Therapies

Mental: A History of the Madhouse14

Arms? What
about your
abnormally
large
head?

Defining Therapy
Psychotherapy is the treatment of
Doctormy
unusually
short arms are
ruining my life!

emotional and behavioral

problems through psychological
techniques

Uses psychological rather than

exclusively biological approaches to
treatment
Involves conversation between an
individual with psychological issues
and someone trained to help
correct the problem known as a
therapist.

History of Treatment
Must
release
demonic..honey
badger!

In early Stone Age society, trepanning was

Release the
demonic honey
badger from my
head!

used many did not survive the procedure

During Middle Ages, supernatural forces
were blamed for mental illness
(demonology) and exorcism was used
During the French Revolution, more humane
treatment started with the work of Philippe
Pinel
By the mid-19th century, people began to
connect abnormal behavior to damage to
the brain/central nervous system
Sigmund Freud helped to popularize the
talking cure in the early 20th century
Since then there has been an explosive
growth in available therapies

Insight Therapies
Focuses on

increasing clients
awareness of their
problems
Helps clients to
understand the
origins of their
problems
Contrasts with
BEHAVIOR
therapies or those
that seek to
remove symptoms

Psychoanalysis
Designed to bring repressed feelings and thoughts to

conscious awareness developed by Freud

Techniques

Therapist must maintain a neutral relationship with the

client so that client may project unresolved
feelings/issues upon him/her
Dream analysis
Hypnosis and post-hypnotic suggestions
Free association
Transference, resistance, and countertransference
Analysis of defense mechanisms
Insight and working through

Person-Centered Thera
py
(:21)

Developed by Carl Rogers

Goal is to help clients become fully

functioning
Therapist expresses unconditional positive
regard and empathy
Therapist strives to be authentic, trying to be
genuine and real rather than formal
Therapy is nondirective but engages in active
listening
Therapist reflects or mirrors clients
statements

Gestalt Therapy

(4:08)

Ya, you
are in ze
hot seat!

Outgrowth of the work of Fritz Perls

Emphasizes the wholeness of personality
Attempts to reawaken people to their emotions

and sensations in the here-and-now

Draws attention to what exists rather than what
is absent, and draws attention to clients voice,
posture, and movements
Encourages confrontation with issues
Therapist is active and directive
Empty Chair and Hot Seat technique

Recent Developments
Short-term psychodynamic

psychotherapy

Focused on trying to help people correct the

immediate problems in their lives
Forego long process of completely excavating
childhood

Virtual therapy

Therapy delivered via chat room, phone or video

conference
Client given techniques to use on their own after
session ends

Behavior Therapies

Behavior Therapies
Based on the belief that all behavior

adaptive and maladaptive - is learned

Objective of therapy is to teach people
new ways of behaving
Focuses on observable, measurable
activities

Using Classical Conditioning

Techniques
Say hello to Mr.
Spider!

Systematic desensitization
Gradually associating relaxation with what
was feared
Extinction through counterconditioning
Ending of old fears or reactions through
repeated exposure to new stimulus pairs
Flooding
Full-intensity exposure to feared object
Aversive conditioning
Eliminate undesirable behavior by
associating it with pain and discomfort
Virtual reality exposure therapy
Expose client to fears in safe, virtual setting

Operant Conditioning
Behavior contracting

Client and therapist set behavioral goals

and agree on reinforcements the person
will receive
Client engages in desired behaviors to
attain reinforcement

Token economy

Clients earn tokens for desired behaviors

and exchange them for desired items or
privileges
Often used in schools and hospitals

Modeling
Person learns new behaviors by
Remembe
r me?

watching others perform those

behaviors
Sometimes used in conjunction with
operant conditioning
Therapist him/herself may model
desirable behaviors for client

Cognitive Therapies

Meichenbaums StressInoculation Therapy

Type of cognitive therapy that trains

people to cope with stressful situations

by learning a more useful patterns of
self-talk
Taught to suppress negative and
anxiety-provoking thoughts in times of
stress
Particularly effective for treating anxiety
disorders

Ellis Rational-Emotive Therapy

(RET)
(7:00)

A directive, confrontational therapy based

on the idea that psychological distress is

caused by irrational and self-defeating
beliefs
Core problem is belief in musts and
shoulds that leave no room for making
mistakes (no more musterbation)
Therapists job is to challenge clients
irrational beliefs

Becks Cognitive Therapy

Aimed at identifying and changing

inappropriately negative and self-critical

patterns of thought
Therapist points out automatic
thoughts (instantaneous, habitual, and
unconscious thoughts that impact mood
and action) and catastrophizing beliefs
and forces client to substantiate them
Good treatment for depression

Cognitive Distortions List

All or nothing thinking (always,

every, never)
Mental filter (focus on negative
aspects while ignoring positive
aspects)
Disqualifying the positive
(shooting down positive
experiences for no reason)
Jumping to conclusions
(drawing conclusions with
little/no evidence)
Overgeneralization (isolated
case assumed for all)

Magnification/minimization (making

mountains out of molehills,

catastrophizing)
Emotional reasoning (decision
making based on feelings, not
logic)
Personalization (attributing
personal responsibility when
individual has no control over
event)
Should statements (emphasizing
what should be rather than what is;
what Ellis called musterbation)

Group Therapies

Family Therapy
Form of group therapy that sees the

family as at least partly responsible for

the individuals problems
Seeks to change all family members
behavior to the benefit of the family and
the individual

Self-Help Groups and Couple

Therapy
Self Help Groups
Small, local gatherings of people who
share common problems and provide
mutual assistance at very low cost
Alcoholics Anonymous is an example
Good for empathy, but may trigger
temptation to relapse
Couple Therapy
A form of group therapy intended to
help troubled partners improve their
communication and interaction
Empathy training: partners taught to
share feelings and listen to and
understand partners feelings

Evaluating
Psychotherapies

Overall Effectiveness of
Psychotherapy
Does Psychotherapy Work?
Psychotherapy helps about 2/3 of people treated
Approximately 1/3 would improve without therapy
Which Type of Therapy is Best for Which

Disorder?

