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Psy101 Ch. 14

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psychological disorder
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-troubling thoughts, feelings, or behaviors that cause psychological discomfort or interfere with a person’s ability to function
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Why do people seek help from mental health professions
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1. suffering from some form of a psychological disorder 2. to deal with troubled relationships, such as parent-child conflicts or an unhappy marriage 3. need help with life’s transitions such as coping with the death of a loved one, dissolving a marriage, or adjusting to retirement
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Psychotherapy
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-the use of psychological techniques to treat emotional, behavioral, and interpersonal problems -all types share the same assumption that psychological factors play a significant role in a person’s troubling feelings, behaviors, or relationships
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biomedical therapies
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-involve the use of medication or other medical treatments to treat the symptoms associated with psychological disorders -use psychotropic medications -therapies based on the assumption that the symptoms of many psychological disorders involve biological factors such as normal brain chemistry
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psychotropic medications
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-drugs used to treat psychological or mental disorders
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Can some psychologists prescribe psychotropic medications?
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Yes, if they have the proper training
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What are the arguments against allowing psychologists to prescribe medication
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-some argue that clinical psychologists should focus on what they do best: providing psychological interventions and treatments that help people acquire more effective patterns of thinking and behaving -others concerned that the safety and well-being of patients could be at risk if psychologists receive inadequate training to prescribe the medication
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Clinical psychologist
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-has an academic doctorate degree and must be licensed to practice -assess and treats mental, emotional, and behavioral disorders -expertise in psychological testing and evaluation, diagnosis, psychotherapy, research, and prevention of mental and emotional disorders -may work in private practice, hospitals, or community mental health centers
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counseling psychologist
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-has academic doctorate and must be licensed to practice -assesses and treats mental, emotional, and behavioral problems and disorders, but usually disorders that are of lesser severity
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psychiatrist
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-has medical degree and must be licensed to practice -able to diagnose, treat, and prevent mental and emotional disorders -often trained in psychotherapy -may prescribe medications, electroconvulsive therapy, or other medical procedures
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psychoanalyst
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-a psychiatrist or clinical psychologist who has received additional training in psychoanalysis
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licensed professional counselor
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-has at least a master’s degree in counseling, with extensive supervised training in assessment, counseling, and therapy techniques -may be certified in specialty areas
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psychiatric social worker
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-master’s degree in social work -training includes internship in a social service agency or mental health center -most states require certification or licensing -may or may not have training in psychotherapy
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marriage and family therapist
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-usually has master’s degree, with extensive supervised experience in couple or family therapy -have also have training in individual therapy -many states require license
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psychiatric nurse
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-has RN degree and has selected psychiatry or mental health nursing as a specialty area -typically works on a hospital psychiatric or in a community mental health center -may or may not be trained in psychotherapy
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psychoanalysis
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-developed by Sigmund Freud -free association, dream interpretation, and analysis of resistance and transference are used to explore repressed or unconscious impulses, anxieties, and internal conflicts
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free association
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-patient spontaneously reports all her thoughts, mental images, and feelings while lying on a couch -psychoanalyst usually sits out of view, occasionally asking questions to encourage the flow of associations
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resistance
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-patient’s conscious or unconscious attempts to block the process of revealing repressed memories and conflicts -a sign that the patient is uncomfortably close to uncovering psychologically threatening material
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dream interpretation
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-because psychological defenses are reduced during sleep, Freud believed that unconscious conflicts and repressed impulses were expressed symbolically in dream images -often, the dream images were used to trigger free associations that might shed light on the dream’s symbolic meaning
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interpretations
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-a technique used in psychoanalysis in which the psychoanalyst offers a carefully timed explanation of the patient’s dreams, free associations, or behaviors to facilitate the recognition of unconscious conflicts or motivations -if the interpretation is offered before the patient is psychologically ready to confront an issue, she may reject the interpretation or respond defensively, increasing resistance
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transference
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-the process in which the patient unconsciously responds to the therapist as though the therapist were a significant person in the patient’s life, often a parent -the psychoanalyst encourages transference by purposely remaining as neutral as possible by not revealing personal feelings, take sides, make judgments, or actively advise the patient
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traditional psychoanalysis
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-is a slow, expensive process that few people can afford
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short-term dynamic therapies
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-type of psychotherapy that is based on psychoanalytic theory but differs in that it is typically time-limited, has specific goals, and involves an active, rather than neutral, role for the therapist
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interpersonal therapy (IPT)
