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AP PSYCH 7

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What are some of the harsh and gentle methods that have been used to treat psychological disorders historically? How did Pinel and Dix contribute to the treatment of psychological disorders and to what degree does it still exist today? What are the varying viewpoints on treatment? What are the two main categories of therapies?
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They include by cutting holes in the head and by giving warm baths and messages; by restraining, bleeding, or “beating the devil” out of people; talking about childhood experiences. They contributed by advocating construction of mental hospitals to offer more humane methods of treatment but the introduction of therapeutic drugs and community based treatment programs has emptied mental hospitals since 1950s. The viewpoints differ depending on the therapist’s viewpoint. Those who believe that psychological disorders are learned will tend to favor psychological therapies and those who view disorders as biologically rooted are likely to advocated medication. Those who believe that disorders are responses to social conditions will want to reform the sick environment. The two main categories of therapies are psychological therapies and biomedical therapies.
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The Psychological Therapies (Pg. 660) How is psychotherapy defined? Upon which perspectives have the most influential therapies been built? How do scientists use the eclectic approach and psychotherapy integration to combine these theories?
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Psychotherapy is defined as an emotionally charged, confiding interaction between a trained therapist and someone who suffers from psychological difficulties. The perspectives include: psychoanalytic, humanistic, behavioral, and cognitive. By drawing from a variety of techniques and combing methods into a single coherent system.
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Psychoanalysis (Pg. 660) How is psychoanalysis defined and to what degree did it survive the Freudian era?
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Psychoanalysis is defined as Freud’s theory of personality and therapeutic technique that attributes our thoughts and actions to unconscious motives and conflicts. Many of his psychoanalytic techniques survived and is part of modern vocabulary.
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Aims (Pg. 660) What are the basic assumptions of psychoanalysis? What are the ultimate objectives of psychoanalysis?
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Psychoanalysis assumes that many psychological problems are fueled by childhood’s residue of repressed impulses and conflicts. The ultimate goal is that healthier, less anxious living becomes possible when patients release the energy they had previously devoted to id-ego-superego conflicts.
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Methods (Pg. 661) What is the process of free association? How is resistance used in the free association process? How does the therapist use interpretation to provide the patient with insights? How are dreams used as part of the interpretive process? What is transference and why did Freud believe it would help a patient to heal? How do critics expose the downsides of psychoanalytical interpretations?
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The process of free association is when the analyst invites you to relax, perhaps by lying on a couch. He or she will probably help you focus attention on your own thoughts. You say whatever comes to your mind in that moment. Sometimes your mind can go blank or you find yourself not being able to remember important details. By how the analyst will want to explore the sensitive areas you are resisting and make you aware that you are resisting and then interpret their underlying meaning. The analyst interpretation for example not wanting to talk to your mother may illuminate what you are avoiding. The analyst may offer a dream analysis suggesting its meaning. Transference is when you transfer your strongest feelings from other relationships to the analyst and he believed it would help a patient heal because it exposes long repressed feelings, giving the person a chance to work through them with the analyst help. They expose it by showing how much of psychoanalysis is based on assumptions that repressed memories exist.
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Psychodynamic Therapy (Pg. 662) What psychodynamic assumptions do psychodynamic therapists make and how does it influence their treatment strategy? What is interpersonal psychotherapy and how does it differ from psychodynamic therapy in terms of both goals and methods?
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They try to understand a patient’s current symptoms by exploring childhood experiences and that influences them trying to probe for supposed repressed, emotion-laden information, seeking to help the person gain insight into the unconscious roots of problems. Interpersonal psychotherapy is a brief 12 to 16 sessions that has been found effective with depressed patients. It aims to help people gain insight into the roots of their difficulties like psychodynamic but rather than focus on undoing past hurts and offering interpretations, it focuses on current relationships and assists people in improving their relationship skills. Its goal is symptom relief.
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Humanistic Therapies (Pg. 663) What are the focuses of humanistic therapy? How do they differ from psychoanalytic therapy? What is client-centered therapy? What are the 3 characteristics a humanistic therapist is supposed to exhibit according to Rogers? What is active listening and its 3 “hints” for utilizing the process? How is unconditional positive regard used in humanistic therapy?