No one type of therapy is better

Key is to match the problem/client with the
appropriate therapy

Effectiveness of Insight and

Cognitive Therapies
Difficult to judge as spontaneous remission

may occur
Who should be asked to judge the effectiveness
of therapy? Therapist or client?
Meta-analysis may be the best bet to evaluate
these therapies
75-80% result in improvement vs. no therapy at
all
Only 10% were worse after therapy
Works best with those who are not severely
disturbed

Effectiveness of Behavior Therapies

Work well for certain problems such as phobias,

compulsive behaviors, impulse control, and

learning new social skills to displace
maladaptive ones
Criticized for ignoring internal thoughts and
expectations and just treating symptoms rather
than underlying causes
Not well suited for some types of problems

Biological Treatments

Biological Treatments:
Overall Trends
View abnormal behavior as a symptom

of an underlying physical disorder

Typically favor biological therapy (drugs,
psychosurgery, ECT, etc.)

Drug Therapies
Psychopharmacotherapy is the

treatment of mental disorders with

medication also known as drug therapy
Major reasons for widespread use of
drugs

Drugs are effective at treating disorders

especially serious disorders
Drug therapies are often less expensive
that psychotherapy

Antipsychotic Drugs
(Neuroleptics)
Used for schizophrenia or psychosis

(hallucinations, delusions, paranoia, disordered

thinking, incoherence)
All antipsychotics block dopamine receptors in
the brain
Side effects include drowsiness, dry mouth,
muscular rigidity, and Tardive Dyskinesia
Examples include Thorazine, Haldol, Mellaril
(First Generation); Clozaril, Risperdal (Second
Generation); Abilify (Third Generation)
60-70% show improvement in symptoms when
these drugs are used

Antidepressant Drugs
(Thymoleptics)
Tricyclics and MAO (monoamine oxidase) inhibitors

Most common antidepressants prior to late 1980s

Work by increasing amount of the neurotransmitters serotonin and norepinephrine
Effective, but have serious side effects such as heart complications and weight gain
Examples: Tofranil, Elevil (Tricyclics), Nardil (MAOi)
Norepinephrine-Dopamine Reuptake Inhibitor (NDRIs)
No sexual side effects
Examples: Wellbutrin
Selective Serotonin Reuptake Inhibitors (SSRIs)
Work by blocking the reuptake of serotonin
Examples: Prozac, Paxil, Zoloft
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Act upon BOTH serotonin AND norepinephrine
Examples: Effexor, Cymbalta
Side effects of SSRIs and SNRIs: sleepiness, reduced sex drive
60-70% show improvement though it may take two weeks for changes to take effect

Action of SSRIs

Thats right!
synapse is back
in da haus!
(stop twitching)

Antimania Drugs:
Lithium
A naturally occurring salt (lithium

carbonate) that is used to treat bipolar

disorder (manic depression) with 80%
effectiveness
Nobody knows how lithium works to
alleviate symptoms
Problem with establishing proper dosage
and with people stopping medication
when symptoms ease
Examples: lithium carbonate, Eskalith

Antianxiety Drugs (Anxiolytics)

Use to treat anxiety disorders and are

often referred to as tranquilizers

Most widely prescribed of all legal drugs
Produce a feeling of calm and mild
euphoria
Side effects include physical
dependence and withdrawal symptoms
is abruptly discontinued
Examples: Valium, Librium, Xanax,
Equanil

Psychostimulants
Used to treat disorders such as AD/HD
Concern that psychostimulants are being

overused
Side effects: lethargy, depression,
aggression

Electroconvulsive Therapy

(.09)

Commonly known as shock therapy

1938 Italian physicians Ugo Cerletti and Lucio

Bini created seizures in patients by passing an

electric current through their brains
During 1940s and 50s, used as a treatment for
depression, schizophrenia and sometimes
mania; now used only for severe depression
Causes brief convulsions and temporary loss of
consciousness
Side effects include memory loss and difficulty
learning following the procedure
Up to 100,000 people receive ECT each year

Psychosurgery
Brain surgery performed to change a

persons behavior or emotional state

History of Lobotomy: Egas Moniz and
Walter Freeman

Prefrontal lobotomy (EM)

Transorbital lobotomy (WF)
Tragedies

Psychosurgery is rarely used today and

removes far less brain tissue

Alternatives to
Institutionalization

Deinstitutionalization
Releasing people with severe psychological

disorders into the community

Can cause problems

Some people are ill-prepared to deal with life

outside of a hospital

Up to 40% of homeless are mentally ill

Alternative forms of treatment (many)

Half-way houses
Family-crisis interventions
Day-care

Prevention
Primary prevention
Improve the social environment so that new cases of
mental disorders do not develop

e.g. Family planning, Genetic counseling

Secondary prevention

Interventions with high risk groups

e.g., suicide hot-lines, job training in economically
depressed areas

Tertiary prevention
Help people adjust after they are released from the
hospital in order to help prevent a relapse
e.g. halfway houses, long-term outpatient care
Community psychology attempts to minimize or

prevent mental disorders not just treat them