psychology unit 13

Is psychotherapy also cost effective?

1. Again, the answer is yes a) Studies show that when people seek psychological treatment, their search for other medical treatment drops-by 16% in one digest of 19 studies b) Given the staggering annual cost of psychological disorders and substance abuse-including crime, accidents, lost work, and treatment-psychotherapy is a good investment, must like money spent on prenatal and well baby care 2. Both reduce long term costs a) Boosting employees' psychological well being, for example, can lower medical costs, improve work efficiency, and diminish absenteeism b) But not that the claim-that psychotherapy on average is somewhat effective-refers to no one therapy in particular c) It is like reassuring lung cancer patients that on average medical treatment of health problems is effective d) What people want to know is the effectiveness of a particular treatment for their specific problems

What is outcome research? What is meta analysis?

1. How can we objectively measure the effectiveness of psychotherapy? a) In search of answers, psychologists have turned to controlled research studies b) Similar research in the 1800s transformed the field of medicine c) Physicians, skeptical of many of the fashionable treatments (bleeding, purging, infusions of plant and metal substances), began to realize that many patients got better on their own, without these treatments, and that others died despite them d) Sorting fact from superstition required observing patients with and without a particular treatment e) Typhoid fever patients, for example, often improve after being bled, convincing most physicians that the treatment worked f) Not until a control group was given mere bed rest and 70% were observed to improve after five weeks of fever-did physicians learn, to their shock, that the bleeding was worthless 2. In psychology, the opening challenge to the effectiveness of psychotherapy was issued by British psychologist Hans Eysenck a) Launching a spirited debate, he summarized studies showing that two thirds of those receiving psychotherapy for nonpsychotic disorders improved markedly b) To this day, no one disputes that optimistic estimate c) Why then are we still debating psychotherapy's effectiveness? d) Because Eysenck also reported similar improvement among untreated persons, such as those who were on waiting lists e) With or without psychotherapy, he said, roughly two thirds improved noticeably f) Time was a great healer g) Later research revealed shortcomings in Eysenck's analyses; his sample was small (only 24 studies of psychotherapy outcomes in 1952) 3. Today hundreds of studies are available a) The best are RANDOMIZED CLINICAL TRIALS, in which researchers randomly assign people on a waiting list to therapy or to no therapy, and later evaluate everyone, using tests and assessments by others who don't know whether therapy was given 4. The results of many such studies are then digested by means of META-ANALYSIS a) Meta analysis: a procedure for statistically combining the results of many different research studies b) Simplify said, meta analyses give us the bottom line results of lots of studies c) Meta analysis of a number of studies suggests that thousands of patients benefit more from therapy than those who did not go to therapy d) in the 50s, they did a meta analysis study and found that 2/3rds of people that go to therapy feel better afterwards. the problem is 2/3rds of people who do not go to therapy also feel better in 6 to 9 months e) people generally benefit from therapy more so than those who do not go to therapy 5. research shows that treated patients were 80% better than untreated ones. a) Psychotherapists welcomed the first meta analysis of some 475 psychotherapy outcome studies b) It showed that the average therapy client ends up better off than 80% of the untreated individuals on waiting lists c) The claim is modest-by definition, about 50% of untreated people also are better off than the average untreated person d) Nevertheless, Mary Less Smith and her colleagues exulted that psychotherapy benefits people of all ages as reliably as schooling educates them, medicine cures them, or business turns a profit e) Dozens of subsequent summaries have now examined this question gf) Their verdict echoes the results of the earlier outcome studies: THOSE NOT UNDERGOING THERAPY OFTEN IMPROVE BUT THOSE UNDERGOING THERAPY ARE MORE LIKELY TO IMPROVE MORE QUICKLY AND WITH LESS RISK OF RELAPSE

What is resilience? Can psychological disorders be prevented?

1. We have seen that lifestyle change can help reverse some of the symptoms of psychological disorders 2. Might such change also prevent some disorders by building individual's RESILIENCE? a) Resilience: the personal strength that helps most people cope with stress and recover from adversity and even trauma 3. Faced with unforeseen trauma, most adults exhibit resilience a) This was true of New Yorkers in the aftermath of the September 11 terrorist attacks, especially those who enjoyed supportive close relationships and who had not recently experienced other stressful events b) More than 9 in 10 New Yorkers, although stunned and grief stricken by 9/11, did not have a dysfunctional stress reaction c) By the following January, the stress symptoms of those who did were mostly gone d) Even in groups of combat stressed veterans and political rebels who have survived dozens of episodes of torture, most do not later exhibit posttraumatic stress disorder 4. Psychotherapies and biomedical therapies tend to locate the cause of psychological disorders within the person with the disorder a) We infer that people who act cruelly must be cruel and that people who act "crazy" must be "sick" b) We attach labels to such people, thereby distinguishing them from "normal" folks c) It follows, then, that we try to treat "abnormal" people by giving them insight into their programs, by changing their thinking, by helping them gain control with drugs 5. There is an alternative viewpoint: we could interpret many psychological disorders as understandable responses to a disturbing and stressful society a) According to this view, it is not just the person who needs treatment, but also the person's social context b) Better to prevent a problem by reforming a sick situation and by developing people's coping competencies than to wait for a problem to arise and then treat it c) Preventive mental health is upstream work d) It seeks to prevent psychological casualties by identifying and alleviating the conditions that cause them e) As George Albee pointed out, there is abundant evidence that poverty, meaningless work, constant criticism, unemployment, racism, sexism, and heterosexism undermine people's sense of competence, personal control, and self esteem f) Such stresses increase their risk of depression, alcohol use disorder, and suicide g) We who care about preventing psychological casualties should, ALbee contended, support programs that alleviate these demoralizing situations 6. Preventing psychological problems means empowering those who feel helpless, changing environments that breed loneliness, renewing the disintegrating family, communication training for couples, and bolstering parents' and teachers' skills a) Everything aimed at improving the human condition, at making life more fulfilling and meaningful, may be considered part of primary prevention of mental or emotional disturbance b) That includes the cognitive training that promotes positive thinking in children at risk for depression c) A 2009 national research council and institute of medicine report-Preventing Mental, Emotional, and Behavioral Disorders Among Young People-offers encouragement d) It documents that intervention efforts often based on cognitive behavioral therapy principles significantly boost child and adolescent flourishing e) Through such preventive efforts and healthy lifestyles, fewer of us will fall into the rushing river of psychological disorders

what is systematic desensitization? What is virtual reality exposure therapy?

1. systematic desensitization: a type of exposure therapy that associates a pleasant, relaxed state with gradually increasing anxiety triggering stimuli commonly used to treat phobias / a type of exposure therapy that associates a pleasant, relaxed state with gradually increasing anxiety triggering stimuli. Commonly used to treat phobias a) One widely used exposure therapy is SYSTEMATIC DESENSITIZATION b) Wolpe assumed as did Jones that you cannot be simultaneously anxious and relaxed c) Therefore, if you can repeatedly relax when facing anxiety provoking stimuli, you can gradually eliminate your anxiety d) The trick is to proceed gradually 2. Let's see how this might work with social anxiety disorder a) Imagine yourself afraid of public speaking b) A therapist might first ask for your help in constructing a hierarchy of anxiety triggering speaking situations c) Yours might range from mildly anxiety provoking situations, perhaps speaking up in a small group of friends, to panic provoking situations such as having to address a large audience d) Next using progressive relaxation, the therapist would train you to relax one muscle group after another, until you achieve a blissful state of complete relaxation and comfort e) Then the therapist would ask you to imagine, with your eyes closed, a mildly arousing situation: you are having coffee with a group of friends and are trying to decide whether to speak up f) If imagining the scene causes you to feel any anxiety, you would signal your tension by raising your finger, and the therapist would instructure you to switch off the mental image and go back to deep relaxation g) This imagined scene is repeatedly paired with relaxation until you feel no trace of anxiety h) The therapist would progress up the obstructed anxiety hierarchy using the relaxed state to desensitize you to each imagined situation i) After several sessions, you move to actual situations and practice what you had only imagined before, beginning with relatively easy tasks and gradually moving to more anxiety filled ones j) Conquering your anxiety in an actual situation, not just in your imagination, raises your self confidence k) Eventually you may even become a confident public speaker. 3. When an anxiety arousing situation is too expensive, difficult, or embarrassing to recreate, VIRTUAL REALITY EXPOSURE THERAPY offers an efficient middle ground a) Virtual reality exposure therapy: an anxiety treatment that progressively exposes people to electronic simulations of their greatest fears, such as airplane, flying, spiders, or public speaking b) Wearing a head mounted display unit that projects a three dimensional virtual world, you would view a lifelike series of scenes that would be tailored to your particular fear and shifted as your head turned 4. Experiments led by several research teams have treated many different people with many different fears-flying, heights, particular animals, and public speaking a) People who fear flying for example can peer out a virtual window of a simulated plane, feel vibrations, and hear the engine roar as the plane taxis down the runway and takes off b) In studies comparing control groups with people experiencing virtual reality exposure therapy, the therapy has provided greater relief from real life fear c) Developments in virtual reality therapy suggest the likelihood of increasingly sophisticated simulated worlds in which people, using avatars (computer representations of themselves), try out new behaviors in virtual environments d) For examples, someone with social anxiety disorder might visit virtual parties or group discussions, which others join over time

what is the medical model?

Medical Model When physicians discovered that syphilis led to mental disorders, they started using medical models to review the physical causes of these disorders 1. etiology: cause and development of the disorder 2. Diagnosis: identifying (symptoms) and distinguishing one disease from another 3. Treatment: treating a disorder in a psychiatric hospital 4. Prognosis: forecast about the disorder

what are the different types of psychological therapies?

Psychological therapies 1. Let's look first at the psychotherapeutic "talk therapies" 2. Among the dozens of types of psychotherapy, we will look at the most influential 3. Each is built on one or more of psychology's major theories: psychodynamic, humanistic, behavioral, and cognitive a) Most of these techniques can be used one on one or in groups 4. we will look at four major forms of psychotherapies used on different theories of human nature: a) psychoanalytic theory A) psychodynamic is also in this, but it focuses more on the unconscious b) humanistic theory c) behavioral theory d) cognitive theory

what is beck's cognitive therapy for depression? What is the stress inoculation training?

1. Aaron Beck suggests that depressed patients believe that they can never be happy (thinking) and thus associate minor failings (failing a test (event) in life as major causes for their depression a) Cognitive therapist Aaron Beck also believes that changing people's thinking can change their functioning, though he has a gentler approach b) Originally trained in Freudian techniques, Beck analyzed the dreams of depressed people c) He found recurring negative themes of loss, rejection, and abandonment that extended into their waking thoughts 2. Such negativity even extends into therapy, as clients recall and rehearse their failings and worst impulses a) With cognitive therapy, Beck and his colleagues have sought to reverse clients' catastrophizing beliefs about themselves, their situations, and their futures b) Gentle questioning seeks to reveal irrational thinking, and then to persuade people to remove the dark glasses through which they view life 3. Beck's treatment approach is based on the idea that certain psychological disorders *especially those involving depression and anxiety) can be traced to errors in logic a) We often think in words b) Therefore, getting people to change what they say to themselves is an effective way to change their thinking c) Perhaps you can identify with the anxious students who make matters worse with self defeating thoughts: "this test is probably going to be impossible. All these other students seem so relaxed and confident. I was better prepared. Anyhow, I'm so nervous I'll forget everything." stress inoculation training 4. To change such negative self talk, Donald Meichenbaum offered STRESS INOCULATION TRAINING: teaching people to restructure their thinking in stressful situations a) Meichenbaum trained people to restructure their thinking in stressful situations b) example: "relax, the exam may be hard, but it will be hard for everyone else too. I studied harder than most people Besiders, I don't need a perfect score to get a good grade." c) After being trained to dispute their negative thoughts, depression prone children, teens, and college students exhibit a greatly reduced rate of future depression d) To a large extent, it is the thought that counts

What is psychosurgery? What is a lobotomy?

