Psychology CH 15: Therapy – Flashcards

-Supernatural forces were somehow responsible for abnormal behavior -Trephination (Stone Age & Middle Ages): an early treatment for an abnormality that involves the surgical removal of a circular section of bone from the skull. The holes allowed an exit for the evil spirits as well as excess "humors" (bile, phlegm, blood) -Reginald Scot (16th century): argued that women were not possessed, but suffered from a sickness that affected their judgment. Protestant Church banned his writings -Earliest approach to treatment of mental illness

people are more likely to engage in bizarre and erratic behavior when there is a full moon

-Psychological abnormalities are caused by illness or bodily dysfunction -India (600BC): abnormality was attributed to an imbalance among bodily fluids, an inappropriate diet, or faulty bodily activity -Ancient Greek: mental illness caused by physical disease -Asylums

-gained popularity in the 1700's -approaches to the care and treatment usually involved attempts to "fix" the body -electric shock, attempts to drain brain of excessive blood, hydrotherapy (very hot or cold baths), exposure to extreme heat -brain surgery (1900's): used to control unruly patients

-disorders are caused by problems in the mind, as opposed to the body -Mental disorders were due to the stresses of society and/or becoming separated from nature -emphasized placing the person in a serene and relaxing environment -Franz Anton Mesmer (Austria): (mesmerize) used hypnosis -Sigmund Freud: "talk therapy"

-increasing emphasis on using scientific evidence to guide approaches to treatment -Evidence-based Treatment (EBT): the use of therapies that have been shown to be effective in controlled, scientifically valid -Therapy: a person who is motivated to change his or her ways of thinking, feeling, or behaving works with a trained professional on specific goals

psychologists, psychiatrists, social workers, nurses

-Location and Cost: seek most qualified professional within your budget -Training and Experience: ask if they are comfortable dealing with your specific problem -Comfort Level

-Informed Consent: goal and nature of treatment discussed prior to therapy. explain risks and benefits. -Dignity and Respect: therapist should be sensitive to you gender, race, culture, sexual orientation, disability, and socioeconomic status -Sexual Relationships are Strictly Forbidden: consensual sexual relationships banned for a minimum of 2 years after therapy relationship has ended -Confidentiality:therapist must disclose information if you become a danger to yourself or others

-20% of adults in US live with a mental illness -39% of those received mental health services -5% of pop. (11 million) suffered from debilitating mental illness -61% received treatment -Costs are one of the main reasons people do not receive care -Most cities and counties have public health facilities that offer therapy for little or not cost for those that cannot afford -"sliding scale": therapist charges based on what their client is able to pay

-Psychologist (Ph.D., Psy.D., Ed.D.): receives advanced degree in area of psychology. Those licensed by state may engage in therapy with clients -Psychiatrist (M.D.): specialized training in psychiatry. Must be "board certified" and can provide evaluations and prescribe and monitor medications -Social Worker (M.S.W., D.S.W, Ph.D.): has advanced training and experience in either hospitals or outpatient settings. -Psychiatric Nurse (R.N., M.A., Ph.D.): Nursing degree, advanced training in the care of hospitalized patients with psychological disorders -Marriage and Family Therapist (M.S., Ph.D.): may have master's or doctoral degree specializing in interpersonal relationships -Alternative Medicine Practitioner: Acupuncture, herbal supplements, reflexology. Does not have training and qualification to treat severe psychological disorders. is not licensed and regulated -Clergy/Spiritual Leader: may provide counseling to individuals and families. May have degree in divinity or training in psychology. Not subjected to licensing and regulations. -Life Coach: hired to help individual reach personal professional goals. -Peer Counselor: nonprofessional. Little training and no degree or license in mental health -Prelicensed Professional: student or intern or trainee in process of meeting requirements to become a licensed practitioner. May treat clients under the supervision of a licensed therapist.

-Most common form of treatment -Psychotropic Drugs: medications that are capable of affecting the mind, emotions, and behaviors. Controls symptoms but does not cure -1950's: widespread use of drugs to treat psychological symptoms -Chlorpromazine (Thorazine 1950's): helped reduce psychotic symptoms in patients with schizophrenia and other severe problems

-Most Commonly administered as pills but can be given in liquid or injections. -3 most prescribed categories of drugs: antipsychotic, antidepressant, antianxiety

-Antipsychotic: Clozaril, Haldol, Risperdal, Thorazine, Vesprin, Abilify -Antianxiety : Klonopin, Librium, Valium, Xanax, Buspar, Ativan -Antidepressant: Celexa, Paxil, Prozac, Zoloft, Effexor, Wellbutrin

-Any group of drugs that are used to treat psychosis (loss of touch with reality) -Used to treat symptoms such as delusional thinking, hallucinations, or paranoia, and schizophrenia -Works by changing the balance of neurotransmitter chemicals in the synapses in the brain -Most interfere with the amount of dopamine (brain chemical associated with schizophrenia) -Early antipsychotics had unpleasant side effects such as abnormal muscle movements and tremors -Atypical Antipsychotics (1990's): was supposed to be more effecting in treating symptoms and produce fewer side effects.

