Psy 202 week 10

Drugs like Paxil, Prozac, and Zoloft are ________ that alter levels of neurotransmitters such as serotonin and norepinephrine.

antidepressents

Today, most people with psychological problems are not hospitalized. Typically they are only hospitalized if they ________.

are an imminent threat to themselves or others

By the 18th century, people who were considered odd and unusual were placed in

asylums

Which kind of therapy involves a therapeutic orientation that employs principles of learning to help clients change undesirable behaviors?

behavior

In contrast to psychoanalysis, humanistic therapists focus on

conscious rather than unconscious thoughts. They also emphasize the patient's present and future, as opposed to exploring the patient's past.

________ led to fewer mentally ill patients going to asylums and instead getting treatment in their own homes and communities.

deinstitutionalization

It was believed that mental illness was caused by

demonic possession, witchcraft, or an angry god (Szasz, 1960).

Clay is in a therapy session. The therapist asks him to relax and say whatever comes to his mind at the moment. This therapist is using ________, which is a technique of ________.

free association; psychoanalysis

A treatment modality in which 5-10 people with the same issue or concern meet together with a trained clinician is known as ________.

group therapy

What is the goal of humanistic therapy?

helping people become more self-aware and accepting of themselves

a therapist and memory researcher. Dr. Kindt uses the drug propranolol, which

interferes with the reconsolidation of the fear aspect of a memory, though it does not prevent the person from feeling fear during the training session nor does it interfere with the person's memory for the events that occurred.

Biomedical therapy

involves medication and/or medical procedures to treat psychological disorders.

Rogerian (client-centered therapy):

non-directive form of humanistic psychotherapy developed by Carl Rogers that emphasizes unconditional positive regard and self-acceptance

exorcism

often conducted by priests or other religious figures: Incantations and prayers were said over the person's body, and she may have been given some medicinal drinks.

About _______ to_______ of U.S. adolescents (ages 8-15) with mental disorders receive treatment, with behavior-related disorders more likely to be treated.

one-third to one-half

From the late 1400s to the late 1600s, a common belief perpetuated by some religious organizations was that

some people made pacts with the devil and committed horrible acts, such as eating babies (Blumberg, 2007

consolidation:

the neural processes that occur between an experience and the stabilization of the memory

Virtual reality exposure therapy is being used to

treat PTSD in soldiers. Virtual Iraq is a simulation that mimics Middle Eastern cities and desert roads with situations similar to those soldiers experienced while deployed in Iraq. This method of virtual reality exposure therapy has been effective in treating PTSD for combat veterans. Approximately 80% of participants who completed treatment saw clinically significant reduction in their symptoms of PTSD, anxiety, and depression (Rizzo et al., 2010)

Donna tells her therapist that she came home from work in a bad mood and kicked her dog. Her humanistic therapist does not judge her for this action, but rather asks Donna to discuss what she was feeling at that time. The therapist is using ________.

unconditional positive regard

On Day 1 for the control group,

we create a memory for participants so that they come to "fear" a yellow box.

According to the reading, in any given year, nearly ________ of U.S. adults experience mental illness.

20%

Another form of treatment for extreme cases of mental illness was trephining:

A small hole was made in the afflicted individual's skull to release spirits from the body. Most people treated in this manner died.

Stimulants

ADHD Adderall, Ritalin Improve ability to focus on a task and maintain attention Decreased appetite, difficulty sleeping, stomachache, headache

. For a few weeks, CeCe felt deranged and hectic, while two weeks later she felt depressive

Anti-cycling agents

Anti-anxiety agents

Anxiety and agitation that occur in OCD, PTSD, panic disorder, and social phobia Xanax, Valium, Ativan (Benzodiazepines) Buspar (non-Benzodiazepine) Depress central nervous system activity Drowsiness, dizziness, headache, fatigue, lightheadedness

Which institutions were created to house, and remove, people with psychological disorders?

Asylums

Mood stabilizers, such as lithium, are used to treat ________.

Bipolar disorder

Mood Stabilizers

Bipolar disorder Lithium, Depakote, Lamictal, Tegretol Treat episodes of mania as well as depression Excessive thirst, irregular heartbeat, itching/rash, swelling (face, mouth, and extremities), nausea, loss of appetite

REINSTATEMENT:

Have the person retrieve the memory. Be sure that the retrieval is emotionally powerful. If the person avoids fully reactivating the memory in its complete painful form, then reduction of the emotional impact will be impossible. The emotion may be fear or anxiety or some other strong negative response.

Therapy SessionsSession DescriptionMiriam's therapy: PreparationPrior to starting progressive exposure, Miriam created her hierarchy of fears. She spent several session working on relaxation. She practiced relaxation at home several times a day until she and you, her therapist, agreed that she was ready to start treatment.Miriam's therapy: Exposure Session 1The bottom (lowest anxiety) of Miriam's fear hierarchy was chatting with friends about everyday topics. When asked to rate the fear level associated with doing this on a 1 to 10 scale, Miriam said 1: No fear at all.

Miriam brought two friends with her to the therapy session today. You had them sit in a comfortable part of your office, drinking tea and chatting for 15 minutes. Afterwards Miriam reported her fear level during the chat as a 1 on a ten-point scale: no fear. You then had her sit in a comfortable chair and think about giving a talk about the challenges of her job to a small, friendly audience. At the beginning of this task, she rated her anxiety as 3 on a 10-point scale. As she thought about it—with helpful suggestions from you—she also relaxed, using her relaxation training. After about 10 minutes, she reported her anxiety had dropped to 1, the lowest level of anxiety on your scale. You gave Miriam "homework"—to repeat this exercise twice a day until the next session. Miriam's therapy: Exposure Session 2At the beginning of today's session, you had Miriam repeat the task from the previous session of thinking about talking about her job to a small, friendly group. At the beginning she rated her fear at 2, but it dropped to 1 within a few minutes. Now you took Miriam to the next level. You had her imagine telling a large audience of company executives about some technical problem she was working on at her job. At the beginning, just thinking about doing this led to a fear level of 5. After 10 minutes, her fear level dropped to 2. You repeated the exercise with a different topic and a different group, with similar results. Relaxation was practiced throughout the session. You gave Miriam homework again—to practice a similar situation at home. Miriam's therapy: Exposure Session 3You started this situation with a new scenario similar to the one Miriam did in the last session and practiced at home. She was quickly able to drop her anxiety level to 1. You had a professional photography group create a video of someone very similar in appearance and manner to Miriam giving a talk in from of a small friendly audience on a topic similar to one Miriam might give. You asked her to watch this video and imagine herself in the place of the real speaker. She rated this a 6 on the anxiety scale. Over several repetitions, her rating dropped to 2. For homework, Miriam watched the video several times a day. You instructed her in ways to make the video seem MORE REAL, so she could really feel the anxiety of being in front of people. Miriam's therapy: Exposure Session 4You have had Miriam arrange to give a talk NEXT SESSION to a small group of Miriam's co-workers. You also had Miriam prepare the talk. Today you practiced the talk with her. At the start of the practice session, with only you there, Miriam rated her anxiety level at 9 out of 10. Over the course of the hour, her anxiety level dropped to 5. Her homework was to continue to practice the talk and to work on relaxation. Miriam's therapy: Exposure Session 5Today, Miriam gave the talk to the small group. Her anxiety rating before she went in front of them was 10. Except for a little stumbling at the start, the 20-minute presentation went well. Miriam reported an anxiety level of 4 after the talk.We'll skip a few sessions.We hope you have the basic idea.Miriam's therapy: Exposure Session 6In this last session, you have arranged for Miriam to be the introductory speaker at a literacy tutoring volunteer organization nearby. Miriam has done a small amount of volunteer work with the organization, but she knows very little about it. With the help of the staff, she prepares a talk during the week before this session. The audience is composed of 45 people, all interested in doing literacy tutoring, who have come to the literacy center for an information session. Miriam knows none of them and none of them has ever heard of her. Miriam's introductory comments take about 15 minutes. She rates her anxiety level before going out at 8. After the talk, she rates her anxiety at 2. In fact, she said it was almost fun. After TherapyMiriam continues to see you for a few more sessions. You give her additional homework and you help her develop a plan that includes arranging to give professional presentations for her job and continuing to give talks at the literacy volunteer organization. Miriam reports that none of these ideas create an anxiety level above 3 when she thinks about doing them.

What was the difference between the control group and the treatment group on Day 2? Multiple Choice Question

The control group had the fear memory reactivated before beginning extinction

Electroshock treatment was also used, and the way the treatment was administered often

broke patients' backs; in 1943, doctors at Willard administered 1,443 shock treatments (Willard Psychiatric Center, 2009). (Electroshock is now called electroconvulsive treatment, and the therapy is still used, but with safeguards and under anesthesia. A brief application of electric stimulus is used to produce a generalized seizure.

The first steps in systematic desensitization is the development of a

"hierarchy of fears." This simply means that you must help Miriam create a list of situations related to her fear of public speaking. Then you create a hierarchy. This means that you have her organize the situations from the least frightening to the most frightening.

What is the minimum amount of time addicts should receive treatment if they are to achieve a desired outcome?

3 months

Cognitive therapy.

Awareness of cognitive process helps patients eliminate thought patterns that lead to distress Patient learns not to overgeneralize failure based on single failure

The process of closing large asylums and providing for people to stay in the community to be treated locally is known as ________.

Deinstitutionalization

In America, who is most likely to receive mental health treatment??

Dillon, a 50 year old white male

Efforts by ________ led to mental health care reform and some of the first mental asylums in the United States.

Dorothea Dix

Imagine that you are a psychiatrist. Your patient, Pat, comes to you with the following symptoms: anxiety and feelings of sadness. Which therapeutic approach would you recommend and why?

I would recommend psychodynamic talk therapy or cognitive therapy to help the person see how her thoughts and behaviors are having negative effects.

In medieval times, abnormal behaviors were viewed as a sign that a person was ________.

Possessed by demons

Which of the following was the earliest step in Miriam's systematic desensitization?

