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PowerPoint PowerPoint Presentations forPresentations for
Philip G. Zimbardo Philip G. Zimbardo Robert L. Johnson Robert L. Johnson Vivian Vivian McCannMcCann
Prepared byPrepared byBeth M. SchwartzBeth M. Schwartz
Randolph CollegeRandolph CollegeThis multimedia product and its contents are protected under copyright law. The following are prohibited by law: any public performance or display, including transmission of any image over a network; preparation of any derivative work, including the extraction, in whole or part, of any images; any rental, lease, or lending of the program.
Seventh Edition
Copyright © 2012 Pearson Education, Inc. All rights reserved
Copyright © 2012 Pearson Education, Inc. All rights reserved
22This multimedia product and its contents are protected under copyright law. The following are prohibited by law: any public performance or display, including transmission of any image over a network; preparation of any derivative work, including the extraction, in whole or part, of any images; any rental, lease, or lending of the program.
Chapter 13Chapter 13
Therapies for Psychological Disorders
33
Therapy for psychological disorders takes a variety of
forms, but all involve a therapeutic relationship focused on improving a
person’s mental, behavioral, or social functioning.
What is Therapy?What is Therapy?
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44
What is Therapy?What is Therapy?
• General term for any treatment process
• In psychology and psychiatry, therapy refers to a variety of psychological and biomedical techniques aimed at dealing with mental disorders or coping with problems of living.
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55
Components of TherapyComponents of Therapy
Identifying the problemIdentifying the problem
Identifying the cause of the Identifying the cause of the problem or the conditions that problem or the conditions that
maintain the problemmaintain the problem
Deciding on and carrying out Deciding on and carrying out some form of treatmentsome form of treatment
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66
Types of Mental Health Care Types of Mental Health Care ProfessionalsProfessionals
Counseling PsychologistCounseling Psychologist
Clinical PsychologistClinical Psychologist
PsychoanalystPsychoanalyst
Clinical Social WorkerClinical Social Worker
PsychiatristPsychiatrist
Psychiatric Nurse PractitionerPsychiatric Nurse Practitioner
Pastoral CounselorPastoral Counselor
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77
Specialty:Specialty:
Problems of Problems of normal livingnormal living
Work setting:Work setting:
Schools, clinics, Schools, clinics, other institutionsother institutions
Credentials:Credentials:
Master’s in Master’s in counseling, PhD, counseling, PhD,
EdD, or PsyDEdD, or PsyD
Professional TitleProfessional Title
Counseling PsychologistCounseling Psychologist
Clinical Psychologist
Psychoanalyst
Clinical Social Worker
Psychiatrist
Psychiatric Nurse Practitioner
Pastoral Counselor
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88
Specialty:Specialty:
Those with severe Those with severe or less severe or less severe
disordersdisordersWork setting:Work setting:
Private practice, Private practice, mental health mental health
agencies, agencies, hospitalshospitals
Credentials:Credentials:
PhD or PsyDPhD or PsyD
Professional TitleProfessional Title
Counseling Psychologist
Clinical PsychologistClinical Psychologist
Psychoanalyst
Clinical Social Worker
Psychiatrist
Psychiatric Nurse Practitioner
Pastoral Counselor
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99
Specialty:Specialty:
Physician trained Physician trained to treat mental to treat mental
problems (often problems (often by means of drug by means of drug
therapies)therapies)
Work setting:Work setting:
Private practice, Private practice, clinics, hospitalsclinics, hospitals
Credentials:Credentials:
MDMD
Professional TitleProfessional Title
Counseling Psychologist
Clinical Psychologist
Psychoanalyst
Clinical Social Worker
PsychiatristPsychiatrist
Psychiatric Nurse Practitioner
Pastoral Counselor
Copyright © 2012 Pearson Education, Inc. All rights reserved
1010
Specialty:Specialty:
Freudian therapyFreudian therapy
Work setting:Work setting:
Private practicePrivate practice
Credentials:Credentials:
MD or PhDMD or PhD
Professional TitleProfessional Title
Counseling Psychologist
Clinical Psychologist
PsychoanalystPsychoanalyst
Clinical Social Worker
Psychiatrist
Psychiatric Nurse Practitioner
Pastoral Counselor
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1111
Specialty:Specialty:
Nursing specialty; Nursing specialty; licensed to licensed to
prescribe drugsprescribe drugs
Work setting:Work setting:
Private practice, Private practice, clinics, hospitalsclinics, hospitals
Credentials:Credentials:
