Psychological Therapies Chapter 16 Copyright 2007 Horizon Textbook Publishing This multimedia product and its contents are protected under copyright law. The following are prohibited by law: •Any public performance or display, including transmission of any image over a network; •Preparation of any derivative work, including the extraction, in whole or in part, of any images; •Any rental, lease, or lending of the program Slide authors: Larry D. Thomas Landon O. Thomas Book authors: R.H. Ettinger
Psychological Therapies Chapter 16 Copyright 2007 Horizon Textbook Publishing This multimedia product and its contents are protected under copyright law
Psychological Therapies Chapter 16 Copyright 2007 Horizon
Textbook Publishing This multimedia product and its contents are
protected under copyright law. The following are prohibited by law:
Any public performance or display, including transmission of any
image over a network; Preparation of any derivative work, including
the extraction, in whole or in part, of any images; Any rental,
lease, or lending of the program Slide authors: Larry D. Thomas
Landon O. Thomas Book authors: R.H. Ettinger
Slide 2
Copyright 2007 Horizon Textbook Publishing All rights reserved
Insight Therapies Insight therapies Any type of psychotherapy based
n the notion that psychological well-being depends on self-
understanding Psychodynamic therapies Therapies that attempt to
uncover childhood experiences that explain a patients current
difficulties Psychoanalysis Freuds method of psychotherapy; uses
free association, dream analysis, and transference
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Insight Therapies Psychodynamic therapies (continued) Free
association A psychoanalytic technique used to explore the
unconscious by having patients reveal whatever thoughts or images
come to mind The analyst pieces together the free-flowing
associations, explains their meaning, and helps patients gain
insight into the thoughts and behavior that are troubling them
Dream analysis is another technique used by psychoanalysts
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Insight Therapies Psychodynamic therapies (continued) Transference
An intense emotional reaction during psychoanalysis, when the
patient displays feelings and attitudes toward the analyst that
were present in a significant relationship in the past Many
therapists today practice brief psychodynamic therapy in which the
therapist and patient decide on the issues to explore at the outset
rather than waiting for them to emerge in the course of
treatment
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Insight Therapies Psychodynamic therapies (continued)
Crits-Christoph Found brief psychodynamic therapy to be as
effective as other psychotherapies Humanistic therapies Therapies
that assume that people have the ability and freedom to lead
rational lives and make rational choices Person-centered therapy A
nondirective, humanistic therapy in which the therapist creates a
warm, accepting climate, freeing clients to be themselves and
releasing their natural tendency toward positive growth
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Insight Therapies Humanistic therapies (continued) Person-centered
therapy (continued) Developed by Carl Rogers According to this
view, people are innately good and if allowed to develop naturally,
they will grow toward self- actualization-the realization of their
inner potential Nondirective therapy An approach in which the
therapist acts to facilitate growth, giving understanding and
support rather than proposing solutions, answering questions, or
actively directing the course of therapy
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Insight Therapies Gestalt therapy A therapy that was originated by
Fritz Perls and that emphasizes that importance of clients fully
experiencing, in the present moment, their feelings, thoughts, and
actions and taking personal responsibility for their behavior The
goal of Gestalt therapy is to help clients achieve a more
integrated self and become more authentic and self-accepting
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Insight Therapies Gestalt therapy (continued) Directive therapy An
approach to therapy in which the therapist takes an active role in
determining the course of therapy sessions and provides answers and
suggestions to the patient
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Relationship Therapies Therapies that attempt to improve patients
interpersonal relationships or create relationships in order to
provide them with support Interpersonal therapy (IPT) A brief
psychotherapy designed to help depressed people better understand
and cope with problems relating to their interpersonal
relationships
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Relationship Therapies Interpersonal therapy (continued) IPT is
designed specifically to help patients cope with four types of
problems commonly associated with major depression: 1.Unusual or
severe responses to the death of a loved one 2.Interpersonal role
disputes 3.Difficulty in adjusting to role transitions such as
divorce, career change, and retirement 4.Deficits in interpersonal
skills
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Relationship Therapies Couple and family therapy Family therapy
Therapy involving an entire family, based on the assumption that an
individuals problem is caused and/or maintained in part by problems
within the family unit Couple or family therapy appears to have
positive effects in treating a number of disorders and clinical
problems Couples therapy can be helpful in the treatment of sexual
dysfunctions
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Relationship Therapies Group therapy A form of therapy in which
several clients meet regularly with one or more therapists to
resolve personal problems Learning that others also chare their
problems leaves people feeling less alone and ashamed A variant of
group therapy is the self-help group Self-help groups usually are
