Chapter 15

Albert Ellis (1913-2007)

"You largely feel the way you think." Developed REBT. This promotes psychologically healthy her thought processes by disrupting irrational beliefs and replacing them with more rational interpretations of events. Or him, psycho analysis did not seem to work.

The ABC model of REBT

1. Common sense view - unhappiness caused by events: A, activating event, you are passed over for a promotion at work. Causes, go directly to C, consequences. You are miserable and depressed. 2. REBT model, beliefs make us miserable - A, activating event, you are passed over for a promotion at work. Triggers. B. "I must be successful at everything I do or I am a complete failure. I was not successful, so I am a worthless human being." Causes. C, consequences. You are miserable and depressed.

Client-centered therapy and Carl Rogers

1. Source of problems - conditional acceptance that causes the person to develop a distorted self-concept and worldview 2. Treatment techniques - nondirective therapist who displays unconditional positive regard, genuineness, and empathic understanding 3. Goals of therapy - to develop self-awareness, self -acceptance, and self-determination

cognitive therapies

A group of psychotherapies based on the assumption that psychological problems are due to illogical patterns of thinking; treatment techniques focus on recognizing and altering these unhealthy thinking patterns. Faulty thinking is the problem - many try to blame their unhappiness and problems on external events and situations, but the real cause is the way the person thinks about the events, not the events themselves. Once irrational patterns have been identified, the next step is to change them to more adaptive, healthy patterns of thinking.

free association

A psychoanalytic technique in which the patient spontaneously reports all thoughts, feelings, and mental images that arise, revealing unconscious thoughts and emotions. While lying on a couch. Therapist usually sits out of view.

aversive conditioning

A relatively ineffective type of behavior therapy that involves repeatedly pairing an aversive stimulus with the occurrence of undesirable behaviors or thoughts. Used for cigarette smoking or alcohol. For substance use disorder and addiction, taste aversions are commonly induced with the use of nausea-inducing drugs. For example, a medication called Antabuse is used in aversion therapy for alcoholism. Consuming alcohol while taking and that Antabuse produces bouts of extreme, highly unpleasant nausea. Mental health professionals are typically very cautious about the use of these techniques, partly because of their potential to harm or produce discomfort for clients. Also, they are generally not very effective.

behavior therapy

A type of psychotherapy that focuses on directly changing maladaptive behavior patterns by using basic learning principles and techniques; also called behavior modification. The idea is to modify specific behaviors, not to change the entire personality. These therapists assume that maladaptive behaviors are learned, just as adaptive behaviors are. So the basic strategy involves reducing the frequency of maladaptive behaviors and learning more adaptive behaviors in their place. They employ techniques that are based on the learning principles of classical conditioning, operant conditioning, and observational learning to modify the problem behavior.

How long before the benefits of psychotherapy become a parent?

Approximately 50% of people show significant improvement by the eighth week of psychotherapy. By the end of six months of weekly psychotherapy sessions, about 75% are significantly improved.

Behavior therapy summary

Based on classical conditioning, operant conditioning, and observation learning; source of problems - learned maladaptive behavior patterns; treatment techniques - systematic desensitization, virtual reality, aversive conditioning, reinforcement and extinction, token economy, contingency management interventions, observational learning; Goals of therapy - to unlearn maladaptive behaviors and replace them with adaptive, appropriate behaviors.

Asian cultures and psychotherapy

Collectivist Asian cultures episodes of respect for the needs of others. According to Japanese Naikan therapy, being self-absorbed is the surest path to psychological suffering. The goal of the therapist to replace the focus on self with a sense of gratitude and obligations towards others. Rather than talking about how his needs were not met by family members, the client is asked to meditate on how he has failed to meet the needs of others. Asian culture stresses that mental health is enhanced by the avoidance of negative thinking. So a depressed or anxious person in China/Asian countries would be encouraged to avoid focusing on upsetting thoughts.

Cognitive biases in depression - selective abstraction

Description - focusing on a single negative detail taken out of context and ignoring the more important aspects of the situation. Example - during Kathy's annual review, her manager praises her job performance but notes that she could be a little more confident when she deals with customers over the phone. Kathy leaves her manager's office thinking that he is on the verge of firing her because of her poor telephone skills.

Cognitive biases in depression - personalization

Description - taking responsibility, blaming oneself, or applying external events to oneself where there is no basis or evidence for making the connection. Example - Andy he becomes extremely upset when his instructor warns the class about plagiarism. He thinks the instructor's warning was aimed at him and concludes that the instructor suspects him of plagiarizing part of his term paper.

Questions for new therapies

Does the treatment work better than no treatment Does the treatment work better than a placebo Does the treatment work better than standard treatments Does the treatment work through the processes that its proponents claim New therapies are developed, advertise, and marketed directly to the public, and to therapist, before controlled scientific studies of their effectiveness have been conducted. Many are in effective or are no more effective than established therapies.

Freud versus Rogers

Freud believed the therapist should carefully time "interpretations" of patient's unconscious conflicts. Rogers believed that the therapist should be nondirective. He believed the therapist role is to create the conditions that allow the client, not the therapist, to direct the focus of therapy.

Challenges with unconventional resources to deliver treatment

Just because treatment is available does not mean people in need will use it or that it will be effective. New ethical and legal considerations have a reason, including some related to confidentiality and privacy.

Cultural values and psychotherapy

Many established approaches to psychotherapy reflect European and North American cultural values. None in Iran. In Western psychotherapy, the client is usually encouraged to become more assertive, more self-sufficient, and less spending on others and making decisions. Intellect of this cultures, the needs of the individual and much more strongly identified with me to the group to which he or she belongs. Traditional native Americans are most likely then European Americans to believe that personal problems are due to a concert with an individual. It is a problem for the entire community to resolve. Network therapy is conducted in the person's home and can involve as many as 70 members of the individual's community.

Challenges to treatment of mental illness

Most people with psychological symptoms do not seek help from mental health professionals. Some people are reluctant because of the stigma that is still associated with it. Not everyone has access to professional treatment. For example, states with the highest percentage of people with psychological disorders of disproportionately lower numbers of psychologist. But many people whether their psychological problems without professional intervention, sometimes seeking help and support from friends and family.

What are the different things that behavior therapy can be used for?

Nail biting and cigarette smoking are the kinds of every day maladaptive behaviors that can be successfully treated. It can also be used to treat more severe psychological problems, such as phobias, and to improve functioning in people with severe mental disorders such as schizophrenia and autistic spectrum disorder.

Repressed memories

Pushed out of conscious awareness as a result of unresolved conflicts and frustrated urges.

VR technology and research

Ralph Lamson And used virtual reality as a form of computer-assisted systematic desensitization to help more than 60 patients conquered your fear of heights. Once the goggles are done, patient begin a 40 minute journey that starts in a café and progresses to an era wooden plank that leads to a bridge. Although computer generated in cartoon like, the scenes of being high above the ground on the plank Road bridge a real enough to trigger the physiological indicators of anxiety. He encourages the person to stay in the same spot until the anxiety diminishes. Once relaxed, the person continues. When done, over 90% of his patients successfully rode a glass elevator up to the 15th floor.