1. Because its effects are irreversible, PSYCHOSURGERY is the most drastic and the least used biomedical intervention for changing behavior a) Psychosurgery: surgery that removes or destroys brain tissue in an effort to change behavior b) Psychosurgery is used as a last resort in alleviating psychological disturbances. c) Psychosurgery is irreversible. removal of brain tissue changes the mind d) used in people with life threatening epilepsy 2. In the 1930s, Portuguese physician Egas Moniz developed what became the best known psychosurgical operation: the LOBOTOMY a) Lobotomy: a psychosurgical procedure once used to calm uncontrollably emotional or violent patients. The procedure cut the nerves connecting the frontal lobes to the emotion controlling centers of the inner brain b) Moniz found that cutting the nerves connecting the frontal lobes with the emotion controlling centers of the inner brain calmed uncontrollably emotional and violent patients c) In what would later become a crude but easy and inexpensive procedure that took only about 10 minutes, a neurosurgeon would shock the patient into a coma, hammer an icepick like instrument through each eye socket into the brain and then widely it to sever connections running up to the frontal lobes d) Between 1936 and 1954, tens of thousands of severely disturbed people were lobotomized e) Although the intention was simply to disconnect emotion from thought, a lobotomy's effect was often more dramatic: it usually decreased the person's misery or tension, but also produced a permanently lethargic, immature, uncreative person 3. During the 1950s, after some 35,000 people had been lobotomized in the United States alone, calming drugs became available and psychosurgery was largely abandoned a) Today, lobotomies are history 4. But more precise, microscale psychosurgery is sometimes used in extreme cases a) For example, if a patient suffers uncontrollable seizures, surgeons can deactivate the specific nerve clusters that cause or transmit the convulsions b) MRI guided precision surgery is also occasionally done to cut the circuits involved in severe obsessive compulsive disorder c) Because these procedures are irreversible, they are controversial and neurosurgeons perform them only as a last resort

what is the client's perspective usually on the progress of their psychological therapy?

1. If you ask clients about their experiences of getting into therapy, they often overestimate its effectiveness. critics however remain skeptical a) If clients' testimonials were the only measuring stick, we could strongly affirm the effectiveness of psychotherapy b) When 2900 Consumer Reports readers related their experiences with mental health professionals, 89% said they were at least fairly well satisfied c) Among those who recalled feeling fair or very poor when beginning therapy, 9 in 10 now we're feeling very good, good, or at least so so FOR SEVERAL REASONS, CLIENT TESTIMONIALS DO NOT PERSUADE PSYCHOTHERAPY'S SKEPTICS: 1. clients enter therapy in crisis, but crisis may subside over the natural course of time (regression to normalcy a) when with the normal ebb and flow of events, the crisis passes, people may attribute their improvement to the therapy 2. clients may need to believe the therapy was worth the effort a) to admit investing time and money in something ineffective is like admitting to having one's car serviced repeatedly by a mechanic who never fixes it. Self justification is a powerful human motive 3. clients generally speak kindly of their therapists a) even if the problems remain, say the critics, clients work hard to find something positive to say. The therapist had been very understanding, the client had gained a new perspective, he learned to communicate better, his mind was eased, anything at all so as not to have to say treatment was a failure 2. We are prone to selective and biased recall and to making judgements that confirm our beliefs c) Consider the testimonials gathered in a massive experiment with over 500 Massachusetts boys, aged 5 to 13 years, many of whom seemed bound for delinquency d) By the toss of a coin, half the boys were assigned to a 5 year treatment program e) The treated boys were visited by counselors twice a month f) They participated in community programs and they received academic tutoring, medical attention, and family assistance as needed g) Some 30 years later, Joan McCord located 485 participants, sent them questionnaires, and checked public records from courts, mental hospitals, and other sources h) Was the treatment successful? i) Clients testimonials yielded encouraging results, even glowing reports j) Some men noted that, had it not been for their counselors, " I would probably be in jail," "my life would have gone the other way," or "I think I would have ended up in a life of crime." k) Court records offered apparent support: even among the difficult boys in the treatment group, 66% had no official juvenile crime record l) But recall psychology's most powerful tool for sorting reality from wishful thinking: the control group m) For every boy in the treatment group, there was a similar boy in a control group receiving no counseling n) Of these untreated men, 70% had no juvenile record o) On several other measures such as a record of having committed a second crime, alcohol use disorder, death rate, and job satisfaction, the untreated men exhibited slightly fewer problems p) The glowing testimonials of those treated had been unintentionally deceiving

what is the relative effectiveness of different therapies? What is evidence based practice?

1. So what can we tell people considering psychotherapy and those paying for it, about which psychotherapy will be most effective for their problem? a) The statistical summarizes and surveys fail to pinpoint any one type of therapy as generally superior b) Clients seemed equally satisfied, consumer reports concluded, whether treated by a psychiatrist, psychologist, or social worker; whether seen in a group or individual context, whether the therapist had extensive or relatively limited training and experience 2. Other studies concur a) There is little if any connection between clinicians' experience, training, supervision, and licensing and their clients' outcomes 3. Some forms of therapy get prizes for particular problems, though there is often an overlapping-or comorbidity-of disorders a) Behavioral conditioning therapies, for example, have achieved especially favorable results with specific behavior problems, such as bed wetting, phobias, compulsions, marital problems, and sexual dysfunctions b) Psychodynamic therapy has helped treat depression and anxiety c) And new studies confirm cognitive and cognitive behavioral therapy's effectiveness in coping with anxiety, posttraumatic stress disorder, and depression d) Moreover, we can say that therapy is most effective when the problem is clear cut e) Those who experience phobias or panic and those who are unassertive can hope for improvement f) Those with less focused problems, such as depression and anxiety, usually benefit in the short term but often relapse later g) And those with the negative symptoms of chronic schizophrenia or a desire to change their entire personality are unlikely to benefit from therapy alone h) The more specific the problem, the greater the hope I) But no prizes-and little or no scientific support-go to certain other therapies 4. We would all therefore be wise to avoid energy therapies that propose to manipulate people's invisible energy fields, recovered memory therapies that aim ot unearth repressed memories of early child abuse and rebirthing therapies that engage people in reenacting the supposed trauma of their birth a) As with some medical treatments, its possible for psychological treatments not only to be ineffective but harmful-by making people worse or preventing their getting better b) The national science and technology council cites the scared straight program (seeking to deter children and youth from crime) as an example of well intentioned programs that have proved ineffective or even harmful c) The evaluation question-which therapies get prizes and which do not?-lies at the heart of what some call psychology's civil war 5. To what extent should science guide both clinical practice and the willingness of health care providers and insurers to pay for therapy? a) On the one side are research psychologists using scientific methods to extend the list of well defined and validated therapies for various disorders b) They decry clinicians who give more weight to their person experiences c) On the other side are non scientist therapists who view their practice as more art than science saying that people are too complex and therapy too intuitive to describe in a manual or test in an experiment d) Between these two factions stand the science oriented clinicians, who aim to base practice on evidence and make mental health professionals accountable for effectiveness 6. To encourage EVIDENCE BASED PRACTICE in psychology, the American Psychological Association and others have followed the Institute of Medicine's lead, advocating that clinicians integrate the best available research with clinical expertise and with patient preferences and characteristics a) Evidence based practice: clinical decisions making that integrates the best available research with clinical expertise and patient characteristics and preferences b) Available therapies should be rigorously evaluated and then applied by clinicians who are mindful of their skills and of each patient's unique situation c) Increasingly, insurer and government support for mental health services requires evidence based practice d) In 2007, for example, Britain's National Health Service announced that it would pour the equivalent of $600 million into training new mental health workers in evidence based practices (such as cognitive behavioral therapy) and to disseminating information about such treatments

What are antidepressant drugs?

1. The ANTIDEPRESSANTS were named for their ability to lift people up from a state of depression, and this was their main use until recently a) Antidepressant drugs: drugs used to treat depression, anxiety disorders, obsessive compulsive disorder, and posttraumatic stress disorder (several widely used antidepressant drugs are selective serotonin reuptake inhibitors-SSRIs) b) The label is a bit of a misnomer now that these drugs are increasingly being used to successfully treat anxiety disorders, obsessive compulsive disorder, and posttraumatic stress disorder c) These drugs are agonists; they work by increasing the availability of certain neurotransmitters, such as norepinephrine or serotonin, which elevate arousal and mood and appear scarce when a person experiences feelings of depression or anxiety d) antidepressant drugs like Prozac, Zoloft, and Paxil are selective serotonin reuptake inhibitors (SSRIs) that improve the mood by elevating levels of serotonin by inhibiting reuptake 2. Fluoxetine, which tens of millions of users worldwide have known as Prozac, falls into this category of drugs a) The most commonly prescribed drugs in this group, including Prozac and its cousins Zoloft and Paxil, work by blocking the reabsorption and removal of serotonin from synapses b) Given their use in treating disorders other than depression-from anxiety to strokes-this group of drugs is most often called SSRIs (selective serotonin reuptake inhibitors) rather than antidepressants c) Some of the older antidepressant drugs work by blocking the reabsorption or breakdown of both norepinephrine and serotonin d) Though effective, these dual action drugs have more potential side effects, such as dry mouth, weight gain, hypertension, or dizzy spells e) Administering them by means of a patch, bypassing the intestines and liver helps reduce such side effects 3. After the introduction of SSRI drugs, the percentage of patients receiving medication for depression jumped dramatically from 70% in 1987 , the year before SSRIs were introduced, to 89% in 2001 a) From 1996 to 2005, the number of Americans prescribed antidepressant drugs doubled, from 13 to 27 million b) Between 2002 and 2007 in Australia, antidepressant drug use increased 41% c) Be advised: patients with depression who begin taking antidepressants do not wake up the next day perfectly fine d) Although the drugs begin to influence neurotransmission within hours, their full psychological effect often requires four weeks e) One possible reason for the delay is that increased serotonin promotes neurogenesis-the birth of new brain cells, perhaps reversing stress induced loss of neurons 4. Antidepressant drugs are not the only way to give the body a lift a) Aerobic exercise, which calms people who feel anxious and energizes those who feel depressed does about as much good for some people with mild to moderate depression, and has additional positive side effects b) Cognitive therapy, by helping people reverse their habitual negative thinking style, can boost the drug aided relief from depression and reduce the post treatment risk of relapse c) Better yet, some studies suggest, is to attack depression (and anxiety) from both below and above d) Use antidepressant drugs (which work, bottom up, on the emotion forming limbic system) in conjunction with cognitive behavioral therapy (which works top-down starting with changed frontal lobe activity) e) Researchers generally agree that people with depression often improve after a month on antidepressants 5. But after allowing for natural recovery and the placebo effect, how big is the drug effect? a) Not big, report Irving Kirsch and his colleagues b) Their analyses of double blind clinical trials indicate that the placebo effect accounted for about 75% of the active drug's effect c) In the follow up review that included unpublished clinical trials, the antidepressant drug effect was again modest d) The placebo effect was less for those with severe depression, which made the added benefit of the drug somewhat greater for them e) Given these results, there seems little reason to prescribe antidepressant medication to any but the most severely depressed patients, unless alternative treatments have failed, Kirsch concluded f) A newer analysis confirms that the antidepressant benefit compared with placebos is minimal or nonexistent, on average, in patients with mild or moderate symptoms g) For those folks, aerobic exercise or psychotherapy is often effective. But among patients with very severe depression, the medication advantage becomes substantial

what is a therapeutic lifestyle change? How does it help with your psychological health?

