Flashcards in Chapter 15 Deck (42):
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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
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Psychological treatments
term used to distinguish evidence-based treatments from the more generic term psychotherapy
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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
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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)
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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
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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
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Humanistic Therapies
• Goal: treat the person as a whole, not as a collection of behaviors or thoughts.
– Focus is on the whole person
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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
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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)
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Social skills training
Can be part of behavior therapy. The person learns appropriate ways to act in specific social situations.
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Exposure
A behavioral therapy technique that involves repeated exposure to an anxiety-producing stimulus
• Particularly effective for OCD and PTSD
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Systematic Desensitization
Exposure therapy that involves exposing the person to increasing levels of an anxiety-producing stimulus, while also teaching them to relax
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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
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Cognitive restructuring
aims to help people recognize maladaptive thought patterns, & replace them with thoughts/perspectives that are more in line with reality
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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
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Interpersonal therapy
focuses on circumstances namely, relationships, that the person attempts to avoid
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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
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Cognitive-Behavioral Therapy (CBT)
many forms of therapy incorporate techniques from cognitive therapy and behavior therapy to correct faulty thinking and change maladaptive behaviors
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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
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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
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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
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Psychotropic medications
broad term referring to drugs that affect mental processes
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Anxiolytics
Psychotropics that reduce anxiety
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Benzodiazepines
(e.g., Xanax, Valium) increase GABA activity, induce drowsiness, and are highly addictive
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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
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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
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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
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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
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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
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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
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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?)
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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
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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
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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
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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).
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Treatment for bipolar disorder
• Pharmacological approaches are most effective
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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
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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
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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
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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
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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
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