Therapies
Chapter 16
AP Psychology
Alice F. Short
Hilliard Davidson High School
Chapter Preivew
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Biological Therapies
Psychotherapy
Sociocultural Approaches and Issues
Effectiveness of Psychotherapy
Therapies and Health and Wellness
Biological Therapies
• Biomedical Approach
– reduce/eliminate symptoms by altering body
functioning
• Common Forms of Biological Therapy
– drug therapy
– electroconvulsive therapy (ECT)
– psychosurgery
Drug Therapy
• antianxiety drugs – commonly known as
tranquilizers, drugs that reduce anxiety by making
the individual calmer and less excitable
– benzodiazepines – the antianxiety drugs that
generally offer the greatest relief for anxiety
symptoms
• potentially addictive
• bind to receptor cites of neurotransmitters that become
overactive during anxiety
• examples: Xanax, Valium, Librium
– nonbenzodiazepine – buspirone (BuSpar) – used to
treat generalized anxiety disorder
Drug Therapy
• antidepressant drugs – drugs that regulate mood
– tricyclics – 3-ringed molecular structure
• believed to work by increasing neurotransmitters, especially serotonin and
norepinephrine
• reduce symptoms of depression in 60-70 percent
• takes 2-4 weeks to improve mood
• side effects: restlessness, faintness, trembling, sleepiness, memory difficulties
– tetracyclics – 4-ringed molecular structure
• a.k.a. noradrenergic and specific serotonergic antidepressants (NaSSAs)
• increases norepinephrine and serotonin
• example: Remeron (mertazapine) – most effective in reducing depression
– monoamine oxidase (MAO) inhibitors
• block the enzyme monoamine oxidase (which breaks down serotonin and
norepinephrine
• worse side effects: high blood pressure, stroke (esp. with fermented foods, drugs)
– selective serotonin reuptake inhibitors (SSRIs)
• interfere with the reabsorption of serotonin in the brain
• examples: Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline)
• fewer side effects, still: insomnia, anxiety, headache, diarrhea, impaired sexual
functioning
Antidepressant Drugs
• 1996  2005 – number of Americans prescribed antidepressants
doubled
• anxiety disorders: generalized anxiety disorder, obsessivecompulsive disorder, social anxiety disorder
• PTSD
• Bipolar Disorder
– lithium – the lightest of the solid elements in the periodic table of
elements
– effective dosage is precariously close to toxic levels
– influences serotonin and norepinephrine (how unknown)
– weight gain, going off drug
• Risks of Antidepressants for Children
– FDA hearings on risk of suicide (2004)
– “Black Box” warning
Drug Therapy
• antipsychotic drugs – powerful drugs that diminish agitated
behavior, reduce tension, decrease hallucinations, improve
social behavior, and produce better sleep patterns in
individuals with a severe psychological disorder, especially
schizophrenia
– small dosages over time, may combine with vocation, family and
social skills training
– neuroleptics (side effect - tardive dyskinesia)
• most used
• ability to block dopamine action in the brain
• tardive dyskinesia – a neurological disorder characterized by involuntary
random movements of the facial muscles, tongue and mouth, as well as
twitching of the neck, arms and legs
– 20% on neuroleptics develop (can develop w/o drugs
– atypical antipsychotic medications (introduced 1990s)
• lower side effects
• affects dopamine and serotonin (mechanism unknown)
• examples: Clozaril (clozapine), Risperdal (risperidone)
Drug Therapy
Biological Therapies
• electroconvulsive therapy (a.k.a. shock therapy)
– small electric current produces a brief seizure
– used to treat major depressive disorder which has not
responded to other treatments
– deep brain stimulation – a procedure for treatmentresistant depression that involves the implantation of
electrodes in the brain that emit signals to alter the
brains electrical circuitry
• treatment-resistant depression, OCD
• nucleus acumbens
– improved dramatically, still memory loss and cognitive
impairments
– for acute depression, great risk of suicide
Biological Therapies
• psychosurgery – a biological therapy, will
irreversible effects, that involves removal or
destruction of brain tissue to improve the
individuals adjustments
– prefrontal lobotomies
• coined by Walter Freemen, “lobotomobile”
• today: small lesion in amygdala or another part of the
limbic system
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OCD
major depression
bipolar disorders
not schizophrenia
Insight Therapies
• insight therapies – encourage self-awareness
as the key to psychological health
– psychodynamic therapies
– humanistic therapies
Psychotherapy
• psychotherapy (face-to-face and cybertherapy) a
nonmedical process that helps people with
psychological disodres recognize and overcome
psychological and interpersonal difficulties
– 32% in 1996  20% in 2005
• Preview of Psychotherapies
