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Flashcards in Chapter 15 Deck (42):
1

Psychotherapy

generic name given to any formal psychological treatment
– All forms of psychotherapy involve interactions between practitioner and client
– Psychologists use two basic categories of techniques:
1) Psychological
2) Biological
* Increased need for evidence-based treatments

2

Psychological treatments

term used to distinguish evidence-based treatments from the more generic term psychotherapy

3

List some counterproductive therapies

– Asking people to describe traumatic experiences soon after
– Scaring adolescents away from committing crimes
– Having police officers run drug education programs such as Drug Abuse Resistance Education (DARE)
– Using hypnosis to recover painful memories

4

3 features that characterize psychological treatments

– Treatments vary according to the psychological disorder and the individual’s specific symptoms
– Techniques used in treatments have been developed by psychologists (particularly behavioral, cognitive, and social psychologists)
– No overall grand theory guides treatment; instead, treatment is based on evidence of effectiveness (gathered via ongoing assessment)

5

Biological therapies

treatment of disorders based on a medical approach to disease (what is wrong with the body) and illness (what a person feels as a result)
– based on the notion that psychological disorders result from abnormalities in neural & bodily processes

6

Psychopharmacology

use of medications (pharmacology) that affect brain or bodily functions, to influence the mental state (psyche)
– a form of biological therapy
• For many disorders, the recent focus has been on combining biological therapies with other approaches to find the best treatment for each person

7

Humanistic Therapies

• Goal: treat the person as a whole, not as a collection of behaviors or thoughts.
– Focus is on the whole person

8

Client-centered therapy

A humanistic therapy. an empathic approach that encourages people to fulfill their individual potentials for personal growth through greater self-understanding
– Therapists strive to create a safe and comforting setting for clients to access their true feelings, to be empathic, and to accept the client through unconditional positive regard

9

Behavior therapy

Based on the premise that behavior is learned, & therefore can be unlearned, through classical and operant conditioning
– Can also learn through modelling (vicarious learning)

10

Social skills training

Can be part of behavior therapy. The person learns appropriate ways to act in specific social situations.

11

Exposure

A behavioral therapy technique that involves repeated exposure to an anxiety-producing stimulus
• Particularly effective for OCD and PTSD

12

Systematic Desensitization

Exposure therapy that involves exposing the person to increasing levels of an anxiety-producing stimulus, while also teaching them to relax

13

Cognitive therapy

based on the idea that distorted thoughts produce maladaptive behavior & emotion
• Techniques attempt to modify these maladaptive thought patterns
– Cognitive Re-structuring
– Rational-Emotive Therapy
– Inter-personal Therapy
– Mindfulness-based Cognitive Therapy
–Cognitive-Behavioral Therapies

14

Cognitive restructuring

aims to help people recognize maladaptive thought patterns, & replace them with thoughts/perspectives that are more in line with reality

15

Rational-emotive therapy

approach in which the therapist acts as a teacher, explaining the person’s errors in thinking, & demonstrating more adaptive ways to think and behave

16

Interpersonal therapy

focuses on circumstances namely, relationships, that the person attempts to avoid

17

Mindfulness-based Cognitive Therapy

based on a view that people who recover from depression continue to be vulnerable to faulty thinking when they experience negative moods

18

Cognitive-Behavioral Therapy (CBT)

many forms of therapy incorporate techniques from cognitive therapy and behavior therapy to correct faulty thinking and change maladaptive behaviors

19

What are the advantages of group therapy

– Significantly less expensive than individual treatment
– Group setting provides an opportunity to improve their social skills, and to learn from one another’s experiences
– Many groups are organized around a particular type of problem (e.g., sexual abuse) or a particular type of client (e.g., adolescents, or couples)
• Group therapy may be highly structured or a more loosely-organized discussion forum

20

Placebo effect

an improvement in physical or mental health following treatment with a drug or treatment that has no active influence on the disorder being treated
– For a placebo to reduce symptoms of psychopathology, the participant must believe it will

21

What is the most effective form of therapy for an anxiety disorder?

Cognitive-Behavioral Therapies (CBT) are the most effective treatment
– Anxiety-reducing drugs can also be helpful, but drug effects last only as long as the drugs are being taken, and CBT benefits persist after therapy

22

Psychotropic medications

broad term referring to drugs that affect mental processes

23

Anxiolytics

Psychotropics that reduce anxiety

24

Benzodiazepines

(e.g., Xanax, Valium) increase GABA activity, induce drowsiness, and are highly addictive

25

What is the most effective treatment for a phobia?

• Cognitive-Behavioral Therapies (CBT) are the most effective treatment
– Exposure therapy focuses more on behavioral responses, and Systematic Desensitization incorporates cognitive techniques
– Practitioners may use virtual environments to treat people without exposing them to real danger
– Neuroimaging evidence suggests that CBT alters the way the brain processes the fear-inducing stimulus

26

Treatment for panic disorders

• CBTs are at least as effective as pharmacological methods in treating panic attacks
– Cognitive restructuring helps people recognize the symptoms and the irrationality of the fears
– Exposure therapy helps break the connection between stimulus and fear response

27

Treatment for OCD

• Traditional anti-anxiety drugs are ineffective, but some SSRI drugs can be effective
• One reason DSM classifies OCD separately from other anxiety disorders
• Adding CBT to pharmacological therapy helps
– Exposure and Response Prevention are the most important aspects of treating OCD with CBT
• Adding CBT to pharmacological therapy helps

