Psychological Therapies

Question 1

Biomedical Therapies

Answer 1

Biomedical therapies are physiological interventions intended to reduce symptoms associated with psychological disorders.  They include:
Psychopharmacotherapy (drug treatment)
Electroconvulsive therapy (ECT)
Psychosurgery
Exercise

Question 2

Anti-anxiety drugs

Answer 2

Relieve tension, apprehensiveness and nervousness
Work by slowing down excitatory synaptic activity
Most drugs use for this purpose are benzodiazepines (Valium, Xanax, Librium, Ativan)
Others are buspirone, which is useful for generalised anxiety disorder: it is slower acting but has fewer side-effects
And beta-blockers, which have specific use for social anxiety

Question 3

Side-effects of benzodiazepines

Answer 3

Drowsiness, lightheadedness, dry mouth, depression, nausea, vomiting, constipation, insomnia, confusion, diarrhoea, tachycardia, rhinitis, blurred vision, addiction

Question 4

Anti-psychotic drugs

Answer 4

Include:
chlorpromazine, thioridazine, and haloperidol – the older generation (for positive symptoms)
olanzapine, clozapine and quetiapine – the newer generation (for negative symptoms)
Used to treat psychosis, primarily in schizophrenia
They gradually reduce hyperactivity, thought disorders, hallucinations and delusions
Generally, patients need to stay on them for life
However, side effects may include drowsiness, constipation, dry mouth, Parkinsonian symptoms or even tardive dyskinesia

Question 5

Anti-depressant drugs

Answer 5

There are essentially three classes:
Tricyclics such as trepiline
Monoamine oxidase inhibitors (MAOIs) such as Nardil
Selective Serotonin Reuptake Inhibitors (SSRIs) such as Prozac, Paxil, Zoloft, Citalopram
They all gradually elevate mood and bring people out of a depression

Question 6

Side-effects of SSRIs

Answer 6

Nausea, dry mouth, drowsiness, insomnia, increased sweating, decreased sexual response, increased sweating are common across the group
Not all people experience any or all of the side effects
They often remediate in the first week or two

Question 7

Mood stabilisers

Answer 7

Used to control mood swings in patients with bipolar mood disorders
The most common is lithium, which is highly effective but must be monitored carefully
High concentrations can be toxic and even fatal; long use can lead to kidney and thyroid gland complications
Newer agents are anti-convulsives (anti-epileptics) such as valproate and topiramate; they seem to be as effective as lithium and to have fewer side effects

Question 8

Electroconvulsive therapy

Answer 8

An electrical shock is used to induce a cortical seizure accompanied by convulsions
Used to treat depression that has failed to respond to other methods
Patients typically receive 6-12 treatments over a month
Side-effects:
Some confusion, disorientation and nausea that clear up in hours
Some memory loss that clears up over weeks

Question 9

Other biomedical therapies

Answer 9

Exercise for depression and anxiety – 30 mins 3-5 days a week makes a significant difference, but even 10-15 mins improves mood in the short term.
Light therapy for Seasonal Affective Disorder (SAD)
Deep brain stimulation (via an implant in the subcallosal cingulate gyrus) for treatment-refractory depression
Deep brain stimulation for treatment-refractory obsessive-compulsive disorder

Question 10

Psychoanalysis

Answer 10

Key concepts:
Disorders are rooted in unconscious conflicts left from early childhood
These are battles between the id, the ego and the superego, usually to do with sexual and aggressive impulses
Defence mechanisms assist us to avoid confronting these conflicts, which remain hidden in the unconscious
The purpose of therapy is to recover unconscious conflicts, motives and defences

Question 11

Projection Psychoanalysis

Answer 11

is a defense mechanism that involves taking our own unacceptable qualities or feelings and ascribing them to other people. For example, if you have a strong dislike for someone, you might instead believe that he or she does not like you. Projection works by allowing the expression of the desire or impulse, but in a way that the ego cannot recognize, therefore reducing anxiety

Question 12

Intellectualisation Psychoanalysis

Answer 12

works to reduce anxiety by thinking about events in a cold, clinical way. This defense mechanism allows us to avoid thinking about the stressful, emotional aspect of the situation and instead focus only on the intellectual component. For example, a person who has just been diagnosed with a terminal illness might focus on learning everything about the disease in order to avoid distress and remain distant from the reality of the situation.