1. The effectiveness of the biomedical therapies reminds us of a fundamental lesson: we find it convenient to talk of separate psychological and biological influences, but everything psychological is also biological a) Every thought and feeling depends on the functioning brain b) Every creative idea, every moment of joy or anger, every period of depression emerges from the electrochemical activity of the living brain 2. The influence is two way: when psychotherapy relieves obsessive compulsive behavior, PET scans reveal a calmer brain a) Anxiety disorders, obsessive compulsive disorder, posttraumatic stress disorder, major depression, bipolar disorder, and schizophrenia are all biological events b) As we have seen over and over again, A HUMAN BEING IS AN INTEGRATED BIOPSYCHOSOCIAL SYSTEM c) Stress affects body chemistry and health d) And chemical imbalances, whatever their cause, can produce schizophrenia, depression, and other mental disorders 3. That lesson is being applied by Stephen Iiardi in training seminars promoting therapeutic lifestyle change a) Human brains and bodies were designed for physical activity and social engagement, they note b) Our ancestors hunted, gathered, and built in groups, with little evidence of disabling depression c) Indeed, those whose way of life entails strenuous physical activity, strong community ties, sunlight exposure, and plenty of sleep (think of foraging bands d) in Papua New Guinea or Amish farming communities in North America) rarely experience depression e) For both children and adults, outdoor activity in natural environments-perhaps a walk in the woods-reduces stress and promotes health f) Simply put: humans were never designed for the sedentary, disengaged, socially isolated, poorly nourished, sleep deprived pace of twenty first century american life g) The Ilardi team was also impressed by research showing that regular aerobic exercise and a complete night's sleep boost mood and energy 4. So they invited small groups of people with depression to undergo a 12 week training program with the following goals: a) AEROBIC EXERCISE, 30 minutes a day, at least 3 times weekly (increasing fitness and vitality stimulating endorphins) b) ADEQUATE SLEEP, with a goal of 7 to 8 hours a night (increasing energy and alertness, boosting immunity) c) LIGHT EXPOSURE, at least 30 minutes each morning with a light 444box (amplifying arousal, influencing hormones) d) SOCIAL CONNECTION, with less alone time and at least two meaningful social engagements weekly (satisfying the human need to belong) e) ANTI RUMINATION by identifying and redirecting negative thoughts (enhancing positive thinking) f) NUTRITIONAL SUPPLEMENTS, including a daily fish oil supplement with omega 3 fatty acids (supporting healthy brain functioning) 5. In one study of 74 people, 77% of those who completed the program experienced relief from depressive symptoms, compared with 19% in those assigned to a treatment-as-usual control condition a) Future research will seek to replicate this striking result of lifestyle change, and also to identify which of the treatment components (additively or in some combination) produce the therapeutic effect b) In the meantime, there seems little reason to doubt the truth of the Latin adage: a healthy mind in a healthy body

What is cigulotomy or corpus callosotomy?

1. cingulotomy a) sometime. neurosurgeons may perform this procedure on people with vastly crippling bdepressions that are resistant to drugs, ECT, or other forms of therapy b) disconnects just one area toward the front of the cortex, called the anterior cingulate cortex (ACC) c) a bit of a mini lobotomy 2. corpus callosotomy a) a condition in which the two hemispheres of the brain are isolated by cutting the corpus callosum

what are the methods of psychoanalysis therapy? What is free association, resistance, trnasference, and interpretation?

1. freud developed the method of free association to unravel the unconscious mind and its conflicts during free association, the patient may edit their thoughts, resisting his or her feelings to express emotions Such resistance becomes important in the analysis of conflict driven anxiety a) make it so that the person can't see the therapist so they can't be distracted by the therapist and focus on the thoughts 2. Psychoanalysis is historical reconstruction a) Psychoanalytic theory emphasizes the formative power of childhood experiences and their ability to mold the adult b) Thus, it aims to unearth one's past in hope of unmasking the present 3. After discarding hypnosis as an unreliable excavator, Freud turned to FREE ASSOCIATION a) Imagine yourself as a patient using free association. b) First, you relax, perhaps by lying on a couch. As the psychoanalyst sits out of your line of vision, you say aloud whatever comes to mind. At one moment, you're relating a childhood memory. At another, you're describing a dream or recent experience. It sounds easy, but soon you notice how often you edit your thoughts as you speak. YOu pause for a second before uttering an embarrassing thought. You omit what seems trivial, irrelevant, or shameful. Sometimes your mind goes blank or you find yourself unable to remember important details. You may joke or change the subject to something less threatening. 4. resistance can be shown if you are opening up, but then stop or you are talking then stop going to sessions resistance means you are on the right track because people are getting uncomfortable and anxious because they are opening up a) to the analyst, these mental blocks indicate RESISTANCE b) Resistance: in psychoanalysis, the blocking from consciousness of anxiety-laden material c) They hint that anxiety lurks and you are defending against sensitive material d) The analyst will note your resistances and then provide insight into their meaning. 5. If offered at the right moment, this INTERPRETATION-of say, your not wanting to talk about your mother-may illuminate the underlying wishes, feelings, and conflicts you are avoiding a) Interpretation: in psychoanalysis, the analyst's noting supposed dream meanings, resistances, and other significant behaviors and events in order to promote insight b) The analyst may also offer to an explanation of how this resistance fits with other pieces of your psychological puzzle, including those based on analysis of your dream content c) through free association eventually the patient opens up and reveals his or her innermost private thoughts developing positive or negative feelings towards the therapist may be transference d) can project feelings onto the therapist. can put romantic feelings onto the therapist and the therapist can also do it to the patient 6. Over many such sessions, your relationship patterns surface in your interaction with your therapist a) You may find yourself experiencing strong positive or negative feelings for your analyst b) The analyst may suggest you are TRANSFERRING feelings, such as dependency or mingled love and anger, that you experienced in earlier relationships with family members or other important people c) Transference: in psychoanalysis, the patient's transfer to the analyst of emotions linked with other relationships (such as love or hatred for a parent) d) By exposing such feelings, you may gain insight into your current relationships

what is group therapy?

1. group therapy normally consists of 6-9 people attending a 90 minute session that can help more people and costs less. Clients benefit from knowing others have similar problems, they are not unique a) this is like Alcoholics Anonymous, used a lot on college campus 2. Except for traditional psychoanalysis, most therapies may also occur in small groups a) GROUP THERAPY does not provide the same degree of therapist involvement with each client b) Group therapy: therapy conducted with groups rather than individuals, permitting therapeutic benefits from group interaction 3. However, it offers benefits: a) IT SAVES THERAPISTS' TIME AND CLIENTS' MONEY, often with no less effectiveness than individual therapy b) IT OFFERS A SOCIAL LABORATORY FOR EXPLORING SOCIAL BEHAVIORS AND DEVELOPING SOCIAL SKILLS A) Therapists frequently suggest group therapy for people experiencing frequent conflicts or whose behavior distressed others. B) For up to 90 minutes weekly, the therapist guides people's interactions as they discuss issues and try out new behavior. c) IT ENABLES PEOPLE TO SEE THAT OTHERS SHARE THEIR PROBLEMS. A) It can be a relief to discover that you are not alone-to learn that others, despite their composure, experience some of the same troublesome feelings and behaviors d) IT PROVIDES FEEDBACK AS CLIENTS TRY OUT NEW WAYS OF BEHAVING A) Hearing that you look poised, even though you feel anxious and self conscious, can be very reassuring

what is psychodynamic therapy? what is interpersonal psychotherapy?

1. influenced by Freud, in a face to face setting, psychodynamic therapist understand symptoms ad themes across important relationships in a patient's life 2. Therapists who use PSYCHODYNAMIC THERAPY techniques don't talk much about id, ego, and superego a) Psychodynamic therapy: therapy deriving from the psychoanalytic tradition that views individuals as responding to unconscious forces and childhood experiences, and that seeks to enhance self insight. Instead they try to help people understand their current symptoms 3. They focus on themes across important relationships, including childhood experiences and the therapist relationship a) Rather than lying on a couch, out of the therapist's line of vision, patients meet with their therapist face to face b) These meetings take place once or twice a week (rather than several times per week) and often for only a few weeks or months (rather than several years) c) In these meetings, patients explore and gain perspective into defended-against thoughts and feelings d) Therapist David Shapiro illustrates with the case of a young man who had told women that he loved them, when knowing well that he didn't e) They expected it, so he said it f) But later with his wife, who wishes he would say that he loves her, he finds he "cannot" do that- "I don't know why, but I can't." g) Further interactions reveal that he can't express real love because it would feel mushy and soft and therefore unmanly h) He is in conflict with himself and he is cut off from the nature of that conflict i) Shapiro noted that with such patients, who are estranged from themselves, therapists using psychodynamic techniques are in a position to introduce them to themselves j) We can restore their awareness of their own wishes and feelings and their awareness, as well, of their reactions against those wishes and feelings 4. Psychodynamic therapies may also help reveal past relationship troubles as the origin of current difficulties Jonathan Shedler recalls his patient Jeffrey's complaints of difficulty getting along with his colleagues and wife, who saw him as hypercritical a) Jeffery then began responding to me as if I were an unpredictable, angry adversary Shedler seized this opportunity to help Jeffrey recognize the relationship pattern and its roots in the attacks and humiliation he experienced from his alcohol abusing father and to work through and let go of this defensive responding to people b) interpersonal psychotherapy, a variation of psychodynamic therapy, is effective in treating depression c) INTERPERSONAL PSYCHOTHERAPY, a brief (12 to 16 session) variation of psychodynamic therapy, has effectively treated depression d) Although interpersonal psychotherapy aims to help people gain insight into the roots of their difficulties, its goal is symptom relief in the here and now e) Rather than focusing mostly on undoing past hurts and offering interpretations, the therapist concentrates primarily on current relationships and on helping people improve their relationship skills f) The case of anna, a 34 year old married professional illustrates these goals g) Five months after receiving a promotion, with accompanying increased responsibilities and longer hours, Anna experienced tensions with her husband over his wish for a second child h) She began feeling depressed, had trouble sleeping, became irritable, and was gaining weight i) A therapist using psychodynamic techniques might have helped Anna gain insight into her angry impulses and her defenses against anger j) A therapist applying interpersonal techniques would concur but would also engage her thinking on more immediate issues-how she could balance work and home, resolve the dispute with her husband, and express her emotions more effectively 5. it focuses on symptom relief here and now, not a overall personality change a) it tries to focus on now and what is going on in your life now and not in another part of your life

what influence does culture and values have on psychotherapy?

