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Psychotherapy

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

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Biomedical Therapy

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prescribed medications or procedures that act directly on the person's physiology. includes drug therapy, ECT,

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Eclectic Approach

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an approach to psychotherapy that, depending on the client's problems, uses techniques from various forms of therapy.

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Psychoanalysis

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

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Resistance

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

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Interpretation

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

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Transference

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

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Psychodynamic Theory

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therapy deriving from the psychoanalytic tradition; views individuals as responding to unconscious forces and childhood experiences, and seeks to enhance self-insight.

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Insight Therapies

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

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Client Centered Therapy

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a humanistic therapy, developed by Carl Rogers, in which the therapist uses techniques such as active listening within a genuine, accepting, empathic environment to facilitate client's growth.

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Active Listening

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

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Unconditional Positive Regard

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

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Behavior Therapy differ from pyschotherapies

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behavior therapy that applies learning principles to the elimination of unwanted behaviors. -psychotherapy treatment involving psychological techniques; consists of interactions between a trained therapist and someone seeking to overcome psychological difficulties or achieve personal growth.

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Counterconditioning

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

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Exposure Therapies

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behavioral techniques, such as systematic desensitization and virtual reality exposure therapy, that treat anxieties by exposing people to the things they fear and avoid.

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Systematic Desensitization

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

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Virtual Reality Exposure Therapy

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

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Aversive Conditioning

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

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Token Economy

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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.

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operant conditioning

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Consequences drive our behaviors (Chapter 6). Knowing this, therapists can practice behavior modification. They reinforce behaviors they consider desirable. And they do not reinforce, or they sometimes punish, undesirable behavior

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Cognitive Therapy

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

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Cognitive-Behavioral Therapy

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a popular integrative therapy that combines cognitive therapy (change self defeating thinking) with behavioral therapy (changing behavior).

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Group Therapy

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

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Family Therapy

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

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Evidence Based Practice

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

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Psychopharmacology

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the study of effects of drugs on mind and behavior.

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Antipsychotic Drugs

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

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Antianxiety Drugs

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drugs used to control anxiety and agitation.

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Antidepressant Drugs

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drugs used to treat depression and some anxiety disorders. Different types work by altering the availability of various neurotransmitters.

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Electroconvulsive Therapy (ECT)

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

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Fluoxetine

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Fluoxetine, which tens of millions of users worldwide have known as Prozac, lifts spirits by prolonging the time serotonin molecules remain in the brain's synapses. It does this by partially blocking the normal reuptake process (FIGURE 14.5) . Prozac and its cousins Zoloft and Paxil are called selective serotonin reuptake inhibitors (SSRIs) because they slow (inhibit) the synaptic vacuuming up (reuptake) of serotonin. they begin to influence neurotransmission within hours. But their full psychological effect may take four weeks, possibly because these drugs promote the birth of new brain cells

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Repetitive Transcranial Magnetic Stimulation (rTMS)

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

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Psychosurgery

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

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Therapeutic Lifestyle Change

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by altering lifestyle through adequate exercise, sleep, and other changes, a healthy biological state is restored.

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Lobotomy

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

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Resilience

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

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Psychoanalysis

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a therapist who helps patients search for the unconscious roots of their problem and offers interpretations of their behaviors, feelings, dreams, is drawing from ...

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Insight

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... therapies are designed to help individuals discover the thoughts and feelings that guide their motivation and behavior.

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Self-fulfillment and Growth

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compared with psychoanalysts, humanistic therapists are more likely to emphasize ...

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Active Listening

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a therapist who restates and clarifies the client's statements is practicing ...

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Eliminate unwanted behavior

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the goal of behavior therapy is to ...

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Counterconditioning

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behavior therapists often use ... techniques such as systemic desensitization and aversive conditioning to encourage clients to produce new responses to old stimuli.

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Systematic Desensitization

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the technique of ... teaches people how to relax in the presence of progressively more anxiety provoking stimuli.

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Behavior therapies are often the best choice for treating phobias. Viewing Rico's fear of the freeway as a learned response, a behavior therapist might help Rico learn to replace his anxious response to freeway driving with a relaxation response.

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after a near fatal car accident, Rico developed such an intense fear of driving on the freeway that he takes lengthy alternative routes to work each day. Which psychological therapy might best help Rico overcome his phobia, and why?

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Token Economy

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at a treatment center, people who display a desired behavior receive coins that they can later exchange for other rewards. This is an example of a ...

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Depression

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cognitive therapy has been especially effective in treating ...

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Cognitive Behavioral

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... therapists help people to change their self defeating ways of thinking and to act out those changes in their daily behavior.

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Each person's actions trigger reactions from other family members.

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in family therapy, the therapist assumes that ...

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Reports of clinicians and clients

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the most enthusiastic or optimistic view of the effectiveness of psychotherapy comes from ...

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No one type of

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studies show that ... therapy is the most effective treatment for most psychological disorders.

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Research Evidence, Clinical Expertise, and Knowledge of the patient

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what are the three components of evidence based practice?

