THERAPY AND TREATMENT

1. THERAPY AND TREATMENT AP Psychology

2. Types of Therapy • The type of therapy used depends on the problem!

3. PSYCHOTHERAPIES Psychoanalysis Humanistic Behavioral Cognitive Group Therapies

4. PSYCHOANALYSIS “Look into the depths of your own soul and learn first to know yourself, then you will understand why this illness was bound to come upon you and perhaps you will thenceforth avoid falling ill.” - Sigmund Freud

5. Psychoanalysis • Based upon the ideas of Freud

6. Psychoanalytic Phenomena • Resistance – the blocking from consciousness of anxiety-laden material • Hints that anxiety exists and you are defending against sensitive material • Transference – the patient’s transfer to the analysts of emotions linked with other relationships • such as love or hatred for a parent • Example Psychoanalytic Session • What About Bob Trailer

7. Psychodynamic Therapy • Influenced by Freud, but not the same as psychoanalysis

8. HUMANISTIC THERAPY “We have two ears and one mouth that we may listen that more an talk the less.” - Zeno. 335-263 BC

9. Humanistic Therapy • Emphasis on self-actualization and self-fulfillment • Developed largely by Carl Rogers Active Listening Example

10. With a neighbor… • Think of the last thing recently that: • Made you angry • Made you sad • Made you anxious/nervous • For 2-3 minutes, talk about the event and feelings. The active listener should: • Use Active Listening Tips sheet • Paraphrase – check your understanding by summarizing the speaker’s words in your own words and ask if you are correct. • Invite clarification – “What might be an example of that?” may encourage the speaker to say more. • Reflect feelings – “It sounds frustrating” might mirror what you’re sensing from the speaker’s body language and intensity. • Remain unbiased and nonjudgmental • Do you notice any differences when you were active listening compared to how you listen everyday?

11. BEHAVIORAL THERAPIES

12. Behavioral Therapy • Behavioral therapists do not emphasize the mental root of a disorder as they assume that the problem behaviors are the problems

13. Counter-conditioning • Systematic Desensitization (exposure therapy) – associating a pleasant relaxed state with gradually increasing anxiety-triggering stimuli • commonly used to treat phobias. • Ex: fear of public speaking. • 1. Ranked list (high to low anxiety) • 2. Establish a relaxed state • 3. Induce mild anxiety by imagining situations on the list • 4. When too much anxiety → return to relaxed state • 5. Repeat the pairing until the anxiety is replaced by relaxed feelings • 6. Move up the anxiety list implementing desensitization each time. • 7. Move from imagined situations to real situations.

14. Counter-conditioning • Aversion therapy - associates an unpleasant state with an unwanted behavior • Commonly used to treat addictions • Ex: quitting smoking • 1. Therapist shocks a patient when a drag is inhaled • 2. Patient smokes rapidly, inducing many shocks • 3. Pair together several times • 4. Patient associates pain of shock with smoking • 5. Quit smoking • Highly successful in the short-run, but has mixed results in the long-run.

15. Behavior Modification • Behaviors are influenced by their consequences • operant conditioning – reinforcement and punishment • Token economy –earn a token of some sort for exhibiting a desired behavior and can later exchange the tokens for various privileges or treats. • Used to help autistic children become more social. • Can teach schizophrenic sufferers or the mentally retarded to care for themselves.

16. COGNITIVE THERAPY “Life does not consist mainly, or even largely, of facts and happenings. It consists mainly of the storm of thoughts that are forever blowing through one’s mind.” - Mark Twain

17. Cognitive Therapy • Best for disorders in which the roots are unclear, like generalized anxiety disorder and major depressive disorder

18. Cognitive-Behavioral Therapy • Useful for disorders that involve maladaptive mental and behavioral elements

19. Other examples of CBT • EX: OCD sufferers – changing thinking patterns concerning obsessive thoughts and changing behaviors concerning compulsions • EX: Anorexia nervosa – changing thinking patterns concerning depression and negative body image and changing behaviors concerning eating.

