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Treatment of Abnormal Behavior, Myers

Modules 70-73
Module 70 Introduction to Therapy, and Psychodynamic and Humanistic Therapies

Module 71 Behavior, Cognitive, and Group Therapies

Module 72 Evaluating Psychotherapies and Prevention Strategies

Module 73 Biomedical Therapies

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AP Outline Says:

“Treatment of Psychological Disorders”

Treatment Approaches
Insight Therapies

Psychodynamic Approaches
Behavioral Approaches
Cognitive Approaches
Eclectic Approach
Modes of Therapy – individual, group
Community and Preventative Approaches

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Main Areas

Psychodynamic Psychotherapy
Humanistic Therapy (Rogers/Maslow)

Client Centered Therapy
Gestalt Therapy

Behavior Therapy

Cognitive Behavior Therapy

Group Family Couples
Biological Treatments

Psycho Surgery
Electro Convulsive Therapy
Psychoactive Drugs

Three main categories:

Psychotherapy

Talk Therapies:
Counselling (not bio)
Psychodynamic
Humanistic
Behavioral
Cognitive

All deal with one on one or group therapy

Inpatient/outpatient

Therapist

2. Biomedical Therapy

A. Psycho-Surgery

B. Medication

3. Eclectic Approach is a blend of psychotherapies.

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Specifically

Treatment
8.7 Introduction to Treatment of Psychological Disorders
History of Treatment- Charcot, Pinel,
8.8 Psychological Perspectives and Treatment of Disorders
Cognitive

Aaron Beck
Albert Ellis
Rational Emotive method

Psychodynamic

Freud

Humanistic

Carl Rogers

Behavioral

BF Skinner
Mary Cover Jones
Joseph Wolpe

8.9 Treatment of Disorders from the Biological Perspective
Summarize the effectiveness of Bio

Cognitive-Behavioral
Sociocultural
Treatment is impacted by culture and ethnic factors
Prevention Strategies = resilience
8.10 Evaluating Strengths Weaknesses
Empirical Support for Treatments of Disorders
Individual
Group
Psychanalytic/psychodynamic method
Client-centered method
Cognitive Method
Behavioral method
Sociocultural method
Biopsychosocial method
Cognitive-behavioral method

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Intro

Successful Treatment
“Psychotherapy heals, it makes some sense of the confusion, reins in the terrifying thoughts and feelings, returns some control and hope and possibility from it all.”

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Historical Treatment

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link

St. Mary of Bethlehem �“Bedlam” video

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The most common targets of treatment are :�

Anxiety
Mood disorders
Impulse control
Substance abuse
And combinations of those

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Goals of Treatment-

Help troubled people change their thinking, feelings, and behavior in ways that relieve discomfort,
Promote happiness
Improve overall functioning
(improve/reduce maladaptive behavior)

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Basic Features of Treatment

Client/Patient
Therapist= Psychologists/Psychiatrists

Clinical Social Workers
Marriage and Family Therapists
Licensed Professional Counselors

Inpatient- could be days, weeks in a hospital/clinical setting- usually with drug therapy

Usually pose a danger to themselves and others

Outpatient- psycho therapy and or drugs could be used
Less severe symptoms

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Psychoanalysis (Psychodynamic Treatment)

Client Therapist Relationship
Unlock hidden subconscious conflicts/fixations
Childhood
Freud
Conflicts Ego, ID, Superego
Unconscious
Personality

Hypnosis
Free Association
Transference video
Resistance
Dream analysis
Duration of analysis

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Today

Humanistic Approach
Innate drive toward personal growth
Self Awareness
Client Centered Therapy
Unconditional Positive Regard
Empathy
Congruence
Gestalt Theory = Humanistic Therapy

Behavioral Therapy
Types of Behavioral Therapy
Mary Cover Jones
Joseph Wolpe
Flooding
Gradual Exposure
Modeling

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Humanistic

Promote growth through more genuine self-expression
Talk Therapy
Personal Growth
Accurate Perceptions
Self Concept
Unconditional Positive regard
Conditions of self worth

Carl Rogers
Reaching human potential
Client Centered Therapy
Lots of listening
Self acceptance
Creating Positive Relationship
Gestalt Therapy
Self Awareness (of feelings)
Show the client they can solve problems and

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Humanistic Psychotherapy

See people as consciously controlling their own actions and taking responsibility for their own decisions.
Say people are motivated by an innate drive toward personal growth and improvement…

Motivations are guided by perception of our world.
Distorted behavior reflects a blockage of natural growth and distorted perception or lack of awareness of feelings.
Basic Assumptions:
1. Treatment is an encounter between equals. Treatment is a way to restart the natural growth.
2. Clients find insight during therapy. Improve awareness, acceptance, and emotional expression.
3. Relationship with client feeling acceptance and support

