PSYCH CH. 16

TRANSFERENCE

in psychoanalysis, the patient's transfer to the analyst of emotions linked with other relationships (such as love or hatred for a parent)

POSTTRAUMATIC GROWTH

positive psychological changes as a result of struggling with extremely challenging circumstances and life crises

BIOMEDICAL THERAPY

prescribed medications or procedures that act directly on the person's physiology

PSYCHOSURGERY

surgery that removes or destroys brain tissue in an effort to change behavior

REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (rTMS)

the application of repeated pulses of magnetic energy to the brain; used to stimulate or suppress brain activity.

RESILIENCE

the personal strength that helps most people cope with stress and recover from adversity and even trauma

PSYCHOPHARMACOLOGY

the study of the effects of drugs on mind and behavior

GROUP THERAPY

therapy conducted with groups rather than individuals, permitting therapeutic benefits from group interaction

SYSTEMATIC DESENSITIZATION

A type of exposure therapy that associates a pleasant relaxed state with gradually increasing anxiety-triggering stimuli. Commonly used to treat phobias.

HOW DOES THE BASIC ASSUMPTION OF BEHAVIOR THERAPY DIFFER FROM THE ASSUMPTIONS OF PSYCHODYNAMIC AND HUMANISTIC THERAPIES?

BEHAVIOR THERAPIES are not insight therapies. Their goal id to apply learning principles to modify behavior problems.

WHAT IS AARON BECK'S THEORY FOR DEPRESSION?

Beck believes that changing people's thinking can change their functioning. In depressed people's dreams he found recurring negative themes of loss, rejection and abandonment that extended into their waking thoughts. With cognitive therapy Beck sought to reverse clients' CATASTROPHIZING beliefs about themselves, their situations and their futures. Used gentle questioning to reveal irrational thinking .

WHAT ARE THE AIMS AND BENEFITS OF GROUP AND FAMILY THERAPIES?

GROUP THERAPY sessions can help more people and costs less per person than individual therapy would. Clients may benefit from exploring feelings and developing social skills in a group situation, learning that others have similar problems, and from getting feedback on new ways of behaving. FAMILY THERAPY views a family as an interactive system and attempts to help members discover the roles they play and to learn to communicate more openly and directly.

HOW DO DOUBLE-BLIND STUDIES HELP RESEARCHERS EVALUATE A DRUG'S EFFECTIVENESS?

Studies may use a double-blind procedure to avoid the placebo effect and researcher's bias.

ELECTROCONVULSIVE THERAPY (ECT)

a biomedical therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized patient

THERAPEUTIC ALLIANCE

a bond of trust and mutual understanding between a therapist and client, who work together constructively to overcome the client's problem

UNCONDITIONAL POSTIVE REGARD

a caring, accepting, nonjudgmental attitude, which Carl Rogers believed would help clients to develop self-awareness and self-acceptance

CLIENT-CENTERED THERAPY

a humanistic therapy, developed by Carl Rogers, in which the therapist uses techniques such as active listening within a genuine, accepting, empathic environment to facilitate clients' growth. (Also called person-centered therapy.)

COGNITIVE BEHAVIORAL THERAPY (CBT)

a popular integrative therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior)

META-ANALYSIS

a procedure for statistically combining the results of many different research studies

LOBOTOMY

a psychosurgical procedure once used to calm uncontrollably emotional or violent patients. The procedure cut the nerves connecting the frontal lobes to the emotion-controlling centers of the inner brain

AVERSIVE CONDITIONING

a type of counterconditioning that associates an unpleasant state (such as nausea) with an unwanted behavior (such as drinking alcohol)

INSIGHT THERAPIES

a variety of therapies that aim to improve psychological functioning by increasing a person's awareness of underlying motives and defenses

VIRTUAL REALITY EXPOSURE THERAPY

an anxiety treatment that progressively exposes people to simulations of their greatest fears, such as airplane flying, spiders, or public speaking

ECLECTIC APPROACH

an approach to psychotherapy that uses techniques from various forms of therapy.