not led by professional therapists They are simply groups of people
who share a common problem and meet to give and receive
support
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Behavior Therapies A treatment approach employing the principles of
operant conditioning, classical conditioning, and/or observational
learning theory to eliminate inappropriate or maladaptive behaviors
and replace them with more adaptive responses Behavior modification
The systematic application of learning principles to help a person
eliminate undesirable behaviors and/or acquire more adaptive
behaviors; also called behavior therapy
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Behavior Therapies Behavior modification techniques based on
operant conditioning Extinction of an undesirable behavior is
accomplished by terminating, or withholding, the reinforcement that
is maintaining that behavior Token economies A behavior
modification technique that reinforces desirable behaviors with
tokens that can be exchanged later for desired objects, activities,
and/or privileges For decades mental hospitals have successfully
used token economies with chronic schizophrenics to improve their
self-care skills and social interaction
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Behavior Therapies Behavior modification techniques based on
operant conditioning (continued) Time out A behavior modification
technique used to decrease the frequency of undesirable behavior by
withdrawing an individual from all reinforcement for a period of
time Monetary reinforcement has been found to be as effective as
nicotine patches for the reduction of smoking among them If you
want to modify any of your behaviors, devise a reward system for
desirable behaviors, and remember the principles of shaping
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Behavior Therapies Therapies based on classical conditioning Joseph
Wolpe Reasoned that if he could get people to relax and stay
relaxed while they thought about a feared object, person, place, or
situation, they could conquer their fear or phobia Systematic
desensitization A behavior therapy that is used to treat phobias
and that involves training clients in deep muscle relaxation and
then having them confront a graduated series of anxiety-producing
situations until they can remain relaxed while confronting even the
most feared situation
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Behavior Therapies Causes of mood disorders (continued) Flooding A
behavioral therapy used to treat phobias, during which clients are
exposed to the feared object or event for an extended period until
their anxiety decreases Flooding sessions typically last from 30
minutes to 2 hours and should not be terminated until patients are
markedly less afraid than they were at the beginning of the session
In vivo flooding, the real-life experience, works faster and is
more effective tan simply imagining the feared object
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Behavior Therapies Exposure and response prevention A behavior
therapy that exposes patients with obsessive compulsive disorder to
stimuli generating increasing anxiety; patients must agree not to
carry out their normal rituals for a specified period of time after
exposure Patients treated with exposure are less likely to relapse
after treatment than those treated with drugs alone Exposure and
resistance therapy has proved useful in the treatment of
posttraumatic stress disorder
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Behavior Therapies Aversion therapy A behavior therapy in which an
aversive stimulus is paired with an undesirable behavior until the
behavior becomes associated with pain and discomfort Alcoholics are
sometimes given a nausea-producing substance such as Antibes, which
reacts violently with alcohol and causes a person to retch and
vomit until the stomach is empty
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Behavior Therapies Participant modeling A behavior therapy in which
an appropriate response is modeled in graduated steps and the
client attempts each step, encouraged and supported by the
therapist In this therapy, not only does the model demonstrate the
appropriate response in graduated steps, but the client attempts to
imitate the model step by step, while the therapist gives
encouragement and support
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Cognitive Therapies Cognitive therapies Therapies that assume
faulty thinking is the basis of most psychological difficulties
Cognitive therapies are also often referred to as
cognitive-behavioral approaches because they combine the insights
into behavior provided by cognitive psychology with the
methodological approaches of behaviorism
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Cognitive Therapies Rational-emotive therapy A directive,
confrontational therapy developed by Albert Ellis and designed to
challenge and modify the irrational beliefs thought to cause
personal distress Rational-emotive therapy is based on Elliss ABC
theory A refers to the activating event, B to the persons belief
about the event C to the emotional consequence that follows
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Use what you have learned about Albert Elliss rational- emotive
therapy to identify-and perhaps even eliminate-an irrational belief
that you hold about yourself. First, identify an irrational belief,
preferably one that causes some stress in you life. For example,
maybe you feel that you must earn all As in order to think of
yourself as a good person Ask yourself the following questions, and
write down your answers in as much detail as possible. Where does
this belief come from? Can you identify the time in your life when
it began? Why do you think this belief is true? What evidence can
you think of that proves your belief? Can you think of any evidence
to suggest that this belief is false? What evidence contradicts
your belief? Do you know anyone who does not cling to this belief?