RN plus special RN plus special training in treating training in treating mental disorders mental disorders and prescribing and prescribing
drugsdrugs
Professional TitleProfessional Title
Counseling Psychologist
Clinical Psychologist
Psychoanalyst
Clinical Social Worker
Psychiatrist
Psychiatric Nurse Psychiatric Nurse PractitionerPractitioner
Pastoral Counselor
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1212
Specialty:Specialty:
Social worker with Social worker with a specialty in a specialty in dealing with dealing with
mental disordersmental disorders
Work setting:Work setting:
Often employed Often employed by governmentby government
Credentials:Credentials:
MSWMSW
Professional TitleProfessional Title
Counseling Psychologist
Clinical Psychologist
Psychoanalyst
Clinical or Psychiatric Clinical or Psychiatric Social WorkerSocial Worker
Psychiatrist
Psychiatric Nurse Practitioner
Pastoral Counselor
Copyright © 2012 Pearson Education, Inc. All rights reserved
1313
Specialty:Specialty:
Combines Combines spiritual guidance spiritual guidance
with practical with practical counselingcounseling
Work setting:Work setting:
Religious order or Religious order or ministryministry
Credentials:Credentials:
VariesVaries
Professional TitleProfessional Title
Counseling Psychologist
Clinical Psychologist
Psychoanalyst
Clinical Social Worker
Psychiatrist
Psychiatric Nurse Practitioner
Pastoral CounselorPastoral Counselor
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1414
Therapy in Historical ContextTherapy in Historical Context
Medieval Europe:
• Mental disorder the work of devils and demons
• Exorcism needed to “beat the devil” out
More Modern Times
• Mentally ill placed in institutions called asylums, which often resulted in neglect
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1515
Modern Approaches to TherapyModern Approaches to Therapy
Modern approaches abandoned demon model and abusive treatments.
• Therapies based on psychological and biological theories of mind and behavior• psychological therapies, often called
psychotherapy• Biological therapies focus on altering the
brain.
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1616
Psychologists employ two main forms of treatment:
insight therapies and behavioral therapies.
How Do PsychologistsHow Do Psychologists Treat Psychological Disorders? Treat Psychological Disorders?
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1717Copyright © 2012 Pearson Education, Inc. All rights reserved
Types of PsychotherapyTypes of Psychotherapy
1818
Insight TherapiesInsight Therapies
Insight Therapies
• Psychotherapies in which the therapists help patients/clients understand (gain insight into) their problems
• Aim at revealing and changing a patient’s disturbed mental processes through discussion and interpretation
• Numerous approaches involve this type of therapy.
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1919
Insight TherapiesInsight Therapies
Freudian Psychoanalysis
• Insight therapies based on the assumption that psychological problems arise from tension created in the unconscious mind by forbidden impulses
• Major goal: To release conflicts and memories from the unconscious
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2020
Insight Therapies:Insight Therapies: Psychodynamic Therapies Psychodynamic Therapies
Psychoanalysis
• The form of psychodynamic therapy developed by Sigmund Freud
• Access to unconscious material through free association
• Helps the patient understand the unconscious causes for his or her symptoms
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2121
Insight TherapiesInsight Therapies
Freudian Psychoanalysis
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2222
Insight Therapies:Insight Therapies: Psychodynamic Therapies Psychodynamic Therapies
Psychoanalysis
• The ego blocks unconscious problems from consciousness through defense mechanisms.• e.g., displacement and repression
Analysis of Transference
• Analyzing and interpreting the patient’s relationship with the therapist, based on the assumption that this relationship mirrors unresolved conflicts in the patient’s past
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2323
Insight Therapies:Insight Therapies: Psychodynamic Therapies Psychodynamic Therapies
Neo-Freudian Psychodynamic Therapies• Therapies developed by psychodynamic theorists
who embraced some but not all of Freud’s ideas• emphasis on conscious motivation• significance of the self• experiences throughout life• the role of interpersonal relationships• abandoned the psychoanalyst’s couch• see patients once a week
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2424
Insight Therapies:Insight Therapies: Humanistic Therapies Humanistic Therapies
Humanistic Therapies
• Mental problems arise from low self-esteem, misguided goals, and unfulfilling relationships.