Practicing relaxation using breathing techniques and positive imagery

Psychoanalysis:

Psychoanalysis was once the only type of psychotherapy available, but presently the number of therapists practicing this approach is decreasing around the world. Psychoanalysis is not appropriate for some types of patients, including those with severe psychopathology or mental retardation. Further, psychoanalysis is often expensive because treatment usually lasts many years. Still, some patients and therapists find the prolonged and detailed analysis very rewarding.

Eclectic Therapy:

Recently, many practitioners have begun to take what's known as an eclectic approach, meaning they combine aspects of multiple types of therapies. This approach can be useful in that is uses the techniques and theories that work best in a specific patient's scenario, rather than sticking solely to the methods of one discipline.

Which is an example of overgeneralization?

Shiloh didn't get asked to homecoming dance and instead of thinking that it was just the first dance and she is still adjusting to her new school she thinks I am such a loser. No one wants to even be my friend.

Psychodynamic psychotherapy

Talk therapy based on belief that the unconscious and childhood conflicts impact behavior Patient talks about his past

Which of the following is true of EXPOSURE THERAPY?

The person starts with fear of something and in therapy replaces fear with a positive response

What happens during an intake?

The therapist gathers specific information to address the client's immediate needs such as the presenting problem, the client's support system, and insurance status. The therapist informs the client about confidentiality, fees, and what to expect in a therapy session.

day 3

What is shown above is what typically happens. Despite the fact that the person learned on day that the yellow box does not signal a shock, if you wait a while (hours or, as in this case, 24 hours), the fear response has returned. This is called spontaneous recovery of the fear response.

In an individual therapy session,

a client works one-on-one with a trained therapist.

Psychosis was

a common diagnosis of individuals in mental hospitals, and it was often evidenced by symptoms like hallucinations and delusions, indicating a loss of contact with reality.

By the time a child is a senior in high school, 20% of his classmates—that is 1 in 5—will have experienced

a mental health problem (U.S. Department of Health and Human Services, 1999), and 8%—about 1 in 12—will have attempted suicide (Centers for Disease Control and Prevention, 2014). Of those classmates experiencing mental disorders, only 20% will receive professional help

mindfulness:

a process that tries to cultivate a nonjudgmental, yet attentive, mental state. It is a therapy that focuses on one's awareness of bodily sensations, thoughts, and the outside environment

In dream analysis

a therapist interprets the underlying meaning of dreams.

Confidentiality refers to ________.

a therapists requirement to not disclose information about their client unless required by law

eclectic psychotherapy:

also called integrative psychotherapy, this term refers to approaches combining multiple orientations (e.g., CBT with psychoanalytic elements).

Behavior therapy focuses on ________, while psychoanalysis focuses on ________.

changing behaviors through learning; resolving unconscious conflicts

Group therapy tends to be ________ than individual therapy.

cheaper

In nondirective play therapy,

children are encouraged to work through their problems by playing freely while the therapist observes (LeBlanc & Ritchie, 2001)

Addiction and substance abuse disorders are difficult to treat because

chronic substance use can permanently alter the neural structure in the prefrontal cortex, an area of the brain associated with decision-making and judgment, thus driving a person to use drugs and/or alcohol

Dr. Phelps and her colleagues

classically conditioned volunteer research participants to fear a shock. They allowed this learning (i.e., the conditioned fear response) to consolidate, and then figured out the way to eliminate the fear response.

Melissa and Brian are going to marriage counseling, as they have had a difficult time getting along and supporting each other since their daughter was born. Which therapeutic method is likely used for their treatment?

cognitive behavioral therapy

The idea behind ________ is that how you think determines how you feel and act.

cognitive therapy

The primary therapeutic orientation used in couples counseling is ________.

cognitive-behavior therapy

At Willard Psychiatric Center in upstate New York, for example, one treatment was to submerge patients in

cold baths for long periods of time.

When an individual has two or more diagnoses, which often includes a substance-related diagnosis and another psychiatric diagnosis, this is known as ________.

comorbid disorder

Exposure therapy seeks to change the response to a

conditioned stimulus (CS). An unconditioned stimulus is presented over and over just after the presentation of the conditioned stimulus. This figure shows conditioning as conducted in Mary Cover Jones' 1924 study.

Behavioral therapy teaches the client to

cope with an anxiety-producing situation by replacing fear with an alternative response. A common alternative response is relaxation. This idea is that fear and anxiety cannot coexist with relaxation—if you are relaxed, you can't be fully afraid. However, most people are not very good at relaxing on command. So the behavioral therapist will teach the client how to relax effectively. The techniques are ones often used in meditation—slow breathing and focus on positive thoughts.

Specific factors make substance-related treatment much more effective. One factor is

duration of treatment. Generally, the addict needs to be in treatment for at least three months to achieve a positive outcome (Simpson, 1981; Simpson, Joe, & Bracy, 1982; NIDA, 2012). This is due to the psychological, physiological, behavioral, and social aspects of abuse (Simpson, 1981; Simpson et al., 1982; NIDA, 2012).

A commonality among the techniques used in psychoanalysis is that they ________.

focus on the clients unconscious thoughts and feelings

rational emotive therapy (RET):

form of cognitive-behavioral therapy

A range of funding sources pay for mental health treatment:

health insurance, government, and private pay.

Humanistic psychology focuses on

helping people achieve their potential. So it makes sense that the goal of humanistic therapy is to help people become more self-aware and accepting of themselves.

Remember that systematic desensitization works by putting the person

in a series of situations. The early ones are not threatening or are only mildly threatening. However, as soon as your client learns to cope with each situation, you start working on the next most frightening situation.

people suffering from obsessive-compulsive disorder (OCD) experience

less confidence in the accuracy of memories they retrieve than people without the disorder. This uncertainty about memory can lead to obsessive thoughts about whether they turned off the stove or paid the electric bill when it was due. People with OCD also tend to show a bias to retrieve threatening memories. Nearly every major psychological disorder you will study in this course has some aspect of memory that is either a symptom or a process that maintains the disorder or more often both.

Treatment for patients with mental disorders has come a long way since medieval times, when mental illness was seen as

madness resulting from being possessed by demons

Humanistic therapy would focus more on finding

meaning and positive growth.

Voluntary treatment

means the person chooses to attend therapy to obtain relief from symptoms.

Which of the following is a benefit of group therapy?

members can confront each other about their patterns

Jarl makes several minor mistakes during his conversational French class. Instead of thinking, "everyone makes mistakes sometimes," he thinks, "I am so stupid." What kind of cognitive distortion is this?

overgeneralization

The quality of the relationship between therapist and patient is of great importance in

person-centered therapy.

It was once believed that people with psychological disorders, or those exhibiting strange behavior, were

possessed by demons. These people were forced to take part in exorcisms, were imprisoned, or executed.

A person suffering symptoms could speak with a

primary care physician, who most likely would refer them to someone who specializes in therapy.

________ tends to take a long time, even several years, while ________ therapy is relatively brief.

psychoanalysis; cognitive behavioral

Dream analysis and transference are techniques used in ________ therapy.

psychodynamic

Edith is a psychologist who has her patients talk about their childhood, dreams, and other things that come to their mind in the moment. She practices ________ therapy.

psychodynamic

Freud's psychoanalytical perspective has been expanded upon by the developments of subsequent theories and methodologies: the

psychodynamic perspective. This approach to therapy remains centered on the role of people's internal drives and forces, but treatment is less intensive than Freud's original model.

Which type of psychotherapy places the greatest emphasis on early childhood and internal emotions and drives?

psychodynamic therapy

The person can receive outpatient mental health services from a variety of sources, including

psychologists, psychiatrists, marriage and family therapists, school counselors, clinical social workers, and religious personnel. These therapy sessions would be covered through insurance, government funds, or private (self) pay.

Medications used to treat psychological disorders are called

psychotropic medications and are prescribed by medical doctors, including psychiatrists. In Louisiana and New Mexico, psychologists are able to prescribe some types of these medications (American Psychological Association, 2014).

One of the first forms of cognitive-behavior therapy was

rational emotive therapy (RET), which was founded by Albert Ellis and grew out of his dislike of Freudian psychoanalysis (Daniel, n.d.). Behaviorists such as Joseph Wolpe also influenced Ellis's therapeutic approach (National Association of Cognitive-Behavioral Therapists, 2009).

Psychotherapy can help

reduce a person's anxiety, depression, and maladaptive behaviors. Through psychotherapy, individuals can learn to engage in healthy behaviors designed to help them better express emotions, improve relationships, think more positively, and perform more effectively at work or school. In discussing therapeutic orientations, it is important to note that many clinicians incorporate techniques from multiple approaches, a practice known as integrative or eclectic psychotherapy.

Some people seek therapy because the criminal justice system

referred them or required them to go. For some individuals, for example, attending weekly counseling sessions might be a condition of parole. If an individual is mandated to attend therapy, she is seeking services involuntarily.

Involuntary treatment

refers to therapy that is not the individual's choice. Other individuals might voluntarily seek treatment.

In the 19th century, Dorothea Dix led

reform efforts for mental health care in the United States (Figure 3). She investigated how those who are mentally ill and poor were cared for, and she discovered an underfunded and unregulated system that perpetuated abuse of this population (Tiffany, 1891). Horrified by her findings, Dix began lobbying various state legislatures and the U.S. Congress for change (Tiffany, 1891). Her efforts led to the creation of the first mental asylums in the United States

John was drug-free for almost six months. Then he started hanging out with his addict friends, and he has now started abusing drugs again. This is an example of ________.

relapse

Lia hasn't had alcohol since her rehab program for over 2 years, but then starts drinking again after the death of her mother. This is known as ________.

relapse

Repeated drug use and/or alcohol use after a period of improvement from substance abuse is called ________.

relapse

Exposure therapy worked by ________.

replacing a negative response (fear) with a positive response(relaxation)

Freud believed most of our psychological problems are the result of

repressed impulses and trauma experienced in childhood, and he believed psychoanalysis would help uncover long-buried feelings.

