Therapy Flashcards
Dual Approaches of Therapy
- Psychotherapy
- Biomedical Therapy
- Usually used together
Psychotherapy
- Trained therapist uses psychological techniques to assist someone seeking to overcome difficulties or achieve personal growth
- people w/ people
- W/ or w/out diagnosis
Biomedical Therapy
- Prescribed medication or medical procedure that acts directly on patient’s nervous system
- Has diagnosis
Psychotherapy types
- Eclectic approach
- Psychoanalytic
- Psychodynamic
- Humanistic
- Behavioral
- Cognitive
- Cognitive-Behavioral
- All 1 on 1 or in groups
- “Talk therapies”
Psychoanalysis Goals
- FREUD
- Bring repressed feelings into conscious awareness
- Healthy living is possible when we let go of ID-ego-superego conflict
- Reduce conflict
- Healthy living is possible when we let go of ID-ego-superego conflict
Methods of Psychoanalysis
- Projective tests: TAT and Inkblots
- Free association: what comes to mind automatically
- Responses are interpreted, looking for moments of resistance
- Free association: what comes to mind automatically
- Hypnosis
- Dream analysis: latent (hidden content) vs manifest (obvious content) of dreams
- Latent reveals anxiety
Transference
- Psychoanalysis
- Patient’s transfer to the analyst of emotions linked with other relationships
- Ex: love or hatred for a parent
Criticisms of Psychoanalysis
- Interpretations cannot be proven or disproven
- Rebuttal: It is a therapy, not a science
How Psychoanalysis is Used
- Lengthy process: Several years of several sessions a week
- Expensive: 3 times a week for 2 years: $30,000
- France, Germany, Quebec, NYC
Goals of Psychodynamic
-Shed light on current symptoms by focusing on themes across important relationships
Humanistic goals
-Self-fulfillment boosting by helping people grow in self-awareness and self-acceptance
Humanistic vs. Pyschodynamic
- Similar: Insight therapies
- Individual gains insight about self and improves
- Differences:
- Present and future (humanistic) vs. past (psychodynamic)
- Conscious mind instead of unconscious
- Immediate responsibility
- Promotes growth, not curing illness
Client-Centered Therapy
- Carl Rogers
- Growth-promoting climate
- Acceptance (Unconditional
- Empathy
- Genuineness
- Non-directive therapy
- Active listening
- Empathetic listening in which the listener echoes, restates, and clarifies
- Don’t add opinion
- Empathetic listening in which the listener echoes, restates, and clarifies
Goals of Behavioral Therapy
- Therapy that applies learning principles to the elimination of unwanted behaviors
- BF Skinner
CounterConditioning
- Behavioral Therapy
- Uses classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors
- Types: Exposure therapy, aversive conditioning
Wolpe
- Created exposure therapies based off Mary Cover Jones’ ideas
- Behavioral Therapy
- Behavioral techniques that treat anxiety by exposing people (In imagination or actuality) to the things they fear and avoid
- Ex: Virtual Reality exposure therapy, systematic desensitization
Aversive Conditioning
- Behavioral Therapy (Type of Counterconditioning)
- Associates an unpleasant state (such as nausea) with an unwanted behavior (such as drinking alcohol)
- Treat nail biting, alcoholism
Behavioral Modification
- Behavioral Therapy
- Reinforcing desired behaviors and withholding reinforcement or undesired behaviors
- Ex: Token Economy
Token Economy
- People earn a token of same sort for exhibiting a desired behavior and can later exchange the tokens for various privilege or treats
- Used in institutions, as well as at arcades (tickets or coins)
Cognitive Therapy Goals
- Teaches people new, more adaptive ways of thinking and acting
- Based on assumption that thoughts intervene between events and our emotional reactions
Cognitive Perspective
- Cognitive Therapy of psych disorders
- Interval beliefs are super important
- Person w/ depression interprets suggestions as criticism, disagreement as dislike
- Ruminating on these thoughts sustain bad moods
Eclectic Approach
-An approach in psychology that, depending on the client’s problems, uses techniques from various forms of therapy
Ellis
- Rational-Emotive Behavior Therapy
- Type of cognitive therapy
- Confrontational cognitive therapy that vigorously challengers people’s illogical, self-defeating attitudes and assumptions
- Point out absurdities in thinking
Beck
- Beck’s therapy for depression
- Type of cognitive therapy
- Gentler than Rational-Emotive Behavior Therapy
- Helps clients see catastrophizing beliefs through gentle questioning
- CB: worst-case scenario
Stress Inoculation Training
- Meichenbaum
- Teaching people to restructure thinking in stressful situations
Cognitive Behavior Therapy
- Popular integrated therapy that combines cognitive therapy (changing self-defeating thinking) w/ behavior therapy (changing behavior)
- Study: People learn to prevent compulsive behaviors by relabeling obsessive thoughts
- Instead of giving in to urge, they would spend 15 minutes doing an alternative, enjoyable activity
Group Therapy
