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San Sebastian College Recoletos-Manila C. M., Recto Ave., Metro Manila The History of Psychological Treatments Submitted by: Aquino, Karina R. De Jesus, Neann Klara M. Diolanda, Jesselle M. Inciso, Genesis C. 4th year BS Psychology December 1, 2014 I. PREHISTORIC TIMES Early man widely believed that mental illness was the result of supernatural phenomena such as spiritual or demonic possession, sorcery, the evil eye, or an angry deity and so responded with equally mystical, and sometimes brutal, treatments. Trephining (also referred to as trepanning) first occurred in Neolithic times. During this procedure, a hole, or trephine, was chipped into the skull using crude stone instruments. It was believed that through this opening the evil spirit(s)-thought to be inhabiting one’s head and causing their psychopathology--would be released and the individual would be cured (Foerschner, 2010). The idea that spirits can enter and control a person is as old as civilization, and historical, biblical, and archeological evidence indicates its presence in diverse forms and in almost all cultures. "Religio-magical rituals are major forms of healing in non-industrialized societies and provide the foundation for faith healing in our own". The earliest healers were shamans who believed in magic and the supernatural; many thought that evil spirits invaded people's bodies and made them disturbed. An exorcism is a ritual that is used to drive the devil, demons, or evil spirits from a person. A form of exorcism exists in all shamanic cultures. Skulls that have been trepanned (bored with small holes, probably to release demons) date back to at least 5000 B.C.E. Belief in spirit possession and exorcism has been documented in Babylonia, Nigeria, Tanzania, Greece, India, Ceylon, Malaysia, Indonesia, China, Tibet, Korea, New Guinea, Brazil, Columbia, Haiti, the United States, and throughout Europe. However, the possession phenomenon is not universal; it has not been found in certain tribal groups in the Philippines, the Malay Peninsula, or Australia (Thomason, 2008). Mesopotamia In ancient Mesopotamia, priest-doctors treated the mentally ill with magico-religious rituals as mental pathology was believed to mask demonic possession. Exorcisms, incantations, prayer, atonement, and other various mystical rituals were used to drive out the evil spirit. Other means attempted to appeal to the spirit with more human devices--threats, bribery, punishment, and sometimes submission, were hoped to be an effective cure.(Foerschner, 2010) Also, Hammurabi the king of Babylon preserved the code of Hammurabi. This code is the first-known example an orderly body of laws created by a ruler which includes legal procedures for physicians in the treatment of a variety of physical ailments such as payment for successful services rendered as well as punishment for a failed service to his patient (Snitchlier and Harris). Egyptians Ancient Egyptians seem to be the most forward-thinking in their treatment of mental illness as they recommended that those afflicted with mental pathology engage in recreational activities such as concerts, dances, and painting in order to relieve symptoms and achieve some sense of normalcy. The priests of the "Abidos" Temple (the biggest center of medicine in Ancient Egypt) treated diseases with chant. In ancient papyrus texts, it was found that there was a saint called Abu Terbo that had treated epilepsy by pipes chant. Egyptian music healers enjoyed a privileged existence, due to their close relationship with priests and other important government leaders. Egyptian priests and physicians referred to music as medicine for the soul and included chant therapies as part of the medical practice. Music therapy has been known since ancient times, when ancient man used singing and dancing as a part of his rituals to throw out the evil spirits, which were waiting to attack him with several diseases (Voices, 2005). Hebrews Hebrews believed that all illness was inflicted upon humans by God as punishment for committing sin, and even demons that were thought to cause some illnesses were attributed to God’s wrath. Yet, God was also seen as the ultimate healer and, generally, Hebrew physicians were priests who had special ways of appealing to the higher power in order to cure sickness. Along the same spiritual lines, ancient Persians attributed illness to demons and believed that good health could be achieved through proper precautions to prevent and protect one from diseases. These included adequate hygiene and purity of the mind and body achieved through good deeds and thoughts. (Foerschner, 2010). Persians Ancient Persians attributed illness to demons and believed that good health could be achieved through proper precautions to prevent and protect one from diseases. These included adequate hygiene and purity of the mind and body achieved through good deeds and thoughts. They made used of the beneficial effects of physical training and utilized it to fit their youth for military duty. Greek and Romans It was said that mental illness was caused by God’s taking a mind away. The foundation of a systemic approach to psychological and physical disorders is considered to have begun with the early Greek philosophers. Hippocrates theorized that “four humours” or bodily fluids were responsible for both physical and mental health. The four important bodily fluids were: black bile, yellow bile, phlegm, and blood. Having too many of any of these fluids could account for changes in