Lecture 16 (chapter 15) Flashcards
Psychological Therapies
Whereas the biological therapies view mental
disorders through the medical model, psychological therapies view the roots of
abnormal behavior in mental states
– Each therapy has its own view as to the cause of mental disorder
– Each therapy has its own approach to the treatment of mental disorder
Insight-Oriented Therapy
E.g. psychoanalysis, humanistic, gestalt
* Help person understand the basis of their thinking, behavior, emotions and perceptions
* Insight into the cause will lead to change
* Emotion focused therapy or process experiential
Action-Oriented Therapy
- E.g. Cognitive-Behavioral therapy, Rational-Emotive therapy
- Encourages individuals to change behavior or thinking
- Multifaceted and individually tailored
- Strong therapeutic relationship
- Behavioral techniques and cognitive restructuring
Varieties of Psychological
Treatment
Psychodynamic
* Humanistic
* Cognitive-behavioral
* Biological/Biomedical
* Group therapy
* Family and marital therapy
Psychodynamic Approach to therapy
The psychodynamic approach was created by S. Freud
– Mental symptoms reflect unconscious conflicts that
induce anxiety
– Insight refers to the situation in a person comes to understand their unconscious conflicts
– Therapeutic change requires an alliance (relationship) between the patient and therapist
Psychodynamic Techniques
- The goal of psychodynamic therapy is to achieve insight into unconscious conflicts
– Free Association refers to a technique in which the patient is encouraged to say whatever comes to mind to reveal the unconscious processes of the
patient
– Interpretation: Therapist interprets the thoughts,
and feelings of the patient in order to reveal the hidden conflicts and motivations
– Analysis of transference: Patients bring into therapy their past troubled relationships; these are
transferred to the therapist
Humanistic Therapy
- Roger’s Client-centered therapy
- Therapeutic Climate
1) Genuineness
2) Unconditional Positive Regard
3) Empathy - TherapeuticProcess
Guidance, clarification, become more comfortable
with genuine self
Behaviour therapies
- Classical conditioning techniques can alter emotional responses
– Systematic desensitization: Patient is encouraged
to confront a feared stimulus (snake) while in a relaxed state - Therapist trains relaxation
- Patient constructs an image hierarchy
- While relaxing, patient imagines the least fearful of
the images in their hierarchy (e.g. being on the planet as a snake)
– Exposure: Patient is exposed to the stimulus that they fear (locked in a room full of snakes)
Cognitive Therapies
Focus of cognitive therapies is on changing dysfunctional thought patterns
- Rational Emotive Therapy focuses on the hurtful thought patterns of the patient
– Ellis’s theory suggests that pathology results when persons adopt illogic in response to life situations
– Therapist notes illogical and self-defeating thoughts and teaches alternative thinking that promotes rational thought
Cognitive-Behavioral Therapies
Cognitive-behavioral therapies focus on the current behaviors of a person
– Emphasis is on the present rather than the past
– Cognitive-Behavioral therapists are very directive
– Therapy duration is short-term rather than years long
– Initial focus is on a detailed behavioral analysis: focus is on the problem behavior and the stimuli associated with it
Cognitive Restructuring: Beck and ellis
Beck: approach emphasizes the cognitive triad and how automatic thoughts (often negative or distorted) shape our emotional experiences and behaviors.
Elis: founder of Rational Emotive Behavior Therapy (REBT), which is also a cognitive therapy that focuses on identifying and challenging irrational beliefs. REBT is built around the premise that irrational beliefs lead to emotional and behavioral problems, and changing these beliefs can result in improved mental health.