1. psychotherapists may differ from each other and from clients in their personal beliefs, values, and cultural background a) you will have clients with very different outlooks on the world compared to you b) can't be judgmental towards the clients. at times they have to release clients if you can't be a good therapist for them 2. All therapies offer hope, and nearly all therapists attempt to enhance their clients' sensitivity, openness, personal responsibility, and sense of purpose a) But in matters of diversity, therapists differ from one another and may differ from their clients 3. These differences can become significant when a therapist from one culture or gender meets a client from another a) In North American, Europe and Australia, or example, most therapists reflect their culture's individualism, which often gives priority to personal desires and identity, particularly for men b) Clients who are immigrants from mAsian countries, where people are mindful of others' expectations, may have trouble relating to therapies that require them to think only of their own well being c) And women seeking therapy, who are from a collectivist culture might be doubly discomfited d) Such differences help explain minority populations' reluctance to use mental health services and their tendency to prematurely terminate therapy e) In one experiment, Asian-American clients matched with counselors who shared their cultural values (rather than mismatched with those who did not) perceived more counselor empathy and felt a stronger alliance with the counselor 4. Recognizing that therapists and clients may differ in their values, communication styles, and language, American Psychological Association-accredited therapy training programs now provide training in cultural sensitivity and recruit members of underrepresented cultural groups a) Another area of potential conflict related to values is religion b) Highly religious people may prefer and benefit from religiously similar therapists c) They may have trouble establishing an emotional bond with a therapist who does not share their values 5. Albert Ellis, who advocated the aggressive rational emotive behavior therapy and Allen Bergin, co editor of the Handbook of Psychotherapy and Behavior Change, illustrated how sharply therapists can differ, and how those differences can affect their view of a healthy person a) Ellis assumed that no one and nothing is supreme that self gratification should be encouraged and that unequivocal love, commitment, service, and fidelity to any interpersonal commitment, especially marriage, leads to harmful consequences b) Bergin assumed the opposite-that because God is supreme, humility, and the acceptance of divine authority are virtues, that self control and committed love and self sacrifice are to be encouraged and that infidelity to any interpersonal commitment, especially marriage, leads to harmful consequences c) Bergin and Ellis disagreed more radically than most therapists on what values are healthiest d) In so doing, however, they agreed on a more general point: psychotherapists' personal beliefs influence their practice e) Because clients tend to adopt their therapists' values, some psychologists believe therapists should divulge those values more openly

Do alternative therapies hold up under scientific scrutiny?

1. 57% of those who have had anxiety attacks and 54% who have had depression have used alternative treatments such as herbal medicines, massage, and spiritual healing. Do alternative therapies hold up under scientific scrutiny? a) no evidence for or against b) The tendency of many abnormal states of mind to regress to normal, combined with the placebo effect, creates fertile soil for pseudo therapies c) Bolstered by anecdotes, heralded by the media, and broadcast on the Internet, alternative therapies can spread like wildfire d) In one national survey, 57% of those with a history of anxiety attacks and 54% of those with a history of depression had used alternative treatments, such as herbal medicine, massage, and spiritual healing 2. Testimonials aside, what does the evidence say? a) This is a tough question, because there is no evidence for our against most of them, though their proponents often feel personal experience is evidence enough b) Some, however have been the subject of controlled research c) Remember that sifting sense from nonsense requires the scientific attitude: being skeptical but not cynical, open to surprises but not gullible TYPES OF ALTERNATIVE THERAPIES: 1. eye movement desensitization reprocessing 2. light exposure therapy

what is electroconvulsive therapy? How does ECT alleviate severe depression?

Electroconvulsive therapy 1. A more controversial brain manipulation occurs through shock treatment, or ELECTROCONVULSIVE THERAPY (ECT) a) Electroconvulsive therapy (ECT): a biomedical therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized patient / produces racking convulsions and brief unconsciousness b) When ECT was first introduced in 1938, the wide awake patient was strapped to a table and jolted with roughly 100 volts of electricity to the brain, producing racking convulsions and brief unconsciousness c) ECT therefore gained a barbaric image, one that lingers d) Today, however, the patient receives a general anesthetic and a muscle relaxant (to prevent injury from seizures) before a psychiatrist delivers 30 to 60 seconds of electrical current e) Within 30 minutes, the patient awakens and remembers nothing of the treatment or the preceding hours f) After three such sessions each week for two to four weeks, 80% or more of people receiving ECT improve markedly, showing some memory loss for the treatment period but no discernible brain damage f) most effective for depressed patients who do not respond to drugs 2. Study after study confirms that ECT is an effective treatment for severe depression in treatment resistant patients who have not responded to drug therapy a) An editorial in the Journal of the American Medical Association concluded that the results of ECT in treating severe depression are among the most positive treatment effects in all of medicine 3. How does ECT alleviate severe depression? After more than 70 years, no one knows for sure a) One recipient likened ECT to the smallpox vaccine, which was saving lives before we knew how it worked b) Others think of it as rebooting their cerebral computer c) Perhaps the shock induced seizures calm neural centers where overactivity produces depression, making it therapeutic d) ECT, like antidepressant drugs and exercise, also appears to boost the production of new brain cells 4. Skeptics have raised one other possible explanation for how ECT works: as a placebo effect a) Most ECT studies have failed to contain a control condition in which people are randomly assigned to receive the same general anesthesia and simulated ECT without the shock b) When given this placebo treatment, note John Read and Richard Bentall, the positive expectation is therapeutic, though a Food and Drug Administration research review concludes that ECT is more effective than a placebo, especially in the short run c) ECT is now administered with briefer pulses, sometimes only to the brain's right side and with less memory disruption d) Yet no matter how impressive the results, the idea of electrically shocking people still strikes many as barbaric, especially given our ignorance about why ECt works e) Moreover, about 4 in 10 ECT treated patients relapse into depression within six months f) Nevertheless, in the minds of many psychiatrists and patients, ECT is a lesser evil than severe depression's misery, anguish, and risk of suicide g) As research psychologist Norman Endler reported after ECT alleviated his deep depression, "a miracle had happened in two weeks."

what is client centered therapy? What is unconditional positive reguard? What is active listening?

client centered therapy 1. developed by Carl Rogers, client centered therapy is a form of humanistic therapy a) Carl Rogers developed the widely used humanistic technique he called CLIENT CENTERED THERAPY, which focuses on the person's conscious self perceptions b) Client centered therapy: a humanistic therapy, developed by Carl Rogers, in which the therapist uses techniques such as active listening within a genuine, accepting, empathetic environment to facilitate clients' growth (also called person centered therapy 2. In this NONDIRECTIVE THERAPY, the therapist listens, without judging or interpreting, and seeks to refrain from directing the client toward certain insights. the therapist listens to the needs of the patient in an accepting and non judgmental way, addressing problems in a productive way 3. involves unconditional positive regard a) the key of unconditional positive regard is that you will not get to the deep unhealthy unconscious stuff if you are need in an accepting presence therapist needs to be accepting an empathetic b) Believing that most people possess the resources for growth, Rogers encouraged therapists to exhibit ACCEPTANCE, GENUINENESS, AND EMPATHY c) When therapists enable their clients to feel true feelings, and when they emphatically sense and reflect their clients' feelings, the clients may deepen their self understanding and self acceptance d) As Rogers explained: hearing has consequences. When I truly hear a person and the meanings that are important to him at that moment, hearing not simply his words, but him, and when I let him know that I have heard his own private personal meanings, many things happen. There is first of all a grateful look. He feels released. He wants to tell me more about his world. He surges forth in a new sense of freedom. He becomes more open to the process of change. I have often noticed that the more deeply I hear the meanings of the person, the more there is that happens. Almost always, when a person realizes he has been deeply heard, his eyes moist. I think in some real sense he is weeping for joy. It is as though he were saying, "Thank God, somebody heard me. Someone knows what it's like to be me." e) the therapist engages in active listening and echoes restates, and seeks clarification of the patient's thinking, acknowledging expressed feelings 4. "Hearing" refers to Rogers' technique of ACTIVE LISTENING-echoing, restraining, and seeking clarification of what the person expresses (verbally or nonverbally) and acknowledging the expressed feelings a) Active listening: empathetic listening in which the listener echoes, restates, and clarifies. A feature of Rogers' client-centered therapy b) Active listening is now an accepted part of therapeutic counseling practices in many high schools, colleges, and clinics. c) The counselor listens attentively and interrupts only to restate and confirm feelings, to accept what is being expressed, or to seek clarification d) Roger sought to provide a psychological mirror that would help clients see themselves more clearly unconditional positive regard is non judgmental e) Can a therapist be a perfect mirror, without selecting and interpreting what is reflected? f) Rogers conceded that one cannot be totally nondirective g) Nevertheless, he believed that the therapist's most important contribution is to accept and understand the client 5. Given a non judgmental, grace filled environment that provides UNCONDITIONAL POSITIVE REGARD, people may accept even their worst traits and feel valued and whole a) Unconditional positive regard: a caring, accepting, non judgmental attitude, which Carl Rogers believed would help clients to develop self awareness and self acceptance b) If you want to listen more actively in your own relationships, three Rogerian hints may help: A) PARAPHRASE: rather than saying "I know how you feel," check your understanding by summarizing the person's words in your own words B) INVITE CLARIFICATION: "what might be an example of that?" may encourage the person to say more C) REFLECT FEELINGS: "It sounds frustrating" might mirror what you're sensing from the person's body language and intensity.

what is deep brain stimulation? What is magnetic stimulation?

Two other neural stimulation techniques-magnetic stimulation and deep brain stimulation-are raising hopes for gentler alternatives that jump start neural circuits in the depressed brain 1. Magnetic stimulation a) Depressed moods seem to improve when repeated pulses surge through a magnetic coil held close to a person's skull b) The painless procedure called REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (rTMS) is performed on wide awake patients over several weeks c) Repetitive transcranial magnetic stimulation (rTMS): the application of repeated pulses of magnetic energy to the brain, used to stimulate or suppress brain activity d) Unlike ECT, the rTMS procedure produces no seizures, memory loss, or other serious side effects (headaches can result) e) Initial studies have found "modest" positive benefits of rTMS f) How it works is unclear g) One possible explanation is that the stimulation energizes the brain's left frontal lobe, which is relatively inactive during depression h) Repeated stimulation may cause nerve cells to form new functioning circuits through the process of long term potentiation i) rTMS: repetitive transcranial magnetic stimulation j) in rTMS, a pulsating magnetic coil is placed over prefrontal regions of the brain to treat depression with minimal side effects 2. Deep brain stimulation a) Other patients whose depression has resisted both drugs that flood the body and ECT that jolts at least half the brain have benefitted from an experimental treatment pinpointed at a depression center in the brain b) Neuroscientist Helen Mayberg and her colleagues have been focusing on a neural hub that bridges the thinking frontal lobes to the limbic system c) This area, which is overactive in the brain of a depressed or temporarily sad person, calms when treated by ECT or antidepressants d) To experimentally excite neurons that inhibit this negative emotion feeding activity e) Mayberg drew upon the deep brain stimulation technology sometimes used to treat Parkinson's tremors f) Among an initial 20 patients receiving implanted electrodes and a pacemaker stimulation, 12 experienced relief, which was sustained over three to six years of follow up g) Some felt suddenly more aware and became more talkative and engaged; others improved only slightly if at all h) Future research will explore whether Mayberg has discovered a switch that can lift depression i) Other researchers are following up on reports that deep brain stimulation can offer relief to people with obsessive compulsive disorder

what is psychopharmacology? What are the different types of drug therapy? What is a double blind procedure?