TOKEN ECONOMY

an operant conditioning procedure in which people earn a token of some sort for exhibiting a desired behavior and can later exchange the tokens for various privileges or treats

EXPOSURE THERAPIES

behavioral techniques, such as systematic desensitization and virtual reality exposure therapy, that treat anxieties by exposing people (in imagination or actuality) to the things they fear and avoid

EVIDENCE-BASED PRACTICE

clinical decision making that integrates the best available research with clinical expertise and patient characteristics and preferences

ANTIANXIETY DRUGS

drugs used to control anxiety and agitation

ANTIDEPRESSANT DRUGS

drugs used to treat depression, anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder. (Several widely used antidepressants are selective serotonin reuptake inhibitors (SSRI's) )

ANTIPSYCHOTIC DRUGS

drugs used to treat schizophrenia and other forms of severe thought disorder

FAMILY THERAPY

therapy that treats the family as a system. Views an individual's unwanted behaviors as influenced by, or directed at, other family members

WHAT ARE 3 WAYS TO LISTEN MORE ACTIVELY?

1.PARAPHRASE--Don't say "I know how you feel"; check your understandings by summarizing the person's words in your own words. 2.INVITE CLASSIFICATION--"What might be an example of that?" may encourage the person to say more. 3.REFLECT FEELINGS--"It sounds frustrating" might mirror what your sensing from the person's body language and intensity.

WHY DO CLIENT TESTIMONIALS NOT PERSUADE PSYCHOTHERAPY'S SKEPTICS?

1.People often enter therapy in crisis. People often attribute improvement to therapy. Depressed people often get better no matter what they do 2.Clients believe that treatment will be effective--placebo effect. 3.Clients want to believe the therapy was worth it. Self-justification for spending time and money. 4.Clients generally speak kindly of their therapists. Clients work hard to say something positive , anything not to have to say treatment was a failure.

WHAT SHOULD A PERSON LOOK FOR WHEN SELECTING A THERAPIST?

A person seeking therapy may want to ask about he therapist's treatment approach, values, credentials, and fees. An important consideration is whether the therapy seeker feels comfortable and able to establish a bond with the therapist.

HOW DO ALTERNATIVE THERAPIES FARE UNDER SCIENTIFIC SCRUTINY?

Abnormal states tend to return to normal on their own, and the placebo effect can create the impression that a treatment has been effective. These two tendencies complicate assessments of alternative therapies (nontraditional therapies) that claim to cure certain ailments. EYE MOVEMENT DESENSITIZATION AND REPROCESSING (EMDR) has shown some effectiveness--not from the eye movement but rather from the exposure therapy nature of the treatments. LIGHT EXPOSURE THERAPY does seem to relieve depression symptoms for those with a seasonal pattern of major depressive disorder by activating a brain region that influences arousal and hormones.

FIG 16.1 AVERSION THERAPY FOR ALCOHOL USE DISORDER

After repeatedly imbibing an alcoholic drink mixed with a drug that produces severe nausea, some people with a history of alcohol use disorder develop at least a temporary conditioned aversion to alcohol.

WHAT THREE ELEMENTS ARE SHARED BY ALL FORMS OF PSYCHOTHERAPY?

All psychotherapies offer new hope for demoralized people; a fresh perspective; and (if the therapist is effective) an empathetic, trusting and caring relationship. The emotional bond of trust and understanding between therapist and client--the THERAPEUTIC ALLIANCE--is an important element in effective therapy.

Fig. 16.6 ELECTROCONVULSIVE THERAPY

Although controversial, ECT is often an effective treatment for depression that does not respond to drug therapy. ("Electroconvulsive" is no longer accurate, because patients are now given a drug that prevents bodily convulsions).

WHAT ARE THE BASIC THEMES OF HUMANISTIC THERAPY?

Both psychoanalytic and humanistic therapists are INSIGHT THERAPIES--they attempt to improve functioning by increasing clients' awareness of motives and defenses. HUMANISTIC THERAPY's goals have included helping clients grow in self-awareness and self-acceptance; promoting personal growth rather than curing illness; helping clients take responsibility for their own growth; focusing on conscious thoughts rather than unconscious motivations; and seeing the present and future was more important than the past.