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The focuses of humanistic therapy are emphasizing people’s inherent potential for self-fulfillment, boosting self-fulfillment by helping people grow in self awareness and self acceptance. They differ by focusing on the present and the future more than the past; conscious rather than unconscious thoughts; promoting growth instead of curing illness. Client centered therapy is where the therapist uses techniques such as active listening within a genuine, accepting, empathic environment to facilitate client’s growth. The three characteristics are genuineness, acceptance, and empathy. Active listening is echoing, restating, and seeking clarification of what the person expresses and acknowledge the expressed feelings. The three hints are Paraphrase, invite clarification, and reflect feelings. It is used by how given a on judgmental, grace-filled environment that provides unconditional positive regard, people internalize unconditional positive self-regard; they may accept even their worst traits and feel valued and whole.
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Behavior Therapies (Pg. 664) What is behavior therapy and what are its basic assumptions? In what fundamental ways does behavior therapy differ from psychodynamic and humanistic therapies?
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Behavior therapy is therapy that applies learning principles to the elimination of unwanted behaviors. It differs by how they assume that problem behaviors are the problems. To treat phobias or sexual disorders they do not delve deep below the surface looking for inner causes. They view maladaptive symptoms as learned behaviors, which they try to replace with constructive behaviors.
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Classical Conditioning Techniques (Pg. 665) How was classical conditioning used by Mowrer to treat childhood bed-wetting? What is counter conditioning and how can it be used to treat phobias?
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The child sleeps on a liquid- sensitive pan constructed to an alarm. Moisture on the pad triggers the alarm, waking the child. With sufficient repetition, this association of urinary relaxation with waking up stops the bed-wetting. Counter conditioning is a behavior therapy procedure that conditions new responses to stimuli that trigger unwanted behavior. It can be used to treat phobia’s by how someone with a fear of elevators, if we repeatedly pair the enclosed space of the elevator space with a relaxed response, the fear response may be displaced.
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Classical Conditioning Techniques (Pg. 665) How was classical conditioning used by Mowrer to treat childhood bed-wetting? What is counterconditioning and how can it be used to treat phobias?
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The child sleeps on a liquid-sensitive pad connected to an alarm. Moisture on the pad triggers the alarm, waking the child up. With sufficient repetition, this association of urinary relaxation with waking up stops the bet-wetting. Counterconditioning conditions new responses to stimuli that trigger unwanted behaviors; based on classical conditioning. Ex. If we repeatedly pair the enclosed space of the elevator with a relaxed response, the fear may be displaced.
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Systematic Desensitization (Pg. 665) What were the methods of Jones’ strategy for curing “Peter’s” fear of rabbits? How did Wolpe refine Jones’ technique and create exposure therapy? How does systematic desensitization use anxiety hierarchies and progressive relaxation, to desensitize a patient? How is virtual reality used to find a “middle ground” for severely afflicted patients?
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Her strategy is to associate the fear evoking rabbit with the pleasurable, relaxed response associated with eating. She presents a caged rabbit next to Peter while he is eating a snack, barely notices the rabbit. On succeeding days, she gradually moves the rabbit closer and closer. Within two months Peter is tolerating the rabbit on his lap, even petting it. Wolpe used exposure therapies; they expose people to what they normally avoid. One widely used exposure therapy is systemic desensitization. Wolpe assumed that you cannot simultaneously be anxious and relaxed. Therefore, if you can repeatedly relax when facing anxiety-provoking stimuli, you can gradually eliminate your anxiety. Using progressive relaxation, the therapist trains you to relax one muscle group after another, until you achieve a drowsy state of complete relaxation and comfort. Then the therapist asks you to imagine, with your eyes closed, mildly anxiety arousing situation, and then to switch of the situation, this is done repeatedly. Virtual reality exposure therapy offers and efficient middle ground. Wearing a head-mounted display unit that projects a three-dimensional virtual world, the client is immersed into a lifelike series of scenes. People have experience great relief.
