Psychological Therapies
AP 604-628
Therapy
• It used to be that if
someone exhibited
abnormal behavior,
they were
institutionalized.
• Because of new drugs
and better therapy,
the U.S. went to a
policy of
deinstitutionalization.
2 Major Types of Therapy
• 1. Psychological Therapies:
employ interaction (usually
verbal) between trained
professional and a client
with a problem
VS.
• 2. Biomedical: therapies
directed at a patient’s
nervous system.
Eclectic Approach Takes a Smorgasbord
Approach
• Eclectic Approach: uses a variety of different
techniques from various theories of therapy
depending on the problem of the individual.
• More than half of therapists take this approach.
Behavior Therapies
• View psychological disorders
as learned behaviors to be
fixed by learning new
behaviors (not searching for
underlying causes)
• Based upon Behaviorist and
Social-Cognitive approaches
to personality/disorder
Behavior Therapies
Behavior Therapy – applies
learning principles to the
elimination of unwanted
learning
Utilizes both classical and
operant conditioning
Classical Conditioning
Counterconditioning –
uses classical conditioning
to evoke new responses to
stimuli that are triggering
unwanted behaviors.
1. Exposure
Therapy
2. Systematic
Desensitization
Exposure Therapies –
behavioral techniques that
treat anxieties by exposing
people to things they may
fear and avoid.
Exposure Techniques
• “Flooding”
– Based on extinction
– Keeps people in feared (but
harmless) situation and
prevents them from normally
rewarding pattern of escape
– Association between feared
stimulus and fear response
gradually weakens
Classical Conditioning
Systematic Desensitization – a type
of counter conditioning that
associates a pleasant relaxed state
with gradually increasing anxietytriggering stimuli (Developed by
Joseph Wolpe)
Used to treat phobias
Virtual reality exposure therapy
progressively exposes people to their
greatest fears
Behavioral Therapies:
Counterconditioning/Exposure Therapy
• Step 1: Learn relaxation
techniques
• Step 2: Create a
hierarchy of what you
fear
• Step 3: Engage each
level of the hierarchy
while using relaxation
techniques
Less Aggressive Exposure Therapy (Not in
Book)
• Implosion: patient
imagines stimulus rather
than being exposed to
actual negative
stimulus…hopes to
reduce anxiety.
• Usually used as first step
in systematic
desensitization.
Behavioral Therapies: Counterconditioning
Aversive Conditioning: a
type of
counterconditioning that
associates an unpleasant
state (such as nausea)
with an unwanted
behavior (such as drinking
alcohol)
Will eventually lead to extinction
Operant Conditioning
Operant Conditioning therapy
has been used to help those
with Autism
Token economy – conditioning
procedure that attempts to
modify behavior by giving
rewards for desired behaviors.
The tokens can later be
exchanged for privileges or
treats.
Parents, schools, daycares,
hospitals all use this token
economy idea
Behavior Affects Biology
• Biofeedback: uses a system
that records physiological
processes such as heart rate,
muscle tension, and skin
temperature.
• Patient can use immediate
information to see degree
which they can change anxietyrelated responses to lessen
physiological arousal.
Biomedical Therapy
• Prescribed medications
or medical procedures
that act directly on the
patients nervous
system.
– Drugs that alter brain
chemistry
– Affecting brain circuitry
with electric shock,
magnetic impulses, or
psychosurgery.
Drug Therapies
• Psychopharmacology =
study of the effects of
drugs on mind and
behavior.
– Drugs have minimized
involuntary
hospitalization.
• Why is this a good thing?
• Why is this a bad thing?
Antipsychotic Drugs
• Antipsychotics are drugs
used to treat people with
psychoses
– Psychoses is a break in
reality where people
experience hallucinations or
delusions.
– Dampen responsiveness to
irrelevant stimuli.
– Antagonist for Dopamine
– Can cause sluggishness,
tremors, and twitches
because of the low
dopamine levels.
Drug Treatments: Antipsychotics
(Neuroleptics)
• Antipsychotics are used to treat psychotic disorders
like schizophrenia.
• Antipsychotics helps those experiencing both
positive and negative symptoms.