– psychodynamic therapies
– humanistic therapies
– behavior therapies
– cognitive therapies
Psychodynamic Therapies
• Emphasis of this Approach
– unconscious mind
– therapeutic interpretation
– early childhood experiences
• Goals of Therapy
– recognize maladaptive coping strategies
– identify sources of unconscious conflicts
Psychodynamic Therapies
• Freudian Psychoanalysis – Freud’s therapeutic technique for analyzing an
individual’s unconscious thoughts
– free association – a psychoanalytic technique that involves encouraging individuals to
say aloud whatever comes to mind, no matter who trivial or embarrassing
• catharsis – the release of emotional tension a person experiences when reliving an emotionally
charged and conflicting experience
– interpretation – a psychoanalyst’s search for symbolic, hidden meanings in what the
client says and does during therapy
– dream analysis – a psychoanalytic technique for interpreting a person’s dreams
• manifest content
• latent content
– transference – a client's relating to the psychoanalyst in ways the reproduce or relive
important relationships in the individual’s life
– resistance – a client’s unconscious defense strategies that interfere with the
psychoanalysts understanding of the individuals problems
• examples: showing up late/missing sessions, arguing, faking free associations
• Contemporary Psychodynamic Therapies
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still interested in childhood trauma
accord more power to the conscious mind and a person’s current relationships
less emphasis on sex
Heinz Kohut (1977) – therapist replaces unhealthy childhood relationship (empathic,
understanding)
Humanistic Therapies
• humanistic therapies – treatments, unique in
their emphasis on people’s self-healing
capacities, that encourage clients to understand
themselves and to grow personally
– self healing
– conscious thoughts
– self-fulfillment
• goals of therapy
– self-understanding
– personal growth
Roger’s Client-Centered Therapy
• client-centered therapy – also called Rogerian therapy
or nondirective therapy, a form of humanistic therapy,
developed by Rogers, in which the therapist provides a
war, supportive atmosphere to improve the client’s
self-concept and to encourage the client to gain insight
into problems
– identify and understand his or her own genuine feelings
– warm, supportive atmosphere
• active listening
• reflective speech – a technique in which the therapist mirrors the
client’s own feelings back to the client
– Roger’s 3 essential elements to grow:
• unconditional positive regard
• empathy
• genuineness
Behavior Therapies
• behavior therapies – treatments, based on the
behavioral and social cognitive theories of
learning, that use principles of learning to reduce
or eliminate maladaptive behavior
– emphasis: overt behavior change rather than insights
into self or into underlying causes
– goal: reduce or eliminate maladaptive behaviors
– common methods: classical and operant conditioning
Behavior Therapies
• Classical Conditioning Techniques Treating Phobias
• systematic desensitization – a method of behavior
therapy that treats anxiety by teaching the client to
associate deep relaxation with increasingly intense
anxiety-producing situations (p. 533)
– develop hierarchy of fearful scenes
– learn relaxation techniques
– apply relaxation while imagining fearful scenes
• Flooding
– intense exposure to feared stimuli without allowing
avoidance
Desensitization
for Test Anxiety
Aversive
Conditioning
• noxious stimuli
paired with
conditioned
stimulus
Behavior Therapies
• Operant Conditioning Techniques…
– unlearning maladaptive behavior (e.g., OCD)
through altered consequences.
• Applied Behavior Analysis
– positive reinforcement of adaptive behaviors
– extinguish maladaptive behaviors
– does not depend on gaining insight
Cognitive Therapies
• cognitive therapies
• Emphasis of this Approach
– thoughts (cognitions) are the primary source of psychological
problems
– how we think controls how we feel
• attempt to change the individual’s feelings and behaviors by changing
cognitions
– focus on overt problems (unlike Freud)
– structured analysis and specific guidance (unlike Rogers)
• Goals of Therapy
– cognitive restructuring – a general concept for changing a
pattern of thought that is presumed to be causing maladaptive
behavior or emotion
Cognitive Therapies
• Albert Ellis’s Rational-Emotive Behavior Therapy
– assertion that individuals develop a psychological disorder
because of irrational and self-defeating beliefs
– eliminate beliefs through rational examination
– directive, persuasive, confrontational
– musterbating
• Beck’s Cognitive Therapy
– illogical automatic negative thoughts
– identify and challenge automatic thoughts
– reflective, open-ended dialogue, less directive
• Both are more effective in treating depression than drugs.