TABLE 16.3 THERAPISTS AND THEIR TRAINING

CLINCIAL PSYCHOLOGISTS-- Description--Most are psychologists with a Ph.D. (includes research training) or a Psy.D. (focuses on therapy) supplemented by a supervised internship and often, postdoctoral training. About half work in agencies and institutions, half in private practice. -------------------------------------------------------------- PSYCHIATRISTS-- Description--Psychiatrists are physicians who specialize in the treatment of psychological disorders. Not all psychiatrists have had extensive training in psychotherapy, but as M.D.s or D.O.s, they can prescribe medications. Thus, they tend to see those patients with the most serious problems. Many have their own private practice. -------------------------------------------------------------- CLINICAL OR PSYCHIATRIC SOCIAL WORKERS-- Description--A two-year master of social work graduate program plus postgraduate supervision prepares some social workers to offer psychotherapy, mostly to people with everyday personal and family problems. About half have earned the National Association of Social Workers' designation of clinical social worker. -------------------------------------------------------------- COUNSELORS-- Description--Marriage and family counselors specialize in problems arising from family relations. Clergy provide counseling to countless people. Abuse counselors work with substance abusers and with spouse and child abusers and their victims. Mental health and other counselors may be required to have a two-year master's degree.

WHAT TECHNIQUES ARE USED IN EXPOSURE THERAPIES AND AVERSIVE CONDITIONING?

Classical conditioning techniques including EXPOSURE THERAPIES (such as SYSTEMATIC DESENSITIZATION or VIRTUAL REALITY EXPOSURE THERAPY) and AVERSIVE CONDITIONING, attempt to change behaviors through COUNTERCONDITIONING--evoking new responses to old stimuli that trigger unwanted behaviors.

DOES PSYCHOTHERAPY WORK? HOW CAN WE KNOW?

Clients' and therapists' positive testimonials cannot prove that psychotherapy is actually effective, and the placebo effect makes it difficult to judge whether improvement occurred because of the treatment. Using META-ANALYSES to statistically combine the results of hundreds of randomized psychotherapy outcome studies, researchers have found that those not undergoing treatment often improve, but those undergoing psychotherapy are more likely to improve more quickly, and with less chance of relapse.

TABLE 16.4 COMPARING BIOMEDICAL THERAPIES

DRUG THERAPIES-- Presumed Problem--Neurotransmitter malfunction Therapy Aim--To control symptoms of psychological disorders. Therapy Technique--Alter brain chemistry thru drugs ------------------------------------------------------------- BRAIN STIMULATION-- Presumed Problem--Severe "treatment resistant" depression Therapy Aim--To alleviate depression that is unresponsive to drug therapy. Therapy Technique--Stimulate brain through electroconvulsive shock, magnetic impulses or deep-brain stimulation. ------------------------------------------------------------- PSYCHOSURGERY-- Presumed Problem--Brain malfunction Therapy Aim--To relieve severe disorders Therapy Technique--Remove or destroy brain tissue ------------------------------------------------------------- THERAPEUTIC LIFESTYLE CHANGE-- Presumed Problem--Stress and unhealthy lifestyle Therapy Aim--To restore a healthy biological state Therapy Technique--Alter lifestyle through adequate exercise, sleep and other changes

WHAT IS DEEP BRAIN STIMULATION?

Deep brain stimulation has been used on patients who are resistant to to drugs and to ECT. They focus on on a neural hub that bridges the thinking frontal lobes to the limbic system (emotions). This area is overactive in brain or a depressed person. Goal is excite neurons that inhibit this negative emotion-feeding activity. They stimulate the neural "sadness center" Some success. 1/3 responded extremely well, 30% improved modestly. May also help people with OCD and drug and alcohol addictions.

HOW BY TAKING CARE OF THEMSELVES WITH A HEALTHY LIFESTYLE, MIGHT PEOPLE FIND SOME RELIEF FROM DEPRESSION? HOW DOES THIS REFLECT OUR BEING BIOPSYCHOSOCIAL SYSTEMS?

