Abnormal Psychology - PowerPoint by 5S4I2Xg5

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									Treatments
       History of Treatments
• Early treatments brutal
  transitioned to more
  humane methods
• Dorothea Dix – 1st to
  transition to gentler
  treatments in U.S.
• Today - Biomedical Drugs
  and better therapy has led
  deinstitutionalization.
        Categories of Therapy
2 Main Categories
1. Psychotherapy – interaction between
   therapist and patient
  –   Phobias
2. Biomedical – prescription meds that act
   on central nervous system
  –   Schizophrenia
Eclectic Approach– uses a variety of psych
   theories and approaches
   Example: combining medication (anti-depressants) with
   different types of psychotherapy such as Cognitive
   Therapy (change feelings of self-blame) and Behavioral
   (go out and run when feeling depressed)to treat
   depression
         Perspectives and Disorders
   Psychological          Cause of the Disorder                   Treatments
 School/Perspective
Psychoanalytic/Psychody   Internal, unconscious        Psychoanalytic
         namic            drives and conflicts         Psychodynamic
      Humanistic          Failure to strive to one’s   Insight Therapy
                          potential or being out of    Client Centered Therapy
                          touch with one’s feelings.

      Behavioral          Reinforcement history, the   Behavioral Therapies
                          environment.                 Classical – counterconditioning,
                                                       exposure therapy, flooding,
                                                       systematic desensitization, virtual
                                                       reality, aversive
                                                       Operant – behavior modification,
                                                       Token economy
       Cognitive          Irrational, dysfunctional    Cognitive Therapy
                          thoughts or ways of
                          thinking.
     Sociocultural        Dysfunctional Society        Group or Family Therapy

Biomedical/Neuroscience Organic problems,              Biomedical Drug Therapy
                        biochemical imbalances,
                        genetic predispositions.
        Insight Therapies
• Insight therapies – try to improve
  mental state by increasing client’s
  awareness of underlying motives and
  defenses
1. Psychoanalytic Therapy
2. Psychodynamic Therapy
3. Humanistic Therapy
       Psychoanalytic Therapy
• Psychoanalysis – uncovering
  childhood experiences to gain
  insight into the unconscious
  origins of the disorder
  – dream analysis – manifest and
    latent
  – free association – uncensored
    reporting of any thoughts that come
    to mind.
     • Resistance - blocking from
       consciousness anxiety-laden material
       during therapy.
         – Example: patient stutters when
           recalling sensitive information
Psychoanalytic Therapy
             – Transferring -
               expression toward a
               therapist of feelings
               linked with earlier
               relationships
                • Example: Hatred
                  toward mother is
                  expressed as hatred
                  toward therapist
     Psychoanalytic Therapy
• Criticisms
  – Interpretations can’t
    be proven or
    disproven
  – Costly and time
    consuming (2 or more
    sessions/week for 2
    or more years)
       Psychodynamic Therapy
• Psychodynamic therapy - try to
  understand patients' current
  symptoms by focusing on recurring
  patterns in their interpersonal
  relationships
   – Patients gain insight into unconscious
     conflicts
   – Face to face, once per week, several
     months
• Interpersonal psychotherapy -
  effective in treating depression by
  helping patients improve their
  interpersonal skills
   – variation of psychodynamic therapy
   – 14-16 sessions
   – Example: helping a depressed patient
     resolve conflicts with friends
            Humanistic Therapy
• Humanistic Therapy - emphasize the
  importance of self-awareness and
  take responsibility for own feelings
  and actions to improve mental state
   – seek to promote personal growth and
     self-fulfillment.
• Client-Centered Therapy (Rogers) -
  patients' discover their own ways of
  effectively dealing with difficulties
   – non-directive therapies – therapist
     listens without judging or giving insight
   – Genuineness, acceptance and empathy
   – Unconditional Positive Regard
   – Active listening – echoing, restating and
     seeking clarification of clients feelings
• Geraldo, a high school senior, is so fearful of asking
  a girl out that he hasn't had a date in over three
  years. He has recently contacted a psychotherapist
  for help in overcoming his fear. Describe how a
  humanistic therapist and a psychoanalyst would
  treat Geraldo's problem.
• A humanistic psychologist would focus on the
  present rather than the past (e.g., what Geraldo can
  do now to get up the nerve to ask for a date rather
  than what he failed to do in the past), conscious
  thoughts (e.g., what Geraldo thinks about dating and
  how he would approach a woman for a date), taking
  responsibility for his actions (e.g., what he can
  control in asking a woman out on a date rather than
  what he can't control). In contrast, a psychoanalyst
  would focus on what unconscious impulses or
  conflicts are causing Geraldo's fear—Does Geraldo
  have unconscious feelings of anxiety about his
  mother that he is transferring to other women?
Behavioral Therapies
       Behavior Therapies – applies
         learning principles to
         unwanted behaviors
       • Classical Conditioning
         – Maladaptive symptoms are
           conditioned responses
       • Operant Conditioning
         – Maladaptive symptoms are
           reinforced
           Behavioral Therapy

