Behavior Therapy

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Chapter 17: Treatment
of Psychological
Disorders
Basic Features of Treatment
•A patient seeking relief from a problem
•A person who is socially accepted as one
who can help the patient because of training
or experience
•A special social relationship between the
patient (client) and therapist, which helps
ease the client’s problems
•A theoretical explanation of those problems
•A set of procedures for dealing with the
problems
Psychodynamic Psychotherapy
The goal of psychoanalysis is to
uncover unconscious conflicts and
analyze how these conflicts affect the
client. The client is then helped to
“work through” these unconscious
conflicts. Psychoanalysis may take as
many as 3 to 5 session per week for
several years.
Psychodynamic Psychotherapy
• Techniques
– Free Association:
patients recline and say whatever
thoughts, memories or images that come
to mind
Psychodynamic Psychotherapy
• Techniques
– Dream Interpretation:
Freud would analyze the manifest content
of the dream in hopes of uncovering the
latent content which reflects the clients
wishes, impulses, and fantasies.
Psychodynamic Psychotherapy
• Techniques
– Transference
Reflects a strong feeling a patient develops toward the
analyst, which likely occurs as a result of an increased
sense of intimacy following the client’s self-disclosure,
and the analyst’s listening and caring. Feelings
involved in transference can be either positive (sexual
attraction) or negative (contempt). Oftentimes a
person will transfer his/her emotional and feeling for a
significant other onto the analyst. The psychoanalytic
view of transference is that it reflects unresolved
conflicts from the past. The psychoanalysts will then
help the client work through these feelings.
Psychodynamic Psychotherapy
• Analyzing/Overcoming Resistance
At times, a patient may put up
resistance (barriers) in therapy. He may
edit his thoughts, come late for
sessions, etc. The analysts will want to
explore these resistances and make the
client aware of them
Psychodynamic Psychotherapy
• Criticism of Psychodynamic Therapy
Psychoanalysis is slow and expensive.
It is hard to prove the interpretations. If
one doesn’t agree with the interpretation
then that person may be accused of
denial or putting up resistance.
Humanistic Psychotherapy
(Phenomenological)
• Focuses on:
– The present rather than the past
– Awareness of feelings as they occur rather
than achieving insights into childhood
origins of the feelings. Under these
conditions the clients will improve on their
own
– Conscious rather than unconscious
materials
– Promoting growth and fulfillment instead of
curing illness
Humanistic Psychotherapy
(Phenomenological)
• Client-Centered Therapy
This is the most widely used of all humanistic
techniques. It was developed by Carl Rogers. Rogers
believes that the responsibility of the therapy rests with
the client. He believes that the client’s self-perceptions
are more important than the therapist’s interpretations.
Rogers believes that the therapist must provide
unconditional positive regard and empathy. A rogerian
technique is active listening
Humanistic Psychotherapy
(Phenomenological)
• Client-Centered Therapy
– Unconditional Positive Regard
A nonjudgmental attitude
of total acceptance on the
part of the therapist that is
fundamental to clientcentered therapy. It consists
of nothing more nor less than
treating the client as a valued
person, no matter what.
Humanistic Psychotherapy
(Phenomenological)
• Client-Centered Therapy
– Empathy
the emotional understanding of what the
client might be thinking and feeling
• Reflection of Feelings: a paraphrased
summary of the client’s words and especially
the feelings and meanings that appear to
accompany them.
Humanistic Psychotherapy
(Phenomenological)
• Client-Centered Therapy
– Congruence (genuineness)
refers to a consistency between the
way the therapist feels and the way
they act toward clients
Humanistic Psychotherapy
(Phenomenological)
• Gestalt Therapy:
This was founded by Fritz Perls in 1969.
Gestalt therapy emphasizes the total
integration of physical and mental processes.
Gestalt Therapy acknowledges the
importance of early life experiences but the
treatment focuses on the here and now. The
Gestalt Model, like the client-centered model,
places the responsibility for change on the
individual. Techniques that are used include
reenactment of dreams, role playing, etc.
