The History and Scope of Psychology Module 1

Treatment and Therapy -History of treatment -Types of therapy -Psychoanalytic/Psychodynamic therapy and techniques History of Treatment Maltreatment of people with disorders throughout the ages was based on

irrational views. Many patients were subjected to strange, debilitating and downright dangerous treatments. History of Insane Treatment Pinel in France and Dix in America founded humane movements to care for the mentally sick. Culver Pictures

http://wwwihm.nlm.nih.gov Philippe Pinel (1745-1826) Dorthea Dix (1745-1826) Through the 20 century th Early 1900s Freud and talking therapy

1930-1950s Institutionalization 1950s Advent of neuroleptics and deinstitutionalization 1960s Humanistic approach 1970-1980s, increase in homelessness, crime, and incarceration 1990s to present Cognitive, Types of Therapies

1. Psychotherapy involves an emotionally charged, confiding interaction between a trained therapist and a mental patient. Sometimes referred to as insight therapy Psychological Therapies We will look at four major forms of psychotherapy based on different theories on human nature: 1. Psychoanalytical

theory 2. Humanistic theory 3. Behavioral theory 4. Cognitive theory 2. Biomedical therapy uses drugs or other procedures that act on the patients nervous system curing him of psychological disorders. 3. An Eclectic approach uses various forms of healing techniques depending on

the clients unique problems. Used by about half of therapists today Psychoanalysis The first formal psychotherapy to emerge was psychoanalysis developed by Sigmund Freud. Edmund Engleman Sigmund Freud's famous couch

Psychoanalysis: Aims The aim of psychoanalysis is to bring repressed feelings into conscious awareness where the patient can deal with them. Know thyself. When energy devoted to id-ego-superego conflict is released, the patients anxiety lessens.

Psychoanalysis: Methods Dissatisfied with hypnosis, Freud developed the method of free association to unravel the unconscious mind and its conflicts. The patient lies on a couch and speaks whatever comes to his mind. http://www.english.upenn.edu Psychoanalysis: Methods During free association, the patient edits

his thoughts to resist his feelings and to express his emotions. Such resistance becomes important in the analysis of conflict-driven anxiety. Eventually the patient opens up and reveals his innermost private thoughts to the therapist, developing positive or negative feelings (transference) towards him. Dream Interpretation

Freud spent a great deal of time analyzing dreams Manifest (what happened) content and latent (what is means) content Psychoanalysis: Criticisms 1. Psychoanalysis is hard to refute because it cannot be proven or disproven. Confirmation Bias False Memories Elizabeth Loftus

2. Psychoanalysis takes a long time and is very expensive. Three psychodynamic approaches: (focus more on society and our relationships with others) Adler- relationships in the family (birth order and feelings of inferiority)

Jung-what we show the world (persona vs. shadow) Horney-pressure according to gender norms Psychodynamic Therapies Interpersonal psychotherapy, a variation of psychodynamic therapy is effective in treating depression. It focuses on symptom relief here and now, not overall personality change.

https://www.youtube.com/watch?v=QV6DpJKW6a0 Psychodynamic Therapies Influenced by Freud, in a face-to-face setting, psychodynamic therapists understand symptoms and themes across important relationships in a patients life. More therapy -Humanistic therapy and

techniques -Behavioral therapy and techniques Humanistic Therapies Humanistic therapists aims to boost selffulfillment by helping people grow in selfawareness and self-acceptance. Person-Centered Therapy Developed by Carl Rogers, personcentered therapy is a form of humanistic therapy. Unconditional Positive Regard: The

therapist listens to the needs of the client in an accepting and nonjudgmental way, addressing his problems in a productive way and building his or her self-esteem. Felt the clients must come to understand their ideal self and improve Humanistic Therapy The therapist engages in active listening and echoes, restates, and clarifies patients thinking, acknowledging expressed feelings.