-medications used to treat symptoms related to mood, particularly depression -work by balancing neurotransmitters in the brain, such as serotonin, norepinephrine, and dopamine. -May be used to treat bipolar disorder, anxiety disorders, or others -Mood stabilizers that bring emotional expression back into a normal range -Selective Serotonin Reuptake Inhibitors (SSRI's): most popular antidepressants. Prozac, Zoloft, Paxil, Effexor -Serotonin molecules that do not attach to receptors on the receiving neuron are normally reabsorbed back into the sending neuron (reuptake). SSRI's block the reabsorption process which causes more of the serotonin to remain in the synapses and is available to be passed between neurons -Side affects of SSRI's: mild, headaches, nausea, dry mouth

-Medications used to reduce fear, nervousness, and panic -Used to treat anxiety disorder, panic disorder, and phobias -Often physically addictive and may have severe side effects if abused -FDA has no approved any of these drugs for use in children under 18 -benzodiazepines (Valium, Ativan, Xanax) may cause serious withdrawal symptoms

-effectiveness of medications maybe influenced by factors such as age, sex, body chemistry, genetics, and lifestyle habits

"black box" warning label: the most serious kind of warning. For the use of antidepressants in children and young adults under the age of 24. Linked to increased risk of suicide -Some psychotropic drugs make people feel drowsy, leading to a greater number of falls, car crashes, and accidental overdoses -long-term side effects: endocrine, metabolic, sexual, and cognitive impairments

-can be both physically and psychologically addictive -antianxiety and antidepressants carry high risk for physical dependency

-patients often fail to keep taking their medications as prescribed. -reasons include: adverse side effects, perceived ineffectiveness, complexity of the regimen, cost -Symptoms such as confusion and paranoia intensify the problem -in schizophrenia, 40% of patients stop taking medications after 1st year; 75% after 2nd year

-Surgery performed on the brain with the intent of reducing the symptoms of psychological disorders -Earliest surgeries conducted in late 1880's by Swiss psychiatrist Gottlieb Buckhardt -Prefrontal Lobotomy: surgery that severs the connections between the frontal lobes and the lower centers of the brain. produced devastating side effects that led to permanent and physical and mental changed (lack of emotion, changes in personality, declines in intelligence, death) -Deep lesioning: pricise destruction of certain areas of the brain in an attempt to reduce severe symptoms of serious mental illness that do not respond to any other treatment. electrical curred used to target specific areas of limbic system. Used in mood, anxiety, depression, ocd

-cut portions of the cerebral cortex in 6 people with schizophrenia to make them easier to control -Medical community did not approve

-developed prefrontal lobotomy in 1935

-Stimulate areas of the brain in an effort to improve psychological symptoms -electroconvulsive therapies -transcranial magnetic stimulation

-intentionally causing a seizure by passing electrical current through the brain -some scientists suggested the seizure rebalances the hormones and chemicals in the brain -viewed negatively by the public -quick (about 30 sec) and relatively painless -downside: slight risk of confusion and memory loss -not always permanent -most effective, last-resort treatment for severe depression -used by apx. 10,000 Americans each year

-electrical stimulation of areas of the brain thought to be involved in the regulation of mood -electromagnetic coil placed externally on the scalp that creates magnetic field that disrupts brain activity -about 30 minutes -painless -can reduce auditory hallucinations in those with schizophrenia -help depression

-an approach to addressing mental or emotional concerns by interacting with a psychologist or other mental health provider -aim to change the psychological processing of the mind -"talk therapies"

-Gaining insight into your unconscious conflicts is critical to resolving psychological problems

-Method of therapy in which the therapist explores repressed or unconscious impulses, anxieties, and internal conflicts -Developed by Sigmund Freud in the late 1890's -Freud: "hidden conflicts and unfulfilled wishes from childhood are the driving forces behind emotional problems" -Goal: help bring unconscious desires, conflicts, and repressed feelings and memories to the client's awareness -Psychoanalyst: offer interpretations of the client's unconscious workings, when the client is "ready" to accept the information without shutting down and building up defenses -Techniques: free association, dream interpretation, transference -Criticized as pseudoscientific and highly subjective