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-focuses on current relationships and social interactions rather than on past relationships -based on the assumption that psychological symptoms are caused and maintained by interpersonal problems -four categories of personal problems: unresolved grief, role disputes, role transitions, and interpersonal deficits
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humanist perspective
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-emphasizes human potential, self-awareness, and freedom of choice -content that the most important factor in personality is the individual’s conscious, subjective perception of his or her self -see people as being innately good and motivated by the need to grow psychologically -if people are raised in a genuinely accepting atmosphere and given freedom to make choices, they will develop healthy self-concepts and strive to fulfill their unique potential as human beings
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client-centered therapy (person-centered therapy)
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-A type of psychotherapy develop by human mystics psychologist Carl Rogers in which the therapist is non directive and reflective, and the client directs the focus of each therapy session -Patient implied that people in therapy were sick
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Carl Rogers
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-Believed that the therapist should not exert power by offering carefully timed interpretations of the patients unconscious conflicts -the therapist should be nondirective
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Non directive
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-The therapists should not direct the client, offers solutions, or pass judgment on the clients thoughts or feelings
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Qualities of a humanistic therapist
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1. genuineness – therapist honestly and openly shares her thoughts and feelings with the client 2. unconditional positive regard – therapist must value, accept, and care for the client, whatever the problems or behavior 3. empathic understanding – reflecting content and personal meaning of the feelings being experienced by the client. Goal is to help the client explore and clarify his feelings, thoughts, and perceptions. In the process, the client begins to see himself, and his problems, more clearly
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Motivational interviewing
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-Designed to help clients overcome the mixed feelings or reluctance they might have about committing to change -Usually lasting only session or two, this is more directive than traditional client centered therapy
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Behavioral therapy (behavioral modification)
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-The type of psychotherapy used to modify specific problem behaviors, not to change entire personality -Rather than focusing on the past, behavior therapists focus on current behaviors -Uses basic learning principles and techniques
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Mary Cover Jones
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-One of watson’s students who explored ways of reversing conditioned fears -Use a procedure known as counter-conditioning -First behavior therapist -Pioneering effort in the treatment of children’s fears
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Counter conditioning
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-The learning of a new condition response that is incompatible with a previously learned response
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Systematic desensitization
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-Developed by South African psychiatrist Joseph Wolpe -The more standardize procedure to treat phobias and other anxiety disorders -The type of behavior therapy in which phobic responses are reduced by pairing relaxation with a series of mental images of real life situations that the person finds progressively more fear provoking -Often combined with other techniques such as observational learning
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Basic steps of systematic desensitization
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1. Progressive relaxation -involves successively relaxing one muscle group after another until a deep state of relaxation is achieved 2. Anxiety hierarchy -a list of anxiety-provoking images associated with the feared situation, arranged in a hierarchy from least to most anxiety-producing 3. Patient develops an image of a relaxing controls scene 4. Actual process of desensitization
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aversive conditioning
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-Attempting to create an unpleasant conditioned response to a harmful stimulus like cigarette smoking or alcohol consumption -Generally not very effective
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Operant conditioning
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-This model of learning by B.F. Skinner is based on a simple principle that behavior is shaped and maintained by its consequences -Treatment involves shaping, positive and negative reinforcement, and extinction
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Shaping
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-reinforcing successive approximations of the desired behavior -Often used to teach appropriate behaviors to patients who are mentally disabled by autism, mental retardation, or severe mental illness
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Positive and negative reinforcement
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-Increase incidence of desired behaviors
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Extinction
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-Absence of reinforcement, used to reduce the occurrence of undesired behaviors
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Baseline rate
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-How often each problem occurred before treatment began
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Token economy
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-An example of the use of operant conditioning techniques to modify behavior -It is a system for strengthening desired behaviors through positive reinforcement in a very structured environment -Tokens or points are awarded as positive reinforcers for desirable behaviors and withheld or taken away for undesirable behaviors -The tokens can be exchanged for other reinforcers, such a special privileges
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Contingency management
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-similar to token economy but are typically and more narrowly focused on one or a small number of specific behaviors
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Cognitive therapies
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-A group of psychotherapies based on the assumption that psychological problems are due to illogical patterns of thinking -Treatment techniques focus on recognizing and altering these unhealthy thinking patterns -Most people blame their unhappiness and problems on external events and situations, but the real cause of unhappiness is the way the person thinks about the events, not the events themselves
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Albert Ellis
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-Trained as both a clinical psychologist and a psychoanalyst -Developed rational emotive therapy (RET) -Believes that it is perfectly appropriate and rational to feel sad when you are rejected, or regrettable when you make a mistake
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Rational emotive therapy (RET)