ABCD of Rational Emotive Therapy
A – activating event
B – belief
C – consequences (emotional)
D – disputing beliefs
Receiving psychotherapy is considerably more effective than
no treatment
CBT shows a
slight but consistent advantage with regards to effectiveness compared to insight-oriented therapy
People who do best in therapy are those
who have the least problems
Medical model
views abnormal behavior
as reflecting a biological disorder
– Usually localized within the brain
– Involving either brain damage or a disruption of
the neurotransmitter processes of the brain
– Person is viewed as a patient, treated by doctors in a mental hospital
– Therapies tend to be physical in nature
* Drugs (Pharmacotherapy)
* Surgical alteration of brain (Psychosurgery)
Pharmacotherapy
- Psychotropic medications are drugs that act on the brain to alter mental function
- Prior to 1956, schizophrenia was virtually untreatable with many patients confined for
life in mental hospitals
– Chlorpromazine (Thorazine) was found to reduce severity of psychotic thought, allowing people to live outside of mental institutions - Reduced size of institutions
– The psychotropic actions of many drugs are often accidentally discoveries
Antipsychotic Medications
Refer to drugs that alleviate schizophrenia
– Antipsychotic medications are more effective for the positive symptoms than for negative symptoms of
schizophrenia
Schizophrenia can be viewed as composed of:
– Positive Symptoms: Presence of hallucinations
– Negative Symptoms: Absence of affect
Dopamine and Schizophrenia
- The positive symptoms of schizophrenia reflect too much brain dopamine activity
– Antipsychotic drugs are effective antagonists of dopamine receptors (block the action of dopamine)
– Drugs such as amphetamine release dopamine from terminals; too much amphetamine exposure
can induce a psychotic state in humans
- Negative schizophrenic symptoms may reflect brain damage enlarged ventricles)
Antidepressant Medications
Psychotropic antidepressant drugs can lift depression (require 3-4 weeks for effect)
3 types of antidepressant medications
– Tricylic antidepressants: Act by blocking the reuptake of norepinephrine and serotonin
– Monoamine oxidase (MAO) inhibitors: MAO degrades transmitters; drugs that inhibit MAO allow the transmitter to work for longer periods
– Selective serotonin reuptake inhibitors: Prozac blocks the reuptake of serotonin
Depression reflects a
disturbance of mood,
sleep, and appetite
Antianxiety Medications
- Drugs such as Valium increase the activity of the transmitter GABA to dampen the neural activity of the brain
– Valium is useful in the short-term treatment of anxiety - Antianxiety medications can result in drug dependence
Anxiety reflects an
Intense emotional state of
dread and apprehension
Electroconvulsive Therapy
Electroconvulsive shock therapy (ECT) refers to the
intentional induction of a brain seizure by shock
administered to either or both hemispheres
– ECT produces immediate improvement in mood
(explanation is unknown)
– Side effects of ECT include memory loss
Con of antidepressant drugs
drugs require 3-4 weeks to take action on mood; the person may be at risk for suicide or is not responding to drug treatment
Common Factors in
Psychotherapy
- Development of a therapeutic alliance
- Providing a rationale
- Opportunity for catharsis or venting
- Acquisition and practice of new behaviors
- Beneficial therapist qualities (objective, confidential, professional)
- Patient positive expectations and hope
Eclecticism
- Involves using different treatments for different clients with different problems
- Using a reasonable combination of various treatments for the same client (technical eclecticism)
- all populations can receive different types of group therapy
Advantages of groups in therapy
- Efficiency 2. Universality
- Empathy 4. Interaction
- Acceptance 6. Altruism
- Modeling 8. Pressure
- Practice 10. Reality testing
- Transference
Suicide Risk Factors
Diathesis
* psychological disorder (90%)
* substance use and abuse (25-50%)
* family history of suicide
* family breakdown
* societal breakdown
* past suicide attempts
Suicide risk factor: Stress
Stress
- changes in relationships, academic/work, or
financial situation
- life event that is shameful or humiliating
- significant loss
- homosexuality
- recent suicide
Suicide warning signs
Warning Signs
- withdrawal
- change in eating, sleeping, friends
- writing and talking about death
- telling statements
- agitation followed by calm resignation
- giving away valued possessions
What to do as a friend in terms of suicide
- Take suicide threats seriously
- Don’t be afraid to discuss suicide
- Recognize the warning signs and the risk
factors - Don’t leave the person alone
- Get help
What to do as a therapist in terms of suicide
- Ask directly about suicide
- Find out if they have a plan
- Do they feel like they are in control of their behaviour?
- Develop a safety plan
- Make a contract
- Treat the psychological disorder
Crisis situation – break confidentiality
Grief after suicide…