an individual’s personality and behavior. Hippocrates theorized that an excess of black bile would make a person "melancholic" (depressed), and an excess of yellow bile would cause a person to be "choleric" (anxious or irritable).Too much phlegm would result in a person being "phlegmatic" (indifferent).An excess of blood would cause a person to be "sanguine" (experience unstable mood shifts).It is important to note that Hippocrates saw no distinction between physical and psychological disorders (Snitchlier and Harris). Demon possession was the theory of Aeschylus to explain Mental illness; exorcism the cure. Socrates believed that mental illness was heaven-sent and not shameful in the least. He believed it to be a blessing, and therefore no treatment was required. Aristotle believed that melancholia was the cause of mental illness and music was the cure. Aulus Cornelius Celsus believed that “A sort of force” should be applied to the insane to cause a sudden fear into the spirit forcing it to flee the body. His beliefs helped to reinforce the belief that some psychological disorders were caused by angry gods or spirits. Celsus believed mental illness to be a form of madness to be treated with entertaining stories, diversion and persuasion therapy. Claudius Galen stated that Psychic functions of the brain were considered by Galen to be the foremost cause of mental illness. Treatment consisted of confrontation, humor and exercise. Galen maintained Hippocrates beliefs in the four humours as the cause of mental disturbance. However, Galen also suggested that a failure to control one’s passions (i.e., anger) might cause a kind of madness. II. THE MIDDLE AGES During the Middle Ages, almost no new scientific advances in the understanding of mental illness were made. Individuals with psychological disorders were blamed for their illness because of moral weakness or for participating in forbidden practices with the devil, sorcerers, or other demons. These views resulted in a large stigma for having a mental illness. Treatment of mentally ill people sometimes consisted of torturous exorcism procedures. This was to combat Satan and eject him from the possessed person’s body. Prayers, Curses, obscene epithets, sprinkling of holy water, as well as such drastic and painful “therapy” as – Flogging (whipping/beating severely), starving, immersion in hot water were used to drive out the devil. The humane treatments that Hippocrates had advocated centuries earlier were challenged severely. The Middle Ages were bleak for the mentally ill. Belief in the supernatural became so prevalent and intense that it frequently affected the whole population. Although religious thinking resulted in a strong belief in spiritual possession and brutal treatments for the mentally ill, Christian views also called for charity. Monasteries or poorhouses, which had been built to house people who could not pay their expenses, were built all over Europe and allowed the mentally ill shelter. Early in the conception of the monasteries, patients were treated with concern. These poorhouses later became known as asylums with the most famous being the Hospital of St. Mary of Bethlehem in London. The hospital was originally created in 1247 for poor people, and by 1403 began to house people called “lunatics.” In the next few centuries, the inhumane and chaotic housing of the psychologically disturbed came to be known as “bedlam”, a shortened name for Bethlehem Hospital. The hospital quickly became overcrowded and the residents more uncontrollable and the hospital employed chains and punishment to control patients. Similar conditions were found at other asylums as they became overcrowded. Beginning of the Renaissance “Witchhunts” began at the beginning of the Renaissance and were at their height in the 14thand 15 centuries in both colonial America and Europe. Most psychiatric historians believe that many psychologically ill were called witches. Torture was used to obtain confessions from suspected witches, and many victims—most of them with mental disorder. Thousands of innocent men, women, and even children were beheaded, burned alive, or mutilated. The witchcraft trials of 1692 in Salem, Massachusetts, were notorious. Several hundred people were accused and thousand people were executed as witches, many were imprisoned and tortured. It has been estimated that some 20,000 people (mainly women) were killed as witches in Scoland alone and that more than 100,000 throughout Europe from the middle of the 15 th century to the end of the 17th century. A rebirth of rational and scientific inquiry during the renaissance led to great advances in science and humanism, a philosophical movement that emphasizes the human welfare, the worth and the uniqueness of the individual. Until this time, most asylums were at best custodial centers in which people who were mentally disturbed were chained, caged, starved, whipped, and even exhibited to the public for a small fee, much like in a zoo. But the new way of thinking held that if people were mentally ill and not possessed, then they should be treated as though they were sick. A number of new methods for treating mentally ill people reflected this humanistic spirit. In 1563, Johann Weyer, a German physician, published a revolutionary book called “The Deception of Demons” that challenged the foundations of ideas about witchcraft. Weyer asserted that many who were tortured and executed as witches were mentally disturbed, not possessed by demons. His book proved to be a forerunner of the humanitarian perspective