1. By far the most widely used biomedical treatments today are the drug therapies a) Since the 1950s, discoveries in PSYCHOPHARMACOLOGY have revolutionized the treatment of people with severe disorders, liberating hundreds of thousands from hospital confinement b) Psychopharmacology: the study of the effects of drugs on mind and behavior 2. Thanks to drug therapy-and to efforts to minimize involuntary hospitalization and to support people through community mental health programs-the resident population of mental hospitals is a small fraction of what it was a half century ago a) For some unable to care for themselves, however, release from hospitals has meant homelessness not liberation b) Almost any new treatment, including drug therapy, is greeted by an initial wave of enthusiasm as many people apparently improve c) But that enthusiasm often diminishes after researchers subtract the rates of (1) normal recovery among untreated persons and (2) recovery due to the placebo effect which arises from the positive expectations of patients and mental health workers alike 3. So to evaluate the effectiveness of any new drug researchers give half the patients the drug, and the other half a similar appearing placebo a) Because neither the staff nor the patients know who gets which, this is called a DOUBLE BLIND PROCEDURE b) The good news: in double blind studies, some drugs have proven useful c) to test the effectiveness of a drug, patients are tested with the drug and a placebo d) the patients and researchers are unaware of who is taking the drug and who is taking the placebo e) prevents experimenter biases and prevents the patients from knowingly or unknowingly messing with the results 5. with the advent of antipsychotics, hospitalization in mental institutions has rapidly declined TYPE OF DRUG THERAPIES: 1. antipsychotic drugs 2. antianxiety drugs 3. antidepressant drugs 4. mood stabilizing medication

what is cognitive behavior therapy?

1. COGNITIVE BEHAVIOR THERAPY (CBT), a widely practiced integrative therapy, aims not only to alter the way people think (cognitive therapy) but also to alter the way they act (behavior therapy) a) Cognitive behavior therapy (CBT): a popular integrative therapy that combines cognitive therapy (changing self defeating thinking) with behavior therapy (changing behavior) b) cognitive therapists often combine the reversal of self defeating thinking with efforts to modify behavior 2. cognitive behavioral therapy aims to alter the way people act (behavior therapy) and alter the way think (cognitive therapy) a) It seeks to make people aware of their irrational negative thinking, to replace it with new ways of thinking, and to practice the more positive approach in everyday settings b) Behavioral change is typically addressed first, followed by sessions on cognitive change; the therapy concludes with a focus on maintaining both and preventing relapses 3. Anxiety and mood disorders share a common problem: emotion regulation a) An effective CBT program for these emotional disorders trains people both to replace their catastrophizing thinking, with more realistic appraisals, and as homework, to practice behaviors that are incompatible with their problem. b) A person might, for example, keep a log of daily situations associated with negative and positive emotions, and engage more in activities that lead them to feel good c) Or those who fear social situations might be assigned to practice approaching people 4. CBT may also be useful with obsessive compulsive disorder a) In one study, people learned to prevent their compulsive behaviors by relabeling their obsessive thoughts b) Feeling the urge to wash their hands again, they would tell themselves, "I'm having a compulsive urge," and attribute it to their brain's abnormal activity, as previously viewed in their PET scans c) Instead of giving in to the urge, they would then spent 15 minutes in an enjoyable, alternative behavior, such as practicing an instrument, taking a walk, or gardening d) This helped "unstick" the brain by shifting attention and engaging other brain areas e) For two or three months, the weekly therapy sessions continued, with relabeling and refocusing practice at home f) By the study's end, most participants' symptoms had diminished and their PET scans revealed normalized brain activity 5. Many other studies confirm CBT's effectiveness for those with anxiety, depression, or anorexia nervosa a) Studies have also found that cognitive behavioral skills can be effectively taught and therapy conducted over the Internet

Compare the biomedical therapies.

1. DRUG THERAPIES: a) PRESUMED PROBLEM: Neurotransmitter malfunction b) THERAPY AIM: Control symptoms of psychological disorders c) THERAPY TECHNIQUE: After brain chemistry through drugs 2. BRAIN STIMULATION: a) PRESUMED PROBLEM: Severe, "treatment resistant" depression b) THERAPY AIM: Alleviate depression that is unresponsive to drug therapy c) THERAPY TECHNIQUE: Stimulate brain through electroconvulsive shock, magnetic impulses, or deep brain stimulation 3. PSYCHOSURGERY:a) PRESUMED PROBLEM: Brain malfunction b) THERAPY AIM: Relieve severe disorders c) THERAPY TECHNIQUE: Remove or destroy brain tissue 4. THERAPEUTIC LIFESTYLE CHANGE: a) PRESUMED PROBLEM: Stress and unhealthy lifestyle b) THERAPY AIM: Restore healthy biological state c) THERAPY TECHNIQUE: After lifestyle through adequate exercise, sleep, or other changes

what are antianxiety drugs?

1. Like alcohol, ANTIANXIETY DRUGS, such as Xanax or Ativan, depress central nervous system activity (and so should not be used in combination with alcohol) a) Antianxiety drugs: drugs used to control anxiety and agitation b) Antianxiety drugs are often used in combination with psychological therapy 2. One antianxiety drug, the antibiotic D'Cycloserine, acts upon a receptor that, in combination with behavioral treatments, facilitates the extinction of learned fears. a) Experiments indicate that the drug enhances the benefits of exposure therapy and helps relieve the symptoms of posttraumatic stress disorder and obsessive compulsive disorder 3. A criticism sometimes made of the behavior therapies-that they reduce symptoms without resolving underlying problems-is also made of drug therapies a) Unlike the behavior therapies, however, these substances may be used as an ongoing treatment b) Popping a xanax at the first sign of tension can create a learned response; the immediate relief reinforces a person's tendency to take drugs when anxious 4. Antianxiety drugs can also be addicting a) After heavy use, people who stop taking them may experience increased anxiety, insomnia, and other withdrawal symptoms b) Over the dozen years at the end of the 12 century, the rate of outpatient treatment for anxiety disorders, obsessive compulsive disorder, and posttraumatic stress disorder nearly doubled c) The proportion of psychiatric patients receiving medication during that time increased from 52 to 70% d) And the new standard drug treatment for anxiety disorders: antidepressants c) antianxiety drugs (Xanax and Ativan) depress the central nervous system and reduce anxiety and tension by elevating the levels of the Gamma-aminobutyric acid (GABA) neurotransmitters d) GABA is inhibitory 5.Gamma aminobutyric acid (GABA) a) main inhibitory neurotransmitter of the CNS when you sleep b) benzodiazepines (Which include tranquilizers such as Valium) and alcohol work on GABA receptors c) antianxiety drugs taken with alcohol can kill you because they are both major depressants

Is psychotherapy effective?

1. Many Americans share confidence in psychotherapy's effectiveness a) Before 1950, psychiatrists were the primary providers of mental health care b) Today's providers include clinical and counseling psychologists, clinical social workers, clergy, marital and school counselors, and psychiatric nurses c) With such an enormous outlay as well as money, effort, and hope, it is important to ask: Are the millions of people worldwide justified in placing their hopes in psychotherapy? 2. it is difficult to gauge the effectiveness of psychotherapy because there are different levels upon which its effectiveness can be measured: a) Does the patient sense improvement? b) Does the therapist feel the patient has improved? c) Why do friends and family feel about the patient's improvement? 3. there is a placebo effect because the money and time spent will have an influence of people

what are the classical conditioning techniques in behavioral therapy?

1. One cluster of behavior therapies services from principles developed in Ivan Pavlov's early 20h century conditioning experiments a) As pavlov and others showed we learn various behaviors and emotions through classical conditioning 2. Could maladaptive symptoms be examples of conditioned responses? a) If so, might reconditioning be a solution b) Learning theorist OH Mowrer thought so and developed a successful conditioning therapy for chronic bedwetters c) The child sleeps on a liquid sensitive pad connected to an alarm d) Moisture on he pad triggers the alarm, waking the child e) With sufficient repetition, this association of bladder relaxation with waking up stops the bed wetting In three out of four cases the treatment is effective in the success provides a boost to the child's self image f) Another example: if a claustrophobic fear of elevators is a learned aversion to the stimulus of being in a confined space, then might one unlearn that association by undergoing another round of conditioning to replace the fear response? 3. counterconditioning is a procedure that conditions new responses to stimuli that trigger unwanted behaviors a) COUNTERCONDITIONING pairs the trigger stimulus (in this case, the enclosed space of the elevator) with a new response (relaxation) that is incompatible with fear b) Counterconditioning: behavior therapy procedures that use classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors, include exposure therapies and aversive conditioning c) Indeed, behavior therapist have successfully counter conditioned people with such fears 4. Two specific counterconditioning techniques-exposure therapy and aversive conditioning-replace unwanted responses a) it is based on classical conditioning and includes exposure therapy and aversive conditioning b) it is usually used to help people with phobias and addictions that have triggers

Compare the modern psychotherapies?

1. PSYCHODYNAMIC a) PRESUMED PROBLEM: Unconscious conflicts from childhood experiences b) THERAPY AIM: Reduce anxiety through self insight c) THERAPY TECHNIQUE: Interpret patients' memories and feelings 2. CLIENT CENTERED a) PRESUMED PROBLEM: Barriers to self understanding and self acceptance b) THERAPY AIM: Enable growth via unconditional positive regard, genuineness, and empathy c) THERAPY TECHNIQUE: Listen actively and reflect clients' feelings. 3. BEHAVIOR a) PRESUMED PROBLEM: Dysfunctional behaviors b) THERAPY AIM: Relearn adaptive behaviors; extinguish problem ones. c) THERAPY TECHNIQUE: Use classical conditioning (via exposure or aversion therapy) or operant conditioning (as in token economies) 4. COGNITIVE a) PRESUMED PROBLEM: Negative, self defeating thinking b) THERAPY AIM: Promote healthier thinking and self talk c) THERAPY TECHNIQUE: Train people to dispute negative thoughts and attributions 5. COGNITIVE BEHAVIORAL a) PRESUMED PROBLEM: Self harmful thoughts and behaviors b) THERAPY AIM: Promote healthier thinking and adaptive behaviors c) THERAPY TECHNIQUE: Train people to counter self harmful thoughts and to act out their new ways of thinking 6. GROUP AND FAMILY a) PRESUMED PROBLEM: Stressful relationships b) THERAPY AIM: Heal relationships c) THERAPY TECHNIQUE: Develop an understanding of family and other social systems, explore roles, and improve communication

what is exposure therapy?