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-Based on the assumption that people are not disturbed by things but rather by their view of things -The key premise is that people’s difficulties are caused by their faulty expectations and irrational beliefs -This therapy focuses on changing the patterns of irrational thinking that are believed to be the primary cause of the clients emotional distress and psychological problems -Therapist tries to vigorously dispute irrational beliefs The-similar to token economy but are typically and more narrowly focused on one or a small number of specific behaviors -This therapy is a popular approach in clinical practice, partly because it is straightforward and simple -It has been shown to be generally effective in the treatment of depression, social phobia, and certain anxiety disorders -Also useful in helping people overcome self defeating behaviors, such as an excessive need for approval, extreme shyness, and chronic procrastination
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Aaron T beck
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-initially train as a psychoanalyst -Developed cognitive therapy (CT) -discovered the depressed people have an extremely negative view of the past, present, and future (negative cognitive bias) -unlike Ellis’s emphasis on irrational thinking, Beck believes that depression and other psychological problems are caused by distorted thinking and unrealistic beliefs
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Cognitive therapy (CT)
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-therapy grew out of Beck’s research on depression -clients learn to identify and change their automatic negative thoughts -this technique has also been applied to other psychological problems, such as anxiety disorders, phobias, and eating disorders -CT therapist acts as a model initially to show the client how to evaluate the accuracy of automatic thoughts -also strives to create a therapeutic climate of collaboration that encourages the client to contribute to the evaluation of the logic and accuracy of automatic thoughts, which contrasts to the confrontational approach used by an RET therapist, who directly challenges the client’s thoughts and beliefs
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Cognitive-behavioral therapy (CBT)
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-refers to a group of psychotherapies that incorporate techniques from RET and CT -based on the assumption that cognitions, behaviors, and emotional responses are interrelated -thus, changes in thought patterns will affect moods and behaviors, and changes in behaviors will affect thoughts and moods -along with challenging maladaptive beliefs and substituting more adaptive cognitions, the therapist uses behavior modification, shaping, reinforcement, and modeling to teach problem solving and to change unhealthy behavior patterns -hallmark of CBT is its pragmatic approach where therapists design an integrated treatment plan, utilizing techniques that are most appropriate for specific problems -used in the treatment of children, adolescents, and elderly -studies have shown CBT is a very effective treatment for many disorders -the treatment involves offering patients alternative explanations for their delusions and hallucinations, and teaching them how to test the reality of their mistaken beliefs and perceptions
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Group therapy
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-involves one or more therapists working with several people simultaneously -may be provided by a therapist in private practice or at a community mental health clinic -often, group therapy is an important part of the treatment program for hospital inpatients -virtually any approach – psychodynamic, client-centered, behavioral, or cognitive – can be used in group therapy and just about any problem that can be handled individually can be dealt with there
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Advantages of group therapy
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1. very cost-effective 2. therapist can observe client’s actual interactions with others, which may provide unique insights into their personalities and behavioral patterns 3. support and encouragement provided by the other group members may help a person feel less alone and understand that his or her problems are not unique 4. group members may provide each other with helpful, practical advice for solving common problems and can act as models for successfully overcoming difficulties 5. working within a group gives people an opportunity to try out new behaviors in a safe, supportive environment
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self-help groups and support groups
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-typically conducted by nonprofessionals while group therapy is conducted by a mental health professional -very cost-effective -ie Alcoholics Anonymous -common 12 step program from AA
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Family therapy
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-focuses on the whole family rather than on an individual -major goal is to alter and improve the ongoing interactions among family members -typically, family therapy involves many members of the immediate family and may also include important members of the extended family -based on the assumption that the family is a system, an interdependent unit, not just a collection of separate individuals -the family is seen as a dynamic structure in which each member plays a unique role -unhealthy patterns of family interaction can be identified and replaced with new “rules” that promote the psychological health of the family as a unit -often used to enhance the effectiveness of individual psychotherapy, ie patients with schizophrenia
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Couple therapy
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-therapy conducted with any couple in a committed relationship, whether they are married or unmarried, heterosexual or homosexual -goal of improving communication, reducing negative communication, and increasing intimacy between the pair
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Spontaneous remission
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-when some people eventually improve on their psychological difficulties with the passage of time
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meta-analysis
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-a statistical technique that combines and interprets the results of large numbers of studies -reveals overall trends in the data -conclusion: psychotherapy is significantly more effective than no treatment -on average, a person who completes psychotherapy treatment is better off than about 80% of those in the untreated control group -benefits of psychotherapy usually become apparent in a relatively short time -the gains that people make as a result of psychotherapy also tend to endure long after the therapy has ended, sometimes for years -both individual and group therapy are equally effective in producing significant gains in psychological functioning
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Factors that contribute to effective psychotherapy
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1. quality of the therapeutic relationship. When psychotherapy is helpful, therapist-client relationship is characterized by mutual respect, trust, and hope. 2. certain therapist characteristics are associated with successful therapy. Helpful therapists have a caring attitude and the ability to listen emphatically. They are genuinely committed to their clients’ welfare. 3. client characteristics are important. If the client is motivated, committed to therapy, and actively involve in the process, a successful outcome is much more likely. 4. external circumstances, such as a stable living situation and supportive family members, can enhance the effectiveness of therapy.