on mental illness. The 17th Century The unique and exotic techniques of Friedrich Anton Mesmer, an Austrian physician who practiced in Paris, presented an early challenge to the biological viewpoint. Mesmer developed developed highly controversial treatment called mesmerism and that was the forerunner of the modern practice of hypnotism. Mesmer performed his most miraculous cures in treatment of hysteria—the appearance of symptoms such as blindness, loss of bodily feeling and paralysis with no organic basis. His techniques for curing this illness involved inducing a sleeplike state, during which his patients became highly susceptible to suggestion. During this state, their symptoms often disappeared. In France, Philippe Pinel, a physician was put in charge of La Bicetre, a hospital for insane people in Paris. He instituted the moral treatment movement, a shift more humane treatment of people who are mentally ill. This involved treating patients with kindness and sensitivity. Pinel ordered that patients’ chains be removed, replaced dungeons, and encourage exercise. This humane treatment seemed to foster recovery and improve behavior. Pinel also instituted similar reforms at la Salpetriere a large mental hospital for women in Paris. Pinel is considered historically to be a primary figure in the movement for humanitarianism. In England, William Tuke, a prominent Quaker tea merchant, established the York Retreat House in rural England for the moral treatment of mental patients. The retreat enabled people with mental illness to rest peacefully, talk about their problems, and work. In the United States, Benjamin Rush widely acclaimed as the father of U.S. Psychiatry. He introduced more humane treatment policies into mental hospitals. He put into action plans for better ventilation, separation from violent and non-violent patients, and arranged recreation and exercise programs for the sick. Yet Rush was not affected by the established practices and belief of his times: His theories were influenced by astrology, and his remedies including bloodletting and purgatives. III. THE 18TH AND 19TH CENTURY Early 1800s: Rotation Therapy - The Swing During the early 1800s, a technique called Rotation Therapy or The Swing was invented by Erasmus Darwin who was Charles Darwin’s grandfather. There were two methods through which this treatment is administered: 1. An ordinary chair, suspended from the ceiling, with ropes attached to the legs. The ropes were used to spin the chair until was set in motion. it 2. A pole fixed from the floor to the ceiling by iron rods. It had a horizontal arm attached, which was used to hang a chair or bed and to spin the patient. Darwin believed that spinning a person around not only induced slumber, but also laughter and that this combination was a great way to resolve mental illness. Both methods had the same results: the spinning motion was continued until the patient promised to obey the doctors and get better. The doctors would then release them and allow them to sleep. But in the end, when the nausea and shock had worn off, the patients were still mentally ill, leading to another session on the swing and thus only repeating the process. There were eminent side effects to the treatment such as:      Anxiety and Fear Nausea and Vomiting Bowel movement Paleness Vertigo But despite these, multiple institutions still administered this treatment and even gained recognition by Benjamin Rush, Father of Modern Psychiatry, who stated that spinning reduced brain congestion and was thus therapeutic. 1800-1850: Moral Therapy It was also termed as Moral Therapy or Moral Treatment. One of its first pioneers was William Tuke who established the York Retreat asylum in 1796. The asylum admitted 30 mentally ill patients who lived as part of a small community in a large country house. The treatment also was supported by Philippe Pinel (Father of American Psychiatry) who initiated the Humanistic Approach in curing the mentally ill individuals in 1792. Moral therapy was based on the patients’ cure and rehabilitation back into society. This enabled many patients to spend only short periods of time in institutions. In 1792, Benjamin Rush initiated the widespread use of moral treatment in the United States. He was hired as a physician at the Pennsylvania Hospital for which he campaigned to the state to build a separate mental ward. It was here where he began the basic practice of moral treatment. In his book the Medical Inquiries and Observations upon the Diseases of the Mind, he stated his belief that most forms of mental illness were a direct cause of disruptions of the blood circulation, or by sensory overload. Therefore, he used methods of treatment that supposedly improved circulation to the brain such as a centrifugal spinning board, and the ‘tranquilizer chair’. The chair was designed as a sensory deprivation tool, where the patient was restrained and a ‘sensory deprivation head enclosure’ was set in place. It was around 1841 when Moral Treatment really became prominent in America through the work of Dorothea Dix. She advocated a humanitarian movement in treating mentally ill patients through the use of a wide-ranging method of treatment that focused on a patient’s social, individual, and occupational needs. Through this, she successfully raised millions of dollars which she used to build 32 state hospitals with humane conditions. However, as state hospitals grew severely crowded and understaffed, focus on the practice of moral treatment was lost and asylums went back to ‘warehousing’ those deemed insane. This led to the Decline of Moral Treatment in the 1830s. Early 1900s: Hydrotherapy Formerly called hydropathy, hydrotherapy was revived by Dominican monk Sebastian Kneipp through his book My Water Cure published in 1889. It was inspired by old German spa therapies and was deemed effective for mental disorders such as anxiety, insomnia, depression and aggression. Hot or warm water was used to calm and relax patients, whilst cold water was used on hyperactive patients as it slowed the blood flow to the brain and decreased activity. Hydrotherapy consisted of a bath tub covered by a thick canvas to maintain the temperature of the water. This canvas had room for the head to stick out from, plus patients could be allowed their arms outside it at meal times. Some say that “hydropathy” is a misleading name for the treatment for the procedure is the same for all forms of hydrotherapy. The only variation is with the medium which is water (hot or cold). “Thermotherapeutics” or “thermotherapy” is said to be more appropriate. Late 1800s to early 1900s: Psychoanalysis From 1838 to 1939, Sigmund Freud established the Psychoanalytic Theory which holds that the human mind was structured in three divisions: 1. Id – unconscious; pleasure principle 2. Ego – mediator; functions consciously and unconsciously; reality principle 3. Superego – moral arm of the personality Freud believed that the unconscious was the seat of psychopathology as it contained unacceptable desires and painful memories that had been repressed by the two higher functions. Anxiety arose as conflict occurs between the three parts of the human mind. This result to mental illness but if the person will be able to reveal and address the content of their unconscious, their mental ailments would be cured. Resulting treatments created by Freud became known as psychoanalysis or “talking cures” examples of which are:     Hypnosis – a revised form of mesmerism Free association – patient is instructed to relax and share whatever thoughts come to mind. Freudian slips – believed to reveal an individual’s beliefs, habits and even slips of the tongue Dream Analysis – patients are asked to record the contents of their dreams and the psychoanalyst interprets 1934: Chemically Induced Seizures Ladislaus von Meduna, a Hungarian pathologist, discovered that there was a distinct correlation between epileptics and schizophrenics. He found that schizophrenia was quite rare in patients suffering from epilepsy and derived the hypothesis that it was seizures which prevented the mental disorder. This was further supported by the notion that epileptic patients often felt a sense of euphoria after a seizure, indicating the same affect would be felt by a schizophrenic after a seizure. This lead to his method of giving patients an array of seizure-inducing drugs but Metrazol became his drug of choice. Critics say that this method left a trail of patients with broken bones and distorted memories. 1935: Lobotomy (Leucotomy) This was first performed by Portuguese neurologist Egas Moniz who believed that patients with obsessive behavioral traits were suffering from fixed circuits in the brain. He believed that severing the connecting fibers of the neurons activity would eliminate the vast proportion of mental disorders, and conducted a procedure involved: 1. drilling two holes in the patient’s skull (top or side) 2. a sharp tool known as leucotome would be forced through the holes and into the brain; 3. it would be swept from left to right to ensure that connections between the frontal lobe and the rest of the brain were severed American neurologist Walter Freeman made lobotomy a mainstream form of treatment in America by 1936 after an encounter with Moniz. He made a simplified version of the lobotomy called ‘transorbital’ lobotomy which involved lifting the upper eyelid and placing a leucotome against the top corner of the eye socket. Using a mallet, the leucotome was then hammered in through the bone and into the brain. It is moved around inside the skull, ensuring the brain tissue was cut. During the 1940s, lobotomy became one of the most popular forms of mental health treatment in the UK and was even regarded as the ‘miracle cure to insanity’. One of the most celebrated lobotomists in the world was Sir Wylie McKissock who reportedly performed over 3, 000 lobotomies during his career. In the late 1950s, lobotomy began to lose popularity due to increase in adverse side effects such as incontinence, epilepsy, loss of motor function, cognitive function, emotion and personality, tact and discipline, lack of empathy, and possible death. 1935: Electroconvulsive Therapy (ECT) Ugo Cerletti and Lucio Bini administered the first shock therapy using electricity to a schizophrenic patient and received successful results. The purpose of the ECT was to induce a clonic seizure in a patient, allowing them to lose consciousness and convulse for 15 seconds. The theory was that this jumpstarts the brain and helps boost neurotransmission, whilst alleviating most mental illness, especially schizophrenia. 