Therapy lecture notes

1. Biological treatments
1. Biological (organic) approach regards mental disorders as diseases that can be treated medically
2. Main classes of drugs used for treatment of medical and emotional disorders
1. Antipsychotic drugs or neuroleptics have transformed the treatment of schizophrenia and other psychoses
1. Although they may lessen the most dramatic symptoms, they usually cannot restore normal thought patterns or relationships
2. Allow people to be released from hospitals, but individuals may be unable to care for themselves or may stop taking medication
3. Overall success is modest; some people even deteriorate on these drugs
2. Antidepressant drugs—used primarily to treat depression, anxiety, phobias and obsessive compulsive disorder come in three classes:
1. Monoamine oxidase (MAO) inhibitors—elevate levels of norepinephrine and serotonin by blocking or inhibiting the enzyme that deactivates these neurotransmitters
2. Tricyclic antidepressants—also elevate levels of norepinephrine and serotonin, but by blocking reabsorption or "reuptake" of these neurotransmitters
3. Selective serotonin reuptake inhibitors (SSRIs)—e.g. Prozac, specifically elevate levels of serotonin by preventing its reuptake
3. Tranquilizers are prescribed for panic, anxiety, and unhappiness
1. These are the least effective drugs for above symptoms
2. Many people develop problems with tolerance and withdrawal—in particular, cessation of Xanax can result in rebound panic attacks
3. Lithium carbonate—prescribed for bipolar disorder; must be administered in the correct dose or can be dangerous
4. Psychologists cannot currently prescribe drugs, but are lobbying for prescription privileges
5. Cautions about drugs
1. Placebo effects may account for much of the apparent effectiveness of drugs; recent evidence suggests that drugs are no more effective than psychotherapy
2. High dropout rates form side effects of drugs
3. People who take antidepressant drugs without learning how to cope with their problems are highly likely to relapse on discontinuing medication
4. Dosage problems – challenge is to find the therapeutic window (the amount that is enough, but not too much); race gender, and age all influence dosage
5. Long-term risks
1. Some drugs have known risks when taken long term (e.g. antipsychotic drugs may lead to development of tardive dyskinesia or neuroleptic malignant syndrome)
2. Long term risks of taking other drugs, such as antidepressants, are not known
6. Many psychotherapists work as well or better and teach people how to cope
7. Because a disorder may have biological origins it does not mean the only appropriate treatment is medical
8. There is considerable pressure for physicians to prescribe drugs as a result of pressure from drug companies and managed-care organizations
3. Surgery and electroshock
1. Psychosurgery—surgery to destroy selected areas of the brain thought to be responsible for emotional disorders
2. Most famous form of psychosurgery is the prefrontal lobotomy
3. Was never assessed scientifically
4. Left patients with personality changes and/or unable to function
5. Rarely used today
4. Electroconvulsive therapy (ECT) or "shock therapy"
1. Used for treatment of the suicidally depressed, who cannot wait for antidepressants to take effect; not effective with other disorders
2. Critics claim that it is often used improperly and can cause brain damage
2. Psychotherapy
1. Common goal of psychotherapies—to help clients think about their lives in new ways and find solutions for problems that plague them
2. Psychodynamic therapy
1. Probes the past and the mind to produce insight and emotional release which eliminates symptoms
2. Freud’s original method was called psychoanalysis—has evolved into psychodynamic therapies
3. Psychodynamic therapies considered "depth" therapies because they explore the unconscious by using techniques such as free association and transference
4. Does not aim to solve an individual’s immediate problem
3. Many psychodynamic therapists use Freudian principles, but not methods
4. Brief psychodynamic therapy does not go into whole history, but focuses on main issue (i.e., dynamic focus), as well as self-defeating habits and recurring problems
3. Behavioral and cognitive therapy
1. Behavioral and cognitive therapies focus on changing current behavior and attitudes rather than striving for insight
2. Behavioral techniques—derived from behavioral principles
1. Behavioral records and contracts identify current unwanted behaviors and their reinforcers
2. Systematic desensitization—a step-by-step process of "desensitizing" a client to a feared object or experience; based on counterconditioning
3. Aversive conditioning—substitutes punishment for the reinforcement that has perpetuated a bad habit
4. Flooding or exposure treatments—therapist accompanies client into the feared situation
5. Skills training—practice in specific acts needed to achieve goals
4. Cognitive techniques
1. Aim is to identify thoughts, beliefs, and expectations that might be prolonging a person’s problems
2. Albert Ellis and Rational Emotive Behavior Therapy—therapist challenges illogical beliefs directly with rational arguments
3. Other cognitive approaches encourages clients to test their beliefs against the evidence
5. Cognitive-behavior therapy—combines the above two approaches’ most common treatment
6. Humanistic therapy
1. Humanistic therapies—assume that people seek self-actualization and self-fulfillment
2. Do not delve into the past; help people to feel better about themselves "here and now"
3. Client-centered or nondirective therapy by Carl Rogers
4. Therapist offers unconditional positive regard to build self-esteem
5. No specific techniques, but therapists must be warm, genuine, and empathic; client adopts these views and becomes self-accepting
7. Existential therapies—help clients explore the meaning of existence and utilize the power to choose a destiny and accept responsibility for their life predicament
8. Family therapy—problems develop in a social context; therefore, the entire context (usually the family) is treated
1. Observing the family together reveals family tensions and imbalances in power and communication
2. Some use genograms—family tree of psychologically significant events—identifies repetitive patterns across generations
3. Family systems approach—recognizes that if one member in the family changes, the others must change, too
9. Psychotherapy in practice
1. Most psychotherapists use techniques from different approaches
2. Group therapy
1. Clients learn that their problems are not unique
2. Often used in institutional settings, but also in other settings
3. Different from self-help or personal growth groups
4. A common process in all therapies is to replace self-defeating narratives or life stories with ones that are more hopeful and attainable
10. Alternatives to psychotherapy
1. The community and rehabilitation movements
2. Majority of people with mental illness live in the community
3. Community psychologists set up programs to help people who are mentally ill, in their own communities; they emphasize community support