Finding treatment sources is also not always easy: there may be limited options, especially in

rural areas and low-income urban areas; waiting lists; poor quality of care available for indigent patients; and financial obstacles such as co-pays, deductibles, and time off from work.

Dorothea Dix was a

social reformer who became an advocate for the indigent insane and was instrumental in creating the first American mental asylum. She did this by relentlessly lobbying state legislatures and Congress to set up and fund such institutions.

Today, instead of asylums, there are psychiatric hospitals run by

state governments and local community hospitals, with the emphasis on short-term stays.

In flooding therapy, you would skip the earliest situations described in

systematic desensitization and you would move directly to highly threatening situations. Right after Miriam had mastered relaxation, your first session would require Miriam to give an actual talk. You would probably not start with the most extreme situation, but your goal would be to start Miriam in situations that she would immediately rate as 9 or 10 on the anxiety scale.

deinstitutionalization

the closing of large asylums, by providing for people to stay in their communities and be treated locally. In 1955, there were 558,239 severely mentally ill patients institutionalized at public hospitals (Torrey, 1997). By 1994, by percentage of the population, there were 92% fewer hospitalized individuals (Torrey, 1997

In free association

the patient relaxes and then says whatever comes to mind at the moment. However, Freud felt that the ego would at times try to block, or repress, unacceptable urges or painful conflicts during free association. Consequently, a patient would demonstrate resistance to recalling these thoughts or situations.

Freud called this transference:

the patient transfers all the positive or negative emotions associated with the patient's other relationships to the psychoanalyst. For example, Crystal is seeing a psychoanalyst. During the years of therapy, she comes to see her therapist as a father figure. She transfers her feelings about her father onto her therapist, perhaps in an effort to gain the love and attention she did not receive from her own father.

reconsolidation:

the process of replacing or disrupting a stored memory with a new version of the memory

Play therapy can also be used to help a therapist make a diagnosis. The therapist observes how the child interacts with toys (e.g., dolls, animals, and home settings) in an effort to understand

the roots of the child's disturbed behavior. Play therapy can be nondirective or directive.

Confidentiality means

the therapist cannot disclose confidential communications to any third party unless mandated or permitted by law to do so. During the intake, the therapist and client will work together to discuss treatment goals.

In directive play therapy,

the therapist provides more structure and guidance in the play session by suggesting topics, asking questions, and even playing with the child (Harter, 1977).

cognitive bias modification:

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

There are two important components of mindfulness:

(1) self-regulation of attention, and (2) orientation toward the present moment (Bishop et al., 2004).

Pharmacotherapy:

"Pharmacotherapy" refers to the use of medications in biomedical treatment. Medications exist in four classes: antipsychotics, antidepressants, anti-cycling agents, and hypnoanxiolytics. In general, the effectiveness of medications is upwards of 80%, but some of the medications also contain serious side effects. Once the medication is discontinued, symptoms often return; however, prolonged use can lead to other problems. Different types and classes of medications are prescribed for different disorders. A depressed person might be given an antidepressant, a bipolar individual might be given a mood stabilizer, and a schizophrenic individual might be given an antipsychotic. These medications treat the symptoms of a psychological disorder; they can help people feel better so that they can function on a daily basis, but they do not cure the disorder. Some people may only need to take a psychotropic medication for a short period of time. Others, with severe disorders like bipolar disorder or schizophrenia, may need to take psychotropic medication continuously for effective symptom management.

psychotherapy:

(also, psychodynamic psychotherapy) psychological treatment that employs various methods to help someone overcome personal problems, or to attain personal growth

In America, who is most likely to receive mental health treatment?

Jenny a 40 year old white female

Who of the following does not support the humane and improved treatment of mentally ill persons?

Medieval priests

Psychologist Carl Rogers developed a therapeutic orientation known as

Rogerian, or client-centered therapy (also sometimes called person-centered therapy or PCT). Note the change from patients to clients

You have decided on exposure therapy, but you are still not ready to get started with therapy. Within the category of "exposure therapy" you have some options that will determine the course of action in therapy. Here are two types of exposure therapy. Which one do you think would be better for Miriam?

Systematic Desensitization

lobotomy:

a form of psychosurgery in which parts of the frontal lobe of the brain are destroyed or their connections to other parts of the brain severed

Which type of therapy would most likely be used to treat phobias?

behavior

Griffeth wants his clients to discover their own inner conflicts and feelings. He acknowledges, restates, and clarifies what the client expresses through active listening. What kind of psychotherapeutic orientation is he using?

humanistic

Two types of therapy are

psychotherapy and biomedical therapy. Both types of treatment help people with psychological disorders, such as depression, anxiety, and schizophrenia

Psychoanalysis

was developed by Sigmund Freud. Freud's theory is that a person's psychological problems are the result of repressed impulses or childhood trauma. The goal of the therapist is to help a person uncover buried feelings by using techniques such as free association and dream analysis.

Asylums

were the first institutions created for the specific purpose of housing people with psychological disorders, but the focus was ostracizing them from society rather than treating their disorders. Often these people were kept in windowless dungeons, beaten, chained to their beds, and had little to no contact with caregivers.

All or nothing thinking,

which is a common type of cognitive distortion for people suffering from depression, reflects extremes. In other words, everything is black or white. After being turned down for a date, Jon begins to think, "No woman will ever go out with me. I'm going to be alone forever." He begins to feel anxious and sad as he contemplates his future.

Which would be the correct order of Miriam's list, beginning with the LEAST frightening situation and ending with the MOST stressful? 1. Actually give a well-prepared and practiced talk to a small friendly audience. 2. Actually give a well-prepared and practiced talk to a large audience of strangers. 3. Watch a video of someone similar to you giving a talk to a small friendly audience as you imagine it is you. 4. Chat with some close friends about everyday topics. 5. Think about giving a talk about something you know to a large, neutral audience. 6. Think about giving a talk about something you know well to a small, friendly audience.

4,6,5,3,1,2

This helps explain why relapse rates tend to be high. About ____________ of individuals relapse, which means they return to abusing drugs and/or alcohol after a period of improvement (National Institute on Drug Abuse [NIDA], 2008).

40%-60% of individuals relapse, which means they return to abusing drugs and/or alcohol after a period of improvement (National Institute on Drug Abuse [NIDA], 2008).

In FLOODING therapy, you would prepare Miriam in just the same way you prepared her in SYSTEMATIC DESENSITIZATION. In fact, this preparation stage may be even MORE important for FLOODING. Which of the following exposure events did Miriam find the MOST threatening (of the ones in the list)?

Actually giving a talk to a small friendly group of coworkers

ECT:

Another biologically based treatment that continues to be used, although infrequently, is electroconvulsive therapy (ECT; formerly known by the unscientific name "electroshock therapy"). It involves using an electrical current to induce seizures in the brain in order to help alleviate the effects of certain mental conditions, such as severe forms of depression or bipolar disorder. The exact mechanism is unknown, although it does help alleviate symptoms for people with severe depression who have not responded to traditional drug therapy (Pagnin, de Queiroz, Pini, & Cassano, 2004). About 85% of people treated with ECT improve (Reti, n.d.). However, the memory loss associated with repeated administrations has led to it typically being implemented as a last resort (Donahue, 2000; Prudic, Peyser, & Sackeim, 2000). A more recent alternative to ECT is transcranial magnetic stimulation (TMS), a procedure approved by the FDA in 2008 that uses magnetic fields to stimulate nerve cells in the brain to improve depression symptoms; like ECT, it is used when other treatments have not worked (Mayo Clinic, 2012).

Luke has trouble getting out of bed in the mornings and doesn't always have an appetite to eat.

Antidepressants

Kasey has been seeing weird visuals lately that aren't there even though they seem real

Antipsychotics

Lobotomy was widely used during the twentieth century - indeed, it was so mainstream that

Antonio Moniz won a Nobel Prize in physiology for his work on one lobotomy procedure. However, lobotomy was always highly controversial, and widely criticized as a tool of behavioral control of people who were engaged in behaviors that were not clinical in nature. By the 1960s and 1970s lobotomy fell out of favor in the United States.

Some behavior therapies employ operant conditioning. Recall what you learned about operant conditioning: We have a tendency to repeat behaviors that are reinforced. What happens to behaviors that are not reinforced? They become extinguished. These principles, defined by Skinner as operant conditioning, can be applied to help people with a wide range of psychological problems. For instance, operant conditioning techniques designed to reinforce desirable behaviors and punish unwanted behaviors are effective behavior modification tools to help children with autism (Lovaas, 1987, 2003; Sallows & Graupner, 2005; Wolf & Risley, 1967). This technique is called

Applied Behavior Analysis (ABA).

`People with psychological disorders have been treated poorly throughout history. Describe some efforts to improve treatment, include explanations for the success or lack thereof.

Beginning in the Middle Ages and up until the mid-20th century, the mentally ill were misunderstood and treated cruelly. In the 1700s, Philippe Pinel advocated for patients to be unchained, and he was able to affect this in a Paris hospital. In the 1800s, Dorothea Dix urged the government to provide better funded and regulated care, which led to the creation of asylums, but treatment generally remained quite poor. Federally mandated deinstitutionalization in the 1960s began the elimination of asylums, but it was often inadequate in providing the infrastructure for replacement treatment.

Cognitive-Behavioral Therapy:

CBT interventions tend to be relatively brief, making them cost-effective for the average consumer. In addition, CBT is an intuitive treatment that makes logical sense to patients. It can also be adapted to suit the needs of many different populations. One disadvantage, however, is that CBT does involve significant effort on the patient's part, because the patient is an active participant in treatment. Therapists often assign "homework" (e.g., worksheets for recording one's thoughts and behaviors) between sessions to maintain the cognitive and behavioral habits the patient is working on. The greatest strength of CBT is the abundance of empirical support for its effectiveness.

Tonya has been working at a successful company for four years. Although Tonya has been with the company for a while, her anxiety seems to increase when she is at work. While the company is still successful and Tonya has a lot of co-workers who enjoy her company, Tonya still finds herself thinking negative thoughts about the company going bankrupt and her losing her job. Tonya even thinks that her co-workers secretly dislike her. What type of therapy would best help Tonya with her anxiety?