1950s: Pharmaceutical Drugs The introduction of anti-psychotic drugs such as chlorpromazine (thorazine) helped in eliminating the need for drastic treatments such as the lobotomy and ECT. Thorazine was first created as a cure for malaria but later on, it was discovered that it had sedative side effects that reduced aggressive behavior, anxiety, hallucinations, and the desire to self-mutilate or harm other. IV. MODERN TRENDS IN PSYCHOLOGICAL TREATMENT Methods of psychological treatment have been varied throughout the history and have evolved with the passage of time. As psychology moved from the science of speculation, perceived by great philosophers such as Socrates, to the scientific study of human behavior, methods of treating psychological diseases also have been adapted with the changing outlook. Different schools of psychology focused on different aspects of psychological problems and all developed their own techniques and methods to get rid of these problems Nowadays, according to the universally accepted standards, we can roughly divide mental diseases into two broad categories: Less severe ones: Neurosis (characterized by anxiety, depression, or other feelings of unhappiness or distress that are out of proportion to the circumstances of a person’s life); More severe ones: Psychosis (a medical condition that happens in the brain, in which there has been some loss of contact with reality. Example: Schizophrenia, delusions of grandeur). It would be interesting to note that over the world, there are two manuals available for classification of diseases, namely: a) International Classification of Diseases (ICD) b) Diagnostic and Statistical Manual (DSM). The former has been developed by the World Health Organization while the latter has been developed by the American Psychiatrist Association.Psychologists from all over the world got together to develop these manuals. These list all the known mental diseases up to date. Moving towards the treatment of mental diseases, depending upon the nature of disease and the extent of severity, two categories of treatments have emerged: 1) Psychological approaches or methods of treatment and 2) Biological approaches or methods of treatment The Psychological method of treatment is an approach in which the patient is not treated with medicines .Instead, the patient in this approach is treated with the help of psychological treatment, which means that the psychologists try to find the root cause of the disease and then try to treat the patient by just listening and talking about the problem or disease. In other words, the psychologist focuses on discovering the root cause of the problem that the patient faces and tries to eliminate the problem through just talking to the patient, making him change his attitude etc. In this technique, no medicine is given to the patient. It involves methods such as psychotherapy. Methods such as group therapy, family therapy, etc. are also part of this mode of treatment. Psychological approach may be divided into: 1. Psychodynamic methodologies, 2. Behavioral methodologies, 3. Cognitive methodologies and 4. Humanistic methodologies. Psychodynamic Methodologies These are based upon the assumption that psychological problems and diseases are caused by unconscious impulses and unresolved past conflicts. So Psychodynamic Psychotherapists try to discover those unconscious motivations and help the patient resolve his past conflicts. Sometimes patient doesn't know the actual cause of his disease and thus gets mentally disturbed, but sometimes the patient knows that he or she had some unresolved past conflicts or some bad memories which are now disturbing him. So the Psychodynamic psychotherapists have to find the reason if the patient don't know or is unable to relate his past with his present problem. Viewpoints of some famous psychologists are important to be noted in this regards. These include Freud’s, Adler’s, Jung’s or Horney’s viewpoints. Sigmund Freud gave the concept of unconscious and motivations. Freud used Hypnosis to help clients recover lost memories and associated emotions while pressing on their foreheads. Hypnosis is a state of consciousness involving focused attention and reduced peripheral awareness characterized by an enhanced capacity for response to suggestion. During hypnosis a person is said to have heightened focus and concentration with the ability to concentrate intensely on a specific thought or memory, while blocking out sources of distraction. Hypnotized subjects are said to show an increased response to suggestions. Hypnosis is usually induced by a procedure known as a hypnotic induction involving a series of preliminary instructions and suggestions. The use of hypnotism for therapeutic purposes is referred to as "hypnotherapy", while its use as a form of entertainment for an audience is known as "stage hypnosis. Psychodynamic methodologies have evolved over time with the contributions of many great psychologists. The psychodynamic perspective was originated with the work of Sigmund Freud. This view of psychology and human behavior emphasizes the role of the unconscious mind, early childhood experiences, and interpersonal relationships to explain human behavior and to treat people suffering from mental illnesses Behavioral Methodologies This approach stems from the behavioral school of psychology. It is based upon Pavlovian concept of conditioning. In this regard, “Systematic Desensitization” is a method developed by Joseph Wolpe which is used to treat some mental disorders. This method involves exposure of certain elements to the individual which may be causing fear etc. For example, gradual exposure of snake to removes fear of snakes. Behavioral psychology is a perspective that focuses on learned behaviors. Behaviorism differed from many other perspectives because instead of emphasizing internal states, it focused solely on observable behaviors. Another method is through Aversion therapy which is a form of psychological treatment in which the patient is exposed