• Most Common Examples:
– Thorazine: alleviates delusions/hallucinations
(positive symptoms).
– Clozaril: alleviates negative symptoms and social
withdrawal. Also prescribed for those at risk for
suicide.
Long Term Use of Antipsychotics
• Tardive Dyskinesia = Involuntary movements of the facial muscles
tongue and limbs.
• Negative side effects
– Nausea
– Headaches
– Exacerbation of other medical problems
Antianxiety Drugs
• Drugs used to control
anxiety and agitation.
– Depress central nervous
system activity by
increasing the amounts
of GABA in the brain.
– Xanax
• Can become
physiologically
dependent.
Antidepressant Drugs
• Drugs used to treat depression or anxiety. Different types work by
altering the levels of various neurotransmitters.
– Norepinephrine
– Serotonin
• SSRI: Prozac, Zoloft, Paxil
– Can have serious side effects
– Full effect of the drug may take up to four weeks
Drug Treatments:
Mood Stabilizers for Bipolar Disorder
• Most common is the salt
lithium (carbonate) is most
frequently used to treat the
mood swings of bipolar
disorder.
• Decreases adrenaline and
increases serotonin.
• Often can have dangerous
side effects including being
toxic at high doses
Drug Treatments: Stimulants
• Stimulants are often used to treat AttentionDeficit/Hyperactivity disorder (ADHD): a
common problem for children who have
difficulty controlling their behavior and
focusing their attention.
• Although its exact mechanism is unknown the
stimulants have a calming and focusing effect
in children by increasing neurotransmitters
associated with such processes.
Antidepressants and the Placebo Effect
• 75% of antidepressants effects
can be contributed to the
placebo effect.
• The placebo effect was less for
those who had sever depression.
– Evidence many use to make
the argument we should only
be using antidepressants in
sever cases after other
therapies have failed.
• 1 in 4 people do not respond to a
particular antidepressant and
switching to another usually
brings relief.
Electroconvulsive Therapy (ECT)
• Electroconvulsive
Therapy: used to treat
the severely depressed
after other treatments
have failed.
• Success rate is high.
ECT
• Introduced in 1938
• 100 volts of electricity
for 30-60 seconds.
• Today patients receive
general anesthetic and
muscle relaxants.
• Some memory loss is
common.
• We do not know why
or how it works.
Biomedical Therapy
• Repetitive Transcranial
Magnetic Stimulation:
the application of
repeated pulses of
magnetic energy to the
brain; used to stimulate or
suppress brain activity
Alternative Neurostimulation
Therapies
• Deep-Brain Stimulation: Focuses on
stimulation an area of the brain that connects
the frontal lobes and the limbic system.
Psychosurgery
• Surgery that removes or
destroys brain tissue in an
effort to change behavior.
• Lobotomy = A procedure
that cut the nerves
connecting the frontal lobes
to the emotion-controlling
centers of the inner brain.
– Created permanently
lethargic personality.
http://www.npr.org/templates/story/story.php?storyI
d=5014080
Psychosurgery is Most Drastic
Intervention
lobotomy: Ice pick like instrument is put
through the eye sockets cutting the links
between the frontal lobes and the emotional
control centers. Used to be used to “cure”
uncontrollably violent patients but now very
rare.
Lobotomy
•
Therapeutic Life-Style Change
• Aerobic Exercise helps to calm those with
anxiety disorders and energize those who
feel depressed.
• Adequate sleep (7-8 hours a day) can
increase energy and alertness.
• Light exposure amplifies arousal and
influences hormones.
• Social connections helps to satisfy the
human need to belong.
• Positive Thinking
• Nutritional supplements helps with
healthy brain functioning.
Cognitive Therapy
• Change the way we view
the world (change our
schemas)
• Based on work by Aaron
Beck and Albert Ellis
Cognitive Therapy
Cognitive Therapy –
teaches people new, more
adaptive ways of thinking
and acting; based on the
assumption that thoughts
intervene between events
and our emotional
reactions.
Our thinking affects how we
feel
Try to teach people to think
constructively as opposed
to destructively.
Cognitive Therapy Cont’d
Cognitive Behavior Therapy
– therapy that combines
cognitive and behavior
therapies.