- Saves therapist time and money
- Often just as effective as individual
- Clients discover:
- Not alone in their problems
- Offers social lab for exploring social behaviors and developing social skills
- It provides feedback as clients try out new ways of behaving
- Ex: Alcoholics Anonymous: 2 million members
Family Therapy
- Treat whole system instead of individual
- Views an individual’s unwanted behaviors as influenced by, or directed at, other family members
Resistance
-In psychoanalysis, the blocking from consciousness of anxiety-laden material
Interpretation
-In psychoanalysis, the analyst’s noting supposed dream meanings, resistances, and other significant behaviors and events in order to promote insight
Insight Therapies
- A variety of therapies that aim to improve psychological functioning by increasing a person’s awareness of underlying motives and defenses
- Psychodynamic and Humanistic= examples
Unconditional Positive Regard
-A caring, accepting, nonjudgmental attitude, which Carl Rogers believed would help clients to develop self-awareness and self-acceptance
Systematic Desensitization
- A type of exposure therapy that associates a pleasant, relaxed state with gradually increasing anxiety-triggering stimuli
- Commonly used to treat phobias
Virtual Reality Exposure Therapy
-An anxiety treatment that progressively exposes people to electronic stipulations of their greatest fears, such as airplane flying, spiders, or public speaking
Regression Toward the Mean
-The tendency for extreme or unusual scores to fall back (regress) toward their average
Meta-Analysis
-A procedure for statistically combining the results of many different research studies
Evidence-Based Practice
-Clinical decision making that integrates the best available research with clinical expertise and patient characteristics and preferences
Therapeutic Alliance
-A bond of trust and mutual understanding between therapist and client, who work together constructively to overcome the client’s problem
Resilence
-The personal strength that helps most people cope with stress and recover from adversity and even trauma
Psychopharmacology
-The study of the effects of drugs on mind and behavior
Antipsychotic Drug
- Drugs that are used to treat schizophrenia and other forms of severe thought disorder
- Accidental discovery: calmed patients w/ psychoses
- Ex: Chlorpromazine
- Dampen response to irrelevant stimuli
- Help patients w/ positive symps of schizo
- Most mimic neurotransmitter dopamine structure to block its activity (doesn’t trigger a response)
- Side effects:
- Sluggishness, tremors, twitches
- Tardive dyskinesia: involuntary movements of facial muscles, tongue, and limbs
Antianxiety Drug
- Drugs used to control anxiety and agitation
- Depress CNS= calming effect
- Xanax, Ativan
- Can cause physiological dependence
- Cessation: heightened anxiety, insomnia, withdrawal symps
- End of 20th century: rate of treatment for anxiety disorders near doubled
- Patients receiving medication increased from 52-70%
- Current standard= antidepressants
Antidepressant Drug
- Drugs used to treat depression, anxiety disorders, obsessive-compulsive disorder, PSTD
- Increase availability of neurotransmitters
- norepinephrine, serotonin
- Ex: Prozac blocks reabsorption and removal of serotonin from synapse
- SSRIs: Serotonin Reuptake Inhibitors
- Others block both norepinephrine and serotonin
- Side effects:
- Dry mouth, weight gain, hypertension, dizzy spells
- Delayed effect
- Increased serotonin==> neurogenesis
- Reverses stress-induced loss of neurons
- Natural antidepressants= aerobic exercise
- Risk of suicide= blown out of proportion
Electroconvulsive Therapy (ECT)
- A biomedical therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized patient
- 1938: 1st introduced
- Wide awake, strapped to table, 100 volts of electricity
- Today: general anesthetic, muscle relaxant (can have seizure)
- Awake after 30 mins, remember nothing
- No brain damage
- Not sure why it works= like restarting computer
- May spark neurogenesis
- Reduces suicidal thoughts
- 4/10 relapse w/in 6 months
- Needs to be revisited, not one-time fix (last resort)
Repetitive Transcranial Magnetic Stimulation
- rTMS
- The application of repeated pulses of magnetic energy to the brain
- Used to stimulate or suppress brain activity
- No seizures, performed wide awake
- Only penetrates to the brain’s surface
- Possibly energizes depressed patients’ inactive left frontal lobe
- Randomized clinical trials show mixed success
Psychosurgery
- Surgery that removes or destroys brain tissue in an effort to change behavior
- Irreversible
- Drastic, rarely used
- LAST EFFORT**
Lobotomy
- A psychosurgical procedure once used to calm uncontrollably emotional or violent patients
- The procedure cut the nerves connecting the frontal lobes to the emotion-controlling centers of the inner brain
- Separates limbic system and cortex
- Intention: Disconnect emotion from thought
- Effect: Decreased misery and tension, but produces lethargy, immature, uncreative person