1. Picture this scene reported in 1924 by psychologist Mary Cover Jones: Three year old Peter is petrified of rabbit and other furry objects a) Jones plans to replace Peter's fear of rabbits with a conditioned response incompatible with fear b) Her strategy is to associate the fear evoking rabbit with the pleasurable, relaxed response associated with eating c) As Peter begins his mid afternoon snack, Jones introduces a caged rabbit on the other side of the huge room. d) Peter eagerly munching away on his crackers and drinking his milk, hardly notices e) On succeeding days she gradually moves the rabbit closer and closer f) Within two months, Peter is tolerating the rabbit in his lap, even stroking it while he eats g) Moreover, his fear of other furry objects subsides as well, having been countered or replaced, by relaxed state that cannot coexist with ear h) Unfortunately for those who might have been helped by her counterconditioning procedures, Jones' story of Peter and the rabbit did not immediately become part of psychology's lore i) It was more than 30 years later that psychiatrist joseph Wolpe refined Jones' technique into what are now the most widely used types of behavior therapies: EXPOSURE THERAPIES 2. expose patients to things they fear and avoid 3. Exposure therapies: behavioral techniques, such as systematic desensitization and virtual reality exposure therapy, that treat anxieties by exposing people (imagination or actual situations) to the things they fear and avoid a) through repeated exposures, anxiety essence because patients habituated to the things feared. b) Exposure therapies have them face their fear, and thus overcome their fear of the fear response itself c) As people can habituate to the sound of a train passing their new apartment, so with repeated exposure, can they become less anxious responsive to things that once petrified them

What is rational emotive behavior therapy?

1. REBT is a treatment designed to identify and change self defeating thoughts that lead to anxiety and other symptoms of disorder a) Rational emotive behavior therapy (REBT): a confrontational cognitive therapy, developed by Albert Ellis, that vigorously challenges people's illogical, self defeating attitudes and assumptions confronting clients with their faulty logic 2. correct self defeating thoughts confrontational atmosphere a) the words have and must probably cause psychological disorder the most b) need to replace them with "like to" because it allows for the world of possibilities more flexible 3. Albert Ellis is a big contributor to this a) According to Albert Ellis, the creator of RATIONAL EMOTIVE BEHAVIOR THERAPY (REBT), many problems arise from irrational thinking b) For example, he described a disturbed woman and suggested how therapy might challenge her illogical, self defeating assumptions: "She does not merely believe it is undesirable if her lover rejects her. She tends to believe, also, that it is awful, she cannot stand it, she should not, must not be rejected, she will never be accepted by any desirable partner, she is a worthless person because one lover has rejected her, and she deserves to be rejected for being so worthless. Such common covert hypotheses are illogical, unrealistic, and destructive...they can be easily elicited and demolished by any scientist worth his or her salt; and the rational emotive therapist is exactly that: an exposing and nonsense annihilating scientists d) Change people's thinking by revealing the "absurdity" of their self defeating ideas, the sharp tongue Ellis believed, and you will change their self defeating feelings and enable healthier behaviors.

What is therapeutic alliance?

1. The emotional bond between therapist and client-the THERAPEUTIC ALLIANCE-is a key aspect of effective therapy a) Therapeutic alliance: a bond of trust and mutual understanding between a therapist and client, who work together constructively to overcome the client's problem b) One US National Institute of Mental Health depression treatment study confirmed that the most effective therapists were those who were perceived as most empathic and caring and who established the closest therapeutic bonds with their clients c) That all therapies offer hope through a fresh perspective offered by a caring person is what also enables paraprofessionals (briefly trained caregivers) to assist so many troubled people so effectively 2. These three common elements are also part of what the growing numbers of self help and support groups offer their members a) And they are part of what traditional healers have offered b) Healers everywhere-special people to whom others disclose their suffering, whether psychiatrists, witch doctors, or shamans-have listened in order to understand and to empathize, reassure, advise, console, interpret, or explain c) Such qualities may explain why people who feel supported by close relationships-who enjoy the fellowship and friendship of caring people-are less likely to need or seek therapy 3. People who seek help usually improve a) So do many of those who do not undergo psychotherapy and that is a tribute to our human resourcefulness and our capacity to care for one another b) Nevertheless, though the therapist's orientation and experience appear not to matter much, people who receive some psychotherapy usually improve more than those who do not c) People with clear cut, specific problems tend to improve the most

what are antipsychotic drugs?

1. The revolution in drug therapy for psychological disorders began with the accidental discovery that certain drugs, used for other medical purposes, calmed patients with PSYCHOSES (disorders in which hallucinations or delusions indicate some loss of contact with reality) a) These ANTIPSYCHOTIC DRUGS, such as chlorpromazine (sold as Thorazine), dampened responsiveness to irrelevant stimuli b) Antipsychotic drugs: drugs used to treat schizophrenia and other forms of severe thought disorder 2. Thus, they provide the most help to patients experiencing positive symptoms of schizophrenia, such as auditory hallucinations and paranoia a) The molecules of most conventional antipsychotic drugs are antagonists; they are similar enough to molecules of the neurotransmitter dopamine to occupy its receptor sites and block its activity b) This finding reinforces the idea that an overactive dopamine system contributes to schizophrenia 3. Antipsychotics also have powerful side effects a) Some produce sluggishness, tremors, and twitches similar to those of Parkinson's disease b) Long term use of antipsychotics can produce TARDIVE DYSKINESIA, with involuntary movements of the facial muscles (such as grimacing), tongue, and limbs c) Although not more effective in controlling schizophrenia symptoms, many of the newer generation antipsychotics, such as risperidone (risperdal) and olanzapine (zyprexa), have fewer of these effects d) These drugs may however increase the risk of obesity and diabetes e) Antipsychotics, combined with life skills programs and family support, have given new hope to many people with schizophrenia f) Hundreds of thousands of patients have left the wards of mental hospitals and returned to work and to near normal lives 4. classical antipsychotics: (chlorpromazine (thorazine): remove a number of positive symptoms associated with schizophrenia such as agitation, delusions, and hallucinations 5. clozapine (clozaril) blocks receptors from dopamine and serotonin to remove the negative symptoms of schizophrenia a) if it binds too tightly, you get parkinson like symptoms so the newer drugs do not bind as tight to cut out the negative side effects

What is the clinician's perceptions of their client's progress in therapy?

1. Unlike clients, clinicians believe in therapy's success. they believe the client is better off after therapy than if the client had not taken part in therapy: a) clinicians are aware of failures, but they believe failures are the problem of other therapists b) if a client seeks another clinician, the former therapist is more likely to argue that the client has developed another psychological problem c) clinicians are likely to testify to the efficacy of their therapy regardless of the outcome of treatment. 2. The problem is that clients justify entering psychotherapy by emphasizing their unhappiness and justify leaving by emphasizing their well being a) Therapists treasure compliments from clients as they say good bye or later express their gratitude, but they hear little from clients who experience only temporary relief and seek out new therapists for their recurring problems. b) Thus, the same person-with the same recurring anxieties, depression, or marital difficulty-may be a success story in several therapists' files c) Because people enter therapy when they are extremely unhappy and usually leave when they are less extremely unhappy, most therapists, like most clients, testify to therapy's success-regardless of the treatment 3. Case studies of successful treatment abound

What is community psychology and self help groups? What is deinstitutionalization?

1. community psychology a) a movement to minimize or prevent psychological disorders through changes in social systems and through community mental health programs b) deinstitutionalization: the release of those with mental disorders from mental hospitals for the purpose of treating them in their home communities 2. Self Help Groups a) Many people also participate in self help and support groups b) One analysis of online support groups and more than 14,000 self help groups reported that most support groups focus on stigmatized or hard to discuss illnesses c) AIDS patients, fro example, are 250 times more likely that hypertension patients to be in support groups d) Those struggling with anorexia and alcohol use disorder often join groups; those with migraines and ulcers usually do not e) People with hearing loss have national organizations with local chapters; people with vision loss more often cope on their own f) The grandparent of support groups, Alcoholics Anonymous (AA) reports having more than 2 million members in 114,000 groups worldwide g) Its famous 12 step program, emulated by many other self help groups, asks members to admit their powerlessness, to seek help from a higher power and from one another, and (the twelfth step) to take the message to others in need of it. h) In one eight year, $27 million investigation, AA participants reduced their drinking sharply, although so did those assigned to cognitive behavioral therapy or to motivational therapy i) Other studies have similarly found that 12 step programs such AS AA have helped reduce alcohol use disorder comparably with other treatment interventions j) The more meetings members attend, the greater their alcohol abstinence k) In one study of 2300 veterans who sought treatment for alcohol use disorder, a high level of AA involvement was followed by diminished alcohol problems l) In an individualistic age, with more and more people living alone or feeling isolated, the popularity of support groups-for the addicted the bereaved, the divorced, or simply those seeking fellowship and growth-seems to reflect a longing for community and connectedness m) More than 100 million Americans belong to small religious, interest, or self help groups that meet regularly-and 9 in 10 report that group members support each other emotionally

Which psychotherapy would be most effective for treating a particular problem?

1. depression: behavior, cognition, interpersonal therapy 2. anxiety: cognition, exposure, stress inoculation 3. bulimia: cognitive behavior 4. phobia: behavior 5. bed wetting: behavior modifications

what is family therapy?

1. family therapy treats the family as a system therapy guides family members toward positive relationships and improved communication a) One special type of group interaction, FAMILY THERAPY, assumes that no person is an island: we live and grow in relation to others, especially our families b) Family therapy: therapy that treats the family as a system. Views an individual's unwanted behaviors as influenced by, or directed at, other family members. 2. We struggle to differentiate ourselves from our families, but we also need to connect with them emotionally a) Some of our problem behaviors arise from the tension between these two tendencies, which can create family stress b) Unlike most psychotherapy, which focuses on what happens inside the person's own skin, family therapists work with multiple family members to heal relationships and to mobilize family resources c) They tend to view the family as a system in which each person's actions trigger reactions from others, and they help family members discover their role within their family's social system d) A child's rebellion, for example, affects and is affected by other family tensions e) Therapists also attempt-usually with some success, research suggests-to open up communication within the family or to help family members discover new ways of preventing or resolving conflicts

what is humanistic therapies?

1. humanistic therapists aim to boost self fulfillment by helping people grow in self awareness and self acceptance 2. The humanistic perspective has emphasized people's inherent potential for self fulfillment a) Like psychodynamic therapies, humanistic therapies have attempted to reduce growth impending inner conflicts by providing clients with new insights b) Indeed, the psychodynamic and humanistic therapies are often referred to as INSIGHT THERAPIES c) Insight therapies: a variety of therapies that aim to improve psychological functioning by increasing a person's awareness of underlying motives and defenses people are conscious of their decisions knowledge of self can help improve decision making and in turn one's life 3. But humanistic therapy differs from psychoanalytic therapy in many other ways: a) HUMANISTIC THERAPY AIMS TO BOOST PEOPLE'S SELF FULFILLMENT BY HELPING THEM GROW IN SELF AWARENESS AND SELF ACCEPTANCE PROMOTING THIS GROWTH, NOT CURING ILLNESS, IS THE FOCUS OF THERAPY. Thus, those in therapy became "clients" or just "persons' rather than "patients" (a change many other therapists have adopted) b) THE PATH TO GROWTH IS TAKING IMMEDIATE RESPONSIBILITY FOR ONE'S FEELINGS AND ACTIONS, RATHER THAN UNCOVERING HIDDEN DETERMINANTS c) CONSCIOUS THOUGHTS ARE MORE IMPORTANT THAN THE UNCONSCIOUS d) THE PRESENT AND FUTURE ARE MORE IMPORTANT THAN THE PAST. The goal is to explore feelings as they occur, rather than achieve insights into the childhood origins of the feelings

what is operant conditioning? what is token economy?