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challenge idiosyncratic meanings
question the evidence
Cognitive
reattribution
Therapy
examine options and alternatives
decatastrophize
Techniques
fantasize consequences
examine advantages and disadvantages
turn adversity to advantage
guided association
scaling
thought stopping
distraction
labeling of distortions
Cognitive-Behavior Therapy
• Albert Bandura and Self Efficacy
– self-efficacy – concept that one can master a situation
and produce positive outcomes
• cognitive-behavior therapy – a therapy that
combines cognitive therapy and behavior therapy
with the goal of developing self-efficacy
– self-defeating thoughts
– incorporates behavior therapy
– self-instructional methods
Therapy Integrations
• Techniques from different therapies are
combined for the benefit of the client (e.g.,
dialectical behavior therapy).
Comparing Psychotherapies
• integrative therapy – a combination of techniques from different
therapies based on the therapist’s judgment of which particular
methods will provide the greatest benefit for the client
– most therapists use an eclectic approach
How Does Therapy Affect the Brain?
• Brain Imaging Studies
– use of functional magnetic resonance imaging
(fMRI)
– shows that brain function can be normalized (e.g.,
cognitive remediation therapy increases prefrontal
cortex activity in schizophrenics)
Sociocultural Approaches
• Emphasis
– influence of various social/cultural factors
• Approaches to Therapy
– group therapy – a sociocultural approach to the treatment of
psychological disorders that brings together individuals who
share a particular psychological disorders in sessions that are
typically led by a mental health professional
– family therapy – group therapy with a family
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validation
reframing
structural change
detriangulation – shift attention away from scapegoat
– couples therapy – group therapy with married or unmarried
couples whose major problem lies within their relationship
– self-help support groups
– community mental health
Sociocultural Approaches and Issues
• Group Therapy
– group shares disorder
– professional facilitates
• Family and Couples Therapy
– symptoms are a function of relationships
– therapeutic techniques
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validation
reframing
structural change
detriangulation
Sociocultural Approaches and Issues
• Self-Help Support Groups
– conducted by paraprofessionals – individuals who
have been thought by a professional to provide some
mental health services but who not have formal
mental health training
• Community Mental Health Act of 1963
– deinstitutionalization (rise in homelessness) – large
numbers of individuals with psychological disorders
were transferred from mental institutions to
community based facilities
– prevention
– empowerment
Sociocultural Approaches and Issues
• Cultural Perspectives
– individualistic v. collectivistic cultures
– ethnicity
• match between client and therapist
– gender
• balance between independence and relatedness
• feminist therapies
Effectiveness of Psychotherapy
• Research results show that all therapies are
“winners”.
• Common Themes in Successful Psychotherapy
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expectations of help
increased sense of competence
emotional arousal is a motivator
therapeutic alliance - the relationship between the
therapist and client—an important element of
successful psychotherapy
– client factors (active engagement)
Effectiveness of
Psychotherapy
Effects of Therapy on Health and
Wellness
• stress reduction in cancer patients
• reduces physical health risks in those who are
depressed
• not only reduces symptoms, but enhances
psychological wellness
• well-being therapy (WBT)
– short-term, problem-focused, directive
– notice and celebrate positive experiences
Chapter Summary
• Describe the biological approaches to therapy.
• Define and characterize four types of
psychotherapy.
• Explain the sociocultural approaches and
issues in treatment.
• Discuss the effectiveness of psychotherapy.
• Discuss the impact that therapy has on health
and wellness.
Chapter Summary
• Biological Therapies
– drug therapy
– electroconvulsive therapy
– psychosurgery
• Psychodynamic Therapies
– Freud’s psychoanalysis
• Humanistic Therapies
– Rogers’s client-centered therapy
Chapter Summary
• Behavior Therapies
– systematic desensitization and flooding
– aversive conditioning
• Cognitive Therapies
– Ellis’s rational-emotive behavior therapy
– Beck’s cognitive therapy
– cognitive-behavior therapies
Chapter Summary
• Sociocultural Approaches and Issues
– group, family, and couples therapy
– self-help groups and community mental health
– cultural perspectives
• Effectiveness of Psychotherapy
• Therapies and Health and Wellness
– physical health and preventing disorders