Chapter 17: Psychological Treatments - 9 marks Flashcards by Unknown Unknown

Help change maladaptive thoughts, feelings, behaviours

The Helping Relationship-Goal of Treatment

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Psychologists & psychiatrists
Psychiatric social workers
Marriage & family counsellors
Pastoral counsellors
Abuse counsellors

The Helping Relationship-Resources

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Relationship between client & therapist & technique

Helping Relationship-Process of therapy

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Based on Freudian principles
Goal: Help patients achieve insight
Insight = conscious awareness of psychodynamics underlying problems
Adjust behaviour underlying problems learned in childhood

Psychodynamic Therapies-Psychoanalysis

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Uncensored conversation
Verbal reports of thoughts, feelings, or images that enter awareness without censorship

Psychoanalysis-Free Association

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Therapist helps client understand the symbolic meaning of their dreams

Psychoanalysis-Dream Interpretation

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Defensive maneuvers that hinder process of therapy
Sign that anxiety-arousing material is being approached

Psychoanalysis-Resistance

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Client responds irrationally to therapist like he/she was important figure from client’s past
Brings out repressed feelings & maladaptive behaviours

Psychoanalysis -Transference

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Feelings of affection, dependency, love

Psychodynamic Therapies-Positive

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Irrational expressions of anger, hatred, disappointment

Psychodynamic Therapies-Negative

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Statements by therapist
Provide client with insight into behaviour
Time consuming as client must arrive at ‘insight’

Psychodynamic Therapies-Interpretation

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Focus on maladaptive past influences
Employ psychoanalytic concept in focused, active fashion

Brief Psychodynamic Therapies-Briefer, more economical

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Focus on client’s current relationships with important people in their lives

Brief Psychodynamic Therapies-Interpersonal Therapy

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A study of more than 4000 clients
In therapy in the UK
Found that clinically significant change did NOT increase
In clients seen for more than ten sessions

Brief Psychodynamic Therapies

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Focus
Conscious control of behaviour
Personal responsibility
Disordered behaviour
Function of distorted perceptions, lack of awareness, negative self-image

Humanistic Psychotherapies

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Key figure:
Carl Rogers
Focused on therapeutic environment

Humanistic Psychotherapies-Client-centered therapy

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Unconditional positive regard
Accept clients without judgment or evaluation
Empathy
View the world through client’s eyes
Genuineness
Consistency between therapist’s feelings & behaviours

Client Centered Therapy

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Goal: Bring feelings, wishes, and thoughts into awareness
Make client “whole” again

Gestalt Therapy

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Often carried out in groups
More active and dramatic approaches than client-centered approaches
Role-play

Gestalt Therapy-Methods

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Aaron Beck & Albert Ellis

Cognitive Therapies Key Figures:

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Role of irrational and self-defeating thought patterns
Help clients discover & change cognitions that underlie problems

Cognitive Therapies-Focus

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Activating event
Belief system
Consequences (emotional & behavioural)
Disputing or challenging maladaptive emotions, behaviours

Cognitive Therapies-Rational Emotive Therapy

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Irrational beliefs
Ideas underlie maladaptive response
Point out errors of thinking
Help clients identify & reprogram “automated” thought patterns

Cognitive Therapies-Beck’s Cognitive Therapy

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Changes in brain function noted after course of Cognitive Behaviour Therapy
Showed change in both limbic system and cortex

Neuroscience of Treating Depression-Treating unipolar depression

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Maladaptive behaviours are the problem, not a symptom Problem behaviours are learned Maladaptive behaviours can be unlearned through classical and operant conditioning, modeling

Behaviour Therapies

Treat phobias through exposure to feared CS in the absence of UCS Response prevention used to keep the operant avoidance response from occurring

Behaviour Therapies-Exposure

Exposed to real-life stimuli

Behaviour Therapies-Flooding

Imagine scenes involving stimuli

Behaviour Therapies-Implosion

Learning-based treatment for anxiety disorders Eliminate anxiety through counterconditioning

Behaviour Therapies-Systematic Desensitization

Train muscle relaxation skills Anxiety & relaxation cannot co-exist Stimulus hierarchy Low-anxiety to high-anxiety scenes (10-15) Relaxation & progressive association with stimulus hierarchy

Behaviour Therapies-Steps

Controlled exposure to ‘real life’ situations Creates more anxiety during treatment than systematic desensitization Anxiety may reduce more quickly though