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Carl Rogers- Client Centered Therapy:

Less formal
Client decides what to talk about, without direction, without judgement.
Relies on the creation of a relationship that reflects three intertwined attitudes of the therapist UPR/Empathy/Congruence

1.Unconditional Positive Regard - treating the client as valued person, no matter what

Improves the clients Conditions of Self-Worth-
Listening without interruption, without judgment, or expressing opinions
The Therapist accepts the clients view of the world
They avoid giving advice, they trust the client to solve their own problems
The therapist wants to empower the client

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Client Centered

2.Empathy- emotional understanding of what the client might be thinking or feeling
Therapist tries to appreciate the clients point of view
Therapist makes an effort to see the world as the client sees it
Includes actively listening
Reflective- paraphrasing summary of the client’s words that accompany feelings and meanings

3. Congruence (genuineness) openness and honesty in therapy

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Gestalt Theory:

Humanistic Treatment
“Gestalt psychologist emphasized the idea that people actively organize their perceptions of the world.”
1. People create their own versions of reality
2. People’s natural psychological growth continues as long as they perceive, remain aware of their true feelings
3. Growth stops and symptoms appear when people are not accurately aware of themselves

Gestalt Therapy seeks to create conditions in which clients become more self-aware, self-accepting, and ready to grow.

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Behavioral

Operant Conditioning
Classical Conditioning
Observational Learning
Rewards
Punishments
Maladaptive thoughts and actions are learned (example Phobias)

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Behavioral Treatment needs

Relationship between client and Therapist is key
Careful listing of behaviors and thoughts to be changed

Establish treatment goals
Work to change specific thoughts, behaviors, and emotional actions

Therapist

Provides learning based treatments
Provides specific plans for dealing with problems

Continuous monitoring and adjustments

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Types of Behavior Therapy

Behavior Therapy

Includes Classical Conditioning

Behavior Modification

Operant Conditioning

Cognitive Behavior Therapy

Changing thoughts

Desensitization therapy
Progressive Relaxation Therapy

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Mary Cover Jones�“Mother of Behavioral Therapy”

Little Peter Experiment
De conditioning of irrational fears/phobias
4 year old kid afraid of rabbits
Desensitization therapy evidence

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Joseph Wolpe�Systematic Desensitization

Joseph Wolpe 1958
Designed to overcome Phobias
Process-
Client visualizes a series of anxiety provoking stimuli while remaining relaxed
Process gradually weakens the learned associations between the fear/anxiety producing object

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Systematic Desensitization 2

Used Progressive Relaxation Training
1^st patient imagines
Desensitization Hierarchy

A sequence of increasingly fear provoking situations
Then tolerating the situation then another high fear provoking situation is introduced

New application includes live stimuli instead of imagination

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Behavioral Therapy3

Flooding- Extinction technique

Continuous exposure to feared stimuli

Gradual Exposure
Modeling

Therapist demonstrates behavior
Client learns skills
Shaping process
Vicarious learning
Example Assertiveness Training

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Behavioral Therapy also4

Positive Reinforcement
Token economy
Punishment – unpleasant stimulus
Extinction- taking away reinforcement
Aversion Conditioning

Associate unpleasant stimulus with other unwanted stimuli

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Cognitive Behavioral Therapy
Rational Emotive Therapy
Albert Ellis
Aaron Beck
Group Therapy
Self Help Organizations
Hypnotherapy
Family and Couples Therapy
Rules for talking

Biological Therapy
Psycho-Surgery
Lobotomy
Trepanning
Electro-Convulsive Shock Therapy
Psychoactive Drugs
Anti-Depressants
Lithium
Tranquilizers
Social Elements to Treatment

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Cognitive Behavior Therapy

Problems exist 🡪 because people have problems thinking about themselves
Goal is to change troubled thoughts

Method:

Use learning principles to help clients change the way they think
Try to identify recurring thoughts
Then help them learn new more adaptive ways of thinking

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Rational Emotive Therapy

Albert Ellis link
Believed psych problems are caused by how people think about events

1. Identify the Self Defeating beliefs

“I should be loved… “I must be perfect…”

2. Show these are problematic thoughts

3. Use logic to show the patient to replace thoughts that are realistic

4 Homework to practice

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RET

According to Ellis, "people are not disturbed by things but rather by their view of things." The fundamental assertion of Rational Emotive Therapy is that the way people feel is largely influenced by how they think. When people hold irrational beliefs about themselves or the world, problems result. Because of this, the goal of REBT is to help people alter illogical beliefs and negative thinking patterns in order to overcome psychological problems and mental distress.