Behavior Therapy
• Behavior Therapies apply well-established
learning principles to eliminate the unwanted
behavior. The Behavior Therapies make two
basic assumptions:
– Self-awareness is not the key to solving problem
behavior. They assume that the problem
behaviors are the problem
– Problem thinking and maladaptive behaviors can
be replaced with more constructive ways of
thinking and acting
Behavior Therapy
• Behavior Therapy
– Treatments that use classical conditioning
principles
• Behavior Modification
– Treatments that use operant conditioning
principles
• Cognitive-Behavior Therapy
– Treatments that focus on changing thinking
patterns as well as overt behavior
Behavior Therapy
• Techniques for Modifying Behavior
– Systematic Desensitization:
This works on the principles that two
incompatible behaviors cannot exist at the
same time. Therefore we cannot be
anxious and at the same time
relaxed.
Behavior Therapy
• Techniques for Modifying Behavior
– Systematic Desensitization:
Step 1: Teach client relaxation techniques
Step 2: Make a hierarchy of feared events
Step 3: Present the client with the hierarchy of
feared events.
Step 4: If these events produce anxiety, the client
engages in relaxation techniques until he
no longer experiences anxiety.
Behavior Therapy
• Techniques for Modifying Behavior
– Modeling:
In modeling, the client watches
other people perform
desired behaviors
Behavior Therapy
• Techniques for Modifying Behavior
– Positive Reinforcement
A therapist uses positive reinforcement to
alter problematic behaviors. The receipt of
rewards or tokens is dependent upon a
client’s display of desirable behaviors.
• Token economy: a form of behavior therapy in
which a behavior is rewarded with tokens or
points that my be exchanged for tangible
rewards
Behavior Therapy
• Techniques for Modifying Behavior
– Extinction
This technique makes undesirable behaviors
less likely by removing the reinforcement that
generally follows that behavior. Extinction
changes behavior rather slowly but it is an
effective way to gently eliminate undesirable
behavior
• Flooding: involves keeping a person in a feared,
but harmless situation. Once deprived of his
normally rewarding escape pattern, the client has
no reason for continued anxiety
Behavior Therapy
• Techniques for Modifying Behavior
– Aversive Conditioning
This is the opposite of systematic
desensitization. Whereas systematic
desensitization substitutes a + response for a
- response, aversive therapy substitutes a
- response (aversive) for a positive one.
Because it is unpleasant and uncomfortable,
and its effect are often temporary, many
therapist avoid it or use it only long enough
for the client to learn alternative behaviors
Behavior Therapy
• Techniques for Modifying Behavior
– Punishment
An operant conditioning technique that can
be used to eliminate a dangerous or
disruptive behavior (ex= mild electrical
shock following an undesirable behavior).
Punishment is used only when all other
methods have failed, and ethical guidelines
have been considered
Behavior Therapy
• Cognitive-Behavior Therapy
Assumes that the way we think
influences our feelings. If thinking
patterns are learned then they can be
replaced with more
positive and
constructive thinking
patterns
Behavior Therapy
• Cognitive-Behavior Therapy
– Rational-Emotive Therapy and Cognitive
Restructuring (Albert Ellis)
Makes the assumption that many problems arise
from irrational thinking. It is a confrontational
therapy developed by Albert Ellis. It vigorously
challenges people’s illogical, self-defeating
attitudes and assumptions by revealing the
absurdity of this thinking
ABC’s of Rational Emotive
Behavior Therapy (REBT)
A. (Activating situation) I tried to do something and failed
B. (irrational Belief I have about A) I must always be
successful
C. (Consequences of believing B) I feel bad, depressed,
etc.
D. (Dispute the Irrational Belief in B) Where is it written in
stone that I must I always be successful?
E. (Effective new thinking to replace B) I would prefer
always to be successful but let's be realistic- that isn't very
likely, is it- I am human and humans are fallible, therefore
do not succeed in everything they attempt. If success is
important, then I will work harder recognizing that failure
may occur again.