-method of investigating the unconscious in which the client expresses a spontaneous outpouring of ideas without any censorship -open-ended "stream of consciousness" -therapist reads a word and client says first thing that pops in their head

-Process of assigning meaning to dreams

-The unconscious assignment to others of feelings and attitudes that were originally associated with important figures in one's early life -Therapist replays key relationships

-shorter (between 10 and 25 sessions) -usually improvement within first 3 months -effective for treatment of depression and post-traumatic stress disorder -Use more direct questions -More focus on current relationships and problems instead of childhood experiences -first few sessions used to identify one major focus and goal for therapy -Restricts their interpretive work to the central issue

-all humans are born with a natural motivation to reach their full potential -You have ultimate control over your behavior and that your choices dictate your life's course -Psychological problems can develop when people aren't reaching their potential or don't live up to the view they have of themselves -Humanistic therapists help people find meaning, self-acceptance, and personal growth -Client-Centered Therapy and Gestalt Therapy

-nondirective form of psychotherapy in which the goal of the therapist is to help the client achieve personal growth by becoming aware of his or her feelings and behavior -Carl Rogers 1950's -responsibility for treatment should be placed on the client -Therapist role: help clients help themselves by asking questions and providing positive and supportive environment -Therapist's attitude was the most important factor

1) Congruence: openness and genuineness on the part of the therapist is critical 2) Unconditional Positive Regard: no judgment, criticism, or disapproval 3) Empathy: good listening skills

-focuses on the client's experience in the present moment and in pulling aspects of personality into a unified whole -Process more important that content -whole is greater than the sum of its parts -Fritz Perls and colleagues (1951): designed a set of therapy principles -therapists may confront or challenge clients -Stop in the middle of talking and take note of body language, tone of voice, gesturing, breathing, or feelings -focus on "here and now" and accept themselves for "how they are at the moment" instead of focusing on "how they want to be"

-take basic principles of learning (classical conditioning and operant conditioning) and apply them to changing unwanted behaviors -focus on altering current behavior patterns through changes in environmental outcomes -effective in treating: depression, anxiety, eating disorders, chronic pain disorders -behavior therapies: exposure, aversion, operant therapies

-Treat: anxiety disorders, especially phobias and PTSD -Therapies: flooding, systematic desensitization, imaginal, direct exposure -direct confrontation with frightening stimuli in order to reduce anxiety

-client is flooded with experiences of a particular kind until his or her anxiety is reduced

-client is exposed to threatening situation under relaxed conditions until the anxiety reaction is extinguished -Joseph Wolpe (1974) -Usually just visualization not actual object -3-step process

1) Relaxation Training: how to relax body. deep breathing, muscle relaxation, imagery 2) Anxiety Hierarchy: ranking of a class of situations from least to most anxiety-producing, which may then be used as a basis for Systematic Desensitization 3) Gradual Exposure: clients exposed to lowest step on the hierarchy

-client is exposed to a stimulus by simultaneously being subjected to some form of discomfort -pair unwanted behavior with something aversive or uncomfortable -Aversive stimuli:nausea, offensive smells, startling sounds, electric shocks, unpleasant thoughts -was used to try to change sexual orientation -used mot commonly to treat sexual deviance and substance abuse -used to treat drug and alcohol addictions since early 1930's -pharmacological aversion: takes a drug (antabuse) that, when combined with alcohol, causes severe nausea and vomiting

-based on principles of operant conditioning -First conducted in 1953 by B.F. Skinner: used to change behavior of school children -Contingency management programs: rewards and punishments "contingent" (depend upon) the client's behavior -Token economy:individual reinforcement of target behaviors in which tokens are administered and exchanged later for reinforcers -behavior contract:written agreement that outlines roles, responsibilities, rules, behaviors, and consequences

-focus on the role of a person's thoughts and beliefs in their behaviors -combine techniques of changing thought patterns with specific techniques designed to change behavior patterns that may accompany the dysfunctional thought -Gaol: help clients change irrational thoughts to rational thoughts

-client's irrational and dysfunctional thoughts are challenged by the therapist -developed by Albert Ellis -Goal: client should challenge their irrational and dysfunctional thoughts and feelings and replace them with healthier ones - Controversial at first because it required therapists to be brutally honest with clients -"tough-minded therapy for a tender-minded profession"

How activating events: A) activating events B) lead to beliefs about the event C) ultimately emotional or behavioral consequences

1) Whether you are disturbed by an event is a personal choice. You choose either rational or irrational beliefs when something bad happens 2) Although life events may strongly affect you, it's not the event itself that disturbs you, but how you think about or respond to the event that causes distress 3) Changing your irrational and dysfunctional emotions and beliefs is possible with persistence and hard work

-Aaron Beck 1976: depressed people in particular are likely to have automatic thoughts that are pessimistic and upsetting -clients encouraged to examine their own habitual beliefs and complete assignments or gather real-world evidence that refutes these beliefs -3 basic questions 1)what is your evidence to support this conclusion? 2) Can you think of another way of looking at the same situation? 3) What will happen if your conclusion is correct?