Behavior therapy, classical conditioning and counterconditioning

Remember Watson classically conditioned little Albert to fear a tame rat by pairing it with a loud clanging sound. Mary Cover Jones, a student of Watson, began to explore ways of reversing conditioned fears. She treated a three-year-old named Peter who was fearful of furry objects, including a tame rabbit. She used counterconditioning, the learning of a new conditioned response that is incompatible with a previously learned response. The rabbit, in a cage, was kept far enough away to avoid eliciting fear. Peter munched on his favorite snack, milk and crackers. Every day for almost 2 months, the rabbit was inched closer and closer to Peter as he ate his milk and crackers. As Peter's tolerance for the rabbit's presence gradually increased, he was eventually able to hold a rabbit in his lap, petting it with one hand while happily eating with his other hand. He also stop being afraid of other furry objects.

In Focus, Increasing access: technology-based solutions

Research also supports the use of technological solutions to deliver mental and physical health care to underserved areas. If it involves computers or smart phones, this innovation is often called eHealth. Psychotherapy delivered via Internet technology, such as Skype, is about as effective as face-to-face psychotherapy, and the skills is increasing dramatically. Some high schools and universities provide online therapy and other mental health resources to their students.

Kittens in the Klink

Tamara Russell. A prison program for inmates to learn altruism by being paired with motherless kittens that they feed and socialize until the kittens are old enough to be adopted.

What are the four most influential approaches in psychotherapy?

The approaches of psychoanalytic, humanistic, behavioral, and cognitive. It is based on different assumptions about the underlying causes of psychological problems, and uses different strategies to produce beneficial changes in the way a person thinks, feels, and behaves.

In Focus, Increasing access: self-help groups

The best known group is Alcoholics Anonymous, which follows a 12-step structure. It includes themes of admitting that you have a problem, seeking help from a "higher power," confessing your shortcomings, repairing your relationship with others, and helping other people who have the same problem. These have been adopted by many different groups to fit their particular problem. These groups can be as effective as therapy provided by a mental health professional, at least for some psychological problems. Because these groups are typically free, would charge just a nominal fee to cover materials, they may provide an alternative for people who cannot afford psychotherapy.

The proliferation of untested psychotherapies

The fact that there is little difference in the outcome among the empirically supported therapies does not mean that any and every form of psychotherapy is equally effective. Untested therapy techniques are heavily marketed and promoted, promising miraculous cures with little or no empirical research to back up the claims.

Psychotherapy

The treatment of emotional, behavior, and interpersonal problems through the use of psychological techniques designed to encourage understanding of problems and modify troubling feelings, behaviors, or relationships.

Insight (psychoanalysis)

The unearthing of unconscious conflicts, to be rexperienced and resolved

Shaping

This involves reinforcing successive approximations of a desired behavior. It is often used to teach appropriate behaviors to patients who have difficulties due to autism spectrum disorder, intellectual disability, or severe mental illness. For example, it has been used to increase the attention span of hospitalized patients with severe schizophrenia.

counseling psychologist

What's an academic doctorate and must be licensed to practice. Assesses and treats mental, emotional, and behavioral problems and disorders. Historically treated disorders of lesser severity, but now there is less distinction between the practices of clinical psychologists and these.

exposure therapy

behavioral therapy for phobias, panic disorder, PTSD, or related anxiety disorders in which the person is repeatedly exposed to the disturbing object or situation under controlled conditions.

Pharmaceutical drug advertising

$25 billion a year in the US

what to expect in psychotherapy

1. Find a competent, qualified psychotherapist - student counseling center, a doctor, family members, friends 2. Strengthen your commitment to change - by thinking about why you want to change & reminding yourself of your commitment 3. Therapy is a collaborative effort - don't expect your therapist to do all the work, you must actively participate, sometimes "homework" - journal, read, rehearse skills, etc. 4. Don't confuse catharsis with change - short-term emotional relief in itself does not resolve the problem, though it is an important element. 5. Don't confuse insight with change - And it allows you to understand your problems in a new light but it still takes effort to change how you think, behave, and react to other people. 6. Don't expect your therapist to make decisions for you - But your therapist will help you explore your feelings about important decisions, including ambivalence or fear. 7. Expect therapy to challenge how you think and act - it can be anxiety producing, which is normal, even expected. Self scrutiny is not always flattering. Examining how you deal with failure and success, conflict and resolution, and disappointment and joy can be disturbing. 8. Your therapist is not a substitute friend - Psychotherapy is focused solely on you. An expert consultant. 9. Therapeutic intimacy does not include sexual intimacy - EVER (fact 9% male, 3% female therapists) 10. Don't expect change to happen overnight - usually significant progress in a few months of weekly therapy sessions.

What are the therapeutic conditions that promote self awareness, psychological growth and self directed change according to Rogers?

1. Genuineness - The therapist honestly and openly shares her thoughts and feelings with the client. By modeling this a therapist indirectly encourages the client to exercise this capability more fully in himself. 2. Unconditional positive regard - The therapist must value, except, and care for the client, whatever her problems or behavior. He believes that people develop psychological problems largely because they have consistently experienced only conditional acceptance. This fosters a persons natural tendency to move towards self fulfilling decisions without fear of evaluation or rejection. 3. Understanding - The therapist must communicate empathic understanding by reflecting the content and personal meaning of the feelings being experienced by the client. The therapist creates a psychological mirror, reflecting the client's thoughts and feelings as they exist in the clients private inner world. The goal is to help the client begin to see himself, and his problems, more clearly. These conditions past your feelings of being psychologically safe, excepted, and valued. Change is more likely to occur. The client is moving in the direction of self actualization, the realization of his or her unique potentials and talents.

Steps in CT

1. Help the client learn to recognize and monitor the automatic thoughts that occur without conscious effort or control. Because the perceptions are shaped by the negative cognitive biases, depressed people usually have automatic that reflect negative interpretations of experience. 2. The therapist helped the client learn how to empirically test the reality of the automatic thoughts that are so upsetting. To test the "I always say the wrong thing.", The therapist might assign the person the task of initiating a conversation with three people and noting how often he actually said the wrong thing. 3. Initially the therapist models techniques for evaluating the accuracy of automatic thoughts, hoping to eventually teach the client to do the same on her own. The therapist strives to create a therapeutic kind of collaboration. This is in contrast with the confrontational approach used by the REBT therapist.

Common Irrational Beliefs

1. It is necessary to be loved or approved by everyone in your community. 2. You must be thoroughly competent and achieving in all possible respects to be worthwhile. 3. Certain people are bad and they should be blamed and punished. You should be extremely upset over other people's wrong doings. 4. It is easier to avoid them too faced difficulties and responsibilities. Will be happier. 5. You need to rely on someone stronger than yourself. 6. Your past history is an all important determinant of your present behavior.