Question 13

Theory of therapeutic processes Psychoanalysis

Answer 13

Probing the unconscious:
Free association
Dream analysis
Transference
Resistance
Offering interpretations to the patient

Question 14

Rogers’s personality theory

Answer 14

Each of has a self-concept, which is more or less congruent with reality
When parental love seems conditional, children block out of their self-concept experiences that make them feel unworthy of love
Anxiety occurs when people have experiences that threaten their views of themselves

Question 15

Rogers’s view of defences

Answer 15

1. Believe affection from others is conditional
2. Need to distort own shortcomings to feel worthy of affection
3. Relatively incongruent self-concept
4. Recurrent anxiety
5. Defensive behaviour protects inaccurate self-concept

Question 16

Theory of therapeutic processes

Answer 16

The therapist provides a supportive emotional climate for patients (clients)
Genuineness or authenticity
Unconditional positive regard
Empathy
The primary tool is clarification
Clients play a major role in determining the pace and direction of their therapy

Question 17

Behaviour therapies

Answer 17

Present a radical departure from insight-oriented therapies:
behaviour itself is the thing to be changed, it is not the symptom of an underlying cause
One can treat behaviour without risking symptom substitution
Treatment is an empirical endeavour

Question 18

Wolpe’s counter-conditioning approach

Answer 18

So we have:
Deep relaxation to counter anxiety in phobic situations
Assertive responses to counter social anxiety
Sexual arousal to counter anxiety as a basis for new approaches to sex therapy

Question 19

Systematic desensitisation

Answer 19

1. Teach the client deep-muscle relaxation.
2. Construct an anxiety hierarchy, ranking stimuli from least to most anxiety-provoking.
3. Start with the patient deeply relaxed; imagine a scene.
4. Once imaginal desensitisation is completed, move to in vivo desensitisation.

Question 20

aversion therapy example

Answer 20

Self-injurious behaviour in an epileptic girl – she often had pseudoseizures in which she would fall to the floor
Punishment: verbal scolding, followed by wearing a football helmet which would be removed only if she didn’t fall over a consistent period; if she fell (even with the helmet on) she was scolded
Falling was eliminated almost entirely within the first 5 days of treatment, maintained through a 30-day hospitalisation, and through a 30-day follow-up
Allowed more accurate diagnosis and treatment of her actual biological epilepsy

Question 21

Social skills training

Answer 21

Essentially three types of social skills deficits:
Refusal assertiveness
Commendatory assertiveness
Request assertiveness

Trained through:
Modelling
Behavioural rehearsal
Shaping

Question 22

Cognitive-behavioural therapies

Answer 22

CBT treatments use strategies to correct habitual thinking errors that underlie various types of disorders
Initially developed for depression, now used to treat a wide range of disorders
They include:
Rational emotive therapy (Albert Ellis)
Cognitive therapy (Aaron Beck)
Other systems developed by Donald Meichenbaum and Michael Mahoney

Question 23

Albert Ellis’s Rational Emotive Therapy

Answer 23

Began to attack clients’ belief systems directly

Was able to demonstrate greater effectiveness with this new rational emotive approach than with psychoanalysis

Question 24

So what do RET therapists do?

Answer 24

D: They Dispute the beliefs:
What do you mean, you can’t stand it? Looks to me like you’re standing!
Where’s the evidence that you deserved it?
E: an Effective new philosphy
Therapists teach clients the ABC’s, and so lead them to an Effective new philosophy.

Question 25

Beck’s Cognitive Therapy

Answer 25

Also focussed on the present and on cognitions
Also helps clients become conscious of maladaptive cognitions
Also eclectic in technique and empirical in revising theory
Problem-oriented, directive and psychoeducational
Homework is a central feature of treatment

Question 26

Theory behind Cognitive Therapy

Answer 26

Cognitive Error vs. assumption
Overgeneralising:
If it’s true in one situation, it applies to any situation that is even remotely similar.
Selective abstraction:
The only events that matter are failures, which are the sole measure of myself.
Excessive responsibility:
I am responsible for all bad things, rotten events and life failures.
Self-references:
I am at the centre of everyone’s attention, particularly when I fail at something.
Dichotomous thinking:
Everything is either one extreme or another (black or white, good or bad)

Question 27

So what do cognitive therapists do?

Answer 27

They ask:
What’s the evidence?
What’s another way of looking at it?
So what if it happens?