Cognitive behavior therapy can help with negative thoughts and support behavior change.

Anti-depressants

Depression and increasingly for anxiety Paxil, Prozac, Zoloft (selective serotonin reuptake inhibitors, [SSRIs]); Tofranil and Elavil (tricyclics) Alter levels of neurotransmitters such as serotonin and norepinephrine SSRIs: headache, nausea, weight gain, drowsiness, reduced sex driveTricyclics: dry mouth, constipation, blurred vision, drowsiness, reduced sex drive, increased risk of suicide

Now that you and your client have agreed upon your goals, it is time to choose a particular technique for the therapy. As a behavioral therapist, you are looking for a method to allow Miriam to learn a new response to the thought of public speaking. Now the idea terrifies her. After therapy is over, she should no longer be terrified and she may even look forward to the opportunity to speak in front of other people. You know that everyone is not the same and different problems may call for different approaches to therapy. For these reasons, you have been trained in a variety of techniques that you can use to customize Miriam's therapy to meet her particular needs. It is time to decide how you are going to help Miriam. Which of the two approaches listed below seems to be the more promising therapeutic approach for Miriam's case?

Exposure therapy

REPETITION ACROSS DAY OR WEEKS:

For a deep-seated problem, it is very unlikely that a single session will eliminate or even substantially reduce the automatic negative emotional response. The process of reinstatement followed by either extinction or drug intervention is necessary for effective treatment.

day 2

For the control group, day involves extinction, which is the process of unlearning the fear response. Extinction is simple. You repeatedly show the person the yellow box, but there are no shocks. Over time, the person learns a new association: the yellow box means no shock. But this takes some time.

Read the dialogue and determine the type of therapy that is most likely taking place. Client: Thank you for meeting with me on such short notice, Dr. Lovelace. I've heard such good things about you and how warm and understanding you are, which is why I decided to see you for therapy. Therapist: I am here to help. I believe that every person has the capacity to change and grow. We all have the answers to our problems, we just may need a little guidance sometimes. Tell me more about yourself and why you are here, Susan. Client: Well, I'm here because I've been doing bad things lately. I've been yelling at my kids, and I've been very irritable with my coworkers. This is so unlike me. Do you think that makes me a bad person? Therapist: I can understand why you might feel upset with yourself, Susan. This doesn't match with your concept of yourself, and it makes you feel bad. I'm not judging you; I accept you for who you are. How do you think you can better line up your ideas about yourself (as being a good person) with reality? What type of therapy is taking place between the client and the therapist?

Humanistic

Nathan is 24-years-old and finishing his bachelors degree. Despite being passionate about what he is majoring in for school, Nathan sometimes feels empty about life. Sometimes the days seem to drag on forever, and Nathan finds himself in a constant routine. Nathan often sees his friends happy with where they are and where they are going, and he wants to experience that too. What type of therapy would best help Nathan and his situation?

Humanistic therapy

Roger feels like he can't breathe when surrounded by groups of people. His anxiety increases when he faces large crowds.

Hypnoanxiolytics

DRUGS THAT BLOCK FEAR MEMORY:

In a therapy session, a person with a phobia (e.g., fear of spiders or dogs or heights) might (a) have the fear response reactivated (have them stand near a spider or dog or on a high perch) and then, (b) the person is given propranolol, a drug that inhibits the storage of emotional aspects of a memory.

EXTINCTION OF THE FEAR RESPONSE:

In a therapy session, a person with a phobia (e.g., fear of spiders or dogs or heights) might (a) have the fear response reactivated (have them stand near a spider or dog or on a high perch) and then, (b) through continuous or repeated exposure to the source of fear with support from the therapist and experience of no bad consequences (not getting bitten or not falling), show a reduction of the fear response.

Compare and contrast individual and group therapies.

In an individual therapy session, a client works one-on-one with a trained therapist. In group therapy, usually 5-10 people meet with a trained group therapist to discuss a common issue, such as divorce, grief, eating disorder, substance abuse, or anger management.

Humanistic therapy

Increase self-awareness and acceptance through focus on conscious thoughts Patient learns to articulate thoughts that keep her from achieving her goals

How does exposure therapy work?

Jayden is terrified of elevators. Nothing bad has ever happened to him on an elevator, but he's so afraid of elevators that he will always take the stairs. That wasn't a problem when Jayden worked on the second floor of an office building, but now he has a new job—on the 29th floor of a skyscraper in downtown Los Angeles. Jayden knows he can't climb 29 flights of stairs in order to get to work each day, so he decided to see a behavior therapist for help. The therapist asks Jayden to first construct a hierarchy of elevator-related situations that elicit fear and anxiety. They range from situations of mild anxiety such as being nervous around the other people in the elevator, to the fear of getting an arm caught in the door, to panic-provoking situations such as getting trapped or the cable snapping. Next, the therapist uses progressive relaxation. She teaches Jayden how to relax each of his muscle groups so that he achieves a drowsy, relaxed, and comfortable state of mind. Once he's in this state, she asks Jayden to imagine a mildly anxiety-provoking situation. Jayden is standing in front of the elevator thinking about pressing the call button. If this scenario causes Jayden anxiety, he lifts his finger. The therapist would then tell Jayden to forget the scene and return to his relaxed state. She repeats this scenario over and over until Jayden can imagine himself pressing the call button without anxiety. Over time the therapist and Jayden use progressive relaxation and imagination to proceed through all of the situations on Jayden's hierarchy until he becomes desensitized to each one. After this, Jayden and the therapist begin to practice what he only previously envisioned in therapy, gradually going from pressing the button to actually riding an elevator. The goal is that Jayden will soon be able to take the elevator all the way up to the 29th floor of his office without feeling any anxiety.

Thirty years later, Joseph Wolpe (1958) refined

Jones's techniques, giving us the behavior therapy technique of exposure therapy that is used today. A popular form of exposure therapy is systematic desensitization, wherein a calm and pleasant state is gradually associated with increasing levels of anxiety-inducing stimuli. The idea is that you can't be nervous and relaxed at the same time. Therefore, if you can learn to relax when you are facing environmental stimuli that make you nervous or fearful, you can eventually eliminate your unwanted fear response (Wolpe, 1958)

Group therapy also has some specific limitations.

Members of the group may be afraid to speak in front of other people because sharing secrets and problems with complete strangers can be stressful and overwhelming. There may be personality clashes and arguments among group members. There could also be concerns about confidentiality: Someone from the group might share what another participant said to people outside of the group.

in 1963, Congress passed and John F. Kennedy signed the

Mental Retardation Facilities and Community Mental Health Centers Construction Act, which provided federal support and funding for community mental health centers (National Institutes of Health, 2013). This legislation changed how mental health services were delivered in the United States.

Miriam is meeting with a behavioral therapist recommended to her by a friend. The therapist is YOU. What are your goals in therapy with Miriam? Choose the approach that fits the philosophy of a behavioral therapist (even if you personally prefer a different approach).

Miriam must learn new ways to respond to audiences, replacing anxiety triggered escape and avoidance with appropriate public speaking

Humanistic Therapy:

One key advantage of person-centered therapy is that it is highly acceptable to patients. In other words, people tend to find the supportive, flexible environment of this approach very rewarding. Furthermore, some of the themes of PCT translate well to other therapeutic approaches. For example, most therapists of any orientation find that clients respond well to being treated with nonjudgmental empathy.

Lashawn is a 24-year-old African American female. For years she has been struggling with bulimia. She knows she has a problem, but she is not willing to seek mental health services. What are some reasons why she may be hesitant to get help?

One reason may be that her culture views having a mental illness as a stigma. Additionally, perhaps she doesn't have insurance and is worried about the cost of therapy. She could also be afraid that a White counselor would not understand her cultural background, so she would feel uncomfortable sharing things. Also, she may believe she is self-reliant and tell herself that she's a strong woman who can fix this problem on her own without the help of a therapist.

The procedure on day 3 is the same for all three groups, but the responses are different.

Participants in the two control conditions (control group and 6-hour group) both act the same: they both show spontaneous recovery of the fear response. Those in the reconsolidation treatment condition (the 10-minute group), however, show no spontaneous recovery of the fear response.

Behavior therapy

Principles of learning applied to change undesirable behaviors Patient learns to overcome fear of elevators through several stages of relaxation techniques

Miriam's therapy: Preparation

Prior to starting progressive exposure, Miriam created her hierarchy of fears. She spent several session working on relaxation. She practiced relaxation at home several times a day until she and you, her therapist, agreed that she was ready to start treatment.Miriam's therapy: Exposure Session 1The bottom (lowest anxiety) of Miriam's fear hierarchy was chatting with friends about everyday topics. When asked to rate the fear level associated with doing this on a 1 to 10 scale, Miriam said 1: No fear at all. Miriam brought two friends with her to the therapy session today. You had them sit in a comfortable part of your office, drinking tea and chatting for 15 minutes. Afterwards Miriam reported her fear level during the chat as a 1 on a ten-point scale: no fear.

Read the dialogue and determine the type of therapy that is most likely taking place. Therapist: So, tell me about your childhood. Client: Well, I had a tough relationship with my father. He never seemed to trust me to do the right thing. I think that still influences how I deal with men today. It even has had an impact on my sleeping habits too. Therapist: Tell me more about your sleeping habits. Please feel free to recall any dreams you can remember so we can explore them. Client: Just last night I had the wildest dream. I was running in a forest being chased by ninjas. I couldn't seem to escape. They were all around me. What does it mean? What type of therapy is taking place between the client and the therapist?

Psychodynamic

Atypical Antipsychotics (developed in the late 1980s)

Schizophrenia and other types of severe thought disorders Abilify, Risperdal, Clozaril Treat the negative symptoms of schizophrenia, such as withdrawal and apathy, by targeting both dopamine and serotonin receptors; newer medications may treat both positive and negative symptoms Can increase the risk of obesity and diabetes as well as elevate cholesterol levels; constipation, dry mouth, blurred vision, drowsiness, and dizziness

Antipsychotics (developed in the 1950s)

Schizophrenia and other types of severe thought disorders Haldol, Mellaril, Prolixin, Thorazine Treat positive psychotic symptoms such as auditory and visual hallucinations, delusions, and paranoia by blocking the neurotransmitter dopamine Long-term use can lead to tardive dyskinesia, involuntary movements of the arms, legs, tongue and facial muscles, resulting in Parkinson's-like tremors

According to the American Psychological Association, three factors work together to produce successful treatment.