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Aversive Conditioning (Pg. 667) What is aversive conditioning and how does it compare to systematic desensitization? How do cognitive influences limit the effectiveness of aversive conditioning?
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Aversive conditioning associated an unpleasant state with an unwanted behavior. It is the opposite of systematic desensitization; it seeks to condition an aversion to something the client should avoid. People know that outside the therapist’s office they can drink without fear of nausea. A person’s ability to discriminate between the aversive conditioning situation and all other situations can limit the treatment’s effectiveness.
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Operant Conditioning (Pg. 668) What are some examples of how operant conditioning has been used to solve specific behavior problems in children? What did the Lovaas study demonstrate about the feasibility of using operant conditioning techniques to treat autism? What is token economy and how is it used in institutional settings to alter unwanted behaviors? What are the concerns of critics of behavior modification and how do the proponents and advocates of it respond?
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Children with mental retardation have been taught to care for themselves. Socially withdrawn children with autism have learned to interact. Lovaas study showed that the combination of positive reinforcing of desired behavior and ignoring or punishing aggressive and self-abusive behaviors by the parents of severely autistic children worked wonders. By first grade most of the children were functioning successfully in school and exhibit normal intelligence. Token economy is when a patient exchanges a token of some sort, earned from exhibiting the desired behavior, for various privileges or treats. Token economies have been successfully applied in various settings ike homes, hospitals, and institutions for delinquents. Critics express to concerns, what happens when the reinforcers stop, as when the person leaves the institution? Could the person become so dependent on the extrinsic rewards that the appropriate behaviors soon disappear? Proponents say that they may wean patients from the tokens by shifting them toward other rewards, such as social approval. They may also train patients to behave in ways that are intrinsically rewarding. Another concern is that is it right for one human to control the behavior of another, advocates say control already exists
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Cognitive Therapies (Pg. 669) What is cognitive therapy and what are its basic assumptions? What types of disorders would be better handled by cognitive therapy than behavior therapy and why?
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Cognitive therapy teaches people new, more adaptive ways of thinking and acting; based in the assumption that thoughts intervene between events and our emotional reactions. The basic assumptions are that our thinking colors our feelings, that between the event and our response lies the mind. Self-blaming and overgeneralized explanations of bad events are an integral part of the vicious cycle of depression. The person with depression iter[rets a suggestion as criticism, disagreement as dislike, praise as flattery, friendliness as pity. Ruminating on such thoughts sustains the bad mood. If depressing thinking patterns are learned, then surely they can be replaced. Cognitive therapists therefore try in various ways to teach people new, more constructive ways of thinking. If people are miserable, then can be helped to change their minds.
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Cognitive Therapy for Depression (Pg. 670) How did Aaron Beck interpret depressed patients’ cognitive processes and work to reverse their negative interpretations? How did Adele Rabin work with these ideas to treat depressed patients and what were the results of her study? What is cognitive-behavior therapy and how has it been used to treat OCD patients? What is stress inoculation training and how effective has it been in treating depression-prone people?
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Beck analyzed the dreams of patients with depression, he found recurring negative themes of loss, rejection, and abandonment that extended into their walking thoughts. Beck sought to reverse clients’ catastrophizing beliefs about themselves, their situations, and their futures. They attempt to convince depressed people to take off the dark glasses through which they view people, and their technique is a gentle questioning that aims to help people discover their irrationalities. Rabin explained to 235 depressed adult the advantages of interpreting events as nondepressed people do. She then trained them to reform the habitually negative patterns of thinking and labeling. Those who went through the positive-thinking exercises found their depression dropped dramatically. Cognitive behavior therapy aims to alter the way people act and to alter the way they think. Patients with OCD learned to relabel their compulsions. Stress inoculation trains people to restructure their thinking in stressful situations, sometimes it may be enough to simply say more positive things.
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Group and Family Therapies (Pg. 672) What are the purposes and advantages of group therapy? What have studies indicated about overall effectiveness of group therapies such as Alcoholics Anonymous? What are the goals and advantages of family therapy?