to a stimulus while simultaneously being subjected to some form of discomfort. This conditioning is intended to cause the patient to associate the stimulus with unpleasant sensations in order to stop the specific behavior. Aversion therapies can take many forms, for example: placing unpleasant-tasting substances on the fingernails to discourage nailchewing; pairing the use of an emetic with the experience of alcohol; or pairing behavior with electric shocks of various intensities. Cognitive Methodologies During the 1960s, a new perspective known as cognitive psychology began to take hold. This area of psychology focuses on mental processes such as memory, thinking, problem solving, language and decision-making. Influenced by psychologists such as Jean Piaget and Albert Bandura, this perspective has grown tremendously in recent decades. Cognitive psychologists often utilize an information-processing model, comparing the human mind to a computer, to conceptualize how information is acquired, processed, stored, and utilized. Under in this category of treatment of mild mental diseases is what is termed as Cognitive therapy. Cognitive therapy is based upon the assumption that mental problems are caused by faulty thinking. The therapist corrects this faulty thinking, relieving the symptoms of the patient. The patient in this kind of thinking assumes that he is not good, or he cannot do something good, feels unconfident and feels that he/she is not being taking cared of. It is a psychotherapeutic approach that addresses dysfunctional emotions, maladaptive behaviors and cognitive processes and contents through a number of goal-oriented, explicit systematic procedures. The name refers to behavior therapy, cognitive therapy, and therapy based upon a combination of basic behavioral and cognitive principles and research. Most therapists working with patients dealing with anxiety and depression use a blend of cognitive and behavioral therapy. This technique acknowledges that there may be behaviors that cannot be controlled through rational thought. CBT is "problem focused" (undertaken for specific problems) and "action oriented" (therapist tries to assist the client in selecting specific strategies to help address those problems). It is based on a theory of personality that maintains that people respond to life events through combination of cognitive, affective, motivational and behavioral responses. These responses are based on human evolution and individual learning history. The cognitive system deals with the way individuals perceive interpret and assign meaning to events. It interacts with the other affective, motivational, and physiological systems to process information from the physical and social environments and to respond accordingly. Sometimes responses are maladaptive because of misinterpretations, or dysfunctional, idiosyncratic interpretations of situations. It aims to adjust information processing and initiate positive change in all systems by acting through the cognitive system. In a collaborative process, the therapist and patient examine the patient’s beliefs about him or herself, other people, and the world. Rational emotive behavior therapy (REBT), previously called rational therapy and rational emotive therapy, is a theory of personality and a method of psychotherapy developed in the 1950’s by clinical psychologist Albert Ellis, holds that when a highly charged emotional consequence (C) follows a significant activating event (A), event A may seem to but actually does not cause C. Instead, emotional consequences are largely created by B- the individual’s belief system. When an undesirable emotional consequence occurs, such as severe anxiety, this usually involves the person’s irrational beliefs, and when these beliefs are effectively disputed (at point D), by challenging them rationally and behaviorally, the disturbed consequences are reduced. From this inception, REBT has viewed cognition and emotion integratively, with thought, feeling, desires, and action interacting with each other. It is therefore a comprehensive cognitive affective behavioral theory and practice of psychotherapy. REBT considered the importance of both mind and body or of thinking, feeling, wanting, and of behavior. It is a holistic approach. It has stressed that personality change can occur in both directions: therapists can talk with people and attempt to change their minds so that they will behave differently, or they can help clients change their behaviors and thus modify their thinking. Another approach is Mindfulness Based approaches; these are designed to deliberately focus one’s attention on the present experience in a way that is non-judgmental. Mindfulness has its roots in Eastern techniques, in particular Buddhist meditation. Mindfulness Based/Contemplative Based Approaches were developed by Zindel Segal, Jon Kabat-Zinn, Mark Williams and John Teasdale. The practice requires that one intentionally directs focus away from states of mind that would otherwise occupy them, such as frightening or worrisome thoughts, and instead observe and accept the present situation and all it has to offer, regardless of whether that is good or bad. Mindfulness approaches include mindfulness based cognitive therapy, (MBCT), mindfulness-based stress reductions (MBSR), acceptance and commitment therapy (ACT) and Dialectical Behavior Therapy (DBT). Mindfulness based approaches and contemplative approaches are becoming widely accepted methods for relieving symptoms related to many psychological issues and can be applied