28

Deep-Brain Stimulation

may be effective for those with OCD who cannot find relief from CBT or medicine
• Electrodes are implanted deep in the brain, & mild electricity is used to stimulate the brain
– Tremendously successful in treating Parkinson’s Disease
DBS of the PFC may also be effective when other treatments for depression fail
– Several recent studies examining the effectiveness of DBS in the prefrontal cortex have all found that at least half of the patients reported either immediate or delayed benefits of treatment

29

Major depression treatment

• Many different treatments have been shown to be effective, but there is no “best” approach
– A variety of different pharmacological approaches have varied effectiveness in different people
– CBTs can be as effective as pharmacological approaches
* A combination of both approaches is most effective
• Not all patients benefit from antidepressant medications, and some cannot (or will not) tolerate the side effects
• CBTs can be just as effective as antidepressants – CBTs lead to changes in brain activity similar to the changes observed with pharmacological treatments
• Combining both approaches seems most effective – A meta-analysis of “combined treatment” studies found that the effects of drugs and CBT are largely independent … supporting the idea that combining treatments leads to greater effectiveness.
• For some patients, regular aerobic exercise can reduce symptoms and prevent recurrence

30

MAOIs (Mono-amine oxidase inhibitors)

-anti-depressant
-effective, but have some dangerous side effects
– prevent breakdown of monoamine
neurotransmitters, leaving them in the synapse
• Monoamines include dopamine, epinephrine, norepinephrine, and serotonin

31

Tri-cyclics

-anti-depressant
-extremely effective, but with a lot of unpleasant side effects
– prevent removal of some monoamines from the synapse (norepinephrine and serotonin?)

32

SSRIs (Selective Serotonin Reuptake Inhibitors)

-anti-depressant
-Variably effective in different people, but have far fewer side effects
– prevent removal of serotonin from the synapse

33

Phototherapy

• Phototherapy is effective for many people suffering from Seasonal Affective Disorder (SAD) – SAD results in episodes of depression during winter months, and the rate of the disorder increases at more northern latitudes
– Phototherapy involves exposure to high-intensity light each day

34

Transcranial magnetic stimulation (TMS)

TMS over the left frontal region can reduce symptoms of depression
– A powerful electrical current produces a strong magnetic field (40,000x as strong as Earth’s)
– Rapidly switching the current on/off interrupts neural functioning in brain regions below the coil
– Single-pulse TMS: a brief period of stimulation – Repeated TMS: multiple pulses of TMS given over an extended period

35

Electroconvulsive therapy (ECT)

a very effective treatment for the severely depressed who do not respond to conventional treatments
– Involves administering a strong electrical current to the brain to produce a seizure
– First developed in 1930’s Europe, first tried on humans in 1938, and commonly used in the US to treat disorders including schizophrenia and depression in the 1940’s-50’s
– The general public has a very negative view of ECT – ECT is still used in extreme cases, but typically with the person under anesthesia and with muscle relaxants to eliminate motor convulsions (and essentially confine the seizure to the brain).

36

Treatment for bipolar disorder

• Pharmacological approaches are most effective

37

Anti-psychotics (“neuroleptics”)

-used to treat bipolar disorder
• Class of psychotropic medications used to treat disorders that involve psychosis
• Most have major side effects, such as tardive dyskinesia, or involuntary twitching of face and neck muscles

38

Mood Stabilizing Anti-psychotics (e.g., Lithium)

-used to treat bipolar disorder
• Lithium seems to modulate neurotransmitter levels, balancing excitatory and inhibitory activity… but has unpleasant side effects (thirst, hand tremors, memory problems)
* Lithium works better on mania symptoms, so is often prescribed with antidepressants

39

Atypical Antipsychotics (e.g., Seroquel)

-used to treat bipolar disorder
-used to treat schizophrenia:
• Clozapine works very differently from earlier drugs
–Reduces positive and negative symptoms
–Fewer, but more serious side effects than the typical anti-psychotics
• More recent drugs (e.g., Risperdal, Zyprexa) work similarly to Clozapine, without the most serious side effects –First line of defense in schizophrenia

40

Historical Treatment of Schizophrenia

• Psychotic patients were often institutionalized
• Surgeries, such as trepanning or frontal lobotomy, were considered options for other disorders, but were ineffective in treating schizophrenia
• Introduction of Anti-psychotic medications has fundamentally altered treatment & prognosis

41

Treatment of Schizophrenia

-Pharmacological approaches are needed in combination with CBTs… to treat different symptoms
• Medications work best to reduce positive symptoms (e.g., delusions and hallucinations)
• Behavioral interventions are effective in improving social functioning and overall prognosis
– Self-care (e.g., grooming, bathing, medication management, financial planning)
• Most people diagnosed with schizophrenia experience multiple psychotic episodes in their lives
• Most patients also improve over time
– A study that followed patients for an average of 32 years showed that over half (1/2 – 2/3) improved considerably.
• Prognosis depends on age of onset, time to treatment, type and consistency of treatment

42

Early Antipsychotics: (“Neuroleptics”)

• Chlorpromazine is a strong tranquilizer, and Haloperidol works similarly (but is less sedating)
–Only reduce positive symptoms
–Significant side effects (e.g., Tardive dyskinesia)