Overview of psychoanalysis and Sigmund Freud

1. Source of problems - repressed, unconscious conflicts stemming from early childhood experiences 2. Treatment techniques - free association in transference 3. Goals of therapy - To recognize, work through, and resolve long-standing conflicts

Basic steps involved in systematic desensitization

1. The patient learns progressive relaxation, which involves successively relaxing one muscle group after another until the deep state of relaxation is achieved 2. The behavior therapist helps the patient construct an anxiety hierarchy, sometimes called an exposure hierarchy, which is a list of anxiety-provoking images associated with the feared situation, arranged in a hierarchy from least to most anxiety-producing. The patient also develops an image of a relaxing control scene, such as walking on a secluded beach on a sunny day. 3. This is the actual process of desensitization through exposure to feared experiences. When deeply relaxed, the patient imagines the least-threatening scene on the anxiety hierarchy. After he can maintain complete relaxation while imagining the scene, he moves to the next. If the patient begins to feel anxiety or tension, the behavior therapist guides him back to imagining the previous scene or the control scene. If necessary, the therapist helps the patient relax again, using the progressive relaxation technique. Over several sessions, the patient gradually and systematically works his way up be hierarchy, imagining each scene while maintaining complete relaxation. Once mastered with mental images, the procedure may be continued with exposure to the actual feared situation, which is called in vivo systematic desensitization. If successful, the feared situation no longer produces a conditioned response of fear and anxiety.

Using a operant conditioning to treat a 4-year-old girl's sleeping problems - techniques

1.Identify specific problem behaviors and determine their baseline rate, or how often each problem occurred before treatment began. This rate allowed the therapist to objectively measure the child's progress. 2. The parents next identified several very specific behavior goals for their daughter. These included not crying when she was put to bed, not crying if she woke up in the night, not getting into her parents' bed, and staying in her own bed throughout the night. 3. The parents were taught operant techniques to decrease the undesirable behaviors and increase the desirable ones. For example, to extinguish the girl's screaming and crying, the parents were taught to ignore the behavior rather than continue to reinforce it with parental attention. In contrast, desirable behaviors were to be positively reinforced with abundant praise, encouragement, social attention, and other rewards.

counterconditioning

A behavior therapy technique based on classical conditioning that involves modifying behavior by conditioning a new response that is incompatible with a previously learned response.

Electro convulsive therapy (ECT)

A biomedical therapy used primarily in the treatment of major depressive disorder that involves electrically inducing a brief brain seizure; also called electroshock therapy. It involves using a brief burst of electric current to induce a seizure in the brain, much like an epileptic seizure. In the short term, ECT is very effective for severe cases of major depressive disorder. About 80% of patients improve. It also relieves the symptoms of depression very quickly, typically within days. As symptoms decrease, quality-of-life tends to increase to a level similar to that of people without depression. The complication rate is low. One theory of how it works is that the ACT seizures me somehow "reboot" the brain by the cleaning and then replacing important neurotransmitters.

interpersonal therapy (IPT)

A brief, psychodynamic psychotherapy that focuses on current relationships and social interactions, and is based on the assumption that symptoms are caused and maintained by interpersonal problems. The therapist helps the person understand his particular into personal problem and develop strategies to resolve it. It may be brief or long term, but it is highly structured. It is used to eating disorders and substance use disorders as well as major depressive disorder. It is effective in helping people deal with interpersonal problems, such as marital conflict, parenting issues, and complex at work.

group therapy

A form of psychotherapy that involves one more therapists working simultaneously with a small group of clients. Virtually any psychological approach can be used to group therapy. Just about any problem that can be handled individually can be dealt with in group therapy.

family therapy

A form of psychotherapy that is based on the assumption that the family is a system (an interdependent unit) and that treats the family as a unit. The major goal is to alter and improve the ongoing interactions among family members. The family is seen as a dynamic structure in which each member plays a unique role. Each family has certain unspoken "rules" of interaction and communication. Some of these tacit rules revolve around issues such as which family members exercise power and how, who keeps the peace, and what kinds of alliances members have formed among themselves. Issues are explored, unhealthy patterns of family interaction can be identified and replaced with new "rules" that promote the psychological health of the family as a unit. It is often used to enhance the effectiveness of individual psychotherapy.

Motivational interviewing: helping clients commit to change

A technique designed to help client overcome the mixed feelings or reluctance they might have about committing to change. It is used for a range of psychological problems, but mostly for addictions, such as substance use disorders or gambling, or to techniques to improve health, like diet or exercise. Usually lasting only a session or two, it is a more directive than the techniques used in traditional client-centered therapy.

interpretation

A technique used in psychoanalysis in which the psychoanalyst offers a carefully timed explanation of the patient's dreams, free associations, or behaviors to facilitate the recognition of unconscious conflicts or motivations. Timing is important - don't want to do too early when patient may reject interpretation.

Decentering

A technique where individuals are taught to notice, label, and relate to their thoughts and emotions as "just passing events" rather than identify with him and allow them to shape experience. By increasing mindful awareness of thoughts, impulses, cravings, and emotions, clients are less likely to act on them or be ruled by them

In Focus, Increasing access: technology-based solutions with self-administered cognitive-behavioral therapy

A treatment technique called cognitive bias modification targets anxiety and depression. In one variation aimed at reducing anxiety, patients play a game in which both threatening and non-threatening targets are presented. For example, cartoon characters with angry or friendly faces. To win, players learn to direct their attention to the nonthreatening target. Repeated play has been demonstrated to lead to decreases in symptoms of anxiety. One meta-analysis found that self-guided therapy might also help people with depression. In 2 different studies, people randomly assigned to use a free app based on cognitive-behavioral strategies were compared to people in control groups. Those who used one of the apps, MoodHacker or SuperBetter, showed a greater decrease in symptoms of depression than those in the control groups.

systematic desensitization

A type of behavior therapy in which phobic responses are reduced by pairing relaxation with a series of mental images for real-life situations that the person finds progressively more fear-provoking; based on the principle of counterconditioning. Developed by South African psychiatrist Joseph Wolpe in the 1950s, involves learning a new conditioned response (relaxation) that is incompatible with or inhibits the old conditioned response (fear and anxiety).

rational-emotive behavior therapy (REBT)

A type of cognitive therapy, developed by psychologist Albert Ellis, that focuses on changing the client's irrational beliefs. The key premise is that people's problems are caused by their faulty expectations and irrational beliefs. It focuses on changing the patterns of irrational thinking.

client-centered therapy

A type of psychotherapy developed by humanistic psychologist Carl Rogers in which the therapist is non-directive and reflective, and the client directs the focus of each therapy session; also called person-centered therapy. This is the most influential humanistic psychotherapy. It emphasizes human potential, self-awareness, and freedom of choice. It contendss that the most important factor in personality is the individual's conscious, subjective perception of his or her self. They see people as being innately good and motivated by the need to grow psychologically. If people are raised in a genuinely accepting atmosphere and given freedom to make choices, they will develop healthy self concepts and strive to fulfill their unique potential as human beings. Purposeful use of the word client rather than patient. Also used for group therapy, marital counseling, parenting, education, business, and even community in international relations.