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Cognitive Therapy

Aaron Beck
Said disorders can be traced to faulty logic = Cognitive Distortions (learned)
Cognitive Distortions

Basically the client never considers that their judgments are not true or might be faulty

Catastrophizing
All or Nothing Thinking
Personalization

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Cognitive Therapy 2

Active problem solving approach
Therapist helps the client to identify the distorted thoughts
Shows the client that these distorted hypotheses need to be tested
Show them that the false beliefs are false
(Page 660)

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Group Therapy

Group Therapy- refers to the treatment of several unrelated clients under the guidance of a therapist who encourages helpful interactions among group members
Many groups are organized around a particular problem or a particular type of client
Allows therapist to see clients interacting w/ one another

Which can help identify clients’ interpersonal styles

Clients discover they’re not alone
Group members can help boost one another’s self-confidence and self-acceptance
Clients learn from one another

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Self- Help Organizations

Self-help groups like Alcoholics Anonymous are made up of people that share some problematic experience and meet to help one another
Professional therapists see these organizations as a stepping stone towards real treatment

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Hypnotherapy

Form of psychotherapy utilized to create unconscious change in the patient in the form of new responses, thoughts, attitudes, behaviors, and/or feelings
Hypnotic Suggestion

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Family and Couples Therapy

Involves treatment of two or more individuals from the same family system
Can be based on psychodynamic, humanistic, or cognitive behavioral approaches
Structural family therapy- concentrates on family communication patterns
Couples therapy- communication between partners is the main focus of treatment

Discussion aimed at identifying and improving problematic interactions

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“Rules for Talking” in Couples Therapy

Always begin w/ something positive
Use specific behaviors rather than overgeneralizations to describe what is bothersome about the other person
Admit your own role in the development of the problem
Be brief; don’t lecture
Maintain focus of present or future
Talk about observable events

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Biological Treatments

Psych disorders have physical causes
Psycho Surgery-

Brain Tissue is destroyed
Antonio Egas Moniz 1935
Created the Prefrontal Lobotomy link
Holes in forehead
Cut connections
Severed the connections between the Thalamus and Prefrontal Cortex

Watch this

“The Lobotomist”

Video

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Electro-Convulsive Therapy�link

1930s Ladislaus Von Meduna
Used ECT to induce schizophrenics + depression and sometimes mania
Induced epileptic like seizures
Side effects memory loss, confusion, speech disorders
Fun Fact- ECT is performed more frequently in US than coronary bypass, appendectomies, tonsillectomies

ECT is administered to an estimated 100,000 people a year,

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Psychoactive Drugs

Work on Neurotransmitters (page 680 chart)
Consciousness
Used to treat:
Schizophrenia
Depression
Mania
Anxiety

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Psychoactive Drugs2

Neuroleptics- aka Anti-Psychotics
Thorazine
Haldol
Long-term use causes Tardive Dyskinesia
Block Dopamine

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Anti-Depressants

Usually Increase Serotonin and Norepinephrine
Takes week or two to take effect
Monomine Oxidase Inhibitors (MAOIs)

Treats also panic and anxiety

Most common is Prozac (affects serotonin)

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Popular types of antidepressants

are called selective serotonin reuptake inhibitors (SSRIs). These include:
Fluoxetine (Prozac)
Citalopram (Celexa)
Sertraline (Zoloft)
Paroxetine (Paxil)
Escitalopram (Lexapro).

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Lithium

Mood stabilizer
For Bipolar
Tranquilizers

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Tranquilizers

The principal minor tranquilizers are the benzodiazepinesThe principal minor tranquilizers are the benzodiazepines, among which are diazepamThe principal minor tranquilizers are the benzodiazepines, among which are diazepam (Valium),chlordiazepoxideThe principal minor tranquilizers are the benzodiazepines, among which are diazepam (Valium),chlordiazepoxide (Librium), and alprazolam (Xanax). These drugs have a calming effect and eliminate both the physical and psychological effects of anxiety or fear. Besides the treatment of anxiety disorders, they are widely used to relieve the strain and worry arising from stressful circumstances in daily life. Because of this, benzodiazepines are among the most widely prescribed drugs in the world. Benzodiazepines work by enhancing the action of the neurotransmitter gamma-aminobutyric acid(GABA), which inhibits anxiety by reducing certain nerve-impulse transmissions within the brain. Benzodiazepines resemble barbiturates in their side effects: sleepiness, drowsiness, reduced alertness, and unsteadiness of gait. Though less dangerous than barbiturates, they can produce physical dependency even in moderate dosages, and the body develops a tolerance to them, necessitating the use of progressively larger doses. The drugs are thus intended for short- and medium-term use.