Behavior Therapy
• Cognitive-Behavior Therapy
– Beck’s Cognitive Therapy
Similar to Rational Emotive Therapy (except it
is less confrontational) it tries to treat patients
by reversing client’s catastrophizing beliefs,
errors in logic, and false beliefs such as “I
can’t do anything right,” or by thoughts that
minimize the value of one’s accomplishments
such as “Anyone could do that” Beck
believes that this type of thinking leads to low
self-esteem, depression, and anxiety
Group, Family and Couples
Therapy
• You know
Evaluating Psychotherapy
• Is Psychotherapy Effective?
– It doesn’t hurt
– It’s better than nothing
• What Therapeutic Methods are Better
– Behavior Therapy is better for treating phobias,
compulsions, or sexual dysfunctions
– Cognitive Therapy is most successful for treating
depression
However…overall no one therapeutic method is
better than any other
Biological Treatments
• Biological treatments for psychological
disorders have been in existence since the
time of Hippocrates. Methods used in the
sixteenth through eighteenth centuries
include laxative purges, bleeding of “excess”
blood, induced vomiting, cold baths, hunger,
and other physical discomforts, all of which
were designed to shock the patient back to
normality
Biological Treatments
• Electroconvulsive Therapy (ECT)
– A controversial therapy that was introduced
in 1938. The patient receives a general
anesthetic and a muscle relaxant to
prevent injury from convulsions. The
patient’s brain is electrically shocked for a
fraction of a second. Within 30 minutes the
patient awakens and remembers nothing of
the treatment or the preceeding hours.
ECT is used primarily to treat severe
depression in patients who don’t respond
to psychoactive drugs and are at a risk for
suicide. Why ECT works is unclear
Biological Treatments
• Psychosurgery
– Surgery that removes or destroys brain
tissue in order to change behavior. Since it
is irreversible, it is the most drastic and
least-used biomedical treatment.
– Today, psychosurgery (including prefrontal
lobotomies) is used only as a last resort
and involves the destruction of only a tiny
amount of brain tissue
Biological Treatments
• Drug Therapies
– Psychopharmacology: the study of drug
effects on mind and behavior
– Neuroleptics
– Antidepressants
– Lithium and Anticonvulsants
– Anxiolytics
Biological Treatments
• Drug Therapies
– Neuroleptics (Antipsychotics)
• Chlorpromazine (Thorazine) block dopamine
receptors. They are good at reducing positive
symptoms. But patients exhibiting negative
symptoms often do not respond well to
antipsychotics. They may also cause
unpleasant side effects such as muscle rigidity,
restlessness, tremors, slowed movements etc.
(Parkinson type symptoms) and tardive
dyskinesia (involuntary movements of the
facial muscles, tongue, and limbs)
Biological Treatments
• Drug Therapies
– Antidepressants
• They work by increasing the availability of
serotonin and norepinphrine.
• Examples: Prozac, Zoloft, Paxil (called
selective-serotonin-reuptake-inhibitors SSRIs)
Biological Treatments
• Drug Therapies
– Lithium and Anticonvulsants (MoodStabilizing Medications)
• Lithium can be effective for treating bipolar
disorder
• 7 in 10 people with bipolar disorder benefit from
a long-term daily dose of lithium
• Depakote (a drug originally used to treat
epilepsy) has been found effective in controlling
manic episodes associated with bipolar
disorder
Biological Treatments
• Drug Therapies
– Antianxiety Drugs (Anxiolytics)
• Depress central nervsous system activity
• Examples: Xanax, Ativan, Valium
• Disadvantages: may cause physiological
dependency, can’t be used with alcohol,
• May cause withdrawal symptoms when
discontinued
Drug Therapies
• Evaluating Psychoactive Drug
Treatments
– Drugs may cover up the problem without
permanently curing it
– Drugs carry the potential for abuse, resulting in
physical or psychological dependence
– Drugs may have undesirable side effects
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