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Group therapy saves the therapist time and the clients’ money, and it often no less effective than individual therapy. Therapists frequently suggest group therapy for people experiencing family conflict or those whose behavior is distressing to others. The social context allows people to both discover that others have problems similar to their own and to try out new ways of behaving. It can help to receive feedback; can be a relief to find that you are not alone. More than 100 million Americans belong to small religious, interest, or self-help groups that meet regularly. AA has 66,000 chapters in 112 countries; famous 12-step program has been emulated by many other self-help groups. Family therapy works to heal relationships and mobilize family sources; it aims to help family members to discover the role they pale within their family’s social system. Also attempts to open up communication within the family or to help the family discover new ways of preventing or resolving conflicts.
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Evaluating Psychotherapies (Pg. 674) How has the practice of psychotherapy evolved since the 1950’s? What important questions has the growth of psychotherapy forced us to ask?
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Before 1950, the primary mental health providers were psychiatrists. Since then, the demand has outgrown the psychiatric profession, and now most psychotherapy is done by clinical and counseling psychologists, clinical social workers, pastoral, marital, abuse, and school counselors, and psychiatric nurses. Much of it is done through community mental health programs which provide outpatient therapy, crisis lines, and halfway houses. Is the faith that Ann Landers and millions of other worldwide place in these therapists justified?
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Client’s Perceptions (Pg. 674) What do client surveys reveal about the overall effectiveness of psychotherapy? What 3 important considerations should we take into account when evaluating client testimonials? What did McCord’s study on at-risk Massachusetts boys and the “scared straight” study reveal about the possible flaws of client testimonials?
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Three out of four clients have reported themselves satisfied and one in two saying very satisfied. Three considerations: people often enter therapy in crisis, clients may need to believe the therapy was worth the effort, clients generally like their therapists and speak kindly of them Boys were asked 30 years later about program, many sad great things and that it really helped. But McCord found that for every boy that was counseled, there was a similar one who wasn’t. McCord tracked down the untreated boys and found that among the predeliquent boys in the control group, 70% had no juvenile record. The glowing testimonials of those treated had been unintentionally deceiving. These showed testimonials can be badly misleading.
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Clinicians’ Perceptions (Pg. 675) What are some reasons why therapists’ perceptions of themselves and their own client’s successes are often misleading?
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Every therapist treasures compliments from clients as they say goodbye or later express their gratitude. The problem is that clients justify entering psychotherapy by emphasizing their woes, justify leaving therapy by emphasizing their well-being, and stay in touch only if satisfied. Therapists are aware of failures, but there are mostly the failures of other therapists, those whose clients are seeking a new therapist.
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“Regressing” From Unusual to Usual (Pg. 676) What is the placebo effect and regression towards the mean? How do these phenomena both inflate therapists’ and client’s perceptions? What are some everyday life examples of how behavior tends to regression from the unusual to the more usual?
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The placebo effect is when a placebo is used and you think it is making you better. Regression towards the mean is the tendency for unusual events to regress toward their average state, extraordinary happenings tend to be followed by more ordinary ones. We sometimes attribute what maybe a normal regression to something we have done. Students who score much lower or higher on an exam than normal are likely, when retested to return to their average. Unusual ESP subjects who defy chance when first tested nearly always lose their “psychic powers” when retested. After a sudden crime wave, the town council initiates a “stop crime” drive and the crime rate then returns to previous level. The drive may therefore seem more successful than it was.
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Outcome Research (Pg. 676) What did Eysenck’s 1952 study reveal about the possibility of psychotherapy’s exaggerated effectiveness? How are “randomized clinical trials” and meta-analysis used to study the effectiveness of therapies? What did Smith and the NIH discover in their meta-analyses studies about the benefits of psychotherapy? What do studies reveal about the relative permanence of improvement from therapy? What circumstances produce the most cost-effective and generally effective therapies?