How does holding this belief affect your life, both negatively and
positively? How would you life be different if you stopped holding
this belief? What would you do differently? Copyright 2004 Allyn
& Bacon All rights reserved
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Cognitive Therapies Cognitive therapy Aaron T. Beck Claims that
much of the misery endured by a depressed and anxious person can be
traced to automatic thoughts- unreasonable but unquestioned ideas
that rule the persons life Cognitive therapy A therapy designed to
change maladaptive behavior by changing the persons irrational
thoughts, beliefs, and ideas The goal of Becks cognitive therapy is
to help patients stop their negative thoughts ass they occur and
replace them with more objective thoughts
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Cognitive Therapies Cognitive therapy (continued) Cognitive therapy
is brief, usually lasting only 10 to 20 sessions Cognitive therapy
teaches patients to change the catastrophic interpretations of
their symptoms and thereby prevent the symptoms from escalating
into panic Cognitive therapy has proved effective for generalized
anxiety disorder
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Cognitive Therapies
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Biological Therapies Biological Therapy A therapy that is based on
the assumption that most mental disorders have physical causes Drug
therapy Antipsychotic drugs Drugs used to control severe psychotic
symptoms, such as the delusions and hallucinations of
schizophrenics; also known as neuroleptics or major tranquilizers
The long-term use of typical antipsychotic drugs carries a high
risk of the most severe side effect tardive dyskinesia almost
continual twitching and jerking movements of the face and tongue,
and squirming movements of the hands and trunk
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Biological Therapies Drug therapy (continued) Antipsychotics
(continued) Newer antipsychotic drugs called atypical neuroleptics
can treat not only the positive symptoms of schizophrenia but the
negative symptoms as well, leading to marked improvement in
patients quality of life Antidepressants Drugs that are prescribed
to treat depression and some anxiety disorders EEG studies have
documented neurological changes in patients who receive placebos
that, while different from those in patients receiving real drugs,
are associated with improvements in mood
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Biological Therapies Drug therapy (continued) Antidepressants
(continued) The first generation of antidepressants are known as
the tricyclics The tricyclics work against depression by blocking
the reuptake of norepinephrine and serotonin into the axon
terminals, thus enhancing the action of these neurotransmitters in
the synapses The second-generation antidepressants, the selective
serotonin reuptake inhibitors (SSRIs), block the reuptake of the
neurotransmitter serotonin, increasing its availability at the
synapses in the brain SSRIs have fewer side effects and are safer
in overdose than tricyclics
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Biological Therapies Drug therapy (continued) Antidepressants
(continued) Another line of treatment for depression is the
monoamine oxidase (MAO) inhibitors By blocking the action of an
enzyme that breaks down norepinephrine and serotonin in the
synapses, MAO inhibitors increase the availability of
norepinephrine and serotonin Lithium and divalproex Lithium A drug
used in bipolar disorder to control the symptoms in a manic episode
and to even out the mood swings and reduce recurrence of future
manic r depressive states
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Biological Therapies Drug therapy (continued) Lithium and
divalproex (continued) Lithium (continued) Considered a wonder drug
for 40-50% of patients suffering from bipolar disorder A proper
maintenance dose of lithium yields reductions in depressive
episodes as well as manic ones Recent research suggests that
anticonvulsant drugs, such as Depakote, may be just as effective
for managing bipolar symptoms as lithium with fewer side
effects
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Biological Therapies Drug therapy (continued) Tranquilizers The
family of minor tranquilizers called benzodiazepines includes,
among others, the well-known drugs sold as Valium and Librium and
the newer high-potency drug Xanax Used primarily to treat anxiety,
benzodiazepines are prescribed more often than any other class of
psychoactive drugs They have been found to be an effective
treatment for panic disorder and generalized anxiety disorder
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Biological Therapies Drug therapy (continued) Tranquilizers
(continued) Xanax, the largest selling psychiatric drug, appears to
be particularly effective in relieving anxiety and depression Xanax
is effective in the treatment of panic disorder, and it works
faster and has fewer side effects than antidepressants If patients
discontinue treatment, relapse is likely Many patients, once they