Client-Centered Therapy: Carl Rogers
• Emphasizes healthy psychological growth through self-actualization• Reflection of feeling: paraphrasing client’s
words to capture the emotional tone expressed
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2525
Insight Therapies:Insight Therapies: Cognitive Therapies Cognitive Therapies
Cognitive Therapy
• Emphasizes rational thinking as the key to treating mental disorder
• Helps patients confront destructive thoughts
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2626
Insight Therapies:Insight Therapies: Group Therapies Group Therapies
Group Therapy
• Psychotherapy with more than one client
Self-Help Support Groups
• Groups that provide social support and an opportunity for sharing ideas about dealing with common problems; typically organized/run by laypersons (not professional therapists)
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2727
Insight Therapies:Insight Therapies: Group Therapies Group Therapies
Couples and Family Counseling • Intended to help clients learn about
relationships• Can be more effective than individual
therapy with one member of the relationship at a time
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2828
Systematic Systematic DesensitizationDesensitization
TokenTokenEconomiesEconomies
Contingency Contingency ManagementManagement
AversionAversionTherapyTherapy
ParticipantParticipantModelingModeling
Behavior TherapiesBehavior Therapies
Behavior Therapy
• Any form of psychotherapy based on the principles of behavioral learning: • operant conditioning and classical
conditioning
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2929
Classical Conditioning TherapiesClassical Conditioning Therapies
Systematic Desensitization
• Technique in which anxiety is extinguished by exposing the patient to an anxiety-provoking stimulus
Exposure Therapy
• Desensitization therapy in which patient directly confronts the anxiety-provoking stimulus (as opposed to imagining it)
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A Sample Anxiety HierarchyA Sample Anxiety Hierarchy
3030Copyright © 2012 Pearson Education, Inc. All rights reserved
3131
Classical Conditioning TherapiesClassical Conditioning Therapies
Aversion Therapy
• Involves presenting individuals with an attractive stimulus paired with unpleasant stimulation in order to condition a repulsive reaction
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3232
Operant Conditioning TherapiesOperant Conditioning Therapies
Contingency Management
• Approach to changing behavior by altering the consequences of behaviors
• Effective in numerous settings• e.g., families, schools, work, and prisons
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3333
Operant Conditioning TherapiesOperant Conditioning Therapies
Token Economies
• Applied to groups (e.g., classrooms or mental hospital wards)
• Involves distribution of “tokens” contingent on desired behaviors
• Tokens can later be exchanged for privileges, food, or other reinforcers.
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3434
Participant Modeling: An Participant Modeling: An Observational-Learning TherapyObservational-Learning Therapy
Participant Modeling
• The therapist demonstrates and encourages a client to imitate a desired behavior.
• Draws on concepts from both operant and classical conditioning
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3535
Cognitive-Behavioral Therapy: Cognitive-Behavioral Therapy: A SynthesisA Synthesis
Cognitive-Behavioral Therapy
• Combines cognitive emphasis on thoughts with behavioral strategies that alter reinforcement contingencies
• Assumes irrational self-statements cause maladaptive behavior
• Seeks to help the client develop a sense of self-efficacy
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3636
Cognitive-Behavioral Therapy: Cognitive-Behavioral Therapy: A SynthesisA Synthesis
Rational-Emotive Behavior Therapy (REBT)• Albert Ellis• Based on the idea that irrational thoughts and
behaviors are the cause of mental disorders• Attempts to eliminate the self-defeating
thoughtsPositive Psychotherapy (PPT)• Positive emphasis on growth• Emphasis on research
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3737
Evaluating the Evaluating the Psychological TherapiesPsychological Therapies
Eysenck (1952) proposed that people with nonpsychotic problems recover just as well with or without therapy.
Reviews of evidence since have shown that:
• Eysenck overestimated the improvement rate in the group without therapy.