Attempts to alter thoughts as
well as the actions
Especially effective in
treating OCD. This is used
as a method to treat most
psychological disorders.
Cognitive Therapies
Rational-Emotive Behavior Therapy (REBT)
– Albert Ellis
• Assumes psychological problems like
anxiety, guilt, depression are caused
by how people think about events
(not the events themselves)
• Aims to identify and change selfdefeating thoughts
– (i.e. “shoulds” and “musts”)
Cognitive Therapies
• Cognitive Therapy
– Aaron Beck
• Certain disorders (esp. depression & anxiety) can
be traced to “cognitive distortions” (errors in
logic)
– “catastrophizing”
– “all-or-none thinking”
– “personalization”
– Some have a pessimistic outlook, tendency to
blame bad events on themselves
• Help identify distorted thoughts/beliefs
• Treat these as hypotheses to be tested
– Often given “homework”
– Provides evidence to challenge distortions
Most Common Illnesses Treated in Cognitive
Perspective
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1.
2.
3.
4.
5.
Depression
Eating Disorders
Chronic Pain
Marital Problems
Anxiety Disorders
Family and Group Therapy
Family Therapy – view’s
an individual’s behavior
as guided by or directed
at other family members;
tries to improve
communication and
relationships.
This focuses on
relationships and can be
used quite often when a
child is dealing with a
neurological disorder
Family and Group Therapy Cont’d
Advantages of group therapy:
1. Help more people in
less time
2. Lower cost
3. Allows people to
discover that others are
dealing with similar
troubles to their own.
This can bring relief
4. Foster a sense of
community
Humanistic Therapy
• Insight Therapy: a
therapy which aims to
improve psychological
functioning by
increasing the client’s
awareness of underlying
motives and defenses
Humanistic Therapy
• People are capable of
consciously controlling own
actions, taking responsibility for
decisions
– Behavior is motivated by drive for
personal growth/improvement,
guided by way they perceive their
world
– Disorder comes from blocked
growth due to distorted
perceptions or lack of awareness
of feelings
Client-Centered Therapy
(aka Person-Centered Therapy)
• Developed by Carl Rogers
Allows client to decide what
to talk about without
direction (non-directive
therapy), judgment, or
interpretation
• Less popular model today,
but still influences therapy
Client-Centered Therapy
• Attitudes of therapist:
– Unconditional Positive Regard
(Acceptance)
• Convey caring/value for client as a
person, no matter what
– Help overcome “conditions of worth”
– Listen without interrupting, making
judgments, or offering advice
– Empathy
• Attempt to understand how world looks
from client’s point of view (need not
approve of everything)
– “active listening”
– “reflection” – paraphrase client’s
statements and note feelings
– Genuineness (Congruence)
• A consistency between way therapists
feel and way they act toward clients
– Shows relationships can be built on
openness/honesty
Humanistic Therapy
• Assumptions:
1. Treatment is an encounter between
equals (not “cure” by “expert”)
2. Clients improve on own given right
conditions (conditions promote
awareness, acceptance, emotional
expression)
3. Ideal conditions established by
feeling fully accepted/supported as
human beings
4. Clients remain responsible for
choosing how they think/behave
Humanistic Therapy
Therapy that aims to promote
self-fulfillment by increasing selfacceptance and self awareness
Differ from the psychoanalytic
perspective in 3 ways:
1. Focus on fostering growth
instead of relieving illness
2. Focus on the present and
future instead of the past
3. Emphasize conscious thought
as opposed to the
unconscious
Psychoanalysis
Sigmund Freud – Founder of
psychoanalysis
Psychoanalysis – Theory of
personality and therapeutic
technique that attributes our
thoughts and actions to
unconscious motives and
conflicts
Classic Psychoanalysis
• Freud developed methods in
medical work with “hysteria”
(conversion disorder) patients
– Initially tried hypnosis – not very
successful
– Came to focus on unconscious
and conflicts raging within it
• Gain insight to unconscious
thoughts/emotions
• Interpret and work through ways it
motivates maladaptive
thoughts/behavior
– May take 3-5 sessions per week
over several years
Psychoanalysis
Psychoanalysis is attempting to
make a “historical reconstruction”
Psychoanalysis tries to find
past events that help