The first is the use of evidence-based treatment that is deemed appropriate for your particular issue. The second important factor is the clinical expertise of the psychologist or therapist. The third factor is your own characteristics, values, preferences, and culture. Many people begin psychotherapy feeling like their problem will never be resolved; however, psychotherapy helps people see that they can do things to make their situation better.

The final experiment tests this idea.

The only difference between this new group and the last group is the time delay on the second day. Rather than waiting 10 minutes between reactivating the memory and extinction, the experimenters waited 6 hours. After 6 hours, the fear memory should no longer be active and extinction should not change the memory.

Flooding has the potential to be more traumatic for Miriam (for your client), so it must be arranged carefully. But the same principles of learning work for flooding that work for systematic desensitization:

The person consciously works to replace anxiety and fear with relaxation. The unconscious parts of the mind learn that the situation does not result in horrible outcomes. New expectations replace old fears. Learning does not just happen immediately. Homework and repeated practice reinforce the new positive response to situations that once produced fear.

REDUCTION OF EMOTIONAL IMPACT:

While the memory is active and painful, the therapist acts to reduce its impact. There are two approaches to this, using the example of a phobia (irrational fear) to illustrate the method:

Cognitive-behavioral therapy

Work to change cognitive distortions and self-defeating behaviors Patient learns to identify self-defeating behaviors to overcome an eating disorder

One popular operant conditioning intervention is called the token economy. This involves

a controlled setting where individuals are reinforced for desirable behaviors with tokens, such as a poker chip, that can be exchanged for items or privileges. Token economies are often used in psychiatric hospitals to increase patient cooperation and activity levels. Patients are rewarded with tokens when they engage in positive behaviors (e.g., making their beds, brushing their teeth, coming to the cafeteria on time, and socializing with other patients). They can later exchange the tokens for extra TV time, private rooms, visits to the canteen, and so on (Dickerson, Tenhula, & Green-Paden, 2005).

Psychoanalysis is a therapy approach that typically takes years. Over the course of time, the patient reveals

a great deal about himself to the therapist. Freud suggested that during this patient-therapist relationship, the patient comes to develop strong feelings for the therapist—maybe positive feelings, maybe negative feelings.

In behavior therapy

a therapist employs principles of learning from classical and operant conditioning to help clients change undesirable behaviors. Counterconditioning is a commonly used therapeutic technique in which a client learns a new response to a stimulus that has previously elicited an undesirable behavior via classical conditioning. Principles of operant conditioning can be applied to help people deal with a wide range of psychological problems. Token economy is an example of a popular operant conditioning technique.

In exposure therapy,

a therapist seeks to treat clients' fears or anxiety by presenting them with the object or situation that causes their problem, with the idea that they will eventually get used to it. This can be done via reality, imagination, or virtual reality. Exposure therapy was first reported in 1924 by Mary Cover Jones, who is considered the mother of behavior therapy. Jones worked with a boy named Peter who was afraid of rabbits. Her goal was to replace Peter's fear of rabbits with a conditioned response of relaxation, which is a response that is incompatible with fear. How did she do it? Jones began by placing a caged rabbit on the other side of a room with Peter while he ate his afternoon snack. Over the course of several days, Jones moved the rabbit closer and closer to where Peter was seated with his snack. After two months of being exposed to the rabbit while relaxing with his snack, Peter was able to hold the rabbit and pet it while eating (Jones, 1924).

In client-centered therapy, the therapist uses the technique of

active listening. In active listening, the therapist acknowledges, restates, and clarifies what the client expresses. Therapists also practice what Rogers called unconditional positive regard, which involves not judging clients and simply accepting them for who they are. Rogers (1951) also felt that therapists should demonstrate genuineness, empathy, and acceptance toward their clients because this helps people become more accepting of themselves, which results in personal growth.

Aversion therapy has been used effectively for years in the treatment of

alcoholism (Davidson, 1974; Elkins, 1991; Streeton & Whelan, 2001). One common way this occurs is through a chemically based substance known as Antabuse. When a person takes Antabuse and then consumes alcohol, uncomfortable side effects result including nausea, vomiting, increased heart rate, heart palpitations, severe headache, and shortness of breath. Antabuse is repeatedly paired with alcohol until the client associates alcohol with unpleasant feelings, which decreases the client's desire to consume alcohol. Antabuse creates a conditioned aversion to alcohol because it replaces the original pleasure response with an unpleasant one.

Cognitive-behavioral therapy aims to change cognitive distortions and self-defeating behaviors using techniques like the ABC model. With this model, there is

an Action (sometimes called an activating event), the Belief about the event, and the Consequences of this belief. Let's say, Jon and Joe both go to a party. Jon and Joe each have met a young woman at the party: Jon is talking with Megan most of the party, and Joe is talking with Amanda. At the end of the party, Jon asks Megan for her phone number and Joe asks Amanda. Megan tells Jon she would rather not give him her number, and Amanda tells Joe the same thing. Both Jon and Joe are surprised, as they thought things were going well. What can Jon and Joe tell themselves about why the women were not interested? Let's say Jon tells himself he is a loser, or is ugly, or "has no game." Jon then gets depressed and decides not to go to another party, which starts a cycle that keeps him depressed. Joe tells himself that he had bad breath, goes out and buys a new toothbrush, goes to another party, and meets someone new.

The goal of substance-related treatment is to help

an addicted person stop compulsive drug-seeking behaviors (NIDA, 2012). This means an addicted person will need long-term treatment, similar to a person battling a chronic physical disease such as hypertension or diabetes. Treatment usually includes behavioral therapy and/or medication, depending on the individual (NIDA, 2012). Specialized therapies have also been developed for specific types of substance-related disorders, including alcohol, cocaine, and opioids (McGovern & Carroll, 2003). Substance-related treatment is considered much more cost-effective than incarceration or not treating those with addictions (NIDA, 2012).

Starting in 1954 and gaining popularity in the 1960s, _______ medications were introduced.

antipsychotic

Bernice Pescosolido, author of the study,

asserts that this is a misconception. However, stigmatization of psychological disorders is one of the main reasons why young people do not get the help they need when they are having difficulties. Pescosolido and her colleagues caution that this stigma surrounding mental illness, based on misconceptions rather than facts, can be devastating to the emotional and social well-being of our nation's children.

The third kind of distortion involves jumping to conclusions—

assuming that people are thinking negatively about you or reacting negatively to you, even though there is no evidence. Consider the example of Savannah and Hillaire, who recently met at a party. They have a lot in common, and Savannah thinks they could become friends. She calls Hillaire to invite her for coffee. Since Hillaire doesn't answer, Savannah leaves her a message. Several days go by and Savannah never hears back from her potential new friend. Maybe Hillaire never received the message because she lost her phone or she is too busy to return the phone call. But if Savannah believes that Hillaire didn't like Savannah or didn't want to be her friend, she is demonstrating the cognitive distortion of jumping to conclusions.

most people thought of memories—particularly memories of personal events, technically known as

autobiographical memories—as mental representations that become relatively stable and unchangeable very quickly. We knew that memories do not stabilize immediately, however, because brain trauma (e.g., a concussion) or certain drugs could interfere with people's ability to recall events immediately before the trauma or administration of the drug.

Which of the following was not listed as a barrier to mental health treatment?

being a member of the ethnic majority

foundational idea behind evidence based treatment is that

best practices are determined by research evidence that has been compiled by comparing various forms of treatment (Charman & Barkham, 2005). These treatments are then operationalized and placed in treatment manuals—trained therapists follow these manuals. The benefits are that evidence-based treatment can reduce variability between therapists to ensure that a specific approach is delivered with integrity (Charman & Barkham, 2005). Therefore, clients have a higher chance of receiving therapeutic interventions that are effective at treating their specific disorder. While EBPP is based on randomized control trials, critics of EBPP reject it stating that the results of trials cannot be applied to individuals and instead determinations regarding treatment should be based on a therapist's judgment (Mullen & Streiner, 2004).

Bronson treats anxiety disorders with Xanax, which exemplifies ________ therapy.

biomedical

Johnson often recommends lithium to her patients with bipolar disorder. This exemplifies ________ therapy.

biomedical

Multicultural counseling and therapy aims to offer

both a helping role and process that uses modalities and defines goals consistent with the life experiences and cultural values of clients. It strives to recognize client identities to include individual, group, and universal dimensions, advocate the use of universal and culture-specific strategies and roles in the healing process, and balancs the importance of individualism and collectivism in the assessment, diagnosis, and treatment of client and client systems (Sue, 2001).

ABA In this treatment, a child's behavior is

charted and analyzed. The ABA therapist, along with the caregivers, determines what reinforces the child, what sustains a behavior to continue, and how best to manage a behavior. For example, Nur may become overwhelmed and run out of the room when the classroom is too noisy. Whenever Nur runs out of the classroom, the teacher's aide chases him and places him in a special room where he can relax. Going into the special room and getting the aide's attention are reinforcing for Nur. In order to change Nur's behavior, he must be presented with other options before he becomes overwhelmed, and he cannot receive reinforcement for displaying maladaptive behaviors.

One commonly used classical conditioning therapeutic technique is counterconditioning: a

client learns a new response to a stimulus that has previously elicited an undesirable behavior. Two counterconditioning techniques are aversive conditioning and exposure therapy. Aversive conditioning uses an unpleasant stimulus to stop an undesirable behavior. Therapists apply this technique to eliminate addictive behaviors, such as smoking, nail biting, and drinking. In aversion therapy, clients will typically engage in a specific behavior (such as nail biting) and at the same time are exposed to something unpleasant, such as a mild electric shock or a bad taste. After repeated associations between the unpleasant stimulus and the behavior, the client can learn to stop the unwanted behavior.