Active listening entails: Paraphrasing: uses the words of the client to summarize the conversation Clarifying: encouraging the client to say more by asking leading questions Reflecting feelings: mirrors the feelings of the client Behavior Therapy Therapy that applies classical and operant

conditioning (learning) principles to the elimination of unwanted behaviors. Example: To treat anxiety disorders therapists do not delve deeply below the surface looking for inner causes. Classical Conditioning Techniques Counterconditioning: a procedure that conditions new responses to stimuli that trigger unwanted behaviors.

It is based on classical conditioning and includes exposure therapy and aversive conditioning. Exposure Therapy https://www.youtube.com/watch?v =wE5F-FjbTRk The Far Side 1986 FARWORKS. Reprinted with Permission. All Rights Reserved.

Exposes patients to things they fear and avoid. Through repeated exposures anxiety lessens because they habituate to the things feared. Systematic Desensitization A type of exposure therapy that associates

a pleasant, relaxed state with gradually increasing anxiety-triggering stimuli commonly used to treat phobias. Aversive Conditioning-Garcia Type of counterconditioning that associates an unpleasant state (such as nausea) with an unwanted behavior (such as alcohol) The person is replacing a positive but harmful response with a

negative response Example with alcoholism: Add a med to a drink that makes the Aversive Conditioning Aversive Conditioning Aversive Conditioning Virtual reality

Behaviorists have turned to VR therapy as a way to place the patient in the situation (in the virtual sense) so that they may experience the anxiety or fear in a controlled environment This allows the patient to approach the situation with more relaxed feelings

Some evasive types of counterconditioning Implosive therapy Patient is guided to visualize the situation or the object that causes the stress response, try to gain control of their reaction Flooding A patient is forced to confront their fears through full-intensity exposure to the

stimuli Forced to cope Kind of like sink or swim Operant Conditioning Operant conditioning procedures enable therapists to use behavior modification in which desired behavior is rewarded and undesired behaviors are not or are punished. A number of withdrawn, uncommunicative

3 year-old autistic children have been successfully trained by giving and withdrawing reinforcements for desired and undesired behaviors. Token Economy In institutional settings therapists may create a token economy, where a patient exchanges a token of some sort,

earned for exhibiting the desired behavior, for various privileges or treats. Kind of like the behavior modification charts in Sociology or https://www.youtube.com/watch?v=A-irAT0 viF0

Therapy continued Cognitive therapy and techniques Group and family therapy Prevalence of approaches Alternative therapies Cognitive Therapy Teaches people adaptive ways of thinking and acting based on the assumption that thoughts

intervene between events and our emotional reactions. Some Cognitivists Remember these guys? Martin Seligman Referred to explanatory styles to explain why people think the way they think

Optimistic vs. Pessimistic Learned helplessness Julian Rotter Locus of control Internal vs. External Case Study

Tina, who worked in publishing, met her boss in the elevator and said 'good morning', but her boss didn't reply. In no time Tina was thinking thoughts like: my boss doesn't like me no-one likes me

I'm going to lose my job life is hell. 36 Cognitive Therapy for Depression Aaron Beck (Cognitive Triad) suggests that depressed patients have: Beck believes that cognitions such as can never

be happy, need to change in order for depressed patients to recover. This change is brought into Cognitive Therapy for Depression Albert Ellis and Rational Emotive Therapy (RET) People are not disturbed by things but rather by their view of things. Therapists boldly challenges the irrational

thoughts and fears of the patient Forces the patient to confront their own way of thinking Highly charged Goal is to help the patient more accurately see themselves within the world Use ABC The ABC Model A Activating Event: Something happens in the environment around you. Identifying the underlying irrational thought

patterns and beliefs. B Beliefs: You hold a belief about the event or situation. Challenging the irrational beliefs C Consequence: You have an emotional response to your belief. Gaining insight and recognizing irrational thought patterns