1. operant conditioning procedures enable therapists to use behavior modification, in who desired behaviors are rewarded and undesired behaviors are either rewarded or punished a) Pioneering research BF Skinner helped us understand the basic concept in operant conditioning that voluntary behaviors are strongly influenced by their consequences b) Knowing this, today's therapists can practice behavior modification-reinforcing desired behaviors, and withholding reinforcement for undesired behaviors c) Using operant conditioning to solve specific behavior problems has raised hopes for some otherwise hopeless cases 2. Children with intellectual disabilities have been taught to care for themselves a) Socially withdrawn children with autism spectrum disorder (ASD) have learned to interact b) People with schizophrenia have been helped to behave more rationally in their hospital ward c) In such cases, therapists use positive reinforcers to shape behavior in a step by step manner, rewarding closer and closer approximations of the desired behavior 3. In extreme cases, treatment must be intensive a) One study worked with 19 withdrawn, uncommunicative 3 year olds with ASD b) Each participated in a 2 year program in which their parents spent 40 hours a week attempting to shape their behavior c) The combination of positively reinforcing desired behaviors, and ignoring or punishing aggressive and self abusive behaviors, worked wonders for some d) By first grade, 9 of the 19 children were functioning successfully in school and exhibiting normal intelligence e) In a group of 40 comparable children not undergoing this effortful treatment, only one showed similar improvement f) Ensuing studies suggested that positive reinforcement without punishment was most effective 4. in institutional settings, therapists may create a token economy in which patients exchange a token of some sort, earned for exhibiting the desired behavior, for various privileges or treats. a) Rewards used to modify behavior vary b) For some people, the reinforcing power of attention or praise is sufficient c) Others require concrete rewards such as food 5. In institutional settings, therapists may create a TOKEN ECONOMY a) Token economy: an operant conditioning procedure in which people earn a token of some sort for exhibiting a desired behavior and can later exchange the tokens for various privileges or treats b) When people display appropriate behavior, such as getting out of bed, washing, dressing, eating, talking coherently, cleaning up their rooms, or playing cooperatively, they receive a token or plastic coin as a positive reinforcer c) Later, they can exchange their accumulated tokens for various rewards, such as candy, TV time, trips to town, or better living quarters. d) Token economies have been successfully applied in various settings (homes, classrooms, hospitals, institutions for juvenile offenders) and among members of various populations (including disturbed children and people with schizophrenia and other mental disabilities)

what are the criticisms of the psychoanalytic therapy?

1. psychoanalysis is hard to refute because it cannot be proven or disproven. therapists say it is not a science (it is an art form instead) a) Relatively few US therapists now offer traditional psychoanalysis b) Much of its underlying theory is not supported by scientific research c) Analysts' interpretations cannot be proven or disproven d) And psychoanalysis takes considerable time and money, often years of several sessions per week e) Some of these problems have been addressed in the modern psychodynamic perspective that has evolved from psychoanalysis 2. psychoanalysis takes a long time and is very expensive a) need to devote 6 to 8 hours a week to therapy for many years to make progress

what is psychotherapy, biomedical therapy, and eclectic approach?

1. psychotherapy involves an interaction between a trained therapist and a patient Today's therapies can be classified into two main categories 2. In PSYCHOTHERAPY, a trained therapist uses psychological techniques to assist someone seeking to overcome difficulties or achieve personal growth a) Psychotherapy: treatment involving psychological techniques, consists of interactions between a trained therapist and someone seeking to overcome psychological difficulties or achieve personal growth 3. Biomedical therapy uses drugs or other procedures that act on the patient's nervous system, treating his or her psychological disorders a) BIOMEDICAL THERAPY offers medication or other biological treatments b) Biomedical therapy: prescribed medications or procedures that act directly on the person's physiology an eclectic approach uses various forms of therapy depending upon the client's unique problems 4. Many therapists combine techniques Jamison received psychotherapy in her meetings with her psychiatrists and she took medications to control her wild mood swings a) Many psychotherapists describe themselves as taking an ECLECTIC APPROACH, using a blend of psychotherapies b) Eclectic approach: an approach to psychotherapy that, depending on the client's problems, uses techniques from various forms of therapy c) Like Jamison, many patients also can receive psychotherapy combined with medication

What is light exposure therapy? Does it work?

1. seasonal affective disorder (SDA), a form of depression, has been effectively treated by light exposure therapy. this form of therapy has been scientifically validated a) this also helps with your sleep cycle 2. Have you ever found yourself oversleeping, gaining weight, and feeling lethargic during the dark mornings and overcast days of winter? a) There likely was a survival advantage to your distant ancestors' slowing down and conserving energy during the dark days of winter b) For some people, however, especially women and those living far from the equator, the wintertime blahs constitute a seasonal pattern for major depressive disorder 3. To counteract these dark spirits, National Institute of Mental Health researchers the early 1980s had an idea: a) Give people a timed daily dose of intense light b) Sure enough, people reported they felt better 4. Was this a bright idea or another dimwitted example of the placebo effect? a) Research sheds some light b) One study exposed some people with a seasonal pattern in their depression symptoms to 90 minutes of bright light and others to a sham placebo treatment-a hissing negative ion generator about which the staff expressed similar enthusiasm (but which was not even turned on) c) After four weeks, 61% of those exposed to morning light had greatly improved, as had 50% of those exposed to evening light and 32% of those exposed to the placebo d) Other studies have found that 30 minutes of exposure to 10,000 lux white fluorescent light produced relief for more than half the people receiving morning light therapy e) From 20 carefully controlled trials we have a verdict f) Morning bright light does indeed dim depression symptoms for many of those suffering in a seasonal pattern g) Moreover, it does so as effectively as taking antidepressant drugs or undergoing cognitive behavioral therapy h) The effects are clear in brain scans; light therapy sparks activity in a brain region that influences the body's arousal and hormones

How are neurotransmitters work in drug therapies?

1. serotonin a) serotonin is involved with mood regulation b) prozac works by keeping serotonin in the synapse longer, giving it more time to exert an effect (blocking reuptake) 2. dopamine: a) important for movement, rewards, and pleasure b) involved with diseases such as schizophrenia and Parkinson's disease c) antagonists block neurotransmitters an agonist mimic neurotransmitters 3. norepinephrine a) arousal b) sympathetic nervous system c) fight or flight response d) wakefulness, sleep e) learning f) mood regulation 4. glutamate a) major excitatory neurotransmitter b) too much glutamate (and too little GABA) associated with epileptic seizures c) involved with memory

what are the types of biomedical therapies?

1. the emptying of US mental hospitals has caused the higher rates of homicide and jailing 2. Biomedical therapy and psychotherapy are ways to treat psychological disorders 3. Biomedical therapy is often used to treat serious disorders by physically changing the brain's functioning by altering its chemistry with drugs or affecting its circuitry with electroconvulsive shock, magnetic impulses, or psychosurgery 4. Primary care providers prescribe most drugs for anxiety and depression, followed by psychiatrists and in some states, psychologists 5. these include physical, medicinal, and other forms of biological therapies a) drug therapies b) brain stimulation c) psychosurgery.

what is psychoanalysis therapy? What are the aims of it?

1. the first formal psychotherapy it was developed by Sigmund Freud a) Sigmund Freud's PSYCHOANALYSIS was the first of the psychological therapies 2. Psychoanalysis: Sigmund Freud's therapeutic technique. Freud believed the patient's free associations, resistances, dreams, and transferences-and the therapist's interpretations of them-released previously repressed feelings, allowing the patient to gain self insight. a) Few clinicians today practiced therapy as Freud did, but his work deserves discussion as part of the foundation for treating psychological disorders 3. Aims: a) the aim of psychoanalysis is to bring repressed feelings into conscious awareness where the patient can deal with them b) when energy devoted to id-ego-superego conflicts is released, the patient's anxiety lessens c) this anxiety manifests into multiple mental illnesses d) Psychoanalytic theory presumes that healthier, less anxious living becomes possible when people release the energy they had previously devoted to id-ego-superego conflicts e) Freud assumed that we do not fully know ourselves f) There are threatening things that we seem to want not to know-that we disavow or deny g) We can have loving feelings and hateful feelings toward the same person, notes Jonathan Shedler and we can desire something and also fear it. h) Freud's therapy aimed to bring patients' repressed or disowned feelings into conscious awareness i) By helping them reclaim their unconscious thoughts and feelings and giving them insight into the origins of their disorders, he aimed to help them reduce growth impeding inner conflicts.

what is aversive conditioning?

Aversive conditioning: a type of counterconditioning that associates an unpleasant state with an unwanted behavior. with this technique, temporary conditioned aversion to alcohol has been reported. 1. In systematic desensitization, the goal is substituting a positive (relaxed) response for a negative (fearful) response to a harmless stimulus a) In AVERSIVE CONDITIONING, the goal is substituting a negative (aversive) response for a positive response to a harmful stimulus (such as alcohol) b) Thus, aversive conditioning is the reverse of systematic desensitization-it seeks to condition an aversion to something the person should avoid 2. The procedure is simple: it associates the unwanted behavior with unpleasant feelings a) To treat nail biting, one can paint the fingernails with a nasty tasting nail polish b) To treat alcohol use disorder, an aversion therapist offers the client appealing drinkings laced with a drug that produces severe nausea c) By linking alcohol with violent nausea (recall the taste aversion experiments with rats and coyotes), the therapist seeks to transform the person's reaction to alcohol from positive to negative 3. Does aversive conditioning work? a) In the short run it may b) Arthur Wiens and Carol Menustik studied 685 patients with alcohol use disorder who completed an aversion therapy program at a Portland, Oregon hospital c) One year later after returning for several booster treatments of alcohol sickness pairings, 63% were still successfully abstaining d) But after three years, only 33% had remained abstinent 4. The problem is that cognition influences conditioning a) People know that outside the therapist's office they can drink without fear of nausea b) Their ability to discriminate between the aversive conditioning situation and all other situations can limit the treatment's effectiveness c) Thus, therapists often use aversive conditioning in combination with other treatments

What is behavior therapy? What are the different techniques in it?

Behavior therapy: therapy that applies learning principles (conditioning/punishment/reinforcement) to the elimination of unwanted behaviors 1. The insight therapies assume that many psychological problems diminish as self awareness grows. a) Psychodynamic therapies expect problems to subside as people gain insight into their unresolved and unconscious tensions b) Humanistic therapies expect problems to diminish as people get in touch with their feelings 2. Proponents of BEHAVIOR THERAPY, however, doubt the healing power of self awareness a) You can become aware of why you are highly anxious during tests and still be anxious b) They assume that the problem behaviors are the problems, and the application of learning principles can eliminate them c) Rather than delving deeply below the surface looking for inner causes, therapies using behavioral techniques view maladaptive symptoms such as phobias or sexual dysfunctions as learned behaviors that can be replaced by constructive behaviors to treat phobias or sexual disorders, behavior therapists do not delve deeply below the surface looking for inner causes. d) fix the behavior and not the causes TECHNIQUES: 1. classical conditioning techniques 2. exposure therapies 3. aversive conditioning 4. operant conditioning

what are the the criticism of behavior modification in operant conditioning?