________ therapy is cost-effective and doesn't typically last too long, while ________ may take several years.

cognitive behavioral; psychoanalysis

Today, there are ________mental health centers across the nation. They are located in neighborhoods near the homes of clients, and they provide large numbers of people with mental health services of various kinds and for many kinds of problems

community ; in neighborhoods near the homes of clients, and they provide large numbers of people with mental health services of various kinds and for many kinds of problems

Frequently, a person who is addicted to drugs and/or alcohol has

comorbid disorders, meaning they may have additional diagnoses of other psychological disorders. In cases of comorbidity, the best treatment is thought to address both (or multiple) disorders simultaneously (NIDA, 2012). Behavior therapies are used to treat comorbid conditions, and in many cases, medications are used along with psychotherapy.

Consolidation is

complex, with some consolidation processes taking minutes to hours and other consolidation processes taking weeks, months, or even years. For the rest of this reading, we will concern ourselves with the quick part of consolidation that occurs in the hours and days immediately after an experience. The idea of consolidation does not rule out forgetting. Memories can fade—that is, lose details—or become impossible to retrieve. In the reading on memory, you also learned that misinformation that a person hears shortly after an event can be incorporated into the memory. But the idea is that the final version of the memory is fixed once it has consolidated within a few hours. This late-20th century theory says that memory is like a book. When it is first printed, the ink must dry (the consolidation process that takes up to a few hours), but when that has occurred, the contents of the book don't change. The ink may fade over time or you may have trouble finding it in your library, but the contents of the book never change, no matter how often you pull it out to read it.

Another benefit of group therapy is that members can

confront each other about their patterns. For those with some types of problems, such as sexual abusers, group therapy is the recommended treatment. Group treatment for this population is considered to have several benefits:

The neural processes that occur between an experience and the stabilization of the memory for that experience is called

consolidation

Mindfulness is a process that tries to

cultivate a nonjudgmental, yet attentive, mental state. It is a therapy that focuses on one's awareness of bodily sensations, thoughts, and the outside environment. Whereas other therapies work to modify or eliminate these sensations and thoughts, mindfulness focuses on non-judgmentally accepting them (Kabat-Zinn, 2003; Baer, 2003). For example, whereas CBT may actively confront and work to change a maladaptive thought, mindfulness therapy works to acknowledge and accept the thought, understanding that the thought is spontaneous and not what the person truly believes

A psychologist who understands the role that race and ethnicity play in providing treatment demonstrates

cultural competence

Pierre has had a difficult childhood. He fled a civil war in his home country before settling in France, and has a unique perspective about the importance of his extended family. A psychologist working with Pierre should be aware of his situation and background in order to provide the best possible treatment. This awareness is known as

cultural competence

As our society becomes increasingly multiethnic and multiracial, mental health professionals must develop

cultural competence (Figure 1), which means they must understand and address issues of race, culture, and ethnicity. They must also develop strategies to effectively address the needs of various populations for which Eurocentric therapies have limited application (Sue, 2004). For example, a counselor whose treatment focuses on individual decision making may be ineffective at helping a Chinese client with a collectivist approach to problem solving (Sue, 2004).

The sociocultural perspective looks at you, your behaviors, and your symptoms in the context of your ________.

culture and background

people suffering from both clinical-level depression and posttraumatic stress disorder (PTSD) often have

difficulty remembering details of specific memories, especially for happy experiences. This is called overgeneralized autobiographical memory (OGM). A therapist might ask a depressed person showing OGM to recall a recent happy experience. The depressed person might answer, "When I was visiting my friends last weekend," but then be unable to recall or describe any particular events or interactions during that visit that were enjoyable or rewarding.

One type of behavior therapy utilizes classical conditioning techniques. Therapists using these techniques believe that

dysfunctional behaviors are conditioned responses. Applying the conditioning principles developed by Ivan Pavlov, these therapists seek to recondition their clients and thus change their behavior. Emmie is eight years old, and frequently wets her bed at night. She's been invited to several sleepovers, but she won't go because of her problem. Using a type of conditioning therapy, Emmie begins to sleep on a liquid-sensitive bed pad that is hooked to an alarm. When moisture touches the pad, it sets off the alarm, waking up Emmie. When this process is repeated enough times, Emmie develops an association between urinary relaxation and waking up, and this stops the bedwetting. Emmie has now gone three weeks without wetting her bed and is looking forward to her first sleepover this weekend.

. Evidence-based practice is used to

educe errors in treatment selection by making clinical decisions based on research (Sackett & Rosenberg, 1995). In any case, evidence-based treatment is on the rise in the field of psychology. So what is it, and why does it matter? In an effort to determine which treatment methodologies are evidenced-based, professional organizations such as the American Psychological Association (APA) have recommended that specific psychological treatments be used to treat certain psychological disorders (Chambless & Ollendick, 2001). According to the APA (2005), "Evidence-based practice in psychology (EBPP) is the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences" (p. 1).

Spontaneous recovery is one of the big problems with

extinction training. You can get rid of a response for a while, but the response can return over and over again. According to the researchers—Dr. Phelps and Dr. Schiller—the problem may be that the person has two memories: one where the yellow box means a shock is coming, and another that means the yellow box equates to no shock. These two memories are both available, so when a yellow box happens to retrieve the first memory (yellow box = shock), the fear response returns.

The study that initially caught the attention of memory scientists was a study using rats as subjects by Karim Nader, Glenn Schafe, and Joseph Le Doux of New York University in the year 2000. They taught their animals a

fear memory by pairing a particular sound with a mild, but unpleasant shock using classical conditioning.[2] The researchers found that they could change a memory that had already been consolidated if they did just the right things at just the right time.

Humanistic therapy

focuses on helping people achieve their potential. One form of humanistic therapy developed by Carl Rogers is known as client-centered or Rogerian therapy. Client-centered therapists use the techniques of active listening, unconditional positive regard, genuineness, and empathy to help clients become more accepting of themselves.

In the late 1700s, a French physician, Philippe Pinel, argued

for more humane treatment of the mentally ill. He suggested that they be unchained and talked to, and that's just what he did for patients at La Salpêtrière in Paris in 1795 (Figure 2). Patients benefited from this more humane treatment, and many were able to leave the hospital.

cognitive-behavioral therapy:

form of psychotherapy that aims to change cognitive distortions and self-defeating behaviors

cognitive therapy:

form of psychotherapy that focuses on how a person's thoughts lead to feelings of distress, with the aim of helping them change these irrational thoughts

unconditional positive regard:

fundamental acceptance of a person regardless of what they say or do; term associated with humanistic psychology

Another benefit of technology is cognitive bias modification. Here, patients are

given exercises, often through the use of video games, aimed at changing their problematic thought processes. For example, researchers might use a mobile app to train alcohol abusers to avoid stimuli related to alcohol. One version of this game flashes four pictures on the screen—three alcohol cues (e.g., a can of beer, the front of a bar) and one health-related image (e.g., someone drinking water). The goal is for the patient to tap the healthy picture as fast as s/he can. Games like these aim to target patients' automatic, subconscious thoughts that may be difficult to direct through conscious effort. That is, by repeatedly tapping the healthy image, the patient learns to "ignore" the alcohol cues, so when those cues are encountered in the environment, they will be less likely to trigger the urge to drink. Approaches like these are promising because of their accessibility, however they require further research to establish their effectiveness.

Systematic desensitization works by

gradually—step-by-step—exposing the person to situations that are increasingly more anxiety-producing. This is called "progressive exposure." By learning to cope with anxiety with less-threatening situations first, the person is better prepared to handle the more-threatening situations. Even more important for treatment, the mind learns that nothing horrible happens. This retraining of the subconscious mind means that the situation actually becomes less threatening.

Mental Health Parity and Addiction Equity Act of 2008, which requires

group health plans and insurers to make sure there is parity of mental health services (U.S. Department of Labor, n.d.). This means that co-pays, total number of visits, and deductibles for mental health and substance abuse treatment need to be equal to and cannot be more restrictive or harsher than those for physical illnesses and medical/surgical problems.

The Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey (NHANES) found that approximately

half (50.6%) of children with mental disorders had received treatment for their disorder within the past year (NIMH, n.d.-c). However, there were some differences between treatment rates by category of disorder (Figure 2). For example, children with anxiety disorders were least likely to have received treatment in the past year, while children with ADHD or a conduct disorder were more likely to receive treatment.

The goal of CBT is to

help people make adaptive, instead of maladaptive, appraisals (e.g., "I do know interesting things!"). This technique of reappraisal, or cognitive restructuring, is a fundamental aspect of CBT. With cognitive restructuring, it is the therapist's job to help point out when a person has an inaccurate or maladaptive thought, so that the patient can either eliminate it or modify it to be more adaptive. In essence, this approach is designed to change the way people think as well as how they act.

In which type of therapy might a therapist not give advice or provide interpretations to her client?

humanistic

The percentage of adults who received mental health treatment in 2004-2008 is shown. Adults seeking treatment _________ slightly from 2004 to 2008.

increased

The Y-axis on the graph below shows the skin conductance response of the subjects. Higher values

indicate higher levels of fear.[3] You will be adjusting the lines, so move them up to indicate more fear and down to indicate less fear. The X-axis shows the end of Day 1, after successful fear conditioning, and the first trial on Day 3, when spontaneous recovery is being measured.

If Dr. Zavidah meets with her patient, Petra, once a week in one-on-one appointments for an hour, she is conducting ________.

individual therapy

There are several modalities, or methods, of treatment:

individual therapy, group therapy, couples therapy, and family therapy are the most common.

comorbid disorder:

individual who has two or more diagnoses, which often includes a substance abuse diagnosis and another psychiatric diagnosis, such as depression, bipolar disorder, or schizophrenia

A therapist's first meeting with a client is called ________.

intake

The initial meeting when a client and therapist meet to discuss the client's immediate needs as well as practical things like fees and insurance information is known as ________.

intake

Once a person seeks treatment, whether voluntarily or involuntarily, he has an

intake done to assess his clinical needs. An intake is the therapist's first meeting with the client. The therapist gathers specific information to address the client's immediate needs, such as the presenting problem, the client's support system, and insurance status.