Depressed people who undergo a program of aerobic exercise, adequate sleep, light exposure, social engagement, negative-thought reduction, and better nutrition often gain some relief. In our integrate biopsychosocial system, stress affects our body chemistry and health; chemical imbalances can produce depression; and social support and other lifestyle changes can lead to relief of symptoms.

HOW ARE BRAIN STIMULATION AND PSYCHOSURGERY USED IN TREATING DISORDERS?

ELECTROCONVULSIVE THERAPY (ECT), in which a brief electric current is sent through the brain of an anesthetized patient, is an effective, last-resort treatment for severely depressed people who have not responded to other therapy. Newer alternative treatments for depression include REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (rTMS) and, in preliminary clinical experiments, deep-brain stimulation that calms an overactive brain region linked with negative emotions. PSYCHOSURGERY removes or destroys brain tissue in hopes of modifying behavior. Radical psychosurgical procedures such as LOBOTOMY were once popular, but neurosurgeons now rarely perform brain surgery to damage behavior or moods. Brain surgery is a last resort treatment because its effects are irreversible.

ACTIVE LISTENING

Empathic listening in which the listener echoes, restates, and clarifies. A feature of Rogers' client-centered therapy.

EMDR

Eye-movement Desensitization & Reprocessing. New treatment for PTSD, client imagines the traumatic event and processes it in a non-threatening manner. Rapidly moving one's eyes while recalling a trauma. Some say the movements relax or distract patients and thus allow the memory-associated emotions to extinguish. Controversial --skeptics claim what is therapeutic is combination of exposure therapy and perhaps some placebo effect.

FIG. 16-5 BIOLOGY OF ANTIDEPRESSANTS

Illustration shows the action of Prozac, which partially blocks the reuptake of serotonin. Prozac partially blocks normal reuptake of the neurotransmitter serotonin; excess serotonin in synapse enhances its mood-lifting effect.

INTERPRETATION

In psychoanalysis, the analyst's noting supposed dream meanings, resistances, and other significant behaviors and events in order to promote insight.

RESISTANCE

In psychoanalysis, the blocking from consciousness of anxiety-laden material.

ARE SOME PSYCHOTHERAPIES MORE EFFECTIVE THAN OTHERS FOR SPECIFIC DISORDERS?

No one type of psychotherapy is generally superior to all others. Therapy is most effective for those with clear-cut, specific problems. Some therapies--such as behavior conditioning for treating phobias and compulsions--are more effective for specific disorders. Psychodynamic therapy has been effective for depression and anxiety, and cognitive and cognitive-behavioral therapies have been effective in coping with anxiety, post traumatic stress disorder and depression. EVIDENCE-BASED PRACTICE integrates the best available research with clinicians' expertise and patients' characteristics, preferences and circumstances.

WHAT IS THE MAIN PREMISE OF THERAPY BASED ON OPERANT CONDITIONING PRINCIPLES, AND WHAT ARE THE VIEWS OF ITS PROPONENTS AND CRITICS? (put after card 20)

OPERANT CONDITIONING operates under the premise that voluntary behaviors are strongly influenced by their consequences. Therapy based on operant conditioning principles uses behavior modification techniques to change unwanted behaviors through positively reinforcing desired behaviors and ignoring or punishing undesirable behaviors. Critics maintain that 1) techniques such as those used in TOKEN ECONOMIES may produce behavior changes that disappear when rewards end, and 2)deciding which behaviors should change is authoritarian and unethical. Proponents argue that treatment with positive rewards is more humane than punishing people or institutionalizing them for unwanted behaviors.

FIG 16.2 COGNITIVE PERSPECTIVES ON PSYCHOLOGICAL DISORDERS

The person's emotional reactions are produced not directly by the event but by the person's thoughts in response to the event.