-started after World War II because of shortage of therapists -Benefits: 1) Cost: less expensive 2) Social Support 3) Social Skills Training -helps: depression, sexual abuse, eating disorders, post-traumatic stress disorder

- more concerned about what goes on between people than what is happening inside of an individual -systems approaches: reflects idea that most people are part of a complex interrelated system of family relationships that contribute to and maintain unhealthy behaviors -psychoeducation: teaches people relationship skills and provides families with the skills they need to create smoother family interaction -advantage: everyone benefits

-therapist may not be present -groups of people who meet to work through shared problems and goals -help: grief, eating disorders, substance abuse -more people seek out self-help groups than all other visits to mental health professionals combined -Alcoholics Anonymous (AA): 80% of people with alcohol dependence. 12 step approach. least helpful than other types of treatments

-Primary prevention: programs designed to stop disorders by eliminating the potential causes of the disorders (unemployment, racism, sexism, violence, poverty) -Secondary Prevention: aimed at reducing the severity of a problem once it already exists -World Health Organization (2004): "more effective than traditional treatments" -between 59%-82% higher benefit

-self-help books, internet therapy, herbal supplement, expressive therapeutic techniques

-self-help books -95% have no basis in scientific research -may promise quick fixes and unrealistic results, filling reader with false hope -bibliotherapy: refers to a therapist's selection of reading material for a client that has relevance to that person's life situation -80% of psychotherapists recommend self-help books

-problems: lack of research evidence, potential misuse and abuse, ethical issues -telecounseling, e-therapy, media counseling

-use of telephone communication to provide mental health education and services across a distance -Advantages: low cost, convenient, efficient, accessible to housebound people, long distance couples -Disadvantage: discomfort with technology, technical problems, greater difficulty developing relationships between, ethical issues

-internet and/or computer-based therapies -80% of people with access to the Web has used it at some point -FearFighter:computer program

-psychologists on the radio or tv offering advice to a guest -Advice affects the individual asking for help as well as thousands that are listening -Disadvantages: ethical costs, qualifications may be lacking -American Psychological Association guidelines: 1) advice should be based on professional training, experience, and research evidence 2) therapist should adhere to same ethical codes as they would when conducting individual therapy

-medical practices and products that are currently not part of conventional medicine -not covered in medical school -yoga, massage, herbal supplements, acupuncture, reflexology, homeopathy -help: anxiety and depression -not a lot of scientific evidence -can have dangerous drug interactions with psychotropic drugs -CAM providers do not have necessary training and qualifications to work with individuals who have severe psychological disorders

-Spontaneous Remission: the disappearance of symptoms of a mentally ill person without formal treatment -Efficacy Studies and Efficiency Studies

-Efficacy Study: method of measuring therapy effectiveness that uses a well-controlled treatment protocol and control groups -advantage: it is possible to see whether a specific treatment does indeed lead to a reduction in psychological symptoms -American Psychological Association (1998): published list of empirically validated treatments based on a comprehensive review of thousands of research studies. studies had to be well designed and demonstrate that the therapy treatment was significantly superior to a placebo -criticism: efficacy studies focus on disorder-specific processes and treatments rather than commonalities that exist across disorders. efficacy studies may not tell us as much about the effectiveness of therapy out in the field

-studies that attempt to evaluate the effectiveness of therapy under actual conditions in real-world settings -Consumer Reports 1995: used several different measures of effectiveness, including improvement of specific symptoms, improvement of overall emotional state, and satisfaction with the therapist's treatment. Showed that adding medication to psychotherapy did not result in any more improvement than psychotherapy alone -"dodo bird" effect: all therapies produce roughly the same results

-a high state of rapport between therapist and client, where they work together in a positive and productive way -feelings and empathy and the ability to work together are most effective elements

-Motivation and commitment of the client is important

-therapists should be able to adjust their techniques based on the qualities and need of the client -eclectic approach: combining and integrating various techniques as needed

-Cultural competence: ability to understand, appreciate, and interact with persons from cultures and/or belief systems other than one's own -Cultural Formulation Model: a method for gathering information when working with a new client. expansion of the cultural guidelines presented in DSM-5. helps therapists evaluate and assess a client's cultural identity, understand the symptoms, create optimal relationships