• Classical Conditioning
  – Counterconditioning (Pavlov)-
    procedure that trains people to
    make new responses to stimuli
    that currently trigger unwanted
    responses
  – 2 Types
     1.   Exposure Therapies
          – Flooding
          – Systematic Desensitization
          – Virtual Reality Exposure Therapy
     2. Aversive Conditioning
           Exposure Therapies
• Exposure Therapies - Repeatedly introducing
  people to things they fear and avoid
  1. Flooding – forced exposure to the stimulus that
     is feared
    •   Example: Putting a Susan who has Arachnophobia in a room full of
        spiders to show that they have no reason to fear them

  2. Systematic Desensitization – gradual exposure to
     the actual stimulus by replacing a positive
     response with a negative response.
    •   Progressive relaxation – imagined scene is repeatedly
        paired with relaxation and progresses to eventually
        facing the worst fear
    •   Example: Therapist first asks Susan to relax and imagine a
        harmless spider climbing up the wall eventually she will face a
        room full of tarantula spiders, her greatest fear
          Exposure Therapies
3. Virtual Reality
   Therapy –
   progressively
   exposing people to
   simulations of their
   greatest fears
  –   Example: exposing
      Susan to Spiders using a
      3 dimensional virtual
      world with life-like
      spiders
  –   Fear of flying
          Aversion Therapy
• Aversion Therapy – unwanted
  behavior systematically
  associated with unpleasant
  experiences
  – Examples: consuming alcohol
    with a nausea producing drug
  – Gambling and shock treatments
• Problem: cognition influences
  conditioning
        Operant Conditioning

1. Behavior Modification - reinforcing
   desired behaviors, giving punishments
   for undesired behaviors
  –   Example: Punishing aggressive behaviors
      of children with autism
2. Token Economy – earning a token for
   desired behavior that can be traded
   in for privileges
  –   Example: Given tokens to ADHD students
      for staying in their seats and allowing
      them to trade them in for a prize
• Describe how a therapist might apply operant
  conditioning techniques to help Rosemary overcome
  a compulsive habit of eating too much junk food. Be
  clear about the exact procedures that would be
  used.
• A therapist might use behavior modification to
  change eating behaviors. The particular technique
  could involve either reinforcing the desired
  behavior (e.g.. encouraging Rosemary to treat
  herself to a favorite, healthy food [such as an
  energy drink] if she doesn't eat any chips or candy
  during the day) or punishing an undesirable
  behavior (e.g., having to put $5 in a jar each time
  she has a piece of candy).
               Cognitive Therapy
• Cognitive Therapy – change the way
  patient thinks (change schemas)
  – Irrational, Self-blaming, over-
    generalized thoughts, negative
    interpretations
  – Anxiety Disorders, Major Depressive
    Disorder, Suicide
  – Example: Dan thinks he can’t get an A in
    AP Psych because he’s incompetent
• Beck’s Therapy for Depression
• Stress Inoculation Training
  – Changes thinking in stressful events
 Cognitive-Behavioral Therapy
• Cognitive Behavioral -
  Changes the way we think
  and act
  – Example: When Olivia is
    anxious, her therapist
    teaches her to attribute her
    arousal to a highly reactive
    sympathetic nervous system
    and to play Temple Run on
    her phone instead.
• One of your best friends feels that he fails at
  everything he does and that his life isn't worth
  living. When you suggest that he talk to a
  psychotherapist, your friend responds, “Talking
  won't help. The more I talk about myself, the more I
  think about my problems. The more I think about
  my problems, the more depressed I get.” What
  procedures would a cognitive therapist use to help
  your friend overcome his negative feelings?
• A cognitive therapist would directly address the way
  your friend is thinking about life and depression. A
  cognitive therapist believes that the emotional
  reaction (depression) is produced by your friend's
  thinking about life events, and so would work with
  the client to change the ways he thinks about life
  events.
Family and Group Therapy
         • Group Therapy
           – Offered for: family
             conflict, stressful
             relationships, patients with
             similar problems
           – Improves communication
             skills and conflict resolution
              • Examples: obesity (OA),
                alcoholism (AA)


           – Family Therapy – unwanted
             behaviors are influenced by
             other family members
              Example: rebellious child
     Evaluating Psychotherapy
• Placebo effect – the beneficial
  consequences of merely expecting
  that a treatment will be effective.
• Regression toward the mean – the
  tendency for unusual events or
  emotion to return to their ave. state .
• Selective Justification –
  overestimating the actual benefits
  (both patients and therapists)
• Eysenck and Eysenck – no more
  beneficial than no treatment at all
    Evaluating Psychotherapy
• Randomized Clinical Trials –
  compare treatment groups with
  control groups
• Meta-analysis – a procedure for
  statistically combining the results
  of many different studies.
• Bottom line – Those not
  undergoing therapy often improve,
  but those undergoing therapy are
  more likely to improve
   Comparison of Psychotherapies