TABLE 16.2 COMPARING MODERN PSYCHOTHERAPIES

PSYCHODYNAMIC THERAPY-- Problem--Unconscious conflicts from childhood experiences. Aim--To reduce anxiety Technique--Interpret patients' memories and feelings. -------------------------------------------------------------- CLIENT-CENTERED THERAPY-- Problem--Barriers to self-understanding and self-acceptance Aim--To enable growth via unconditional positive regard, genuineness, acceptance and empathy Technique--Listen actively and reflect clients' feelings -------------------------------------------------------------- BEHAVIOR THERAPY-- Problem--Dysfunctional behaviors Aim--To learn adaptive behaviors; extinguish problem ones. Technique--Use classical conditioning (via exposure or aversion therapy) or operant conditioning (as in token economies) -------------------------------------------------------------- COGNITIVE THERAPY-- Problem--Negative self-defeating thinking. Aim--To promote healthier thinking and self-talk. Technique--Train people to dispute negative thoughts and attributions -------------------------------------------------------------- COGNITIVE BEHAVIORAL THERAPY-- Problem--Self-harmful thoughts and behaviors Aim--To promote healthier thinking and adaptive behaviors. Technique--Train people to counter self-harmful thoughts and to act out their new ways of thinking -------------------------------------------------------------- GROUP AND FAMILY THERAPY-- Problem--Stressful relationships Aim--To heal relationships. Technique--Develop an understanding of family and other social systems, explore roles and improve communication.

WHAT ARE THE DRUG THERAPIES?

PSYCHOPHARMACOLOGY, the study of drug effects on mind and behavior, has helped make drug therapy the most widely used biomedical therapy. ANTIPSYCHOTIC DRUGS, used in treating schizophrenia, block dopamine activity. Side effects may include tardive dyskinesia (with involuntary movements of facial muscles, tongue, and limbs) or increased risk of obesity and diabetes. ANTIANXIETY DRUGS, which depress central nervous system activity, are used to treat anxiety disorders, obsessive-compulsive disorder, and posttraumatic stress disorder. These drugs can be physically and psychologically addictive. ANTIDEPRESSANT DRUGS, which increase the availability of serotonin and norepinephrine, are used for depression, with modest effectiveness beyond that of placebo drugs. The antidepressants known as selective serotonin reuptake inhibitors (SSRIs) are now used to treat other disorders, including strokes and anxiety disorders. Lithium and Depakote are mood stabilizers prescribed for those with bipolar disorder.

HOW DO PSYCHOTHERAPY AND THE BIOMEDICAL THERAPIES DIFFER?

PSYCHOTHERAPY is treatment involving psychological techniques; it consists of interactions between a trained therapist and someone seeking to overcome psychological difficulties or achieve personal growth. The major psychotherapies derive from psychology's PSYCHODYNAMIC, HUMANISTIC, BEHAVIORAL, and COGNITIVE PERSPECTIVES. BIOMEDICAL THERAPY treats psychological disorders with medications or procedures that act directly on a patient's physiology. An ECLECTIC APPROACH combines techniques from various forms of therapy.

WHAT IS THE RATIONALE FOR PREVENTIVE MENTAL HEALTH PROGRAMS, AND WHY IS IT IMPORTANT TO DEVELOP RESILIENCE?

Preventative mental health programs are based on the idea that many psychological disorders could be prevented by changing oppressive, esteem-destroying environments into more benevolent , nurturing environments that foster growth, self-confidence, and RESILIENCE. Struggling with challenges can lead to POSTTRAUMATIC GROWTH. Community psychologists are often active in preventive mental health programs.

PSYCHOANALYSIS

Sigmund Freud's therapeutic technique. Freud believed the patient's free associations, resistances, dreams, and transferences - and the therapist's interpretations of them - released previously repressed feelings, allowing the patient to gain self-insight.

FIG. 16.7 MAGNETS FOR THE MIND

Repetitive transcranial magnetic stimulation (rTMS) sends a painless magnetic field through the skull to the surface of the cortex. Pulses can be used to alter activity in various cortical areas.

WHAT ARE THE SPECIFIC GOALS AND TECHNIQUES OF ROGERS' CLIENT-CENTERED APPROACH?

Rogers' CLIENT-CENTERED THERAPY proposed that therapists' most important contributions are to function as a psychological mirror through ACTIVE LISTENING and to provide a growth-fostering environment of UNCONDITIONAL POSITIVE REGARD, characterized by genuineness, acceptance, and empathy.