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It is the healing power of belief in a treatment. When patients expect a treatment to be effective, they may believe it was.

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how does the placebo effect bias patients' attitudes about effectiveness of drug therapies?

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Sluggishness, Tremors, and Twitches

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some antipsychotic drugs, used to calm people with schizophrenia, can have unpleasant side effects, most notably ...

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Antianxiety

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drugs like Xanax and Ativan, which depress central nervous system activity, can lead to psychological and physical dependency when used as ongoing treatment. these drugs are referred to as ... drugs.

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Lithium

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a simple salt that often brings relief to patients suffering the highs and lows of bipolar disorder is ...

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Severe Depression

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when drug therapies have not been effective, electroconvulsive therapy (ECT) may be used as treatment, largely for people with ...

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Biomedical Therapy

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an approach that seeks to identify and alleviate conditions that put people at high risk for developing psychological disorders is called ...

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How do psychotherapy, biomedical therapy, and an eclectic approach to therapy differ?

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psychotherapy is treatment involving psychological techniques; it consists of interactions between a trained therapist and someone seeking to overcome psychological difficulties or achieve personal growth. The major psychotherapies derive from psychology's psychodynamic, humanistic, behavioral, and cognitive perspectives. Biomedical therapy treats psychological disorders with medications or procedures that act directly on a patient's physiology. An eclectic approach combines techniques from various forms of therapy.

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What are the goals and techniques of psychoanalysis, and how have they been adapted in psychodynamic therapy?

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through psychoanalysis, Sigmund Freud tried to give people self-insight and relief from their disorders by bringing anxiety laden feelings and thoughts into conscious awareness. Psychoanalytic techniques included using free association and interpretation of instances of resistance and transference. Psychodynamic therapy has been influenced by psychoanalysis but differs from it in many ways, including the lack of belief in id, ego, and superego. This contemporary therapy is briefer, less expensive, and more focused on helping the client find relief from current symptoms. Psychodynamic therapists help clients understand how past relationships create themes that may be acted out in present relationships.

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What are the basic themes of humanistic therapy, and what are the specific goals and techniques of Rogers' client centered approach?

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both psychoanalytic and humanistic therapies are insight therapies - they attempt to improve functioning by increasing clients' awareness of motives and defenses. Humanistic therapy's goals have included helping clients grow in self-awareness and self acceptance; promoting personal growth rather than curing illness; helping clients take responsibility for their own growth; focusing on conscious thoughts rather than unconscious motivations; and seeing the present and future as more important than the past. Carl Rogers' client centered therapy proposed that therapists' most important contributions are to function as a psychological mirror through active listening and to provide a growth fostering environment of unconditional positive regard, characterized by genuineness, acceptance, and empathy.

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How does the basic assumption of behavior therapy differ from the assumptions of psychodynamic and humanistic therapies? What techniques are used in exposure therapies and aversive conditioning?

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behavior therapies are not insight therapies. Their goal is to apply learning principles to modify problem behaviors. Classical conditioning techniques, including exposure therapies (such as systematic desensitization or virtual reality exposure therapy) and aversive conditioning, attempt to change behaviors through counterconditioning - evoking new responses to old stimuli that trigger unwanted behaviors.

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What is the basic idea of operant conditioning therapy, and what arguments have been used for and against it?

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therapy based on operant conditioning principles uses behavior modification techniques to change unwanted behaviors through positively reinforcing desired behaviors and ignoring or punishing undesirable behaviors. Critics maintain that 1. techniques such as those used in token economies may produce behavior changes that disappear when rewards end, and 2. deciding which behaviors should change is authoritarian and unethical. Proponents argue that treatment with positive rewards is more humane than punishing people or institutionalizing them for undesired behaviors.

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What are the goals and techniques of the cognitive therapies and of cognitive behavioral therapy?

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the cognitive therapies, such as Aaron Beck's cognitive therapy for depression, assume that our thinking influences our feelings, and that the therapist's role is to change client's self defeating thinking by training them to view themselves in more positive ways. Rational emotive behavior therapy is a confrontational cognitive therapy that, actively challenges irrational beliefs. The widely researched and practiced cognitive behavioral therapy combines cognitive therapy and behavioral therapy by helping clients regularly act out their new ways of thinking and talking in their everyday life.

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What are the aims and benefits of group therapy?

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

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Does psychotherapy work? Who decides?

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

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Are some psychotherapies more effective than others for specific disorders?

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

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How do alternative therapies fare under scientific scrutiny?

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abnormal states tend to return to normal on their own, and the placebo effect can create the impression that a treatment has been effective. These two tendencies complicate assessments of alternative therapies (nontraditional therapies that claim to cure certain aliments). EMDR has shown some effectiveness - not from the eye movement but rather from the exposure therapy nature of the treatments. Light exposure therapy does seem to relieve the symptoms of seasonal affective disorder (SAD) by activating a brain region that influences arousal and hormones.

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What should a person look for when selecting a therapist?

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

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According to the author, which psychotherapies should be avoided because they are not supported by scientific research?