are panic-free, find themselves unable to discontinue the drug
because they experience moderate to intense withdrawal symptoms,
including intense anxiety Valium seems to be just as effective as
Xanax for treating panic disorder, and withdrawal is easier
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Biological Therapies Drug therapy (continued) Disadvantages of drug
therapy Its important to not that drugs do not cure psychological
disorders, so patients usually experience a relapse if they stop
taking the drugs when their symptoms lift Maintenance doses of
antidepressants following a major depression reduce the probability
of recurrences
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Biological Therapies Electroconvulsive Therapy (ECT) A treatment in
which an electric current is passed through the brain, causing a
seizure; usually reserved for severely depressed patients who are
either suicidal or unresponsive to other treatment For many years,
ECT involved passing an electric current through both cerebral
hemispheres, a procedure known as bilateral ETC Today electric
current is administered to the right hemisphere only, and the
procedure is called unilateral ETC
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Biological Therapies Electroconvulsive Therapy (continued) Rapid
transcranial magnetic stimulation Performed on patients who are not
sedated; it causes no seizures, no memory lose, and has no known
side effects Psychosurgery Brain surgery to treat some severe,
persistent, and debilitating psychological disorder or severe
chronic pain
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Biological Therapies Psychosurgery (continued) Egas Moniz Developed
the first experimental brain surgery for human patients to treat
severe phobias, anxiety, and obsessions His technique, the
lobotomy, surgeons severed the neural connections between the
frontal lobes and the deeper brain centers involved in emotion
Eventually it became apparent that this treatment left patients in
a severely deteriorated condition Modern psychosurgery procedures
result in less intellectual impairment
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Biological Therapies Psychosurgery (continued) Cingulotomy
Electrodes are used to destroy the cingulum, a small bundle of
nerves connecting the cortex to the emotional centers of the brain
Several procedures have been helpful for some extreme cases of
obsessive compulsive disorder
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Evaluating the Therapies Smith, Glass, and Miller Reanalyzed the
results of 475 studies, which involved 25,000 patients Revealed
that psychotherapy was better than no treatment, but no one type of
therapy was more effective than another Hans Eysenck Showed a
slight advantage for behavioral therapies over other types
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Evaluating the Therapies Holloa, These, and Marches Found an
advantage for cognitive and interpersonal therapies over
psychodynamic approaches for depressed patients Regardless of
training or theoretical orientation, all therapists are bound by
ethical standards established by professional organizations and, in
most cases, codified in state laws
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Evaluating the Therapies Informed consent Therapists must inform
clients of the cost and expected duration of therapy prior to
beginning any actual interventions Clients must be informed of the
legal limits of confidentiality Therapists are forbidden to engage
in any kind of intimate relationships with clients or with other
who are close to them Therapists are ethically obligated to use
tests that are reliable and valid
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Culturally Sensitive and Gender- sensitive Therapy Culturally
sensitive therapy Kleinman and Cohen Believes that people
experience and suffer from psychological disorders within a
cultural context that may dramatically affect the meaning of
symptoms, outcomes, and responses to therapy Therapeutic alliance
The bond between therapist and client that is known to be a factor
in the effectiveness of psychotherapy Culturally sensitive
psychotherapy An approach to therapy that considers cultural
variables in the diagnosis and treatment of psychological
disorders
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Culturally Sensitive and Gender- sensitive Therapy Culturally
sensitive therapy (continued) Culturally sensitive therapists
recognize the language differences between therapists and patients
can pose problems Culturally sensitive therapists also attempt to
address group differences that can affect the results of therapy
Gender-sensitive therapy An approach to therapy that takes into
account the effects of gender on both the therapists and the
patients behavior
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Culturally Sensitive and Gender- sensitive Therapy Gender-sensitive
therapy (continued) Advocates of gender-sensitive therapy point out
that knowledge of real sex differences is important to the practice
of gender-sensitive therapy