39 Cognitive Therapy Stress Inoculation Training Meichenbaum (1977, 1985) trained people to restructure their thinking in stressful situations. Relax, the exam may be hard, but it will be hard for everyone else too. I studied harder than most people. Besides, I dont need a perfect score to get a good

grade. Cognitive-Behavior Therapy Cognitive therapists often combine the reversal of self-defeating thinking with efforts to modify behavior. Richard Lazarus concept of appraisal and how we view stress affecting our emotional experience was a pioneer in the use of c-b therapy Cognitive-behavior therapy aims to alter

the way people act (behavior therapy) and alter the way they think (cognitive therapy). Primary Appraisal is this harmful to me? Secondary Appraisal what resources do I have to cope? Reappraisal do I still think this is harmful? Group Therapy Group therapy normally consists of 6-9 people and a 90-minute session which can help more people and cost less. Clients

benefit from knowing others have similar problems. Mary Kate Denny/ PhotoEdit, Inc. Family Therapy Family therapy treats the family as a system. Therapy guides family members toward positive relationships and improved communication. Evaluating Therapies

To whom do people turn for help with psychological difficulties? Community mental health specialists provide the largest outpatient psychotherapy. Evaluating Psychotherapies Within psychotherapies cognitive therapies are most widely used, followed by psychoanalytic and family/group therapies.

Is Psychotherapy Effective? It is difficult to gauge the effectiveness of psychotherapy because there are different levels on which its effectiveness can be measured. 1. 2. 3. Does the patients sense improvement?

Does the therapist feel the patient has improved? How do friends and family feel about patients improvement? Clients Perceptions If you ask clients about their experiences of getting into therapy, they always overestimate its effectiveness. Critics however remain skeptical. 1.

2. 3. Clients enter therapy in crisis and crisis may subside over the natural course of time (regression to normalcy/mean). Clients may need to believe the therapy was worth the effort. Clients generally speak kindly of their therapists.

Clinicians Perceptions Like clients, clinicians believe in the therapys success. They believe that the client is better off after receiving therapy than not. 1. 2. 3.

Clinicians are aware of failures, but those of other therapists. If a client seeks another clinician, the former therapist is more likely to argue that the client has developed another psychological problem. Clinicians are likely to testify to the efficacy of their therapy regardless of the outcome of treatment. The Relative Effectiveness of

Different Therapies Which psychotherapy will be most effective for treating a particular problem? Disorder Depression Anxiety Therapy Behavior, Cognition, interpersonal Cognition, Exposure, Stress Inoculation

Bulimia Cognitive-behavior Phobia Behavior Bed Wetting Behavior Modification Evaluating Alternative Therapies Lilienfeld (1998) suggests comparing scientific versus popular therapies through electronic means. The results of

such a search are below: Eye Movement Desensitization and Reprocessing (EMDR) In EMDR therapy the therapist attempts to unlock and reprocess previously frozen traumatic memories by waving a finger in front of the eyes of a client. EMDR has not held up under scientific testing. 8 step process that

entails relaxation techniques and rewiring memories Light Exposure Therapy may be linked to the fact that light therapy makes up for lost sunlight exposure and resets the body's

Courtesy of Christine Brune Seasonal Affective Disorder (SAD), a form of depression has been effectively treated by light exposure therapy. This form of therapy has been scientifically validated.

Commonalities Among Psychotherapies Three commonalities shared by all forms of psychotherapies are: Mary Kate Denny/ PhotoEdit, Inc. 1. Hope for demoralized people. 2. A new perspective.

3. An empathic, trusting and a caring relationship. Therapists & Their Training Clinical psychologists: Mostly PhDs. Expert in research, assessment, and therapy, supplemented by a supervised internship. Clinical or Psychiatric Social Worker: Master of Social Work plus postgraduate

supervision prepares some social workers to offer psychotherapy, mostly to people with everyday personal and family problems. Therapists & Their Training Counselors: Pastoral counselors, abuse counselors work with a problems arising from family relations and substance abuse and with spouse and child abusers and their victims.