20. GROUP THERAPIES “The feeling of having shared in a common peril is one element in the powerful cement that binds us.” - Alcoholics Anonymous member

21. Group Therapy and Support Groups • Except for psychoanalytic therapies, psychotherapy techniques can be used in therapist-led small groups. • Group therapy does not allow for the same degree of individual attention, but it is time and cost effective and has often been found no less effective than individual therapy. • The social context of group therapy often allows client to feel as if they are not alone in their problems. It can be a relief to find that others share your problems and feelings. • EX: AA, cancer or AIDS support groups, online support groups

22. Family Therapy • Treats the family as a system in which undesirable behaviors are influenced by and affect other members • tries to foster healthier relationships within the family. • Ex: A family might attend therapy if one member is addicted to drugs/medication during which the therapist would evaluate relationships in the family that could contribute to conflict and possible drug abuse. Crash Course - Psychotherapy

23. EVALUATING PSYCHOTHERAPIES

24. Is Therapy Effective? Clinicians… Clients… • YES • More aware of the failures of other therapists. • The same person with the same recurring problems could be considered a “success story” for several therapists. • Although treatments have varied widely, every generation of therapists view its own approach as the most enlightened and effective. • Self-serving bias • YES • Self-justification – rationalize the time and money spent. • Confirmation bias and selective recall • Enter therapy in troubled state, when we return to a “normal” state, we attribute this to whatever we have done in the interim. • Placebo effect?

25. Outcome Research • Controlled experiments! • Outcome studies are randomized clinical trials in which people on a waiting list receive therapy or no therapy. • Meta-analysis – a procedure for statistically combining the results of many different research studies • People who remain untreated often improve (2/3) • People who receive psychotherapy are more likely to improve. • People who receive psychological treatment spend less time and money later seeking other medical treatments, compared with those on the waiting list.

26. EVALUATING PSEUDOTHERAPIES As critical thinkers, exploring and evaluating pseudotherapies requires a scientific attitude -- being skeptical but not cynical, and open to surprise but not gullible.

27. Pseudotherapies • Every therapy, based on testimonials, will seem effective for some people. • Placebo effect? Regression toward the mean? • For many pseudotherapies, little/no scientific evidence about the effectiveness exists (uncontrolled exp., unreliable results) • Hypnotherapy • Anger-release therapists • Reflexologists • Aromatherapists • Massage therapy • Herbal medicines

28. Eye Movement Desensitization and Reprocessing (EMDR) • A therapist attempts to unlock and reprocess previously frozen traumatic memories by waving a finger/flashing a light in front of the eyes of a person imagining a traumatic scene. • EDMR has its believers and also its critics. • Combination of exposure therapy (repeatedly reliving traumatic memories in a safe and reassuring context) and the placebo effect? EMDR

29. Light Exposure Therapy • Light exposure therapy – exposure to daily timed doses of light that mimics outdoor light. • Seasonal affective disorder – (SAD) a form of depression linked to periods of decreased sunlight. • Light comes out of manufactured light boxes that can be bought or rented from health supply and lighting stores. • Research and controlled experiments suggest that light exposure therapy diminishes symptoms associated with SAD.

30. THE BIOMEDICAL THERAPIES “Medicine, the only profession that labors incessantly to destroy the reason for its existence,” - James Bryce

31. Biomedical Therapies • Physically change the brain’s functioning… • Altering chemistry with medication • Overloading its circuits with electroconvulsive shock • Using magnetic impulses to stimulate or dampen activity • Altering its circuits through psychosurgery

32. Psychopharmacology • The study of the effects of drugs on mental processes and behaviors. • Led to more independent lives for sufferers of psychological disorders • Reduced hospitalization of many people • To evaluate the effectiveness of new drugs, researchers use the double-blind experimental technique to reduce researcher bias.

33. Tardive Dyskenesia Antipsychotic Drugs = Dopamine = Antipsychotic drug

34. Anti-anxiety Drugs

35. Anti-depressant Drugs

36. Mood Stabilizing Drugs

37. “Shock” Trailer Brain Stimulation

38. Psychosurgery • Lobotomy– a now-rare psychosurgical procedure that cut the nerves that connect the frontal lobes to the emotion-controlling centers of the inner brain. • Developed in the 1930s • Shock the patient into a coma • Hammer an ice pick-like instrument through each eye socket into the brain, then wiggle it to sever connections running up tothe frontal lobes.

39. Lobotomies • Crude but easy and inexpensive (10 minutes) • Tens of thousands of severely disturbed people were lobotomized during the 1940s-50s • The lobotomy usually produced a permanently lethargic, immature, impulsive personality. • In the 1950s, calming drugs were introduced and lobotomized fell out of favor in the US. • Other early therapies • Crash Course – Biomedical Therapies