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Psych Chapter 16: Therapy

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History of Mental Health Treatment
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When people had displayed unusual behaviors rooted in the mind, they used to believe that the individual had “evil spirits” inside of their minds. They used methods such as beating them out of people, bleeding them out, and letting the spirits out through holes drilled in the skull.
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Reforms in treatment
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Seeing the “insane” as ill rather than possessed and treating them with tenderness rather than harshness. Also, people started housing them in hospitals rather than locking them up in asylums. Another reform was the development of psycho-therapeutic treatments, medications, and community supports to allow life outside hospitals. (ex. a chair with shackles and a face cover was used and thought to have a calming effect on those experiencing mania)
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Psychotherapy
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The therapist uses psychological techniques to help someone
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Bio-medical Therapy
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Medications or medical procedures are used to alter physiology
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Eclectic
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Use a blend of techniques depending on client’s problem
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Psychoanalysis (psycho-dynamic theory)
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Use dream analysis, free association, transference, etc. to resolve conflict between conscious and unconscious mind.
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Humanistic (client-centered therapy)
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Emphasize potential for fulfillment, promote taking responsibility for ones actions. (Uses active listening techniques)
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Behavior Therapy
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Uses principles of classical and operant conditioning to modify behaviors (ex. token economies). Sometimes, insight is not helpful to recover from some mental health problems (the client might know the right changes to make, but finds that it’s hard to change actual behavior). Behavior therapy uses the principles of learning, especially classical and operant conditioning, to help reduce unwanted responses. (could include behaviors such as addictions, or emotions such as panic)
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Cognitive Therapy
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Teaches new, more adaptive ways of thinking about situations
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Psychoanalysis
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A set of techniques for releasing the tension of repression and resolving unconscious inner conflicts. Sigmund Freud found that the unusual symptoms of patients sometimes improved when repressed inner conflicts and feelings were brought to conscious awareness. Techniques: Free Association, Interpretation,
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Free Association
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The patient speaks freely about memories, dreams, and feelings
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Interpretation
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The therapist suggests unconscious meanings and underlying wishes to help the client gain insight and release tension.
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The therapist may see unconscious meaning in…
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Resistance, Dreams, Transference
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Resistance
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The therapist notices times when the patient seems blocked in speaking about certain subjects
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Dreams
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There may be themes or “latent content” behind the plot of a patients dream
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Transference
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The patient may have reactions toward the therapist that are actually based on feelings toward someone from the past
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Humanistic Psychology (Abraham Maslow and Carl Rogers)
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Emphasizes the human potential for growth, self-actualization, and personal fulfillment.
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Humanistic Therapy
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Attempts to support personal growth by helping people gain self-awareness and self-acceptance
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“Client-Centered Therapy”
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Carl Rogers’s name for his style of humanistic therapy
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Humanistic vs. Psychoanalytic Theory
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Humanistic Psychotherapy Goal: Promote Growth How to improve: Take responsibility for feelings and actions Role of therapist: Provide an environment in which growth can occur Content of Therapy: Conscious feelings, actual self and ideal self Time focus: The present and future Psychoanalytic Psychotherapy Goal: Cure mental illness How to improve: Bring unconscious conflicts into conscious awareness Role of therapist: Provide interpretations (ex. dreams, resistance, and transference) Content of Therapy: Unconscious conflicts Time focus: The past
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Classical Conditioning Techniques
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Counter-conditioning, exposure therapy
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Counter-conditioning
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Refers to linking new, positive responses to previously aversive stimuli. (ex. if you’ve been conditioned to fear stores due to having panic attacks there before, you could be led into a store and then helped with relaxation exercises. The goal would be to associate stores with relaxation rather than fear)
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Exposure Therapy
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A conditioned fear can worsen when avoidance of the feared situation gets reinforced by a quick reduction in anxiety. Exposure therapy can help reverse that by waiting for anxiety to subside during the exposure. The person can then get used to the anxiety itself and then the feared situation.
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In cases when exposure to the feared situation is too anxiety-provoking or impractical, you can use…
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Systematic desensitization, virtual reality therapy
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Systematic Desensitization
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Beginning with a tiny reminder of the feared situation, keep increasing the exposure intensity as the person learns to tolerate the previous level.
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Virtual Reality Therapy
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This involves exposure to stimulation’s, such as flying or snakes.
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Aversive Conditioning
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Can associate a bad habit with a negative response. (ex. if someone is addicted to alcohol, you can put a drug in their drink that makes them feel nausea so that they then associate alcohol with nausea).
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Operant Conditioning
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The shaping of chosen behavior in response to the consequences of the behavior.