Behaviour Therapies-In-Vivo desensitization

Condition an aversion to a CS (e.g. alcoholic drink) CS paired with noxious UCS

Behaviour Therapies-Aversion Therapy

Use positive reinforcement, extinction, negative reinforcement, or punishment Attempt to increase or reduce behaviour Successful when traditional therapies are difficult to implement E.g., Profoundly disturbed children, mentally retarded

Behaviour Therapies-Operant Conditioning (Behaviour Modification) Treatments

System for strengthening desired behaviours through application of positive reinforcement Tokens given for desirable behaviours Tokens exchanged for tangible reinforcers

Behaviour Therapies-Token Economies

Achieve desired behaviours with reinforcers Become reinforced with social reinforcers & self-reinforcement processes (e.g., self pride)

Behaviour Therapies-Goal

Are there alternative, less painful approaches? Is behaviour to be eliminated sufficiently injurious to justify punishment severity?

Behaviour Therapies-Use of Punishment: Two Questions:

Consent of client or client’s legal guardian

Behaviour Therapies-Never employed without

With severely disturbed, self-destructive children

Behaviour Therapies-Success

Modeling approach Learning of new skills by observing and imitating a model who performs a socially skillful behaviour

Modelling & Social Skills-Social Skills Training

Increased self-efficacy Believe you can - you succeed! Watching some one else = I can do that too!

Modelling & Social Skills -Key Factor

Concepts of mindfulness Humanistic and eastern methods

“Third-wave” Cognitive-behavioural Therapies

Acceptance Commitment Dialectical behaviour therapy

“Third-wave” Cognitive-behavioural Therapies-Mindfulness-based approaches

Focus on mindfulness as vehicle of change Exert control over thoughts and feelings

Acceptance and Commitment Therapy-Acceptance and commitment therapy

Borderline personality disorder Elements from cognitive, humanistic, behavioural, psychodynamic therapies

Acceptance and Commitment Therapy-Dialectical behaviour therapy

Problems originate within individual Take form of dysfunctional thinking, conflict, stress responses People capable of expressing feelings People should take personal responsibility for improvement Not shared by all cultures

Cultural And Gender Issues In Psychotherapy-Cultural Factors in Treatment Utilization North American & Western European Assumptions

Not seeking help outside one’s culture Language Access to treatment Affordability Outside of community Lack of culturally responsive treatments

Cultural And Gender Issues In Psychotherapy-Cultural norms

Use knowledge about client’s culture to achieve broad understanding of client Understand cultural background Attentive to differences from cultural stereotype as well Understand both individual & cultural differences

Cultural Issues-Culturally Competent Therapists

Focus on changing women’s life circumstances Aware of oppressive environmental conditions Focus on supporting people in choices that meet their needs

Gender Issues in Therapy-For females

not gender- of therapist important

Gender Issues in Therapy-Gender sensitivity

Which types of therapy Which kinds of therapists Which kinds of clients Which kinds of problems Which kinds of effects

Evaluating Psychotherapies-Specificity Question

Many variables not controlled Therapist-client interactions varied Measuring therapeutic effects Who measures outcomes

Evaluating Psychotherapies-Difficulties:

Symptom reduction in absence of treatment was as high as success rate reported by therapists

Psychotherapy Research Methods-Spontaneous remission

APA guidelines Which therapies are effective for specific disorders

Psychotherapy Research Methods-Does therapy work?

Random assignment of clients to experimental or control groups

Psychotherapy Research Methods-What Is a Good Psychotherapy Research Design? Randomized Clinical Trials

No-treatment Placebo control condition Other effective treatment

Psychotherapy Research Methods-Types of control groups:

Procedures must be followed exactly Standardize the treatment Sessions taped or observed Not know which ‘condition’ clients are in Minimizes experimenter bias Some measures of improvement must be behavioural Need for follow-up data

Psychotherapy Research Methods-What Is a Good Psychotherapy Research Design? APA Guidelines for RCT

Researchers combine statistical results of many studies to reach overall conclusion

Psychotherapy Research Methods-Meta-Analysis: A Look at the Big Picture Meta-Analysis

What percentage of clients receiving therapy had a more favourable outcome than average control client

Psychotherapy Research Methods-Effect Size

Dodo Bird Verdict ‘everybody wins’ Similar efficacy found for differing therapies

Psychotherapy Research Methods

Require that at the end of therapy, clients’ seeking treatment for a particular disorder, falls within the range of those not experiencing the particular problem

Psychotherapy Research Methods-Clinical significance

Client variables Therapist variables Techniques

Psychotherapy Research Methods-Factors Affecting the Outcome of Therapy 3 Factors