Eclectic therapy is

integrating more than one approach to psychotherapy

Which of the following is eclectic therapy?

integrating more than one approach to psychotherapy

Joey was convicted of domestic violence. As part of his sentence, the judge has ordered that he attend therapy for anger management. This is considered ________ treatment.

involuntary

Stavros is arrested for drunk driving. His prison sentence includes attending therapy sessions to treat alcohol addiction. He doesn't want to attend these sessions, but his sentence will be extended if he doesn't attend them. What kind of treatment does this describe?

involuntary

Couples therapy

involves two people in an intimate relationship who are having difficulties and are trying to resolve them. The couple may be dating, partnered, engaged, or married. The therapist helps them resolve their problems as well as implement strategies that will lead to a healthier and happier relationship.

Lobotomy

is a form of psychosurgery in which parts of the frontal lobe of the brain are destroyed or their connections to other parts of the brain severed. The goal of lobotomy was usually to calm symptoms in people with serious psychological disorders, such as schizophrenia.

Family therapy

is a special form of group therapy. The therapy group is made up of one or more families. The goal of this approach is to enhance the growth of each individual family member and the family as a whole

The procedure on Day 3 for this group

is exactly the same as it was for the Control Group. What is different is the subjects' response. There is NO SPONTANEOUS RECOVERY for this group. The fear response is gone. The experimenters attribute this lack of a fear response to a changed memory, one that now associates the yellow box with no shock

The psychodynamic therapy developed by Sigmund Freud is almost entirely based on remembering actual experiences or recent dreams. Even newer forms of therapy,

like Cognitive-Behavioral Therapy (CBT), involve a great deal of memory work.

In a psychoanalyst's office, you might see a patient

lying on a couch speaking of dreams or childhood memories, and the therapist using various Freudian methods such as free association and dream analysis (Figure 1).

Treatment also usually involves

medications to detox the addict safely after an overdose, to prevent seizures and agitation that often occur in detox, to prevent reuse of the drug, and to manage withdrawal symptoms. Getting off drugs often involves the use of drugs—some of which can be just as addictive. Detox can be difficult and dangerous.

MBSR uses

meditation, yoga, and attention to physical experiences to reduce stress. The hope is that reducing a person's overall stress will allow that person to more objectively evaluate his or her thoughts.

Mindfulness is thought to improve

mental health because it draws attention away from past and future stressors, encourages acceptance of troubling thoughts and feelings, and promotes physical relaxation.

During the 1980s and 1990s, cognitive and behavioral techniques were

merged into cognitive-behavioral therapy. Pivotal to this merging was the successful development of treatments for panic disorder by David M. Clark in the UK and David H. Barlow in the U.S. Over time, cognitive-behavioral therapy came to be known not only as a therapy, but as an umbrella category for all cognitive-based psychotherapies.

Psychologists have adapted the practice of

mindfulness as a form of psychotherapy, generally called mindfulness-based therapy (MBT). Several types of MBT have become popular in recent years, including mindfulness-based stress reduction (MBSR) (e.g., Kabat-Zinn, 1982) and mindfulness-based cognitive therapy (MBCT) (e.g., Segal, Williams, & Teasdale, 2002).

Oscar is being treated for depression. His therapist, Annalise, encourages him to notice his unpleasant thoughts and feelings without trying to avoid them or judge them. She then encourages him to meditate daily. This is likely an example of:

mindfulness based therapy

cognitive-behavioral therapies, through the use of technological advances. For example, internet- and mobile-delivered therapies make psychological treatments

more available, through smartphones and online access. Clinician-supervised online CBT modules allow patients to access treatment from home on their own schedule—an opportunity particularly important for patients with less geographic or socioeconomic access to traditional treatments. Furthermore, smartphones help extend therapy to patients' daily lives, allowing for symptom tracking, homework reminders, and more frequent therapist contact.

Philippe Pinel and Dorothea Dix argued for

more humane treatment of people with psychological disorders. In the mid-1960s, the deinstitutionalization movement gained support and asylums were closed, enabling people with mental illness to return home and receive treatment in their own communities. Some did go to their family homes, but many became homeless due to a lack of resources and support mechanisms.

If Dr. Marshall quietly watches Mateo play in the corner with toys in order to observe his behavior and make a diagnosis, he is utilizing

nondirective play therapy

Today, instead of asylums, there are psychiatric hospitals run by state governments and local community hospitals focused ______ and why?

on short-term care. In all types of hospitals, the emphasis is on short-term stays, with the average length of stay being less than two weeks and often only several days. This is partly due to the very high cost of psychiatric hospitalization, which can be about $800 to $1000 per night (Stensland, Watson, & Grazier, 2012). Therefore, insurance coverage often limits the length of time a person can be hospitalized for treatment. Usually individuals are hospitalized only if they are an imminent threat to themselves or others.

Effectiveness of psychotherapy-For example,

one large-scale study that examined 16 meta-analyses of CBT reported that it was equally effective or more effective than other therapies in treating PTSD, generalized anxiety disorder, depression, and social phobia (Butlera, Chapmanb, Formanc, & Becka, 2006). Another study found that CBT was as effective at treating depression (43% success rate) as prescription medication (50% success rate) compared to the placebo rate of 25% (DeRubeis et al., 2005). Another meta-analysis found that psychodynamic therapy was also as effective at treating these types of psychological issues as CBT (Shedler, 2010). However, no studies have found one psychotherapeutic approach more effective than another (Abbass, Kisely, & Kroenke, 2006; Chorpita et al., 2011), nor have they shown any relationship between a client's treatment outcome and the level of the clinician's training or experience (Wampold, 2007). Regardless of which type of psychotherapy an individual chooses, one critical factor that determines the success of treatment is the person's relationship with the psychologist or therapist.

In MBCT, rather than reducing one's general stress to address a specific problem, attention is focused on

one's thoughts and their associated emotions. For example, MBCT helps prevent relapses in depression by encouraging patients to evaluate their own thoughts objectively and without value judgment (Baer, 2003). Although cognitive behavioral therapy (CBT) may seem similar to this, it focuses on "pushing out" the maladaptive thought, whereas mindfulness-based cognitive therapy focuses on "not getting caught up" in it.

What Nader and his colleagues found was that memories become

open to changes for a brief period of time when they are retrieved. For a few hours, the changed memories can be disrupted (e.g., by trauma to the brain, by drugs, and by other means), but once they have reconsolidated, they become the new version of the memory. This newer theory of memory says that our memories are not really like books, which don't change after the print has dried. Now memory is more like a computer file that is updated without saving the original. You originally create the memory (consolidation) and store it away. When you retrieve the memory, you can change some information in the file, but this new version now becomes the memory. Many researchers believe we don't have a backup version of the original memory. All we have is the new, modified memory of the event.

Groups that have a strong educational component are called

psycho-educational groups. For example, a group for children whose parents have cancer might discuss in depth what cancer is, types of treatment for cancer, and the side effects of treatments, such as hair loss. Often, group therapy sessions with children take place in school. They are led by a school counselor, a school psychologist, or a school social worker. Groups might focus on test anxiety, social isolation, self-esteem, bullying, or school failure (Shechtman, 2002). Whether the group is held in school or in a clinician's office, group therapy has been found to be effective with children facing numerous kinds of challenges (Shechtman, 2002).

Biomedical therapies approach

psychological disorders as having biological causes and focus on eliminating or alleviating symptoms of psychological disorders. The mind and body are viewed as connected; poor physical health leads to poor mental health, and vice versa.

Cognitive therapy is a form of

psychotherapy that focuses on how a person's thoughts lead to feelings of distress.

Unfortunately, part of what occurred with deinstitutionalization was that those released from institutions were

supposed to go to newly created centers, but the system was not set up effectively. Centers were underfunded, staff was not trained to handle severe illnesses such as schizophrenia, there was high staff burnout, and no provision was made for the other services people needed, such as housing, food, and job training. Without these supports, those people released under deinstitutionalization often ended up homeless.

Yet another emerging treatment employs CBT-enhancing pharmaceutical agents. These are drugs used to improve

the effects of therapeutic interventions. Based on research from animal experiments, researchers have found that certain drugs influence the biological processes known to be involved in learning. Thus, if people take these drugs while going through psychotherapy, they are better able to "learn" the techniques for improvement. For example, the antibiotic d-cycloserine improves treatment for anxiety disorders by facilitating the learning processes that occur during exposure therapy. Ongoing research in this exciting area may prove to be quite fruitful.

While individual therapy is used in

the treatment of substance-related disorders, group therapy is the most widespread treatment modality (Weiss, Jaffee, de Menil, & Cogley, 2004). The rationale behind using group therapy for addiction treatment is that addicts are much more likely to maintain sobriety in a group format. It has been suggested that this is due to the rewarding and therapeutic benefits of the group, such as support, affiliation, identification, and even confrontation (Center for Substance Abuse Treatment, 2005).

In psychoanalysis, therapists help their patients look into

their past to uncover repressed feelings. In behavior therapy, a therapist employs principles of learning to help clients change undesirable behaviors—rather than digging deeply into one's unconscious. Therapists with this orientation believe that dysfunctional behaviors, like phobias and bedwetting, can be changed by teaching clients new, more constructive behaviors. Behavior therapy employs both classical and operant conditioning techniques to change behavior.