Psychoanalysis (in psychotherapy)

A type of psychotherapy originated by Sigmund Freud in which free association and transference are used to explore repressed or unconscious impulses, anxieties, and internal conflicts. It is based on Freud's theory of personality. The various techniques are designed to help the patients see how past conflicts influence her current behavior in relationships, including her relationship with the psychoanalyst. Once these kinds of insights are achieved, the therapist helps the patient work through and resolve long-standing conflicts. If resolution occurs, maladaptive behavior patterns that were previously driven by unconscious conflicts can be replaced with more adaptive emotional and behavioral responses. Takes time, usually 3X a week for years. Can be expensive.

Mindfulness based interventions

Also known as mindfulness-based therapies, or mindfulness and acceptance therapies. Mindfulness is a meditation technique that involves present-centered awareness without judgment. These techniques target both thoughts and behaviors. So these do not seek to challenge the content of thoughts. Rather, the goal is to change the context in which those thoughts are understood. That is, clients are taught to observe and change their relationship to maladaptive thoughts and emotions. The ability to monitor her thoughts and feelings without judgment I Deleigh allows people to experience disturbing thoughts and feelings without reacting to them. Mindfulness training has also been incorporated as a core element in cognitive behavioral treatment, including therapy is designed to treat substance use disorder and borderline personality disorder.

Buspar

An antianxiety drug with fewer side effects. It is not a benzodiazepine, and it does not affect the neurotransmitter GABA. It is believed to affect brain dopamine and serotonin levels. It relieves anxiety while allowing the individual to maintain normal alertness. Does not cause drowsiness or cognitive impairment. It has a low risk of dependency and physical addiction. Unfortunately, it must be taken for 2 to 3 weeks before anxiety is reduced, thus it decreases its effectiveness for for treating acute anxiety.

Vegus nerve stimulation

An experimental treatment that involves the surgical implantation of a device about the size of a pacemaker into the left chest wall. The device provides brief, intermittent electrical stimulation to the left vagus nerve, which runs through the neck and connects to the brainstem.

Sigmund Freud and psychoanalytic therapy

At the beginning of the 20th century, he developed an influential form of psychotherapy called psychoanalysis. It is not widely practiced today, partly because it is 290 and expensive. Many of the techniques that he pioneered, such as free association in transference, are still commonly used in different forms of psychotherapy.

How do antipsychotic medications diminished psychotic symptoms?

Both drugs reduce levels of the neurotransmitter called dopamine. The first antipsychotics effectively reduced the positive symptoms of schizophrenia - hallucinations, delusions, and distorted thinking. It had a revolutionary impact on the number of people hospitalized for schizophrenia.

Selective Serotonin Reuptake Inhibitors (SSRIs)

Class of antidepressant medications that increase the availability of serotonin in the brain and cause fewer side effects than earlier antidepressants; examples include Prozac, Paxil, and Zoloft. 1987. The 1st, fluoxetine, trade name Prozac. Again, no more effective than previous generations, but they tend to produce fewer, and milder side effects. Among Prozac's potential side effects are headaches, nervousness, difficulty sleeping, loss of appetite, and sexual dysfunction. By the early 1990s, an estimated 1 million prescriptions per month were being written for Prozac. Today, it is available in generic form greatly reducing its cost. In 2010, sales of antidepressants surpassed 11 billion a year in the US.

Trial and error medications

Currently, medications are typically prescribed this way; different drugs or combination of drugs in different dosages are tried until the right regimen is found.

Evaluating the effectiveness of psychotherapy

Decades of research demonstrates that psychotherapy is effective in helping people with psychological disorders. The best strategy for investigating this issue is to compare people who enter psychotherapy with a carefully selected, matched control group of people who do not receive psychotherapy. They have been hundreds of such studies. Through meta-analysis researchers consistently arrive at the same conclusion: psychotherapy is significantly more effective than no treatment. On average, the person who completes psychotherapy treatment is better off than about 80% of those in the untreated control group. The games that people make as a result of psychotherapy also tend to endure long after the therapies and it, sometimes for years. Even breathe forms of psychotherapy tend to produce beneficial in long lasting changes. Multiple meta-analysis of found an individual and group therapy are equally effective in producing significant gains and psychological functioning. But it is not a miracle cure. Not everyone benefits to the same degree.

Cognitive biases in depression - arbitrary inference

Description - drawing a negative conclusion when there is little or no evidence to support it; example - when Joanne calls Jim to cancel their lunch date because she has an important meeting at work, Jim concludes that she is probably going out to lunch with another man.

Cognitive biases in depression - overgeneralizations

Description - drawing a sweeping, global conclusion based on an isolated incident in applying that conclusion to other unrelated areas of life. Example - Tony spilled coffee on his final exam. He apologizes to his instructor but can't stop thinking about the incident. He concludes that he is a klutz who will never be able to succeed in a professional career.

Aaron T Beck (b. 1921)

Developer of cognitive therapy, where clients learn to identify and change their automatic negative thoughts. Originally developed to treat major depressive disorder, it has also been applied to other problems, such as anxiety disorders, phobias, and eating disorders. The therapy grew out of his research on depression. He begin collecting data on the free associations in dreams of his depressed patients. What he found was that depressed people have an extremely negative view of the past, present, and future. Depressed patients have developed a negative cognitive bias, consistently distorting their experiences in a negative way.

Sample anxiety hierarchy

Driving past a dentist office Calling dentist office to make an appointment Listening to a family member talk about her last successful dental visit Driving to the dentist for an appointment Walking back to the dental chair Sitting in the dental chair Opening mouth in preparation for an oral injection Holding mouth open, eyes closed, listening to the sound of the dental field is a cavity is repaired

psychotropic medications

Drugs that alter mental functions, alleviate psychological symptoms, and are used to treat psychological or mental disorders. These are prescription drugs that affect neurotransmitter functioning in the synapses between neurons. They are used increasingly in combination with psychotherapy

What are the two most influential forms of cognitive therapy?

Ellis' rational-emotive behavior therapy (REBT) and Beck's cognitive therapy (CT)

Steps in REBT

First, identify the core irrational beliefs that underlie distress, which result in unhealthy emotions and responses that interfere with constructive attempts to change disturbing situations. Next, the therapist vigorously disputes the irrational beliefs. Therapists tend to be very direct and even confrontational. The idea is to recognize and dispute the patient's irrational beliefs in a wide range of situations. The long-term goal is to teach clients to recognize and dispute their own irrational beliefs in a wide range of situations.But it does not mean denying your feelings. It is ok to feel sad when you are rejected. Simple, generally effective w/ major depressive disorder, social anxiety disorder and other anxiety disorders.

