive Behavior Therapy Aaron Beck’s Cognitive Therapy Cognitive-Behavior Therapy
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Rational-Emotive Behavior Therapy
Emotional reactions to life events as product of irrational beliefs and expectations
Central false belief that feelings cannot be controlled
Demands (“musterbating”) create dysfunctional, exaggerated beliefs
Goal of eliminating self-defeating beliefs by rationally examining them
Directive, persuasive, confrontational
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Beck’s Cognitive Therapy
Problems, such as depression, as result of illogical thoughts about self, world, future
Emotions as product of cognitions
Goal of bringing automatic thoughts to awareness so they can be changed
Challenging accuracy of automatic thoughts Logical errors Erroneous beliefs
More open-ended dialogue with therapist
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Cognitive-Behavior Therapy
Combination of . . . Cognitive therapy Reducing self-defeating
thoughts Behavior therapy Changing behavior
Self-Efficacy (Bandura) Mastering situation and producing positive outcomes
Self-Instructional Methods Teaching to modify own behavior Using reinforcing self-statements to take positive steps
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Use of Cognitive Therapy
Anxiety Disorders Panic Disorder Post-Traumatic Stress Disorder Generalized Anxiety Disorder, Phobias, OCD
Mood Disorders Depression
Schizophrenia
Personality Disorders
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Therapy Comparisons
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Therapy Integrations
Integrative Therapy Combination of techniques from different therapies based
on therapist’s judgment
Dialectical Behavior Therapy Used for borderline personality disorder Includes variety of techniques
Also, treating with psychotherapy and drug therapy
Conceptually compatible with biopsychosocial model
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Sociocultural Approaches & Issues
Individual as part of social system of relationships, influenced by social and cultural factors
Group Therapy Family and Couples Therapy Self-Help Support Groups Community Mental Health
Cultural Perspectives on Therapy
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Group Therapy
Individuals sharing psychological disorder brought together in sessions typically led by mental health professional
Relationships as key to successful therapy
Features: Information Universality Altruism Experiencing positive family group Development of social skills Interpersonal learning
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Family and Couples Therapy
Family Therapy Group therapy among family members
Couples Therapy Group therapy with married or unmarried couples
with relationship problems
Symptoms as function of relationships
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Family Therapy Techniques
Validation Understanding and acceptance of each family
member’s feelings and beliefs
Reframing Problems as family (not individual) problems
Structural Change Restructuring coalitions in family
Detriangulation Disentangle situations where scapegoating occurs
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Couples Therapy
Conflict frequently involves poor communication Attempt to improve communication
Focus on roles partners play
Addresses diverse problems
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Self-Help Support Groups
Voluntary organizations of individuals who get together regularly to discuss topics in common
Conducted by paraprofessionals
Sympathetic audience for confession, sharing, and emotional release
Social support, role modeling, and sharing of concrete problem-solving strategies
Alcoholics Anonymous (AA) Compeer
Reduce stress and promote adjustment
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Community Mental Health
Movement born in 1960s Individuals with disorders ought to remain in society Deinstitutionalization Success depends on resources and commitment of
community
Training those who directly interact with community members to offer services
Explicit goal of helping people who are disenfranchised from society
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Cultural Perspectives
Collectivistic Cultures More importance on group, rather than individual Individual psychotherapies may not be as effective
Ethnicity Ethnic match between therapist and client Cultural sensitivity and skill
Gender Changing roles affect therapy goals
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Effectiveness of Psychotherapy
Research Psychotherapy works.
Meta-analysis Statistical combination of results of different studies
No one therapy significantly better than others
Therapy benefits during first 6 months
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Health & Wellness Benefits
Positive effect of therapy on . . . Ability to cope with disease, such as cancer Physical health as result of relieving psychological disorders,
such as depression Health behavior and physical illness
May also prevent psychological and physical problems
May enhance positive psychological well-being Well-Being Therapy (WBT)
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Common Themes
Effective psychotherapies have common elements of . . . Expectations Mastery Emotional arousal
Therapeutic Alliance Relationship between therapist and client
Client Factors Quality of participation