Psychiatrists: Physicians who specialize in the treatment of psychological disorders. Not all psychiatrists have had extensive training in psychotherapy, but as MDs they can prescribe medications. Psychological Therapies and Treatments are Biopsychosocial in Nature The

Biomedical/Somatic Therapies Psychopharmacology Physical treatment techniques Psychosurgery The Biomedical Therapies Include physical, medicinal and other forms of biological therapies. Sometimes referred to as somatic approach 1. Drug Treatments

(psychopharmacolo gy) 2. ECT, TMS, insulin 3. Psychosurgery Drug Therapies Psychopharmacology is the study of drug effects on mind and behavior. With the advent of drugs, hospitalization in mental institutions has rapidly declined.

Drug Therapies However, many patients are left homeless on the streets due to their ill-preparedness to cope independently outside in society. Double-Blind Procedures To test the effectiveness of a drug patients are tested with the drug and a placebo, in which two

groups of patients and medical health professionals are kept blind to who got the drug and who got the placebo. Antipsychotic Drugs Classical antipsychotics [Chlorpromazine (Thorazine)]: Remove a number of positive symptoms associated with

schizophrenia, like agitation, delusions and hallucination. Atypical antipsychotics [Clozapine (Clozaril)]: Remove negative symptoms associated with schizophrenia, like apathy, jumbled thoughts, concentration difficulties, difficulty in interacting with others. A side effect of neuroleptics is tardive dyskinesia

Atypical Antipsychotic Clozapine (Clozaril) blocks receptors for dopamine and serotonin to remove the negative symptoms of schizophrenia. Antianxiety Drugs Antianxiety drugs (Xanax and Ativan) depress central nervous system and reduce anxiety and tension by elevating the levels of the Gamma-aminobutyric acid (GABA) neurotransmitter.

Antidepressant Drugs Antidepressant drugs like Prozac, Zoloft, and Paxil are Selective Serotonin Reuptake Inhibitors (SSRIs) and improve mood by elevating the levels of serotonin by inhibiting reuptake. Prozac and the Brain Prozac and the Brain

Prozac and the Brain Mood-Stabilizing Medications Lithium Carbonate a common salt has been used to stabilize manic episodes in bipolar disorders. It moderates the levels of norepinephrine and glutamate neurotransmitters. Insulin shock therapy Patient given a near lethal overdose

of insulin Would cause a coma Glucose used to bring patient out Used over several weeks 1930s and 1940s treatment of schizophrenia, replaced by neuroleptics (thorazine) in the later 1950s and 1960s Brain Stimulation Electroconvulsive Therapy

(ECT) ECT is delivered to severely depressed patients who do not respond to drugs. The patient is anesthetized and is given a muscle relaxant. Patients usually get a 100 volt shock that relieves them of depression. -Causes a change in blood flow patterns to help

Alternatives to ECT Transcranial Magnetic Stimulation (TMS) In TMS, a pulsating magnetic coil is placed over prefrontal regions of the brain to treat depression, with

minimal side effects. Psychosurgery http://www.epub.org.br Psychosurgery was popular even in Neolithic times. Although used sparingly today, about

200 such operations do take place in the US alone. Psychosurgery Psychosurgery is used as a last resort in alleviating psychological disturbances. Psychosurgery is irreversible. Removal of brain tissue changes the mind. Psychosurgery

Modern methods use stereotactic neurosurgery and radiosurgery (Laksell, 1951) that refine older methods of psychosurgery. Lobotomies (Moniz, Freeman) and split-brain (Sperry, Gazannaga) AP info https:// www.youtube.com/

watch? v=mbbMLOZjUYI Know the history of treatment Pinel and the medical model Majority use some form of cognitive (50%) Know the schools Psychoanalytic/psychodynamic approach

Unconscious mind, relationships, talking therapy Freud, Adler, Jung, Horney Humanistic approach More AP info Behavioral approach Counter conditioning, token economy, systematic desensitization (Skinner, Garcia)

Cognitive approach Perceptions and thinking (Bandura, Seligman, Rotter), rational-emotive (Ellis), triad (Beck) Biomedical approach Thorazine/clozaril-schizophrenia, SSRIdepression, GABA-anxiety, Lithium-mania Psychosurgery, split-brain, lobotomy, ECT, rTMS, insulin Rosenhan hospital study (labeling,

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