understand the present
1.Freud used dream
interpretation
2. Free association was used by
Freud to explore the unconscious
mind
Psychoanalysis
Resistance – In psychoanalysis, the blocking from consciousness of anxietyladen material
Interpretation – In psychoanalysis, the analyst’s noting supposed dream
meanings, resistances, and other significant behaviors in order to promote
insight
Psychoanalysis
You will work through the
past issues through
Freud’s idea of
transference with the
psychologist
Transference – the
patient’s transfer to the
analyst of emotions linked
with other relationships
Classic Psychoanalysis
• Methods:
– Eventually asked patients to lie on
couch and report whatever thoughts,
memories, or images came to mind
(free association)
• Resistance – when block sensitive
material from free association
– therapist needs to explore
– “Freudian slips”
– Latent content of dreams – wishes,
impulses, fantasies kept out of
consciousness while awake by defense
mechanisms
– Transference – patients express
dependence, hostility, even love
toward therapist
• seen as unconscious process of
transferring childhood feelings/conflicts
• analysis of this provides insight
Contemporary Psychodynamic Therapy
• Very few Freudian psychoanalysts left
• Forms of “short-term psychodynamic
therapy” more common now
– Interpersonal therapy, Object relations
therapy, etc.
• May involve less time and money, meet
face-to-face, de-emphasize the past & id,
stress social/interpersonal relationships
– Still focus on unconscious and
conscious, internal conflicts, and
transference analysis
Psychodynamic Therapists
Psychodynamic therapy –
deriving from
psychoanalysis
• focuses on themes
across important
relationships, including
childhood experiences,
and the therapist
relationship
Criticism of Psychoanalytic Therapy
• 1. Built on assumption that repressed
memories exist.
• 2. Interpretations cant be proven right or
wrong.
• 3. Is very time-consuming and
costly…usually takes several years to
achieve insight.
Is Psychotherapy Effective?
Some researchers believe
that two phenomena make
psychotherapy seem more
effective than it is.
1. The Placebo Effect
2. Regression toward the
mean
• Tendency for
extreme or unusual
scores to fall back
to the average
Effectiveness of Psychotherapy? How do We
Evaluate?
• Is it therapy that helps people get better
or would it occur naturally?
• Regression towards the Mean: the
tendency for for unusual emotions
(depression/sadness) or events to return
(regress) toward their average state with
time.
Effectiveness of Psychotherapy? How do We
Evaluate?
• In order to test impact of treated vs.
untreated, studies using meta-analysis
must be used.
• Meta-analysis: procedure for statistically
combining the results of many different
research studies.
Ineffective Therapies
Research has shown us
that some therapies are
ineffective
• Energy therapies
• Recovered-memory
therapies
• Rebirthing therapies
• Facilitated
communication
• Crisis debriefing
Alternative Therapies
There are many alternative types
of therapy
Therapeutic Touch Therapy
• Move their hands around a
person to push their energy fields
into balance.
• Many skeptics including James
Randi
• Not currently accepted as a
medical practice
Alternative Therapies Cont’d
Light Exposure Therapy to
treat SAD – Seasonal
Affective Disorder
This is an accepted practice
that appears to give some
benefit.
The Most Dominant Therapy is the Cognitive
Approach
Review: Who Conducts Therapy?
• Clinical psychologists
–Most are psychologists with a Ph.D. and
expertise in research, assessment, and
therapy, supplemented by a supervised
internship.
–About half work in agencies and
institutions, half in private practice.
–May work in conjunction with a psychiatrist.
Review: Who Conducts Therapy?
• Counseling Psychologists
–Marriage and family counselors specialize in
problems arising from family relations.
–Typically have one of advanced degrees
–Pastoral counselors provide counseling to
countless people.
–Abuse counselors work with substance
abusers and with spouse and child abusers
and their victims.
Review: Who Conducts Therapy?
• Psychiatrists
–Physicians who specialize in the treatment
of psychological disorders.
–Not all psychiatrists have had extensive
training in psychotherapy, but as M.D.s
they can prescribe medications. Thus,
they tend to see those with the most
serious problems.
–Many have a private practice.