Cognitive-behavioral therapy (CBT) helps clients examine how their

their thoughts affect their behavior. It aims to change cognitive distortions and self-defeating behaviors. For example, if it's your first time meeting new people, you may have the automatic thought, "These people won't like me because I have nothing interesting to share." That thought itself is not what's troublesome; the appraisal (or evaluation) that it might have merit is what's troublesome

nondirective therapy:

therapeutic approach in which the therapist does not give advice or provide interpretations but helps the person identify conflicts and understand feelings

humanistic therapy:

therapeutic orientation aimed at helping people become more self-aware and accepting of themselves

confidentiality:

therapist cannot disclose confidential communications to any third party, unless mandated or permitted by law

Since this is a form of nondirective therapy, a therapeutic approach in which the

therapist does not give advice or provide interpretations but helps the person to identify conflicts and understand feelings, Rogers (1951) emphasized the importance of the person taking control of his own life to overcome life's challenges.

structural family therapy:

therapist examines and discusses with the family the boundaries and structure of the family: who makes the rules, who sleeps in the bed with whom, how decisions are made, and what are the boundaries within the family

strategic family therapy:

therapist guides the therapy sessions and develops treatment plans for each family member for specific problems that can addressed in a short amount of time

cultural competence

therapist's understanding and attention to issues of race, culture, and ethnicity in providing treatment

One of the reasons lobotomy fell out of favor was the development in the 1950s and 1960s of new medications for the treatment of psychological disorders;

these are now the most widely used forms of biological treatment. While these are often used in combination with psychotherapy, they also are taken by individuals not in therapy. This is known as biomedical therapy

Your emotional reactions are the result of your

thoughts about the situation rather than the situation itself. For instance, if you consistently interpret events and emotions around the themes of loss and defeat, then you are likely to be depressed. Through therapy, you can learn more logical ways to interpret situations.

In strategic family therapy, the goal is

to address specific problems within the family that can be dealt with in a relatively short amount of time. Typically, the therapist would guide what happens in the therapy session and design a detailed approach to resolving each member's problem (Madanes, 1991).

When is electroconvulsive therapy shown to be effective?

treating severe depression

biomedical therapy:

treatment that involves medication and/or medical procedures to treat psychological disorders

electroconvulsive therapy (ECT):

type of biomedical therapy that involves using an electrical current to induce seizures in a person to help alleviate the effects of severe depression

Another biologically based treatment that continues to be used, although infrequently, is electroconvulsive therapy (ECT) (formerly known by its unscientific name as electroshock therapy). It involves

using an electrical current to induce seizures to help alleviate the effects of severe depression. The exact mechanism is unknown, although it does help alleviate symptoms for people with severe depression who have not responded to traditional drug therapy (Pagnin, de Queiroz, Pini, & Cassano, 2004). About 85% of people treated with ECT improve (Reti, n.d.). However, the memory loss associated with repeated administrations has led to it being implemented as a last resort (Donahue, 2000; Prudic, Peyser, & Sackeim, 2000). A more recent alternative is transcranial magnetic stimulation (TMS), a procedure approved by the FDA in 2008 that uses magnetic fields to stimulate nerve cells in the brain to improve depression symptoms; it is used when other treatments have not worked (Mayo Clinic, 2012).

group therapy,

usually 5-10 people meet with a trained group therapist to discuss a common issue (e.g., divorce, grief, eating disorders, substance abuse, or anger management)

Sometimes, it's too impractical, expensive, or embarrassing to re-create anxiety- producing situations, so a therapist might employ

virtual reality exposure therapy by using a simulation to help conquer fears. Virtual reality exposure therapy has been used effectively to treat numerous anxiety disorders such as the fear of public speaking, claustrophobia (fear of enclosed spaces), aviophobia (fear of flying), and post-traumatic stress disorder (PTSD), a trauma and stressor-related disorder (Gerardi, Cukor, Difede, Rizzo, & Rothbaum, 2010).

Deja has been having dark thoughts for a few months, and is also feeling lethargic, unmotivated, and depressed. She talks to her parents and together they decide she should see a counselor. What kind of treatment does this describe?

voluntary

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), in 2017,

14.8% of adults received treatment for a mental health issue (NIMH, 2017). These percentages, shown in Figure 1, reflect the number of adults who received care in inpatient and outpatient settings and/or used prescription medication for psychological disorders.

According to the U.S. Department of Health and Human Services (2017), ________ U.S. adults experienced mental illness in 2017. ... and for teens and children?

18.9% of U.S. adults experienced mental illness in 2017. For teens (ages 13-18), the rate is similar to that of adults, and for children ages 8-15, current estimates suggest that approximately 13% experience mental illness in a given year (National Institute of Mental Health [NIMH], 2017).

Approximately what percentage of homeless adults living in shelters experience mental illness?

26%

Even today, a large portion of the homeless population is considered to be mentally ill (Figure 3). Statistics show that _____ of homeless adults living in shelters experience mental illness (U.S. Department of Housing and Urban Development [HUD], 2011).

26%

According to a 2006 special report by the Bureau of Justice Statistics (BJS), approximately _______ mentally ill adults were incarcerated in the state prison system, and another 78,800 were incarcerated in the federal prison system. A further...

705,600 479,000 were in local jails. According to the study, "people with mental illnesses are overrepresented in probation and parole populations at estimated rates ranging from two to four times the general population" (Prins & Draper, 2009, p. 23). The Treatment Advocacy Center reported that the growing number of mentally ill inmates has placed a burden on the correctional system (Torrey et al., 2014).

Cognitive therapy was developed by psychiatrist

Aaron Beck in the 1960s. His initial focus was on depression and how a client's self-defeating attitude served to maintain a depression despite positive factors in her life (Beck, Rush, Shaw, & Emery, 1979)(Figure 1). Through questioning, a cognitive therapist can help a client recognize dysfunctional ideas, challenge catastrophizing thoughts about themselves and their situations, and find a more positive way to view things (Beck, 2011).

Usually someone is hospitalized only if they are an imminent threat to themselves or others. Describe a situation that might meet these criteria.

Frank is severely depressed. He lost his job one year ago and has not been able to find another one. A few months after losing his job, his home was foreclosed and his wife left him. Lately, he has been thinking that he would be better off dead. He's begun giving his possessions away and has purchased a handgun. He plans to kill himself on what would have been his 20th wedding anniversary, which is coming up in a few weeks.

Play therapy

Psychoanalytical therapy wherein interaction with toys is used instead of talk; used in child therapy Patient (child) acts out family scenes with dolls

Many of the wards and rooms were so cold that

a glass of water would be frozen by morning (Willard Psychiatric Center, 2009). Willard's doors were not closed until 1995. Conditions like these remained commonplace until well into the 20th century.

An individual might go to a

community mental health center or a practitioner in private or community practice. A child might see a school counselor, school psychologist, or school social worker. An incarcerated person might receive group therapy in prison. There are many different types of treatment providers, and licensing requirements vary from state to state. Besides psychologists and psychiatrists, there are clinical social workers, marriage and family therapists, and trained religious personnel who also perform counseling and therapy.

In total, hundreds of studies have shown the effectiveness of cognitive-behavioral therapy in the treatment of numerous psychological disorders such as

depression, PTSD, anxiety disorders, eating disorders, bipolar disorder, and substance abuse (Beck Institute for Cognitive Behavior Therapy, n.d.). For example, CBT has been found to be effective in decreasing levels of hopelessness and suicidal thoughts in previously suicidal teenagers (Alavi, Sharifi, Ghanizadeh, & Dehbozorgi, 2013). Cognitive-behavioral therapy has also been effective in reducing PTSD in specific populations, such as transit workers (Lowinger & Rombom, 2012).

If someone was considered to be possessed, there were several forms of treatment to release spirits from the individual. The most common treatment was

exorcism,

Play therapy

is a psychodynamic therapy technique often used with children. The idea is that children play out their hopes, fantasies, and traumas, using dolls, stuffed animals, and sandbox figurines.

Psychotherapy

is a psychological treatment that employs various methods to help someone overcome personal problems, or to attain personal growth.

Cognitive therapy

is a technique that focuses on how thoughts lead to feelings of distress. The idea behind cognitive therapy is that how you think determines how you feel and act. Cognitive therapists help clients change dysfunctional thoughts in order to relieve distress. Cognitive-behavioral therapy explores how our thoughts affect our behavior. Cognitive-behavioral therapy aims to change cognitive distortions and self-defeating behaviors.

Over 85% of the l,669 federally designated

mental health professional shortage areas are rural; often primary care physicians and law enforcement are the first-line mental health providers (Ivey, Scheffler, & Zazzali, 1998), although they do not have the specialized training of a mental health professional, who often would be better equipped to provide care. Availability, accessibility, and acceptability (the stigma attached to mental illness) are all problems in rural areas. Approximately two-thirds of those with symptoms receive no care at all (U.S. Department of Health and Human Services, 2005; Wagenfeld, Murray, Mohatt, & DeBruiynb, 1994). At the end of 2013, the U.S. Department of Agriculture announced an investment of $50 million to help improve access and treatment for mental health problems as part of the Obama administration's effort to strengthen rural communities.

Most people suffering from mental illnesses are

not hospitalized. If someone is feeling very depressed, complains of hearing voices, or feels anxious all the time, he or she might seek psychological treatment. A friend, spouse, or parent might refer someone for treatment. The individual might go see his primary care physician first and then be referred to a mental health practitioner.

Play therapy is often used with children since they are

not likely to sit on a couch and recall their dreams or engage in traditional talk therapy. This technique uses a therapeutic process of play to "help clients prevent or resolve psychosocial difficulties and achieve optimal growth" (O'Connor, 2000, p. 7). The idea is that children play out their hopes, fantasies, and traumas while using dolls, stuffed animals, and sandbox figurines.

free association:

technique in psychoanalysis in which the patient says whatever comes to mind at the moment

The idea behind cognitive therapy is that how you

think determines how you feel and act. Cognitive therapists help their clients change dysfunctional thoughts in order to relieve distress. They help a client see how they misinterpret a situation (cognitive distortion). For example, a client may overgeneralize. Because Ray failed one test in his Psychology 101 course, he feels he is stupid and worthless. These thoughts then cause his mood to worsen. Therapists also help clients recognize when they blow things out of proportion. Because Ray failed his Psychology 101 test, he has concluded that he's going to fail the entire course and probably flunk out of college altogether. These errors in thinking have contributed to Ray's feelings of distress. His therapist will help him challenge these irrational beliefs, focus on their illogical basis, and correct them with more logical and rational thoughts and beliefs.