Overview of the Conceptual and Practical Problems

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• Overview of the Conceptual and Practical Problems
• What are the most effective ways to treat
  biologically based problems?
• How can irrational beliefs and faulty
  attributions be changed?
• How can the environment be altered to reduce or
  eliminate abnormal behaviors?
• How can we evaluate the effectiveness of
  psychotherapy?

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• Three Main Approaches
• Treating the body
• Biomedical therapies
• Treating the mind
• Insight therapies
• Treating the environment
• Behavioral therapies

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• Biomedical Therapies Overview
• Biologically based treatments for reducing or
  eliminating symptoms of psychological disorders
• Main types of biomedical therapies
• Drug therapies
• Electroconvulsive therapy
• Psychosurgery

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• Drug Therapies
• Antipsychotic drugs reduce positive symptoms of
  schizophrenia
• Chlorpromazine first used in 1950s to treat
  delusions, hallucinations
• Most act on dopamine
• Side effects include involuntary movements of
  tongue, jaw, face (tardive dyskinesia)

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• Drug Therapies, continued
• Antidepressant drugs modulate availability or
  effectiveness of neurotransmitters implicated in
  mood disorders
• Tricyclics modulate effectiveness of
  norepinephrie
• Fluoxetine (Prozac) modulates effectiveness of
  serotonin
• Lithium carbonate used to treat bipolar
  disorder
• Antianxiety drugs reduce tension, anxiety
• Also known as tranquilizers
• Most act on gamma-aminobutyric acid (GABA)

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Figure 15.3
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• Electroconvulsive Therapy
• Brief electric shock delivered to the brain
• Used mainly for depression
• Successful 50-70 of the time
• Often the treatment of last resort
• Anesthesia, muscle relaxants make modern
  procedure less physically traumatic
• Controversial
• Unclear exactly how or why it works
• Causes confusion, loss of memory, at least
  temporarily
• Relapse rate is high
• Long-term effects of repeated treatment?

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• Psychosurgery
• Surgery that destroys or alters tissues in the
  brain in an effort to affect behavior
• Extremely rare approach to treatment
• Prefrontal lobotomy is the most famous example
• Pioneered by Egas Moniz in 1930s
• Produced calming effects, but also serious
  cognitive deficits, sometimes death
• Modern example Cingulotomy
• Used for severe obsessive-compulsive disorder,
  depression

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• Insight Therapies Overview
• Psychoanalysis
• Special characteristics of psychoanalysis
• Cognitive therapies
• Rational-emotive therapy
• Particular beliefs targeted by rational-emotive
  therapy
• Becks cognitive therapy
• Humanistic therapies
• Client-centered therapy
• What the client-centered therapist provides
• Group therapy

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• Psychoanalysis
• Derived from Freuds work
• Goal Bring hidden impulses, memories to
  surface of awareness
• Intended to free patient from disordered
  thoughts, behaviors
• Techniques
• Free association Patient relaxes and freely
  expresses whatever comes to mind
• Dream analysis Determine latent content of
  dreams

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• Special characteristics of psychoanalysis
• Resistance Patients unconsciously motivated
  attempts to subvert or hinder therapy
• Reflects the anxiety produced when unconscious
  conflicts, urges are exposed
• Special form of resistance Transference
• Psychoanalysis is highly time-consuming
• Psychodynamic therapy Modern, streamlined
  version of psychoanalysis

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Figure 15.4
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• Cognitive Therapies
• Goal Remove irrational beliefs, negative
  thoughts presumed to be responsible for
  psychological disorders
• Example Depression
• Techniques
• Identify irrational beliefs, maladaptive
  interpretations of events
• Challenge beliefs directly
• Encourage more rational beliefs and
  interpretations

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Figure 15.5
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• Rational-Emotive Therapy (Ellis)
• Therapist verbally assaults irrational thought
  processes almost like a cross-examiner
• Can be harsh and confrontational at times

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• Particular beliefs targeted by rational-emotive
  therapy
• I must be loved and approved of by everyone
• Its awful when things are not the way I would
  like them to be
• I should be very anxious about events that are
  uncertain or potentially dangerous
• I am not worthwhile unless I am (competent,
  adequate, achieving, etc.)
• I need someone stronger on whom to depend or
  rely

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• Becks Cognitive Therapy
• Less harsh and confrontational than
  rational-emotive therapy
• Encourages clients to identify irrational
  thought processes themselves
• Record keeping or homework is often used to
  pinpoint thought processes that lead to negative
  emotions

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Figure 15.6
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• Humanistic Therapies
• Goal Help clients gain insight into their
  fundamental self-worth, value as human beings
• Techniques
• Offer support act as a confidant or friend
• Rogers client-centered therapy is the most
  common approach others include
• Gestalt therapy
• Empty-chair technique
• Existential therapies
• Focus on fundamental choices in life