• Therapy is better than no therapy.• It appears advantageous to match specific
therapies with specific conditions.
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Comparing the Different Types of TherapyComparing the Different Types of Therapy
3838Copyright © 2012 Pearson Education, Inc. All rights reserved
3939
How Is the BiomedicalHow Is the BiomedicalApproach Used toApproach Used to
Treat Psychological Disorders?Treat Psychological Disorders?
Biomedical therapies seek to treat psychological disorders
by changing the brain’s chemistry with drugs, its
circuitry with surgery, or its patterns of activity with pulses
of electricity or powerful magnetic fields.
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4040
Drug TherapyDrug Therapy
Antipsychotic Drugs• E.g., chlorpromazine, haloperidol, and
clozapine• Usually affect dopamine pathways• May have side effects
• tardive dyskinesia: incurable disorder of motor control resulting from long-term use of antipsychotic drugs
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4141
Drug TherapyDrug Therapy
Antidepressant Drugs
• Three major categories:• tricyclic compounds (e.g., Tofranil and Elavil)• SSRIs (e.g., Prozac)• Monoamine oxidase (MOA) inhibitors and
lithium carbonate (effective against bipolar disorder)
Mood Stabilizers• E.g., Lithium and Depakote: effective for
bipolar disorders
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4242
Drug TherapyDrug Therapy
Antianxiety Drugs• Include barbiturates and benzodiazepines
• May include some antidepressant drugs that work on certain anxiety disorders
• Should not be used to relieve the ordinary anxieties of everyday life
• Should not be taken for more than a few days at a time
• Should not be combined with alcohol
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4343
Drug TherapyDrug Therapy
Stimulants (e.g., caffeine, nicotine, cocaine)
• Produce excitement or hyperactivity
• Suppress activity level in persons with attention-deficit/hyperactivity disorder (ADHD)
• Controversy exists concerning the use of these stimulants for children.• side effects• growth slowed• concern regarding overdiagnosis of ADHD
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4444
PsychosurgeryPsychosurgery
The general term for surgical intervention in the brain to treat psychological disorders• The infamous prefrontal lobotomy is no
longer performed.
• Severing the corpus callosum, however, can reduce life-threatening seizures.
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4545
Brain-Stimulation TherapiesBrain-Stimulation Therapies
Used to treat severe depression
Electroconvulsive Therapy (ECT) • Apply an electric current to temples briefly• Patient is put to “sleep.”• Memory deficits are a side effect.
Transcranial Magnetic Stimulation (TMS) • High-powered magnetic stimulation to the brain• Also effective for bipolar disorderDeep Brain Stimulation• Surgical implants of a micro electrode directly in
the brain• Still highly experimental
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4646
Hospitalization Hospitalization and the Alternativesand the Alternatives
Therapeutic Community • Designed to bring meaning to patients’ lives• Hospital setting to help patients cope with the world
outside• Higher costs
Deinstitutionalization• Removing patients, whenever possible, from mental
hospitals
Community Mental Health Movement • Effort to deinstitutionalize mental patients and to
provide therapy from outpatient clinics
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How do the Psychological How do the Psychological Therapies and Biomedical Therapies and Biomedical
Therapies Compare?Therapies Compare?While a combination of
psychological and medical therapies is better than either
alone for treating some (but not all) mental disorders, most
people who suffer from unspecified “problems in living”
are best served by psychological treatment alone.
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4747
4848
DepressionDepression
Psychological vs. Medical Treatment
• Both are equally effective ways to treat depression in the short run.
• Cognitive behavioral therapy is more effective in the long run.
• A combination of both is most effective.
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4949
Anxiety DisordersAnxiety Disorders
Psychological vs. Medical Treatment
• Both can be effective.
• Most effective is a combination of both.
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5050
Empirically Supported Therapy (EST)Empirically Supported Therapy (EST)
Therapies validated by research evidence showing that they actually work
This research raises interesting questions about whether counselors/therapists should be limited to these therapies.• Can this guideline help practitioners to avoid
harmful therapies?• Can practitioners still meet individual needs?• How will the insurance companies be
involved?Copyright © 2012 Pearson Education, Inc. All rights reserved