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eclecticism
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-the pragmatic and integrated use of diverse psychotherapy techniques -eclectic psychotherapists carefully tailor the therapy approach to the problems and characteristics of the person seeking help
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integrative psychotherapy
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-use multiple approaches to therapy, but they tend to blend them together rather than choosing different approaches for different clients
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psychotropic medications
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-prescription drugs that alter mental functions and alleviate psychological symptoms -although often used alone, psychotropic medications are increasingly combined with psychotherapy
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antipsychotic medications
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-prescription drugs that are used to reduce psychotic symptoms -frequently used in the treatment of schizophrenia -also called neuroleptics
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how do antipsychotic medications work
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-reduce levels of the neurotransmitter dopamine -also act on dopamine receptors in the brain
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drawbacks of antipsychotic medications
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1. don’t actually cure schizophrenia, symptoms returned if a person stopped taking them 2. early medications not very effective in eliminating negative symptoms of schizophrenia 3. often produced unwanted side effects like dry mouth, weight gain, constipation, sleepiness, and poor concentration 4. could produce motor-related side effects like muscle tremors, rigid movements, a shuffling gait, and a masklike facial expression because of it’s effect on dopamine 5. tardive dyskinesia 6. “revolving door” ‘pattern of hospitalization, discharge, and rehospitalization
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tardive dyskinesia
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-long-term use of antipsychotic medications -potentially irreversible motor disorder -characterized by severe, uncontrollable facial tics and grimaces, chewing movements, and other involuntary movements of the lips, jaws, and tongue
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atypical antipsychotic medications
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-newer medications that block dopamine receptors in brain regions, associated with psychotic symptoms rather than more globally throughout the brain, resulting in fewer side effects
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Antianxiety medications
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-prescription drugs that are used to alleviate the symptoms of anxiety -calm jittery feelings, relax the muscles, and promote sleep
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Lithium
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-medication most commonly used to treat bipolar disorder -a naturally occurring substance that counteracts both manic and depressive symptoms in bipolar patients -can prevent acute manic episodes over the course of a week or two -once it is under control, the long0term use of lithium can help prevent relapses into either mania or depression
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antidepressant medications
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-counteract classic symptoms of depression-hopelessness, guilt, dejection, suicide thoughts, difficulty concentrating, and disruptions in deep, energy, appetite, and sexual disaster
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selective serotonin reuptake inhibitors (SSRIs)
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-rather than acting on multiple neurotransmitter pathways, SSRIs primarily affect the availability of a single neurotransmitter-serotonin
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pharmacogenetics
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-study of how genes influence an individual’s response to drugs
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electroconvulsive therapy (ECT)
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-a biomedical therapy used primarily in the treatment of depression that involves electrically inducing a brief brain seizure -also called electroshock therapy -in the short term, ECT is a very effective treatment for severe depression: ~80% of depressed patients improve -typically used only after the other forms of treatment, including both psychotherapy and medication, have failed to help the patient -in general, complication rate from ECT is very low -drawback is that its effects are short-lived but today’s patients are often treated with long-term antidepressant medication following ECT, which reduces relapse rate