across many different population segments. Mindfulness is practiced individually or in group setting. Compared to other behavioral and cognitive behavioral approaches, mindfulness and acceptance based approaches are still new. Mindfulness-based cognitive therapy (MBCT) is a psychological therapy designed to aid in preventing the relapse of depression, specifically in individuals with Major depressive disorder (MDD). It uses traditional Cognitive behavioral therapy(CBT) methods and adds in newer psychological strategies such as mindfulness and mindfulness meditation. Cognitive methods can include educating the participant about depression Mindfulness-based stress reduction (MBSR) is a mindfulness-based program designed initially to assist people with pain and a range of conditions and life issues that were difficult to treat in a hospital setting developed by Jon Kabat-Zinn at the University of Massachusetts Medical Center, which uses a combination of mindfulness meditation, body awareness, and yoga to help people become more mindful Dialectical behavior therapy (DBT) – it was developed by psychologist Marsha Linehan (1993). It combines traditional cognitive behavioral techniques with mindfulness based strategies for acceptance and tolerating distress. It was first developed to treat borderline personality disorder, although it is now used for a wide range of other problems, including eating disorders, substance abuse disorders, and trauma based problems. It is a therapy designed to help people change patterns of behavior that are not effective, such as self-harm, suicidal thinking and substance abuse. This approach works towards helping people increase their emotional and cognitive regulation by learning about the triggers that lead to reactive states and helping to assess which coping skills to apply in the sequence of events, thoughts, feelings and behaviors that lead to the undesired behavior. Acceptance and commitment therapy or ACT (typically pronounced as the word "act") is a form of clinical behavior analysis (CBA) used in psychotherapy. It is an empiricallybased psychological intervention that uses acceptance and mindfulness strategies mixed in different ways with commitment and behavior-change strategies, to increase psychological flexibility. It is a form of psychotherapy developed by Stephen Hayes and colleagues (2012). ACT includes two main components. The first component involves fostering acceptance fostering acceptance. Rather than trying to control or avoid unwanted thoughts, feelings and other private events, ACT teaches clients to notice, accept, and even embrace private events. Clients are encouraged to distance themselves from their thoughts and take the perspective of an observer. The second component of ACT involves encouraging clients to become more aware of their values and to take action so that their behaviors match their values, bringing more vitality and meaning into the client’s life and ultimately increasing flexibility in the client’s behavioral repertoire. Therapeutic Applications of Mindfulness based approaches to Psychological Disorders Stress Disorders- Mindfulness based therapies can ameliorate multiple anxiety disorders such as generalized, social, panic, phobia and ptsd. Meta analyses show large effect sizes compared to CBT and that multicomponent mindfulness-based therapies- such as MBSR, MBCT, and ACT are more effective than mindfulness alone, it reduces anxiety in special occasions. Depression- one of the most painful psychological disorders. Often chronic and relapsing, and exacts an enormous worldwide toll. Unfortunaltely, antidepressants help only 2/3 of patients, fortunately, MBCT as well as therapeutic lifestyle changes (TLC) such as yoga and exercise and diet (esp.fish and oil supplements) can be helpful (Wals, 2011)’ Contemplative therapies can help treat some diseases and reduce anxiety and distress accompanies many diseases. Research suggests that many stress related psychosomatic disorders benefit from meditation. CARDIOVASCULAR SYSTEM- it reduces both high blood pressure and cholesterol levels. But the effects dissipate if practice is discontinued. (Anderson, Liu & Kryscio, 2008) HORMONAL AND IMMUNE EFFECTS- Meditation can enhance immune function in both healthy people and cancer patients. Example, meditators have an enhanced response to influenza immunization FURTHER ADJUVANT TREATMENTS Meditation enhances the conventional treatment of many other psychological disorders, including asthma, psoriasis, prostate cancer, and chronic pain disorders. Meditation, yoga, tai chai can reduce secondary distress in a wide array of illnesses including cancer, fibromyalgia, rheumatoid arthritis, and gastrointestinal disorders. (Wang, et. al 2010) Contemplative practices were originally intended to enhance psychological and spiritual well being. Humanistic Approach Carl Rogers was one of its practitioners. Humanistic therapists view themselves more as guides than therapists. The assumption is that a person has the potential to get well but he just needs the way to be shown to mental health. Client Centered therapy is one such method of humanistic method of treatment. It is also called Person-centered therapy, a form of talk-psychotherapy developed by psychologist Carl Rogers in the 1940s and 1950s. The goal of PCT is to provide clients with an opportunity to develop a sense of self where they can realize how their attitudes, feelings and behavior are being negatively affected. Treatment of less severe forms of mental diseases may also be done in