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Eysenck summarized studies showing that two-thirds of those suffering nonpsychotic disorders improve markedly after undergoing psychotherapy. He also reported similar improvement among untreated persons, such as those who were on waiting lists. He said with or without psychotherapy roughly two-thirds improved noticeably. Time was a great healer. The best of these ‘randomized clinical trials” randomly assign people on a waiting list to therapy or to no therapy. Afterward, researchers evaluate everyone, using tests and the reports of friends and family or of the psychologists who don’t know whether therapy was given. The results of such studies are then digested by a technique called meta-analysis, a procedure for statically combining the results of many different studies as if they had come from one huge study with thousands of participants. They discovered the benefits were that the results show the overwhelming support of the efficacy of psychotherapy. The average therapy client ends up better than 80% if the untreated individuals on waiting lists. Improvement was not permanent. Only one in four patients undergoing psychotherapy and one in 6 undergoing drug therapy both recovered and experienced no relapse within 8 months. On average psychotherapy is somewhat effective. An investment in almost any effective treatment for psychological problems will reduce long-term costs.
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The Relative Effectiveness of Different Therapies (Pg. 678) What did Smith, as well as Consumer Reports reveal about the relative difference between various therapies and clinicians? What are some examples of “empirically supported therapies” that have achieved favorable results?
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Smith revealed no one type of therapy is generally superior. Consumer reports, too, were equally satisfied, no matter that type of therapy they received and whether treated by a psychiatrist, psychologist, or social worker. The group or individual context of the therapy made no difference, nor did the level of training and experience of the therapist. Empirically supported therapies- cognitive therapy, interpersonal therapy, and behavior therapy for depression Cognitive therapy, exposure therapy, and stress inoculation training for anxiety Cognitive-behavior therapy for bulimia Behavior modification for bed wetting
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Evaluating Alternative Therapies (Pg. 679) How do the methodologies and evaluation techniques differ for “alternative therapies?”
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57% of those with a history of anxiety attacks and 54% of those with a history of depression had used alternative treatments such as relaxation techniques, herbal medicine, massage, and spiritual healing.
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Therapeutic Touch (Pg. 680) What are the basic practices involved in “therapeutic touch” and what is it purportedly supposed to accomplish? How did “Emily” scientifically test the validity of therapeutic touch and what were the results?
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Practitioners move their hands a few inches from a patient’s body, purportedly ‘pushing energy fields into balance’. Advocates say these manipulations help heal everything from headaches to burns to cancer. After a toss of a coin, Emily would hover a hand over one of the practitioner’s hands to see if the practitioner could detect that his hand rather than the other was receiving the energy field. The average 47% correct. A year later when the trials were repeated, this time allowing the practitioner to ‘feel’ Emily’s energy field in each hand and then choose which hand Emily would use, they got 41%.
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Eye Movement Desensitization and Reprocessing (EMDR) Pg. 680 What are the procedures involved in EMDR therapy and what are the supposed results of it? What is the rationale of those who dismissed the therapy as a hoax? What happened when the therapy was tested without the eye movements? Where do the “real” therapeutic effects probably lie?
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While people imagined traumatic scenes, Shapiro triggered eye movements by waving her finger in from of the patient’s eyes. She tried this on 22 people haunted by old traumatic memories, and all reported marked reductions in their distress after just one therapeutic session. Those who dismiss it say an excellent vehicle for illustrating the differences between scientific and pseudoscientific therapy techniques, why should rapidly moving one’s eyes while recalling traumas be therapeutic. When the tested the therapy without the eye movements, like with finger tapping or with eyes fixed straight ahead while the therapist’s finger wagged, the therapeutic result were the same. What is therapeutic, the skeptics suspect, is the combination of exposure therapy, a robust placebo effect.
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Light Exposure Therapy (Pg. 681) What is seasonal affective disorder (SAD)? What were the characteristics of the therapy that was used to treat SAD? What are the methodologies of the controlled experiments that have been used to study the therapy and what have the results been?