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Cognitive Therapy Theory
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Being depressed and/or anxious involves negative thoughts and interpretations. In the cognitive perspective, the cause of depression is not bad events, but our thoughts about those events.
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Cognitive Therapy (again)
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Helps people alter the negative thinking that worsens depression and anxiety. A therapist might suggest other thoughts that the clients could have about their lives, or at least point out when clients jump to conclusions that make them feel worse.
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Albert Ellis’s Rational-Emotive Behavior Therapy
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Depression is worsened by irrational beliefs, so challenge the irrational beliefs and assumptions. Operant conditioning: reward yourself for using better thoughts (help establish new thinking as a habit)
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Aaron Beck’s Cognitive Therapy for Depression
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Notice and correct cognitive distortions (ex. catastrophizing)
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Cognitive Behavioral Therapy (CBT)
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Works to change both cognition’s and behaviors that are part of a mental health disorder. Using this, people with OCD are led to resist the urge to act on their compulsions, as well as learn to manage obsessional thinking.
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Psychotherapies that work on Depression
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Cognitive-behavioral therapy and Psycho-dynamic Therapy
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Psychotherapies that work on Anxiety
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Cognitive-behavioral therapy, Psycho-dynamic therapy, and Exposure Therapy
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Psychotherapies that work on Phobias
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Exposure therapy and Behavior conditioning
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What effective therapies have in common:
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Hope, a new perspective, the relationship
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Hope
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Therapists assume the client has resources that can be used for recovery, and that improvement is possible
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A New Perspective
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New interpretations and narratives (from “victim” to “survivor”) can improve mood and motivate change
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The Relationship
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Empathy, trust, and caring provide an environment for healthy growth
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The difference between therapists
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Psychotherapist is not the same as psychologist. Psychologist (PhD, PsyD): does therapy plus intelligence and personality testing. Psychiatrists (MD, DO): prescribe medicine and sometimes do psychotherapy Social workers (MSW): as well as counselors, nurses, and other professionals may be trained and licensed to diagnose and treat mental health disorders
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Bio-medical Therapies
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Physically changing the brain’s functioning by altering its chemistry with medications, or affecting its circuitry with electrical or magnetic impulses or surgery
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Drug (Medication) Therapies
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Psychopharmachology: refers to the study of drug effects on behavior, mood, and the mind.
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Types of medications
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Antipsychotic, Antianxiety, Antidepressant, Mood Stabilizers, ADHD “Stimulants”
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Antipsychotic
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What it does: Reduces the symptoms of schizophrenia, especially “positive” symptoms such as hallucinations and delusions. How it works: Blocks dopamine receptors Side Effects: Obesity, diabetes, and movement problems (sluggishness, twitching, odd facial/tongue and body movements)
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Antianxiety
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What it does: Temporarily reduces worried thinking and physical agitation. Might permanently erase traumatic associations. How it works: Slowing nervous system activity in the body and brain Side Effects: Slowed thinking, reduced learning, dependence, and withdrawal.
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Antidepressant
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What it does: Improves mood and control over depressing and anxious thoughts. How it works: Increasing levels of serotonin (sometimes norepinephrine) at synapses by inhibiting re-uptake. Possible neurogenesis. Side Effects: Dry mouth constipation, and reduced sexual desire and/or response
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Inhibiting Reuptake
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Many medications increase synaptic neurotransmitter levels; they stop the sending neuron from taking back its chemical messages.
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Mood Stabilizers
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What it does: Reduces the “highs” of mania as well as reducing the depressive “lows” How it works: Under investigation Side Effects: various; blood levels must be monitored
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ADHD “Stimulants”
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What it does: Helps control impulses, reduce distractibility, and reduce the need for stimulation including fidgeting. How they work: blocking re-uptake of dopamine from synapses Side Effects: Decreased appetite
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Electroconvulsive Therapy (ECT)
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Induces a mild seizure that disrupts severe depression for some people. It might allow neural re-wiring and might boost neurogenesis.
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Repeated Transcranial Magnetic Stimulation (another option is repeated deep-brain stimulation using implanted electrodes)
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Like ECT these techniques may disrupt depressive electrochemical brain patterns.
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Psychosurgery
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Lobotomy, Microsurgery
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Lobotomy
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Destroys the connections between the frontal lobes and the rest of the brain. This decreases depression, but also destroys initiative, judgment, and cognition.
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Microsurgery
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Might work by disrupting problematic neural networks involved with aggression or obsessive-compulsive disorder.
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Therapeutic Lifestyle Change
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Exercise, changing negative thoughts, meeting our basic needs of sleep, nutrition, light, meaningful activity, and social connection.