groups. Where this approach is adopted, it is called Group therapy. Group psychotherapy or group therapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group. The term can legitimately refer to any form of psychotherapy when delivered in a group format, including Cognitive behavioural therapy or Interpersonal therapy, but it is usually applied to psychodynamic group therapy where the group context and group process is explicitly utilized as a mechanism of change by developing, exploring and examining interpersonal relationships within It may take the form of a group of people taking part in a drama, as in psychodrama, a technique developed by J.L. Moreno (1920) , in which groups were used as both cast and audience for the exploration of individual problems by reenactment under the direction of the leader. Group therapy is a form of psychotherapy in which the therapist has regular meetings with a small group of individuals. The purpose of group therapy is to assist each of these individual in his or her emotional development and assist him to solve his or her personal problem. People may choose group therapy for several reasons which include reasons such as group therapy being cheaper than individual therapies since the the cost is divided among group members. Another reason may be that group therapy allows inte raction with other people giving more insights into how people solve their problems effectively and a chance to learn from these. In addition, it was revealed that Cognitive therapy had a success rate of 95%: Behavioral therapy had a success rate of 85% followed by Psychodynamic methods having a success rate of 80% and so on. Biological Mode of Treatment/Approach In the biological approach, the patient is treated not only by listening and discussing the problem but also through medicines. The psychiatrist advises/recommends some medicines. Usually the psychiatrist advises medicines which help the patient to relax himself. In other words, biological approach focuses not only on solving the patient's problem through talkingand discussing; it alsoinvolves use of medicine for the treatment of mental diseases. The first major mode of treatment in biological approach is Drug therapy. This is control of mental disorders through drugs. Some such drugs include: Antipsychotic drugs, drugs which are used for severe cases of psychosis, including delusions, hallucinations or disordered thought, including major tranquilizers such as Risperda, Olanzapine (Zyprexa), which helps people with severe or psychotic depression, which often is accompanied by a break with reality, hallucinations, or delusions and Aripiprazole (Abilify) which can be taken as a pill or as a shot; Anti-depressant drugs, such as Zoloft and Lexapro, Prozac, Paxil (paroxetine), Cymbalta, and Luvox. These drugs are used to relax the patient and elevate mood and combats depression; and Anti-anxiety drugs, drugs which are used to help anxiety such as Benzodiazepines, (Valium), Anti Beta blockers , Tricyclic Antidepressants, Monoamine Oxidase Inhibitors, Serotonin Norepinephrine Re-uptake Inhibitors,Mild Tranquilizer and Anticonvulsants. Another method apart from prescribing drugs is called Electroconvulsive therapy or ECT in short. It is formerly known as electro shock therapy and often referred to as shock treatment, a standard psychiatric treatment in which seizures are electrically induced in patients to provide relief from psychiatric illnesses. ECT is usually used as a last line of intervention for major depressive disorder, schizophrenia, mania and catatonia. A usual course of ECT involves multiple administrations, typically given two or three times per week until the patient is no longer suffering symptoms. In this method, mild shocks are given to the head of the patient to help him rid his mental disease. Usually a shock of 70 to 150 volts is administered to the head of a severely sick patient. Scientists and psychiatrists are still unable to understand the phenomenon behind the success of ECT. The third method in this category is Psycho-surgery. This method involves surgically removing a part of the brain. This method is very rarely used today and only as a last resort. Transcranial magnetic stimulation- A magnetic field passes unimpeded and uncharged through the skull, creating an electrical spark only when it bumps against neural tissues. Scalp discomfort, pain at the site and temporary headache — are minimal in comparison with ECT. It is a noninvasive method to cause depolarization or hyperpolarization in the neurons of the brain. TMS uses electromagnetic induction to induce weak electric currents using a rapidly changing magnetic field; this can cause activity in specific or general parts of the brain with little discomfort, allowing for study of the brain's functioning and interconnections. According to the United States National Institute of Mental Health, TMS "uses a magnet instead of an electrical current to activate the brain. An electromagnetic coil is held against the forehead and short electromagnetic pulses are administered through the coil. The magnetic pulse easily passes through the skull, and causes small electrical currents that stimulate nerve cells in the targeted brain region. Because this type of pulse generally does not reach further than two inches into the brain, scientists can select which parts of the brain will be affected and which will not be. The magnetic field is about the same strength as that of a magnetic resonance imaging (MRI) scan." 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