Evidence Based Practices - Clinical decision making that integrates the
best available research with clinical expertise and an understanding of
patient characteristics

**Scientifically Unsupported Therapies - Energy Therapy, Recovered-memory
Therapy, Rebirthing Therapies, Facilitated Communication, Crisis Debriefing
          Alternative Therapies
• EMDR (Eye Movement Desensitization
  and Reprocessing - Rapidly moving one's
  eyes while recalling traumatic
  experiences
   – similar to exposure treatment
   – Originally developed for anxiety
   – Value in placebo effect and exposure
     therapy
• Light Exposure Therapy – exposure to
  intense light that mimics outdoor light
   – activity in the brain region responsible for
     arousal
   – Seasonal Affective Disorder – depression
     caused by lack of exposure to natural light
           Biomedical Therapy

Biomedical Therapy – drugs, or
  treatments that act on the brain’s
  central nervous system
   – Examples:
   – Drugs, electroconvulsive
     therapy,
   – Magnetic impulses
   – Psychosurgery
          Biomedical Therapy
Psychopharmacology – study of
  the effects of drugs on the
  mind and behavior
   – Antipsychotics
     (thorazine,Chlorpromazine,
     Clozapine)
   – Anti-anxiety ( Xanax,
     Ativan d-cycloserine)
   – Anti-depressants (Paxil,
     Prozac, Zoloft – SSRI’s)
   – Mood Stabilizers Bipolar
     (lithium, Depakote)
                Anti-Psychotics
• Anti-Psychotic Drugs – drugs used to
  treat schizophrenia that block
  receptor sites for dopamine
   – Thorazine & Chlorpromazine – dampen
     responsiveness to irrelevant stimuli in
     schizophrenia patients with positive
     symptoms –hallucinations and paranoia
      • Tardive dyskinesia -Sluggishness,
        tremors, twitches, involuntary
        movements of face, tongue, limbs from
        long-term use
• Atypical antipsychotics
   – Block both dopamine and serotonin
     receptors
   – Clozapine –used to treat negative
     symptoms –apathy and withdrawal
         Anti-Anxiety Drugs
• Anti-anxiety drugs – depress
  central nervous system activity
  – Xanax & Ativan
  – D-cycloserine – acts on receptor
    site that extinguishes learned
    fear –helps with PTSD and OCD
  – Addictive
     • Withdrawal symptoms – increased
       anxiety and insomnia
          Anti-Depressants
• Anti-depressants – used to
  treat depression & anxiety by
  increasing the availability of
  serotonin and norepinephrine
  that elevate arousal and mood
  – Paxil, Prozac, Zoloft (SSRIs) –
    blocks serotonin reuptake
  – Dual Action Drugs – block both
    the reuptake of serotonin and
    norepinephrine
  – Delay in increased serotonin due
    to neurogenesis
  Alternatives for Depression
• Cognitive-Therapy +
  antidepressants
  – Cognitive therapy top down
  – Antidepressant bottoms-up
    – works on limbic system
• Mood Stabilizing Drugs
  – Lithium – simple salt used to
    treat Bipolar disorder
  – Depakote – epilepsy drug
    used to treat mania
• Exercise
                  Brain Stimulation
• 3 Types Used to Treat
  Depression
  1.   ECT (Electroconvulsive therapy) –
       electric shock therapy for patients
       with sever depression
       1.   Can trigger seizures and memory loss
  2. rTMS (repetitive transcranial
     magnetic stimulation)- repeated
     pulses of magnetic energy to brain’s
     surface
       1.   No seizures or memory loss
       2.   Triggers long-term potentiation of
            inactive left frontal lobe nerve cells.
  3. Deep Brain Stimulation – uses
     implanted electrodes to inhibit
     activity in an area of the cortex
     that triggers negative emotions
               Psychosurgery
• Psychosurgery – removes
  or destroys brain tissue
  – Lobotomy - cut the nerves
    connecting the frontal lobes
    to the emotion controlling
    centers of inner-brain
     • Once used to calm severely
       emotional or violent patients
  – MRI-guided precision
    surgery – cut brain circuits
    of severe OCD
     Preventing Psychological
           Disorders
• Therapeutic Lifestyle Change
  – reverses the symptoms of
  psychological disorders
  – Aerobic exercise, adequate
    sleep, light exposure, and social
    engagement, anti-rumination,
    nutrition
  – Resilience – ability to cope with
    stress and recover from
    adversity

								
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