Advantages of second generation antipsychotic medications

First, the newer drugs are less likely to cause movement related side effects. They do not like dopamine receptors in the movement areas of the brain. Second, these are much more effective in treating the negative symptoms of schizophrenia - apathy, search the web job, and flat emotions.

Dangerous side effects of benzodiazepines

First, they can reduce coordination, alertness, and reaction time Second, their fix can be intensified when they are combined with alcohol in many other drugs, including over-the-counter antihistamine's. This combination can produce severe drug intoxication and even death Siri, they can be physically addictive if taken in large quantities and over a long period of time. They are less widely prescribe today, there's some believe they are still over prescribed

Tranference

In psychoanalysis, the process by which emotions and desires originally associated with a significant person in the patient's life, such as a parent, are unconsciously transferred onto the psychoanalyst. Therapist encourages this by remaining as neutral as possible, to produce "optimal frustration " And so that the patient transfers and projects unresolved conflicts onto the psychoanalyst. They are then relived and played out in the context of the relationship between the psychoanalyst and the patient.

Drawbacks of Antipsychotic Medications

First, they didn't actually cure schizophrenia; symptoms returned if a person stopped the medication Second, the early medications were not very effective in eliminating the negative symptoms of schizophrenia - social withdrawal, empathy, and lack of emotional expressiveness, and sometimes the negative symptoms were made worse Third, they often produced unwanted side effects, such as dry mouth, weekend, constipation, sleepiness, and poor concentration Fourth, the fact that early antipsychotics globally altered brain levels of dopamine was a double edge sword. Because dopamine is involved in motor movements, the early medications could produce motor-related side effects - muscle tremors, rigid movements, a shuffling gait, and a mask-like facial expression. Fifth, the long-term use causes a small percentage of people to develop a potentially irreversible motor disorder called tardive dyskinesia, characterized by severe, uncontrollable facial tics and grimaces, chewing movements, and other involuntary movements of the lips, jaw, and tongue. Sixth, the "revolving door" pattern of hospitalization - when released from the hospital, because of either the medication's unpleasant side effects or inadequate medical follow-up, or both, many patients eventually stop taking the medication and ended up back in the hospital.

Power of placebos

For example, patients who observe others improve after taking a medication and experience greater improvement themselves, likely because the expectation is that the medication will work is enhanced. Some now question the premise that people taking a placebo do not know it is a placebo. One study on irritable bowel syndrome observe dimprovement in patients even after they were told they were receiving "placebo pills made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in IBS through mind-body self healing processes"

Psychiatric social worker

Holds a masters degree in social work (M.S.W.). Training includes an internship in a social service agency your mental health center. Usually has certification or licensing. May have training in psychotherapy.

psychiatrist

Holds a medical degree (M.D. or D.O.) and is required to be licensed to practice. His expertise in the diagnosis, treatment, and prevention of mental and emotional disorders. Often his training in psychotherapy. May prescribe medications and medical procedures.

psychiatric nurse

Holds an R.N. degree and has selected psychiatry or mental health nursing as a specialty. May or may not have training in psychotherapy.

clinical psychologist

Holds an academic doctorate (Ph.D., Psy.D, or Ed.D) in this required to be licensed to practice. Assesses and treats mental, emotional, and behavioral disorders. Has expertise in psychological testing and evaluation, diagnosis, psychotherapy, research, and prevention of mental and emotional disorders.

Licensed Professional Counselor

Holds at least a master's degree in counseling, with supervised training and assessment and therapy techniques. Maybe certified in specialty areas. Most states require licensure or certification.

side effects of lithium

If the level is too low, manic systems persist. If it is too high, lithium poisoning may occur, with symptoms such as vomiting, muscle weakness, and reduced muscle coordination. Thus, the patient's lithium blood level must be carefully monitored.

Reserpine

In India, a herb derived from the snake root plant was used to diminish psychotic symptoms commonly associated with schizophrenia. The same herb was used in traditional Japanese medicine to treat anxiety and restlessness. Indian physicians also discovered it was helpful in the treatment of high blood pressure. They developed a synthetic version of the herb's active ingredient, called this. It was later used to treat schizophrenia. An antipsychotic medication.

Lay mental health workers in Haiti

In a refugee camp, lay mental health worker teachers relaxation techniques to people who have been displaced from their homes. Studies suggest that people treated by lay mental workers have better mental health outcomes than people who receive no care.

Psychotherapy and the brain, focus on neuroscience, part 2

In a study of people with major depressive disorder, pet scans revealed patient who took the antidepressant XL and patients who completed interpersonal therapy showed a trend toward more normalized brain functioning. Activity declined significantly in brain regions that has shown abnormally high activity before treatment began.

Carl Rogers (1902-1987)

In his classic text, On becoming a person, he described how his own thinking changed as he developed client-centered therapy. Early on he asked "how can I treat, or cure, or change this person? Now I would phrase the question in this way: how can I provide a relationship which this person may use for his own personal growth?"

Intimate disclosure between therapist and client

In most Western psychotherapy, there is the assumption that clients will disclose their deepest feelings and most private thoughts. In some cultures, issues of one's personal life would never be discussed with a stranger. Native American cultures tend to value the restraint of emotions rather than open expression of emotions. The Vietnamese patient said the psychotherapist was too nosy. In many cultures, people are far more likely to turn to family members or friends than to mental health professionals.

Brain imaging technologies and psychotherapy effectiveness

In one study, CAT scans are used to measure brain activity before and after 10 weeks of therapy for obsessive compulsive disorder. The cycle therapy patients who improved show the same changes in brain function that are associated with effective drug therapy for this disorder.

resistence

In psychoanalysis, the patient's unconscious attempts to block the revelation of repressed memories and conflicts. Happens during free association when a patient has a silent spell or sudden change of topic. It is a sign that the patient is uncomfortably close to uncovering psychologically threatening material.

Techniques based on operant conditioning

These are based on the simple principle that behaviors shaped and maintained by its consequences. Behavior therapist have developed several treatment techniques that are derived from this. This includes shaping, and positive and negative reinforcement. Extinction is also used.

Is one form of psychotherapy superior?

In some cases, one type is more effective than another and treating a particular problem. For example, cognitive, cognitive-behavioral, and behavior therapies tend to be more successful than insight-oriented therapies in helping people who are experiencing panic disorder, obsessive compulsive disorder, phobias, and PTSD. Meta-analyses have found that in general, there is little or no difference in the effectiveness of different psychotherapies. And one, seven different types of psychotherapy for depression were examined and all seven more more effective than a control group in which patients receive no therapy, and the seven were fairly similar in their effectiveness in reducing symptoms of depression. Remember that they are all empirically supported treatments. They are based on known psychological principles, have been subjected to controlled scientific trials, and have demonstrated their effectiveness in helping people with psychological problems.

What type of psychological disorders can be helped with CT?

Initially major depressive disorder, but others as well, including anxiety disorders, borderline personality disorders, eating a disorders, PTSD, and relationship problems. In addition to helping major depressive disorder, it can help prevent it from recurring, especially if clients learn and then use the skills they have learned in therapy.