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For some people, especially women living far from the equator, the wintertime blahs constitute a form of depression known as SAD. TO counteract these dark spots, SAD people are given a timed daily dose of intense light. Clinical experience indicated light exposure could relieve symptoms associated with wintertime depression, manufacturers now produce light boxes. One study exposed SAD patients to 90 min of bright light and others to a sham placebo treatment- a hissing -negative ion generator about which the staff expressed similar enthusiasm. After 4 weeks of exposure 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 treatment. Two other studies found that 30 min of light exposure produced relief for more than half the people receiving morning light therapy and for one-third receiving evening light therapy. For many people, morning bright light does indeed dim SAD symptoms.
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Commonalities Among Psychotherapies (Pg. 682) What are the common ingredients of psychotherapists? What 3 benefits do they offer their clients?
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Many share compassion, sensitivity, and empathy. They all offer three benefits: hope for demoralized people, a new perspective on oneself and the world, and empathic, trusting, and caring relationship.
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Hope for Demoralized People (Pg. 682) What do studies comparing placebo treated and untreated people demonstrate about the usefulness of therapy as well as the possible reason why therapy is helpful for demoralized people?
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THe finding that improvement is greater for placebo-treated people than for untreated people suggests that one reason therapies help is that they offer hope. Therapy outcomes vary with the client’s attitude. Each therapy, in its individual way, may harness the client’s own healing powers. And that helps us understand why all sorts of treatments may in their own time and place produce cures.
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Antipsychotics
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Thorazine—helps schizophrenics with positive symptoms by reducing brain reactions to irrelevant stimuli Block the over-activity of dopamine by blocking its receptor sites Dosages are difficult to determine in individuals, side effects include tremors and fatigue Clorazil—can enable “awakenings” in negative symptom schizophrenics
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Anti-anxiety
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Xanax (Valium)—depress central nervous system activity, relieving anxiety Its effects are exacerbated with alcohol and are prone to dependencies Because it does not resolve the underlying cause of anxiety, requires additional therapy
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Anti-depressants
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Prozac, Paxil, Zoloft—increase availability of norepinephrine or serotonin by slowing reuptake Though widely used, has physical side effects similar effects can be achieved through exercise Double blind studies have shown similar improvement with placebos
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Anti-manic
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Lithium—used to treat bipolar disorder but is still a mystery why 70% of sufferers seem to achieve so much benefit Some bipolar patients are reluctant to take medication
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ECT
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Electroconvulsive Therapy (shock treatment)— an electric current sent through the body: can supposedly illicit norepinephrine works on severely depressed patients Also proves effective with bipolar type 1
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Psychosurgery
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Removal of brain tissue in an effort to change behavior Gazzangia study Hemispherectomies Has been proved to be helpful in treating forms of very severe OCD Cut the circuits in motor cortex Removes the urge to conduct compulsions
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Psychoanalysis
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Although most therapists aren’t Freudian, some use variations on his techniques Assumes problems are left over from childhood Presumes that when buried feelings surface people will be healthier, less anxious, and release energy previously devoted to inner conflicts
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Psychoanalysis’ Methodology
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Free association leads to attempt to find resistance, analyst then interprets resistances or dream meanings offers suggestions of underlying feelings and conflicts based on what you are resisting Transference—patient’s reassigning emotions linked with other relationships upon therapist
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Psychodynamic Therapy
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Still explores childhood experiences, looking for repressed emotions Tries to have patient do most of the talking Analyst makes occasional comments involving more objective observations such as patterns of behavior
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Interpersonal Psychotherapy
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Tries to gain insight into roots of current relationship difficulties, offering suggestions for improving relationship skills Doesn’t advocate personality change only behavior or habit adjustments
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Humanistic Therapy
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Aims for self-awareness and realization of individual potential Varies from psychoanalysis-studies present more than past, conscious thoughts, taking personal responsibility for feelings and actions, and promoting growth
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Client-Centered Therapy
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Carl Rogers Genuine, accepting, empathy, unconditional acceptance Active listening—echoing listener’s words, asking for clarifications A psychological mirror will help clients see themselves clearly
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Behavior Therapies