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• Client-Centered Therapy
• Client, not therapist, holds the key to
  psychological health, happiness
• Problems stem from incongruence between
  self-concept, reality of everyday experiences
• Others attach conditions of worth to approval,
  causing us to act inconsistently with true
  feelings

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• What the client-centered therapist provides
• Genuineness Therapist is not phony,
  expresses feelings openly and honestly
• Unconditional positive regard Therapist does
  not place conditions of worth on client
• Or Accepts and respects client no matter how
  client behaves, no matter what client says
• Empathy Therapist tries to see things from the
  clients perspective
• Validation, not pity

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• Group Therapy
• Form of therapy in which several people are
  treated simultaneously in the same setting
• Advantages and special uses
• Cost effective
• Can learn how others deal with similar problems
• Can learn that you are not alone with
  psychological problems
• Special form Family therapy
• Attempts to treat family as a social system,
  improve communication and collaboration

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• Behavioral Therapies Overview
• Designed to change behavior through the use of
  established learning techniques
• Idea is that maladaptive behavior is learned,
  can be unlearned through changes in the
  environment
• Main types
• Conditioning techniques
• Applying rewards and punishments
• Social skills training

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• Conditioning Techniques
• Systematic desensitization Use
  counterconditioning, extinction to reduce fear,
  anxiety associated with an object or event
• Work through an anxiety hierarchy of
  situations that lead to fearful reactions
• Imagine fearful situations while remaining
  relaxed
• Can eventually face the real situation
• Aversion therapy Replace a positive reaction
  to a harmful stimulus with something negative
• Example Give a drug (Antabuse) that causes
  severe nausea when alcohol is ingested

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Figure 15.7
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• Applying Rewards and Punishments
• Token economies Patients rewarded with small
  tokens when they act appropriately
• Can exchange tokens for privileges
• Useful for helping institutionalized patients
  develop life skills
• Punishment Follow an undesirable behavior with
  something aversive, or removing something
  pleasant
• Example Give mild shocks to a disturbed child
  to prevent self-destructive behavior
• Note potential side effects, ethical concerns

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• Social Skills Training
• Uses modeling and reinforcement to shape
  appropriate adjustment skills
• Usually involves a series of steps
• For example, to teach conversational skills,
  the therapist might
• Discuss appropriate verbal responses
• May be followed with a videotaped demonstration
• Role play a conversation
• Therapist gives feedback
• Assign client to practice skills before next
  session

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• Evaluating Different Approaches to Psychotherapy
• Clinical researchers have contrasted outcomes
  associated with different approaches
• The Philadelphia study Contrasted behavior and
  psychodynamic therapy with a control group on a
  waiting list
• Most participants had anxiety disorders
• Both approaches produced improvement, but
  little differences between them
• Meta-analysis comparing many different studies
  found similar results as the Philadelphia study

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Figure 15.8
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Figure 15.9
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• Is it really the case that all therapies are
  equally effective?
• Note that the control group improved over time
  as well
• Spontaneous remission
• However Did the support given while on the
  waiting list produce improvement?
• Other research suggests that the effectiveness
  of a kind of therapy depends on the kind of
  problem
• Cognitive therapies are best for depression,
  while behavioral therapies are best for some
  kinds of anxiety disorders

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• What do different therapies have in common?
• Support factors
• Therapist listens, offers empathy
• Therapeutic alliance
• Learning factors
• Learn about thought processes, behavior, role
  of past experiences
• Get feedback
• Action factors
• Therapists provide specific suggestions for
  action
• Examples relaxation techniques, coping
  techniques

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• How should you choose a therapist?
• Choose someone you trust and are comfortable
  with
• Consider the persons approach
• Most therapists are eclectic - they pick and
  choose from several approaches
• Consider cultural factors
• Not necessary to go to a therapist with an
  identical background as your own
• However, therapist should be sensitive to such
  factors

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• Solving the Conceptual and Practical Problems
• Treating biologically based problems
• Biomedical therapies include drug therapy,
  electroconvulsive therapy, and psychosurgery
• Changing irrational beliefs and faulty
  attributions
• Insight therapies encourage clients to gain
  self-knowledge about thought processes
• Psychodynamic, cognitive, and humanistic
  therapies use different techniques to produce
  insight

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• Solving the Conceptual and Practical Problems,
  continued
• Altering the environment to reduce or eliminate
  abnormal behaviors
• Conditioning and instrumental learning
  principles can be used to replace associations,
  reduce anxiety, and produce new patterns of
  behavior
• Evaluating the effectiveness of psychotherapy
• Research suggests that while psychotherapy
  produces significant improvement, there are few
  advantages for one kind of therapy over another
• Effective therapies have several factors in
  common, including support, learning, and action
  factors