SUMMARY of Psych Therapy designs

Refer to chapter 16 to accompany these notes!

History of treatment• Attitudes towards and treatment of the mentally ill

have changed significantly over time• Anciently – believed mentally ill were possessed by

demons – trephining – drilled holes in their skull to release spirits

• Imprisonment

• Progressive era – call for more humane treatment – counseling and institutions – Dorothea Dix in US– Philippe Pinel in France

Post 1950s

Pharmacology• MEDS – drugs

De-institutionalization• Seek to treat mentally

with meds and with out-patient counseling

• Get away from lifetime institutionalization

• Side effect – increase mentally ill population in prison or homeless - struggle to function

60 Minutes Clip• Jan 2014 – Cree Deeds son’s suicide – danger of de-

institutionalization

• http://www.cbsnews.com/news/mentally-ill-youth-in-crisis/

Today• Continue trend in medication and out-

patient therapy

• Increased emphasis on PREVENTION – how……?– de- stressors–Stable families–Emphasize better nutrition, exercise,

sleep, etc.

Summary of different treatment perspectives

Psychoanalysis• Issue - Person’s symptoms are outward manifestation

of deeply repressed problems, possibly from childhood

• Freud• Role of Uncon• Developmental fixation• Emphasis on childhood, trauma, repression• Projective tests – free association, hypnosis, dream

analysis, ink blot, TAT

Humanism Summary• Issue – boost patients self-esteem by helping him realize his

potential, possibilities for growth, and self-actualization• Maslow and Rogers

• Therapy techniques – unconditional positive regard, client centered therapy, active listening, show genuine concern for patient

• People are innately good

• NOT deterministic – you can use your agency to choose your course in life

• Key terms – hierarchy of needs, free will, self-actualization

Behaviorism Summary• Issue – abnormal behavior is caused by a dysfunctional

environment. Change the environment – fix the behavior• 100% nurture – ALL behaviors are learned• Skinner and operant conditioning (alter reinforcements or

punishments)• Bandura and social modeling – model healthy behaviors• Classical Conditioning – Counter Condition – replace

association of anxiety/fear with calm – hierarchy of fears– Systematic desensitization – proceed step by step by imagining– In vivo desensitization – proceed step by step live– Implosive Therapy – imagine most frightening scenario (top of hierarchy)– Flooding – actually do most frightening scenario – live

– (ultimate goal is always to do it live – but you may do imagination first)

Cognitive - Summary• Issue – dysfunctional behaviors are caused by dysfunctional

thoughts. Confront the patient’s irrational thoughts• Albert Ellis – Rational Emotive Therapy – expose irrational

thoughts

• Locus of Control – (internal V. external) be realistic in what you take credit for or what you take blame for

• Seligman’s – Learned helplessness – do you have control of your situation – do you take action?

• Aaron Beck’s Cognitive Triad – dysfunctional thoughts about your 1.) self, 2.) your world, and 3.) your future

Cognitive Summary

Aaron Beck’s Cognitive Triad – dysfunctional thoughts about your 1.) self, 2.) your world, and 3.) your future

Cognitive SummaryDysfunctional Attribution Style

Failures• Internal – I am a loser

• Global – I suck at everything

• Stable – I will always suck at everything

Successes• External – I got lucky/the

test was easy

• Specific – I only got a good grade on this one test

• Unstable – this success won’t last

Pharmacology – MEDS

Emphasis on biomedical causes –

Chemical imbalances

Brain abnormalities

Genetic Predispositions

(NATURE)

MEDS• Anti-Psychotic (Schizophrenia)

– Too much dopamine– Drugs block receptor sites for dopamine - diminish + symptoms

(hallucinations and delusions)– Haldol, Thorazine– Side effect – tardive dyskinesia

Anti-Depressants- Unipolar depression - Too little serotonin – Prozac and Zoloft block

serotonin reuptake- Bipolar – lithium

Anti-Anxiety

- Barbiturates – valium, Xanax – depress activity of central nervous system

MEDS• Risks of all meds

– Finding right med at the right dosage – often process of trial and error

–ALL meds have some kind of undesirable side effect

Other Medical Interventions• Electroconvulsive Therapy (ECT)

– induced medical seizure– used historically to treat multiple mental

illnesses–used today as last resort treatment of

depression–Risk = possible memory loss

Other Medical Interventions

• Psychosurgery – historical prefrontal lobotomies• 1950s/60s (JFK’s sister, “One Flew Over the

Cuckoo's Nest”)

60 Minute Clips on Treatment

• Sept 2013 – Untreated Mental illness and connection to mass shootings:

• http://www.cbsnews.com/video/watch/?id=50156091n