What are other treatments for bipolar disorder?

It can be treated with an anticonvulsant medicine called Depakote. Originally used to prevent epileptic seizures, it seems to be especially helpful in treating those who rapidly cycle through bouts of bipolar disorder several times a year. Additional treatment with individual or family therapy tends to increase the likelihood that a patient will take her medication as prescribed and experience reduced symptoms.

CBT and schizophrenia

It can help decrease the incidence of positive symptoms, such as delusions and hallucinations, by teaching them how to test the reality of their mistaken beliefs and perceptions.

advantages of group therapy

It is less expensive for the client and less time-consuming for the therapist. Rather than relying on a clients self perceptions about how she relates to other people, the therapist can observe her actual interactions with others. Sometimes, the group can serve as a microcosm of the client's actual social life. Also, the support and encouragement provided by the other group members may help a person feel less alone and understand that other people struggle with similar problems. Working with in the group gives people an opportunity to try out new behaviors in a safe, Support is environment.

Dangers of ECT

It is used only after other forms of treatment, including both psychotherapy and medication, have failed to help the patient, especially when depressive symptoms are severe. For some people it may be less dangerous than antidepressant drugs (the elderly). Serious cognitive impairments can occur, such as extensive amnesia and disturbances in language and verbal abilities. Fears that it might produce brain damage have not been confirmed by research. The biggest drawback is that its anti-depressive effects can be short-lived. Relapses w/in 4 months are relatively common. About half the patients treated experience a relapse within 6 months. Today patients are often treated with long-term antidepressant medication following ECT which reduces the relapse rate.

Innovative use of IPT therapy

It was successfully used to treat symptoms of major depressive disorder in villages in Uganda, demonstrating its effectiveness in a non-western culture. It has proved to be valuable and family and group therapy.

How does lithium work?

It works by affecting levels of an excitatory neurotransmitter called glutamate, which is found in many areas of the brain. Lithium stabilizes the availability of glutamate within a narrow, normal range, preventing both abnormal eyes and abnormal lows.

Do antidepressants work better than placebos? Critical thinking

Kirsch - 2012, 69 Minutes, he declared that the difference between the effect of the placebo and antidepressants is minimal for most people (more pronounced when more severely depressed). It was based on meta-analyses that included all studies ever submitted to the FDA during the process of approval for new antidepressants. Other researchers have found that anti-depressants are superior to the stables. Using different statistical methods, several identified a subset of about 20% of patients who benefited from anti-depressants over placebos at all levels of depression severity. But even these researchers don't entirely dispute Kirsch's findings. It is appropriate to try to harness the power of placebos.

biomedical therapies

Medical treatments for the symptoms of psychological disorders and include medication and electro convulsive therapy.

mindfulness-based cognitive therapy (MBCT)

This was developed to treat major depressive disorder, although it has been expanded to include other disorders.

atypical antipsychotic medications

Newer antipsychotic medications that, in contrast to the early antipsychotic drugs, block dopamine receptors in brain regions associated with psychotic symptoms rather than more globally throughout the brain, resulting in fewer side effects. Around 1900. 2nd generation. These drugs affect brain levels of dopamine and serotonin. The first were clozapine and risperadone. More recent ones include olanzapine, sertindole, and quetiapine.

antianxiety medications

Prescription drugs that are used to alleviate the symptoms of anxiety. The best known are benzodiazepines, which include the trade-name drugs Valium and Xanax. These medications calm jittery feelings, relax muscles, and promote sleep. They used to go by the name of "tranquilizers" because of this affect. In general, they produce their affects by increasing the level of GABA, and neurotransmitter that inhibits the transmission of nerve impulses in the brain and slows brain activity.

antipsychotic medications

Prescription drugs that are used to reduce psychotic symptoms; frequently used in the treatment of schizophrenia; also called neuroleptics.

antidepressant medications

Prescription drugs that are used to reduce the symptoms associated with major depressive disorder. They counteract the classic symptoms, such as hopelessness, guilt, dejection, suicidal thoughts, difficulty concentrating, and disruptions in sleep, energy, appetite, and sexual desire.

Process of electroconvulsive therapy

Relatively simple and quick. Electrodes on the patient's temples And the patient is given a short-term, light anesthetic and muscle-relaxing drugs. To ensure adequate airflow, a breathing tube is sometimes placed in the patient's throat. While the patient is unconscious, a split second burst of electricity induces a brief seizure. Outwardly, it produces mild muscle tremors. After the anesthesia wears off and the patient wakes up, confusion and disorientation may be present for a few hours. Some experience a temporary or permanent memory loss for the events leading up to the treatment. Typically a patient receives to the three treatments per week for 2 to 7 weeks, with less frequent follow-up treatments for several additional months.

Why do people respond so differently to drugs?

Researchers believe that genetic differences, and other biological differences including in patterns of brain connectivity, may explain why people respond so differently to antidepressants and other psychotropic medications. The new field of pharmacogenetics is the study of how genes influence and individuals response to drugs.

Money and second-generation antipsychotics

Sales of antipsychotic drugs earn more money than any other group of drugs, almost $15 billion in 2010. Helping to fuel sales was the development of the new atypical antipsychotic medications, which are much more expensive than the older, traditional antipsychotic drugs. Also, the increased off-label use of antipsychotic medications for non-psychotic conditions, including anxiety disorders and bipolar disorder, despite the fact there is little evidence to support the use of these powerful drugs to treat the symptoms of these disorders.

Therapeutic sensitivity to cultural differences

Sensitivity to a clients cultural values can affect the ability to perform a good working relationship and come ultimately the success of psychotherapy. Thus, some clients prefer to see therapists who are from the same ethnic or cultural background.

How do antidepressants and psychotherapy compare in their effectiveness?

Several large-scale studies have found that both cognitive therapy and interpersonal therapy are just as effective as antidepressant medication in producing remission from depressive symptoms. Brain imaging studies are beginning to show how such treatments might change brain activity. But more people with depression are treated with antidepressants them with psychotherapy.

Mary Cover Jones (1896-1987)

She pioneered the use of behavioral techniques in therapy and this way they regarded as the first behavior therapist. But she did not consider herself a behaviorist and ultimately came to disagree with many of Watson's views. 50 years after she treated Peter, she wrote "now I would be less satisfied to treat the fears of a three-year-old...in isolation from him as a tantalizingly complex person with unique potentials for stability and change.

Psychotherapy and the brain, focus on neuroscience

Siegel & others; fMRI scans were done on 27 people with major depressive disorder and compared to a matched group of 25 normal control subjects who were not depressed. The depressed individuals showed altered brain activity following an emotional task and a cognitive task. These tests were chosen because major depressive disorder tends to affect both people's emotional responses and their thought processes. All were asked to view negative emotional words that they perceived to be relevant to them personally. The depressed people showed increased activity in the amygdala. Not so in the control group. For the cognitive task, in which they were asked to mentally sort a short list of numbers, depressed people showed less activity in the pre-frontal cortex then did those in the control group. Nine of the same depressed people completed 14 weeks of cognitive therapy. After treatment, the brain activity of the people treated for depression resembled that of the control group.