Willingness to invest self in therapy; take risks

Psychotherapy Research Methods-Client Variables Openness

Experience & understand internal states Be attuned to processes in relationship with therapist Apply what is learned in therapy to their lives Nature of Problem

Psychotherapy Research Methods-Self-Relatedness: Ability to:

Needs to “fit” with therapy being used

Psychotherapy Research Methods-Nature of Problem

Empathy Unconditional acceptance Genuineness Trust Caring

Psychotherapy Research Methods-Therapist Variables Quality of relationship with client

Selecting & implementing appropriate techniques for client and situation

Psychotherapy Research Methods-Techniques

Amount of treatment & quality of outcome

Psychotherapy Research Methods-Dose-response effect

Faith in therapist Client’s belief that he/she is receiving help Plausible explanation for problems Alternative way of looking at selves & problems Protective setting & supportive relationship Opportunity to practice new behaviours Increased optimism & self-efficacy

Factors in Effective Therapy

Drugs, Electroconvulsive therapy, Psychosurgery

Biological Approaches To Treatment-Emphasize biological factors

Study of how drugs affect cognitions, emotions, behaviour 200 million such prescriptions written per year Most for anti-anxiety; antidepressants; antipsychotic

Biological Approaches To Treatment-Psychopharmacology

Newer drug - Buspirone (Buspar) Fewer side effects Enhances inhibitory neurotransmitter GABA

Drug Therapies

Reduce anxiety without affecting alertness Slow down excitatory synaptic activity Side effects: drowsiness, lethargy, dependence

Drug Therapies-Anti-Anxiety Drugs

Increase activity of norepinephrine & serotonin Prevent reuptake of excitatory neurotransmitters

Drug Therapies-Antidepressant Drugs Tricyclics

Increase activity of norepinephrine & serotonin Monamine oxidase breaksdown neurotransmitters

Drug Therapies-Monoamine oxidase (MAO) inhibitors

Block reuptake of serotonin Milder side effects than other antidepressants Reduce depressive symptoms more rapidly

Drug Therapies-Antidepressant Drugs Selective serotonin reuptake inhibitors (SSRIs)

Decrease action of dopamine Reduce positive symptoms of schizophrenia (e.g. delusions and hallucinations) Little effect on negative symptoms

Drug Therapies-Antipsychotic drugs

Severe movement disorder

Drug Therapies-Tardive dyskinesia

Antipsychotic drugs have revolutionized the treatment of severely disturbed individuals Allows many to leave mental hospitals

Drug TherapiesAntipsychotic drugs

Began with observation that schizophrenia & epilepsy rarely occur together

Electroconvulsive Therapy

Effects can be immediate 60-70% improve

Electroconvulsive Therapy -Useful in treating severe depression

Patient given sedative and muscle relaxant Shock less than 1 second, causing seizure of CNS

Electroconvulsive Therapy-Procedure

Possibility of relapse is high Possibility of permanent memory loss Possibility of permanent brain damage

Electroconvulsive Therapy-Criticisms

of treatments limited MRI scans reveal no brain damage

Electroconvulsive Therapy-Currently

Remove or destroy parts of brain Least used of biomedical procedures

Psychosurgery

Destroy nerve tracts to frontal lobes Decreased with antipsychotic drugs

Psychosurgery-Lobotomy

Cut fibres that connect frontal lobes & limbic system Useful in severe depression & OCD

Psychosurgery-Cingulotomy

Psychological & biological treatments affect brain function

Mind, Body, and Therapeutic Interventions

Psychotherapy & drug therapy showed similar changes in blood flow for 3 brain areas

Mind, Body, and Therapeutic Interventions-PET scans

Effects of psychotherapy and drug therapy on brain activity in clients treated for social phobia

Mind, Body, and Therapeutic Interventions

Transfer of treatment to community 77.4% treated as in-patients in 1955 27.1% in 1990 Good concept Requires availability of mental health care in community. Otherwise…..

Psychological Disorders And Society-Deinstitutionalization

Revolving door phenomenon Repeated rehospitalizations Large # of disturbed people who live on streets

Deinstitutionalization

Severe emotional discomfort Unable to handle problem or life transition Past problem is worsening or has resurfaced Thinking about, dreaming about, or responding to a traumatic event with negative emotions

ApplicationsWhen & Where to Seek Therapy-When

School counselling center Community agency Hospital emergency room Professional in private practice

ApplicationsWhen & Where to Seek Therapy-Where

Degree of value similarity between therapist & client Feeling of ease with therapist methods Explicit, agreed-upon goals for treatment

ApplicationsWhen & Where to Seek Therapy-Therapist-client relationship