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Application of learning principles to elimination of unwanted behavior don’t believe that self-awareness is the issue but rather problem behaviors
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Classical Conditioning Therapies
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Counter-conditioning—conditions new responses to stimuli that trigger unwanted behaviors Works with claustrophobia and bedwetting
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Operant Conditioning Therapies
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Behavior therapy that reinforces, withholds reinforcement or punishes particular behaviors Structured step-by-step process, intensive usually requires full time therapy (40 hours a week) Generally used for mentally retarded, autistic, or schizophrenic people
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Cognitive Therapies
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Based on idea that thoughts come between events and emotions/ behaviors Teaches adaptation techniques
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Cognitive Therapies-Depression
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Depressed patients tend to think suggestions are criticism and friendliness is pity Teaches people to avoid over-generalizations or self-blame, think constructively Rational Emotive Therapy (Action-Belief-Consequences) If people realize that how they interpret negative experiences impacts how they feel, they can be convinced to think differently Breaking self-defeating bias attribute positive things to themselves rather than others
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Cognitive/Behavior Therapies-OCD
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Have people think their compulsion is attributable to chemical imbalances in the brain Have people engage in something they enjoy instead of the compulsion
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Group Therapy
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Therapist led discussion involving 6 to 10 people with similar problems who engage and react to each other cheaper shows people they are not alone helps people practice healthier social behaviors
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Family Therapy
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Attempts to guide family members toward healthier relationships and better communication Assumes we need to connect with our families emotionally and realize the role that each individual plays
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An Empathetic, Trusting, Caring Relationship (Pg. 682) What are the characteristics of effective therapists? According to the NIMH and Goldfried studies, what seems to be the hallmark of effective therapists everywhere? What characteristics are revealed by meta-analytical studies to be most important for therapies and therapists everywhere?
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The characteristics are empathic people who seek to understand another’s experience; who’s care and concern the client feels; whose respectful listening, reassurance, and advice can earn the clients respect and trust. Warmth and empathy are hallmarks of effective therapists everywhere. The characteristic include hope, a fresh way of looking at life, and an empathic, caring relationship.
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Culture and Values in Psychotherapy (Pg. 683) What are some examples of how personal values can influence therapy? How do value differences within individualistic and collectivist cultures influence therapeutic expectations?
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An example includes how in Canada and the United States about 1 person in 25 are atheists as are one-fifth to one-half of psychiatrists. Highly religious people prefer religiously similar therapies. By how clients who are immigrants from Asian countries, which expect people to be mindful of others’ expectations, may have problems with therapies that require them to think only of their own well being. Recognizing that therapists and clients may differ in values many therapy training programs now provide training in cultural sensitivity and recruit members from under represented culture groups.
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Drug Therapies (Pg. 685) What is psychopharmacology and how did it revolutionize the treatment of mental patients? What have been the positive and negative effects of this change? What is the double-blind technique and why is it important to use in any drug research study?
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Psychopharmacology is the study of the effects of drugs on mind and behavior. It minimized involuntary hospitalization and supported people with community mental programs. The negative effects are that for some people unable to take of themselves, release from the hospitals means homelessness. A positive effect is that the resident population of state and country mental hospitals in the United States today is but 20 percent of what it was a half century ago. The double blind technique is when half the patients receive the drug, the other half a similar – appearing placebo. Neither the staff nor the patients know who gets which. It is important because it helps evaluate the effectiveness of the drug.
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Antipsychotic Drugs (Pg. 686) What have the positive effects been of Thorazine and Clorazil? How is molecular activity at neurotransmitter receptor sites impacted by anti-psychotic drugs? What are the negative effects and complications associated with anti-psychotics?
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The positive effects have been that they dampen responsiveness to irrelevant stimuli. Thus they provide the most help to schizophrenia patients experiencing positive symptoms such as auditory hallucinations and paranoia. The anti-psychotic drugs are similar enough to neurotransmitters to occupy its receptor sites and block its activity. Thorazine can produce sluggishness, tremors, and twitches similar to Parkinson’s disease.
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Anti-anxiety Drugs (Pg. 687) What are the 2 major drugs that have been used to treat anxiety and how do they work? What major criticisms and drawbacks have been presented regarding the use of anti-anxiety drugs?