TABLE 16.1 SELECTED COGNITIVE THERAPY TECHNIQUES

TO REVEAL BELIEFS-- 1. Question your interpretations (explore your beliefs, revealing faulty assumptions such as "I must be liked by everyone") 2. Rank thoughts and emotions (Gain perspective by ranking your thoughts and emotions from mildly to extremely upsetting) TO TEST BELIEFS 1. Examine consequences (Explore difficult situations, assessing possible consequences and challenging faulty reasoning) 2. Decatastrophize thinking (work through actual worst case consequences of the situation, often not as bad as imagined. Then determine how to cope with the real situation you face.) TO CHANGE BELIEFS 1. Take appropriate responsibility (Challenge total self-blame and negative thinking, noting aspects for which you may be truly responsible as well as aspects that aren't your responsibility) 2. Resist extremes (Develop new ways of thinking and feeling to replace maladaptive habits. EX--change from thinking "I am a total failure" to "I got a failing grade on that paper and I can make these changes to succeed next time.")There

WHAT ARE THE GOALS AND TECHNIQUES OF COGNITIVE THERAPY AND OF COGNITIVE BEHAVIORAL THERAPY?

The COGNITIVE THERAPIES such as Aaron Beck's cognitive therapy for depression, assume that our thinking influences our feelings, and that the therapist's role is to change clients' self-defeating thinking by training them to view themselves in positive ways. The widely researched and practiced COGNITIVE-BEHAVIORAL THERAPY (CBT) combines cognitive therapy and behavior therapy by helping clients regularly act out their new ways of thinking and talking in their everyday life.

FIG. 16.8 MIND-BODY INTERACTION

The biomedical therapies assume that mind and body are a unit. Affect one and you will affect the other.

HOW DO CULTURE AND VALUES INFLUENCE THE THERAPIST-CLIENT RELATIONSHIP?

Therapists differ in the values that influence their goals in therapy and their views of progress. These differences may create problems if therapists and clients differ in their cultural or religious perspectives.

WHAT ARE THE GOALS AND TECHNIQUES OF PSYCHOANALYSIS AND HOW HAVE THEY BEEN ADAPTED IN PSYCHODYNAMIC THEORY?

Through PSYCHOANALYSIS, Sigmund Freud tried to give people self-insight and relief from their disorders by bringing anxiety-laden feelings and thoughts into conscious awareness. Psychoanalytic techniques included using free association and INTERPRETATION of instances of RESISTANCE and TRANSFERENCE. PSYCHODYNAMIC THEORY has been influenced by traditional psychoanalysis but differs from its many ways, including the lack of belief in id, ego, and superego. This contemporary theory is briefer, less expensive, and more focused on helping the client find relief from current symptoms. Psychodynamic therapists help clients understand how past relationships create themes that may be acted out in present relationships. Interpersonal therapy is a brief, 12-16 session form of psychodynamic therapy that has been effective in treating depression.

LIGHT EXPOSURE THERAPY

Treats seasonal affective disorder (SAD); scientifically proven to be effective, exposure to daily doses of intense light. Effects are clear in brain scans, light therapy sparks activity in a brain region that influences the body's arousal and hormones.

FIG. 16.3 TREATMENT VERSUS NO TREATMENT

Two normal distribution curves. Based on data from 475 studies show the improvement of untreated people and psychotherapy clients. The outcome for the average therapy client surpasses the outcome for 80% of the untreated people.

COUNTERCONDITIONING

behavior therapy procedures that use classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors; include exposure therapies and aversive conditioning

PSYCHODYNAMIC THERAPY

therapy deriving from the psychoanalytic tradition that views individuals as responding to unconscious forces and childhood experiences, and that seeks to enhance self-insight. (a type of insight therapy)

BEHAVIOR THERAPY

therapy that applies learning principles to the elimination of unwanted behaviors

COGNITIVE THERAPY

therapy that teaches people new, more adaptive ways of thinking and acting; based on the assumption that thoughts intervene between events and our emotional reactions

PSYCHOTHERAPY

treatment involving psychological techniques; consists of interactions between a trained therapist and someone seeking to overcome psychological difficulties or achieve personal growth