Mindfulness-based stress reduction (MBSR)

The first therapy to earn broad acceptance. Developed by Jon Kabat-Zinn. It involves a structured program of mindfulness meditation, yoga, mindful body practices, and group discussion. The success in the treatment of stress and anxiety helped spark the development of other mindfulness-based therapies targeted to specific disorders.

What factors contribute to effective psychotherapy?

The following factors are crucial to producing improvement in all effective therapies: First, and most important, is the quality of the therapeutic relationship. When psychotherapy is healthy, the therapist-client relationship is characterized by mutual respect, trust, hope, and common goals. Second, certain therapist characteristics are associated with successful therapy. They have a caring attitude and the ability to listen empathically. They are generally committed to their clients welfare. Third, client characteristics are important. If the client is motivated, committed to therapy, and actively involved in the process, a successful outcome is much more likely. Emotional and social maturity and the ability to express thoughts and feelings are important. Finally, external circumstances, such as a stable living situation and supportive family members, can enhance the effectiveness of therapy. Effective therapists are sensitive to the cultural differences that may exist between themselves and the clients. Increasingly, training and cultural sensitivity in multicultural issues is being incorporated into training programs in the US.

Using a operant conditioning to treat a 4-year-old girl's sleeping problems - interventions

The intervention for each problem behavior was introduced separately over several weeks. Behavior therapy produced a rapid reduction in the rate of each problem behavior, and the behavior was maintained over a six month follow-up. For entering the parents' bed the problem decreased rapidly with intervention and the behavior almost stopped entirely. For crying more than 10 minutes, it took less than a week for it to decrease but then it began rapidly decrease over 2 weeks so that the behavior was practically nonexistent. Finally, for leaving her In her own bed, it took less than 2 weeks for this behavior to stop, and again, it became minimal.

Eclecticism

The pragmatic and integrated use of techniques from different psychotherapies

ECT and experimental treatments

The seizures may not actually be necessary as it may be possible to provide lower levels of electrical current to the brain and still reduce severe symptoms of depression and other mental illnesses. For example, transcranial direct current stimulation (tDCS) is similar to ECT, but uses a small fraction of the electricity. Another related treatment is transcranial magnetic stimulation (TMS)§, which involves stimulation of certain regions of the brain with magnetic pulses of various frequencies. Both require no anesthetic, induce no seizures, and can be conducted in a private doctors office rather than a hospital.

biomedical therapies

The use of medications (psychotropic), electroconvulsive therapy, or other medical treatments to treat the symptoms associated with psychological disorders. These are based on the assumption that the symptoms of many psychological disorders involve biological factors, such as abnormal brain chemistry.

Cognitive therapy (CT)

Therapy developed by Aaron T. Beck that focuses on changing the client's unrealistic and maladaptive beliefs. Similar to REBT, Big believes what people think creates their moods and emotions. Similarly, it involves helping clients identify multi thinking and replace and healthy patterns of thinking with healthy ones. But in contrast to it, Beth believes that major depressive disorder and other psychological problems are caused by distorted thinking an unrealistic believes (not irrational thinking). The therapist encourages the client to empirically test the accuracy of his or her assumptions.

cognitive-behavioral therapy (CBT)

Therapy that integrates cognitive and behavioral techniques and that is based on the assumption that thoughts, moods, and behaviors are interrelated. This is a group of psychotherapies that incorporate techniques from both cognitive and behavioral approaches. Along with challenging maladaptive beliefs and substituting more adaptive techniques, the therapist uses behavior modification, shaping, reinforcement, and modeling to teach problem-solving and to change unhealthy behavior patterns. The hallmark is its pragmatic approach. There is an integrated treatment plan, combining techniques. Used for children, adolescents, and the elderly. It is very effective for major depressive disorder, eating disorders, substance use disorders, and anxiety disorders. Flexible. Adapted for different cultures.

Marital or Couple Therapy

There are different approaches. Behavioral couples therapy is based on the assumption that couples are satisfied when they experience more reinforcement than punishment in their relationship. It focuses on increasing caring behaviors and teaching couples how to constructively resolve conflicts and problems. Most therapies have the goal of improving communication, reducing negative communication, and increasing intimacy between a pair.

In Focus: Increasing Access - Paraprofessionals and lay counselors, international

These are clinicians who have not received traditional academic training are increasingly delivering mental health care. Worldwide, there are 40 million community health workers, paraprofessionals without extensive medical or psychological training. They typically have some kind of training and they earn a certificate in the field, but they do not earn the licensure that a professional such as a psychologist or licensed clinical social worker has. Play counselors have even less training. In a refugee camp in Uganda, Somali and Rwandan refugees with as little as a primary school education received brief training as lay counselors to serve other refugees with PTSD. Following treatment, about 30% of their fellow refugees met criteria for PTSD, as compared with more than 60% of those who were not treated.

First generation of antidepressants

These consist of two classes of drugs, called tricyclics and MAO inhibitors. These inhibitors affect multiple neurotransmitter pathways in the brain. Evidence suggests that these medications alleviate major depressive disorder by increasing the availability of two key brain neurotransmitters, norepinephrine and serotonin. However, even though these levels rise within hours of taking these drugs, it can take up to six weeks before depressive symptoms begin to lift. Side effects include, for tricyclics, weight gain, dizziness, dry mouth and eyes, and sedation. And, because they affect the cardiovascular system, an overdose can be fatal. As for MAO inhibitors, they can interact with a chemical found in many foods, including cheese, smoked meats, and red wine. Eating or drinking these while taking an MAO inhibitor can result in dangerously high blood pressure, leading to stroke or even death.

Second generation antidepressants

These include trazodone and bupropion, trade name Wellbutrin. These second generation medications are chemically different from the first generation but we're generally no more effective, and they turned out to have many of the same side effects.

Antidepressants Serzone and Remeron

These newer ones, called dual action antidepressants, also affect serotonin levels, but the mechanism is somewhat different from other SSRIs.

Systematic desensitization and observational learning

These two can be combined for optimal results. For example, in addition to using an anxiety hierarchy, a behavior therapist's treatment of a 60-year-old man afraid of flying on airplanes could include showing him videos of people calmly boarding and riding on airplanes.

Are antidepressants used in treatment of disorders other than depression?

They are commonly prescribed to treat anxiety disorders, obsessive-compulsive disorder, and eating disorders. Wellbutrin is also used to treat a number of other disorders, including anxiety, obesity, and adult attention-deficit hyperactivity disorder. Under the name Zyban, Wellbutrin is also prescribed to help people stop smoking.

Latino cultures and psychotherapy

They emphasize interdependence over independence. They stress the value of familisimo - the importance of the extended family network. Because of the importance of family, some psychologists recommended members of the client's extended family, such as grandparents and in-laws, be actively involved in psychological treatment.