Critics of behavior modification express two concerns 1. The first is practical: how durable are the behaviors? Will people become so dependent on extrinsic rewards that the appropriate behaviors will stop when the reinforcers stop? a) Proponents of behavior modification believe that behaviors will endure if therapists wean patients from the tokens by shifting them toward other, real life rewards, such as social approval b) They also point out that the appropriate behaviors themselves can be intrinsically rewarding c) For example, as a withdrawn person becomes more socially competent, the intrinsic satisfaction of social interaction may help the person maintain the behavior. 2. The second concern is ethical: is it right for one human to control another's behavior? a) Those who set up token economies deprive people of something they desire and decide which behaviors to reinforce b) To critics, this whole process has an authoritarian taint c) Advocates reply that some patients request the therapy d) Moreover, control already exists; rewards and punishers are already maintaining destructive behavior patterns 3. So why not reinforce adaptive behavior instead? a) Treatment with positive rewards is more humane than being institutionalized or punished, advocates argue, and the right to effective treatment and an improved life justifies temporary deprivation

what is the history of insane treatments for psychological disorders? Who were the reformers?

History of insane treatment 1. Maltreatment of the insane throughout the ages was the result of irrational views 2. Man patients were subjected to strange debilitating, and downright dangerous treatments 3. The long history of efforts to treat psychological disorders has included a bewildering mix of harsh and gentle methods. a) Well meaning individuals have cut holes in people's heads and restrained, bled, or beat the devil out of them. b) But they also have given warm baths and massages and placed people in sunny, serene environments c) They have administered drugs and electric shocks d) And they have talked with their patients about childhood experiences, current feelings, and maladaptive thoughts and behaviors 4. Phillippe Pinel in France and Dorthea Dix in America founded humane movements to care for the mentally ill a) Reformers Phillippe Pinel and Dorothea Dix pushed for gentler, more humane treatments and for constructing mental hospitals 5. Since the 1950s, the introduction of effective drug therapies and community based treatment programs have emptied most of those hospitals 6. Understanding Psychological disorders a) Ancient Treatments of psychological disorders include trephination, exorcism, being caged like animals, being beaten, burned, castrated, mutilated, or transfused with animal's blood

what are mood stabilizing medications?

Mood stabilizing medications 1. In addition to antipsychotic, anti anxiety, and antidepressant drugs, psychiatrists have mood stabilizing drugs in their arsenal a) For those suffering the emotional highs and lows of bipolar disorder, the simple salt lithium can be an effective mood stabilizer 2. Australian physician John Cade discovered this in the 1940s when he administered lithium to a patient with severe mania and the patient became perfectly well in less than a week 3. After suffering mood swings for years, about 7 in 10 people with bipolar disorder benefit from a long term daily dose of this cheap salt, which helps prevent or ease manic episodes and to a lesser extent, lifts depression a) It also protects neural health, thus reducing bipolar patients' vulnerability to significant cognitive decline 4. Lithium also reduces bipolar patients' risk of suicide-to about one sixth of bipolar patients not taking lithium a) Lithium amounts in drinking water have also correlated with lower suicide rates (across 18 Japanese cities and towns) and lower crime rates (across 27 Texas counties) b) Although we do not fully understand why, lithium works c) And so does Depakote, a drug originally used to treat epilepsy and more recently found effective in the control of manic episodes associated with bipolar disorder 5. Lithium Carbonate, a common salt, has been used to stabilize manic episodes in bipolar disorders a) it is heap and very helpful

what is regression toward the mean?

Regression toward the mean: the tendency for extreme or unusual scores to fall back (regres) toward their average 1. Clients' and therapists' perceptions of therapy's effectiveness are vulnerable to inflation from two phenomena a) One is the placebo effect-the power of belief in a treatment b) If you think a treatment is going to be effective, it just may be (thanks to the healing power of your positive expectations) 2. The second phenomenon is REGRESSION TOWARD THE MEAN a) Thus, extraordinary happenings (feeling low) tend to be followed by more ordinary ones (a return to our more usual state) b) Indeed, when things hit bottom, whatever we try-going to a psychotherapist, starting yoga, doing aerobic exercise-is more likely to be followed by improvement than by further descent c) The point may seem obvious, yet we regularly miss it: we sometimes attribute what may be a normal regression (the expected return to normal) to something we have done 3. Consider: a) Students who score much lower or higher on a test than they usually do are likely, when retested, to return toward their average b) Unusual ESP subjects who defy chance when first tested nearly always lose their "psychic powers" when retested (a phenomenon parapsychologists have called the decline effect) c) Coaches often yell at their players after an unusually bad first half. They may then feel rewarded for having done so when the team's performance improves (returns to normal) during the second half d) In each case, the cause effect link may be genuine. e) Each may, however, be an instance of the natural tendency for behavior regress from the unusual to the more usual f) And this defines the task for therapy-efficacy research: does the client's improvement following a particular therapy exceed what could be expected from the placebo and regression effects alone, shown by comparison with control groups?

what is cognitive therapy? What are the techniques of cognitive therapy?

cognitive therapies: teachers people adaptive ways of thinking and acting based on the assumption that thoughts intervene between events and our emotional reactions /therapy that teaches people new, more adaptive ways of thinking; based on the assumption that thoughts intervene between events and our emotional reactions 1. We have seen how behavior therapies treat specific fears and problems behaviors a) But how do they deal with major depression? Or with generalized anxiety disorder, in which anxiety has no focus and developing a hierarchy of anxiety triggering situations is difficult? b) Therapists treating these less clearly defined psychological problems have had help from the same cognitive revolution that has profoundly change other areas of psychology during the last half century 2. The COGNITIVE THERAPIES assume that our thinking colors our feelings a) Between the event and our response lies the mind b) Self blaming and overgeneralized explanations of bad events are often an integral part of the vicious cycle of depression c) The depressed person interprets a suggestion as criticism, disagreement as dislike, praise as flattery, friendliness as pity d) Ruminating on such thoughts sustains the negative thinking e) If such thinking patterns can be learned then surely they can be replaced f) Cognitive therapists therefore try in various ways to teach people new, more constructive ways of thinking g) If people are miserable, they can be helped to change their minds TECHNIQUES: 1. rational emotive behavior therapy 2. Aaron Beck's therapy for depression 3. stress inoculation training

what are the three commonalities that are shared by all forms of psychotherapies?

commonalities among psychotherapies 1. Why have studies found little correlation between therapists' training and experience and clients' outcomes? a) In search of some answers, Jerome Frank, Marvin Goldfried, and Bruce Wampold have studied the common ingredients of various therapies THREE COMMONALITIES SHARED BY ALL FORMS OF PSYCHOTHERAPIES ARE THE FOLLOWING: 1. a hope for demoralized people a) bringing hope back in your life is important b) people seeking therapy typically feel anxious, depressed, devoid of self esteem, and incapable of turning things around. What any therapy offers is the expectation that, with commitment from the therapy seeker, things can and will get better. This belief, apart from any therapeutic technique, may function as a placebo, improving morale, creating feelings of self efficacy, and diminishing symptoms 2. a new perspective a) every therapy also offers people a plausible explanation of their symptoms and an alternative way of looking at themselves or responding to their world. b) Armed with a believable fresh perspective, they may approach life with a new attitude, open to making changes in their behaviors and their views of themselves. 3. an empathic, trusting and caring relationship a) to say that therapy outcome is unrelated to training and experience is not to say all therapists are equally effective, no matter what therapeutic technique they use, effective therapists are empathic people who seek to understand another's experience; who communicate their care and concern to the client; and who earn the client's trust through respectful listening, reassurance, and advice. b) Marvin Goldfriend and his associates found these qualities in recorded therapy sessions from 36 recognized master therapists. Some took a cognitive behavioral approach, others emphasize psychodynamic teachings. c) Regardless, the striking finding was how similar they were. d) At key moments, the empathic therapists of both persuasions would help clients evaluate themselves, link one aspect of their life with another, and gain insight into their interactions with others

what is eye movement desensitization and reprocessing? Does it work?

eye movement desensitization and reprocessing (EMDR) 1. In EMDR therapy, the therapist attempts to unlock and reprocess previous frozen traumatic memories by waving a finger in front of the eyes of the client. jury is still out a) EMDR is a therapy adored by thousands and dismissed by thousands more as a shame-an excellent vehicle for illustrating the differences between scientific and pseudoscientific therapy techniques, suggested James Herbert and seven others b) Francine Shapiro developed EMDR while walking in a park and observing that anxious thoughts vanished as her eyes spontaneously darted about c) Offering her novel anxiety treatment to others, she had people imagine traumatic scenes while she triggered eye movements by waving her finger in front of their eyes, supposedly enabling them to unlock and reprocess previously frozen memories d) Tens of thousands of mental health professionals from more than 75 countries have since undergone training e) Not since the similarly charismatic Franz Anton Mesmer introduced ANIMAL MAGNETISM (hypnosis) more than two centuries ago (also after feeling inspired by an outdoor experience) has a new therapy attracted so many devotees so quickly 2. Does it work? a) For 84 to 100% of single trauma victims participating in four studies the answer is Yes reports Shapiro b) Moreover, the treatment need take no more than three 90 minute sessions c) The society of clinical psychology task force on empirically validated treatments acknowledges that EMDR is probably efficacious for the treatment of nonmilitary posttraumatic stress disorder 3. Why, wonder the skeptics, would rapidly moving one's eyes while recalling traumas be therapeutic? a) Some argue that eye movements serve to relax or distract patients, thus allowing the memory associated emotions to extinguish b) Others believe that the eye movements in themselves are not the therapeutic ingredient c) Trials in which people imagined traumatic scenes and tapped a finger or just stared straight ahead while the therapist's finger wagged, have produced therapeutic results d) EMDR does work better than doing nothing, acknowledged skeptics, but many suspect that what is therapeutic is the combination of exposure therapy-repeatedly associating with traumatic memories a safe and reassuring context that provides some emotional distance from the experience-and a robust placebo effect e) Had Mesmer's pseudotherapy been compared with no treatment at all, it too (thanks to the healing power of positive belief), might have been found probably efficacious, observed Richard McNally

what are the different types of therapists? What training do they have?

therapists and their training 1. clinical psychologists: they have PhDs mostly. they are experts in research, assessment, and therapy all of which is verified through a supervised internship 2. clinical or psychiatric social worker: they have a Masters of social work. postgraduate supervision prepares some social workers to offer psychotherapy, mostly to people with everyday personal and family problems 3. counselors: pastoral counselors or abuse counselors work with problems arising from family relations, spouse and child abusers and their victims, and substance abusers 4. psychiatrists: they are physicians who specialize in the treatment of psychological disorders. not all psychiatrists have extensive training in psychotherapy, but as MDs they can prescribe medications