- At worst: people die, comatose
Client’s Perceptions
- 89% fairly well satisfied
- 9/10 transition from poor/fair to very good/good
Why not to trust client’s perceptions
- People enter therapy in crisis
- Will improve regardless and regress back to the mean
- Money, energy, time spent on therapy
- Self-justification of expenditure
- Hard to be critical of therapist if you like them as a client
Clinicians’ perceptions
- Biased: Hear selective outcomes (success stories)
- Those who did not like therapy will not reach out, while those who did will reach out with their success
Longitudinal Study of Therapy
- McCord
- 500 high-risk Mass boys (juvenile delinquents)
- 1/2 randomly assigned to 5 year treatment program
- 30 yrs later:
- Experimental group: glowing testimonials, 66% no juvenile record
- Control group: 70% had no record
- *Shows there is no long-term effect, only short term effect
Outcome Research and Eysenck
- 2/3 receiving psychotherapy improved markedly, yet same improvement for those on the waiting list
- Time= powerful healer
- Randomized clinical trials are best
- Randomly assign people to therapy or not
- Assessed via meta-analysis
- Average therapy patient fairs better than 80% of untreated individuals on waiting lists
- Those not undergoing therapy often improve, but those undergoing therapy are more likely to improve
- Cost effective? Yes
- Patients do not seek other medical answers when in therapy
Effectiveness of Different Therapies
- Stats cannot pinpoint one type as superior
- Behavioral conditioning: good for specific behavioral problems (phobias, compulsions, marital problems)
- Cognitive: depression, suicide
- Most effective when problem is well defined
- APA recommends evidence-based practice
Drug Therapies
- Most widely used biomedical treatment
- 1950s: advances in psychopharmacology
- Effectiveness assessed with double-blind procedures
Atypical Antipsychotics
- For those w/ negative symps of schizo
- Ex: Clozapin
- Target dopamine and serotonin receptors
- Newer drugs have fewer conventional side effects
- Increase risk of obesity and diabetes
- Hopeful about effectiveness of stimulates glutamate receptors
Mood stabilizing medications
- Lithium (salt) can help bipolar disorder
- Discovered by John Cade by accident
- Helps 7/10 people w/ bipolar disorder
- Risk of suicide in 1/6 of those not taking lithium
- Not sure why this works
Therapeutic Life-style change
- Mind and body= connected
- Stephen Ilardi and colleagues hold seminars promoting this
- Humans were designed for physical activity and social engagement
- Those whose way of life is about strenuous physical activity, strong community ties, sunlight exposure, plenty of sleep= rarely experience depression
- Not designed for sedentary. disengaged, socially isolated, poorly nourished, sleep deprived pace of American life
- Humans were designed for physical activity and social engagement
Ilardi’s Solution
- 12 week program
- Aerobic exercise
- Adequate sleep
- Light exposure
- Social connection
- Nutritional supplements
- Anti-rummination
- *77% experience releif from depression, compared w/ 19% in normal-treatment conditions
Evaluating Alternative Therapies
- National survey: 57% anxiety attacks, 54% those w/ a history of depression use alternative treatments
- Ex: herbal medicine, massage, spiritual healing
- No evidence for or against most of them
- Ex: Eye movement Desensitization and Reprocessing, Light Exposure Therapy
Eye Movement Desensitization and Reprocessing
- Mixed feelings
- Developed by Francine Shapiro
- People imagine traumatic scenes while eye movements are triggered
- Enables the unlocking and reprocessing of previously stored memories
- Does it work?
- single trauma victims
- 4 studies, 84-100% said yes
- Treatment only takes 90 mins
- Treats non-military PSTD
- single trauma victims
- Why does it work?
- Eye movements relax and distract patients
- Memory-associated emotions extinguish
- Rebuttel: other movements produce therapeutic results
- Eye movements relax and distract patients
Light Exposure Therapy
- Combats major depressive disorder
- Timed daily dose of intense light
- Study: Seasonal-pattern depression individuals w/ 90 mins of bright light, or negative ion generator (Placebo)
- 4 wks: 61% improved (Morning light), 50% improved (evening light), 30% improved placebo
- Morning bright light does dim depression symps, as effective as taking antidepressants or cognitive-behavior therapy
- Sparks activity in brain region that influences body arousal and hormones
Mary Cover Jones
- Peter= scared of rabbits
- Replace Peter’s fear with something incompatible to fear
- Peter eats a snack while furry animals enter room, doesn’t notice
- w/in two months, Peter touches the animals without being scared
- Relaxed state cannot coexist w/ fear
Albert Ellis
- Advocated for Rational-Emotive Behavior Therapy
- No one and nothing is supreme
- Self-gratification= good
- Harmful consequences of unequivocal love, commitment, service, fidelity to any interpersonal commitment