Disadvantages of the second generation antipsychotic medications

They still cause side effects such as weight gain and cardiac problems. Also, large scale studies have demonstrated that the newer ones do not produce greater improvements than the 1st generation ones. Their effectiveness in general is enhanced when patients also have access to psychotherapy, family therapy, and support.

Meta-analyses of mindfulness-based therapies

They were effective treatments for depressive disorders, but results were mixed for anxiety disorders. And one large, carefully controlled study found that MBCT was as effective as antidepressant medications in preventing relapse after an acute episode of major depressive disorder.

Virtual reality therapy (VT) to treat phobia and PTSD

This consists of computer-generated scenes that you view wearing goggles and a special motion-sensitive headset. First used for phobias such as fear of flying, heights, spiders, driving, and enclosed places. Patients are progressively exposed to the feared object or situation. This is easier and less expensive to administer than graduated exposure to the actual feared at sector situation. The availability of this may make people who are extremely phobic more willing to seek treatment. In one survey, more than 80% preferred this treatment over graduated exposure to real spiders. Research suggests the patients will be less likely to refuse treatment or drop out of treatment with this exposure than with real-world exposure.

Chlorpromazine

This diminished the psychotic symptoms seen in schizophrenia. It is an antipsychotic medication. Fewer side effects than reserpine. Trade name Thorazine.

In Focus, Increasing access: technology-based without the need for a therapist

This includes support of emails or text messages, sent automatically, for use in conditions such as smoking addiction and eating disorders. People with schizophrenia received more than 800 automatic text messages over several months. For example, one text might ask "what do you do to help cope with voices?" Patients who receive these messages were more likely to take their medication regularly, had more social interactions, and had less severe hallucinations than those who did not receive the messages. Automated programs offer cost-effective means of delivering treatment in multiple languages.

Ketamine as an antidepressant

This promising new treatment is used in high doses as an anesthetic, and is called special K when sold as a street drug. In one study, 71% of severely depressed patients who receive intravenous treatment saw a decrease in depressive symptoms within just one day, as compared with 0% of those taking placebo. There were some serious side effects, such as hallucinations. But none lasted more than two hours, and researchers are now looking for safer alternatives. It is likely to be used only in emergency situations, in large part because its effects tend to last no more than a week. But the fast response time means that seriously depressed people who visit the ER might be able to forgo inpatient treatment. While wearing off, more traditional and antidepressants and psychotherapy might have time to start working.

deep brain stimulation (DBS)

This utilizes electrodes surgically implanted in the brain and a battery powered neurotransmitter surgically implanted in the chest. Wires under the skin connect the two implants and the neurotransmitter sends electrical signals to the brain. Research findings are mixed. And the specific mechanisms by which the experimental methods work are not entirely clear.

What are the goals of motivational interviewing?

To encourage and strengthen the clients self-motivating statements, or "change talk". These are expressions of the client's need, desire, and reasons for change. The therapist responds with empathic understanding and reflective listening, helping the client explore his or her own values and motivations for change

Historical treatments for mental illness

Trephining, a pre-Columbian skull surgery to allow evil spirits to leave the body; a "tranquilizing chair" chair in 1800s to restrain and sedate unmanageable patients; the "circulating swing" involved spinning patients.

psychological disorder

Troubling thoughts, feelings, or behaviors that cause psychological discomfort or interfere with a person's ability to function.

short-term dynamic therapies

Type of psychotherapy that is based on psychoanalytic theory but differs in that it is typically time-limited, has specific goals, and involves an active, rather than neutral, role for the therapist. Similarities: 1. Usually no more than a few months. 2. The patient's problems are quickly assessed at the beginning of therapy. 3. The therapist and patient agree on specific, concrete, and attainable goals. 4. And most psychodynamic therapists are more directive than traditional psychoanalysts, actively engaging the patient in a dialogue.

Self-help groups and support groups

Typically conducted by non-professionals, these groups have become increasingly popular in the US and can be very helpful. The potential for these groups to promote mental health should not be underestimated.

In Focus: Increasing Access -Paraprofessionals and lay counselors in the US

US, 2/3 with mental illness do not get treatment, and even higher for African-American and Hispanics. Not too much in the US, but a lay counselor model exist in many Latino communities, which deploy minimally trained mental healthcare workers called promotoras into neighborhoods. Lay counselors are also used in the US to provide online or telephone support, "hotlines", for people who are thinking of suicide, have been sexually assaulted, or are trying to quit smoking.

Who dispenses psychotropic medications?

Until recently, only licensed psychologists were legally allowed to prescribe these. Since the 1990s, a movement to allow specially trained psychologists to prescribe them has achieved some success. An increasing number of clinical psychologists are involved in medication treatment decisions. The APA released new guidelines for psychologists regarding prescription medications. They stress that psychologists should educate themselves about potential benefits and side effects of any medication.

Cognitive bias modification

Using exercises (e.g., computer games) to change problematic thinking habits.

Psychoanalyst

Usually a psychiatrist or clinical psychologist who has received additional training in the specific techniques of psychoanalysis, the form of psychotherapy originated by Sigmund Freud.

marriage and family therapist

Usually holds a master's degree, with extensive supervised experience in couple or family therapy. They also have training in individual therapy. Many states require licensing.

VR and other disorders

Virtual reality therapy is now being used with substance-related disorders, schizophrenia, and eating disorders. An innovative application is the treatment of PTSD in war veterans. A veteran was successfully treated after fighting in Iraq and developing PTSD, as the therapist is there if the patient starts to get too anxious. The technology create the very realistic sensation of being immersed in a shared environment to help veterans overcome their trauma related anxieties.

Lithium water

Was used in many over-the-counter medicines before it was discovered to be helpful in the treatment of mania. Small amounts of lithium salt were added to bottled water. And early version of 7-Up included small amounts of lithium. Lithium soda.

Graph of patients hospitalized for mental disorders, 1946-1983

When the first antipsychotic drugs came into why do use in the late 1950s, the number of people hospitalized for mental disorders begin to drop dramatically.

Lithium

a naturally occurring substance that is used in the treatment of bipolar disorder. It counteracts manic symptoms, and to a lesser degree depressive symptoms in bipolar patients. It's effectiveness has been well-established since the 1960s. The long-term use can prevent relapse is into either mania or major depressive disorder. The majority of patients respond well to this therapy. But it doesn't help everyone.

ECT treatment

it is used only after other forms of treatment, including both psychotherapy and medication, have failed to help the patient, especially when depressive symptoms are severe for some people it may be less dangerous than antidepressant drugs,

MDMA

methylenedioxymethamphetamine. "Ecstasy." There is growing evidence that a few doses of this, prescribed and monitored by a physician, can improve the outcome for people undergoing psychotherapy for anxiety disorders. But it can lead to dangerous or unpleasant side effects and has a potential for abuse.