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Xanax and Vallum have been used to treat anxiety and they work by depressing central nervous system activity. Criticisms include that they reduce symptoms without resolving underlying problems. When heavy users stop taking the drug they may experience both increased anxiety and insomnia, driving them back to the drug for relief.
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Antidepressant Drugs (Pg. 687) What are the major anti-depressants and how do most anti-depressants affect neurotransmitter availability? Which neurotransmitters are affected? How do SSRIs work? How do non-SSRIs work and what are the potential side effects? To what extent have SSRIs gained popularity? Why does it take 4 weeks for anti-depressants to take effect? What alternative treatments can “give the body a lift?” What have placebo studies revealed about the effectiveness of anti-depressants? What arguments do critics and defenders of drug therapy utilize? What improvements do scientists hope to bring to the next generation of drug therapies? How has lithium helped people diagnosed with bipolar disorder?
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Most anti depressant work by increasing the avability of the neurotransmitters norepinephrine or serotonin, which elevate arousal and mood and appear scarce during depression; major anti depressants are Prozac, Zoloft and Paxil. Norepinephrine and serotonin are affected. SSRIs work by slowing the synaptic vacuuming up of serotonin. Non-SSRIs work by blocking the re absorption of both norepinephrine and serotonin and the potential side effects include dry mouth, weight gain, hypertension. It takes 4 weeks because increased serotonin seems to promote neurogenesis, the birth of new brain cells. Alternate treatments include cognitive therapy and aerobic exercise. Placebo studies have revealed that the drugs are effective. Critics say that our knowledge of the biochemical roots of disorder and recovery is elementary. The chemistry and circuitry and life experiences that underlie behavior are too complex for drugs. They hope that the next generation of therapeutic drugs will target specific receptors that control specific symptoms. Lithium has helped people by stabilizing their mood.
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Electroconvulsive Therapy (Pg. 689) What is the process of electroconvulsive therapy (ECT) in the past, as compared with today? What are the typical circumstances where a patient would receive ECT treatments? What are the various results of ECT? Why does ECT have a “barbaric image?” What are some modern alternatives to ECT and to what degree has it been successful?
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In the past the wide wake patient was strapped to a table and jolted with roughly 100 volts of electricity to the brain, producing racking convulsions and brief unconsciousness. Today patients receive a general anesthetic so they are not conscious. Then a psychiatrist momentarily electrically shocks the unconscious patient’s brain. A patient has to have severe depression. It has a barbaric image because of the idea of electrically shocking people into convulsions. Alternatives include chest implant and repeated pulses surge through a magnetic coil held close to a person’s skull above the right eyebrow. They don’t produce any side effects unlike ECT.
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Psychosurgery (Pg. 690) What is psychosurgery and why is it the most dramatic and least used biomedical intervention? What are the procedures involved in a lobotomy? What were the positive and negative results of most lobotomies? What is the state of lobotomies today? How are biomedical therapies in general a two-way street?
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Psychosurgery is surgery that removes or destroys brain tissue in an effort to change behavior and because it produced when used in the 40s and 50s permanently lethargic, immature, impulsive personality. The procedure is a neurosurgeon would hammer an icepicklike instrument through each eye socket into the brain, then wiggle it to sever connections running up to the frontal lobes. Today lobotomies are almost never performed. By how when therapy relieves obsessive compulsive behavior, PET scans reveal a calmer brain.
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Preventing Psychological Disorders (Pg. 692) What is the alternative viewpoint of psychological disorders and their treatments and how does it differ from the therapeutic/biomedical perspective? What do believers in the alternative view believe should be done to prevent psychological “casualties?” Why does the separation between mind and body no longer seem valid?
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The alternate viewpoint is that we could interpret many psychological disorders as understandable responses to a disturbing and stressful society. The person’s social context needs treatment too. They believe that we should find ways to find out what’s causing these disorders and alleviate them; Because stress affects body chemistry and chemical imbalances. Anger and stress can threaten our physical health and a healthy mind is a healthy body.