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We would all be wise to avoid the following unsupported approaches: • Energy therapies, which seek to manipulate people's invisible energy fields. • Recovered-memory therapies, which aim to unearth "repressed memories" of early childhood abuse (Chapter 7). • Rebirthing therapies, which engage people in reenacting their supposed birth trauma. This list of d

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Describe how psychotherapies help people.

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all psychotherapies offer three basic ben- efits: hope for demoralized people; a new perspective on oneself and the world; and an empathic, trusting, caring relationship.

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Do culture and values influence the client-therapist relationship? Give examples from the textbook—e.g., influence of religion, individualism/collectivism.

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in matters of cultural and moral diversity, therapists differ from one another and may differ from their clients (Delaney et al., 2007; Kelly, 1990) . These differences can create a mismatch when a therapist from one culture interacts with a client from another. In North America, Europe, and Australia, for example, many therapists reflect the majority culture's individualism, which often gives priority to personal desires and identity. Clients with a collectivist perspective, as with many from Asian cultures, may assume people will be more mindful of others' expectations. Such clients may have trouble relating to therapies that require them to think only of their individual well - being (Markus & Kitayama, 1991) . Highly religious people may prefer and benefit from therapists who share their values and beliefs (Masters, 2010; Smith et al., 2007; Wade et al., 2006) . They may have trouble establishing an emotional bond with a therapist who views the world differently.

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What are the drug therapies? How do double-blind studies help researchers evaluate a drug's effectiveness?

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psychopharmacology, the study of drug effects on mind and behavior, has helped make drug therapy the most widely used biomedical therapy. Antipsychotic drugs, used in treating schizophrenia, block dopamine activity. Side effects may include tardive dyskiesia (with involuntary movements of facial muscles, tongue, and limbs) or increased risk of obesity and diabetes. Antianxiety drugs, which depress central nervous system activity, are used to treat anxiety disorders. These drugs can be physically and psychologically addictive. Antidepressant drugs, which increases the availability of serotonin and norepinephrine, are used for depression, with modest effectiveness beyond that of a placebo drug. The antidepressants known as selective serotonin re uptake inhibitors (often called SSRI drugs) are now used to treat other disorders, including strokes and anxiety disorders. Lithium and Depakote are mood stabilizers prescribed for those with bipolar disorder. Studies may use a double blind procedure to avoid the placebo effect and researcher's bias.

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Describe the different type of therapists and the training each must receive in order to be able to treat patients.

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Clinical psychologists- Most are psychologists with a Ph.D. (includes research training) or Psy.D. (focuses on therapy), supplemented by a supervised internship and, often, postdoctoral training. About half work in agencies and institutions, half in private practice Psychiatrists- medical doctors who specialize in the treatment of psychological disorders. As M.D.s or D.O.s, they can prescribe medications. Many have their own private practice. Clinical or psychiatric social workers- A two-year master of social work graduate program plus postgraduate supervision prepares some social workers to offer psychotherapy, mostly to people with everyday personal and family problems. About half have earned the National Association of Social Workers' designation of clinical social worker. Counselors- Marriage and family counselors specialize in family relations problems. Clergy provide counseling to countless people. Abuse counselors work with substance abusers and with spouse and child abusers and their victims. Mental health and other counselors may be required to have a two-year master's degree.

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How are brain Stimulation and psychosurgery used in treating specific disorders?

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

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How, by adopting a healthier lifestyle, might people find some relief from depression, and how does this reflect our being biopsychosocial systems?

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

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How effective are antidepressants compared to placebo? Are they more effective for certain types of depression?

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People with depression often improve after a month on antidepressant drugs. But after allowing for natural recovery (the return to normal called spontane- ous recovery) and the placebo effect, how big is the drug effect? Not big, report some researchers (Kirsch et al., 1998, 2002, 2010) . In double - blind clinical trials, pla- cebos produced improvement compa- rable to about 75 percent of the active drug's effect. In a follow-up review that included unpublished clinical trials, the antidepressant effect was again modest (Kirsch et al., 2008) . The placebo effect was less for those with severe depression,

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What is the rationale for preventative mental health programs?

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

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small groups of people with depression undergo a 12-week training program with the fol- lowing goals:

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Aerobic exercise, 30 minutes a day, at least three times weekly (increases fitness and vitality, stimulates endorphins) • Adequate sleep, with a goal of 7 to 8 hours a night (increases energy and alertness, boosts immunity) • Light exposure, at least 30 minutes each morning with a light box (amplifies arousal, influences hormones) • Social connection, with less alone time and at least two meaningful social engagements weekly (helps satisfy the human need to belong) -Antirumination, by identifying and redirecting negative thoughts (enhances positive thinking) • Nutritional supplements, including a daily fish oil supplement with omega-3 fatty acids (aids in healthy brain functioning)

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Vagus nerve stimulation

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stimulates a nerve in the neck, via an electrical device implanted in the chest. The device periodically sends sig- nals to the brain's mood - related limbic system, increasing avail- able serotonin by boosting the firing rates of some neu- rons (Fitzgerald & Daskalakis, 2008; Marangell et al., 2007)

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