San Sebastian College Recoletos-ManilaC. M., Recto Ave., Metro Manila

The History of Psychological Treatments

Submitted by:

Aquino, Karina R.De Jesus, Neann Klara M.Diolanda, Jesselle M.Inciso, Genesis C.

4th year BS Psychology

December 1, 2014I. PREHISTORIC TIMES

Early man widely believed that mental illness was the result of supernatural phenomena such as spiritual or demonic possession, sorcery, the evil eye, or an angry deity and so responded with equally mystical, and sometimes brutal, treatments. Trephining (also referred to as trepanning) first occurred in Neolithic times. During this procedure, a hole, or trephine, was chipped into the skull using crude stone instruments. It was believed that through this opening the evil spirit(s)-thought to be inhabiting ones head and causing their psychopathology--would be released and the individual would be cured (Foerschner, 2010).The idea that spirits can enter and control a person is as old as civilization, and historical, biblical, and archeological evidence indicates its presence in diverse forms and in almost all cultures. "Religio-magical rituals are major forms of healing in non-industrialized societies and provide the foundation for faith healing in our own". The earliest healers were shamans who believed in magic and the supernatural; many thought that evil spirits invaded people's bodies and made them disturbed. An exorcism is a ritual that is used to drive the devil, demons, or evil spirits from a person. A form of exorcism exists in all shamanic cultures. Skulls that have been trepanned (bored with small holes, probably to release demons) date back to at least 5000 B.C.E. Belief in spirit possession and exorcism has been documented in Babylonia, Nigeria, Tanzania, Greece, India, Ceylon, Malaysia, Indonesia, China, Tibet, Korea, New Guinea, Brazil, Columbia, Haiti, the United States, and throughout Europe. However, the possession phenomenon is not universal; it has not been found in certain tribal groups in the Philippines, the Malay Peninsula, or Australia (Thomason, 2008).

Mesopotamia

In ancient Mesopotamia, priest-doctors treated the mentally ill with magico-religious rituals as mental pathology was believed to mask demonic possession. Exorcisms, incantations, prayer, atonement, and other various mystical rituals were used to drive out the evil spirit. Other means attempted to appeal to the spirit with more human devices--threats, bribery, punishment, and sometimes submission, were hoped to be an effective cure.(Foerschner, 2010) Also, Hammurabi the king of Babylon preserved the code of Hammurabi. This code is the first-known example an orderly body of laws created by a ruler which includes legal procedures for physicians in the treatment of a variety of physical ailments such as payment for successful services rendered as well as punishment for a failed service to his patient (Snitchlier and Harris).

Egyptians

Ancient Egyptians seem to be the most forward-thinking in their treatment of mental illness as they recommended that those afflicted with mental pathology engage in recreational activities such as concerts, dances, and painting in order to relieve symptoms and achieve some sense of normalcy. The priests of the "Abidos" Temple (the biggest center of medicine in Ancient Egypt) treated diseases with chant. In ancient papyrus texts, it was found that there was a saint called Abu Terbo that had treated epilepsy by pipes chant. Egyptian music healers enjoyed a privileged existence, due to their close relationship with priests and other important government leaders. Egyptian priests and physicians referred to music as medicine for the soul and included chant therapies as part of the medical practice. Music therapy has been known since ancient times, when ancient man used singing and dancing as a part of his rituals to throw out the evil spirits, which were waiting to attack him with several diseases (Voices, 2005).

Hebrews

Hebrews believed that all illness was inflicted upon humans by God as punishment for committing sin, and even demons that were thought to cause some illnesses were attributed to Gods wrath. Yet, God was also seen as the ultimate healer and, generally, Hebrew physicians were priests who had special ways of appealing to the higher power in order to cure sickness. Along the same spiritual lines, ancient Persians attributed illness to demons and believed that good health could be achieved through proper precautions to prevent and protect one from diseases. These included adequate hygiene and purity of the mind and body achieved through good deeds and thoughts. (Foerschner, 2010).

Persians

Ancient Persians attributed illness to demons and believed that good health could be achieved through proper precautions to prevent and protect one from diseases. These included adequate hygiene and purity of the mind and body achieved through good deeds and thoughts. They made used of the beneficial effects of physical training and utilized it to fit their youth for military duty.

Greek and Romans

It was said that mental illness was caused by Gods taking a mind away. The foundation of a systemic approach to psychological and physical disorders is considered to have begun with the early Greek philosophers. Hippocrates theorized that four humours or bodily fluids were responsible for both physical and mental health. The four important bodily fluids were: black bile, yellow bile, phlegm, and blood. Having too many of any of these fluids could account for changes in an individuals personality and behavior. Hippocrates theorized that an excess of black bile would make a person "melancholic" (depressed), and an excess of yellow bile would cause a person to be "choleric" (anxious or irritable).Too much phlegm would result in a person being "phlegmatic" (indifferent).An excess of blood would cause a person to be "sanguine" (experience unstable mood shifts).It is important to note that Hippocrates saw no distinction between physical and psychological disorders (Snitchlier and Harris).Demon possession was the theory of Aeschylus to explain Mental illness; exorcism the cure. Socrates believed that mental illness was heaven-sent and not shameful in the least. He believed it to be a blessing, and therefore no treatment was required. Aristotle believed that melancholia was the cause of mental illness and music was the cure. Aulus Cornelius Celsus believed that A sort of force should be applied to the insane to cause a sudden fear into the spirit forcing it to flee the body. His beliefs helped to reinforce the belief that some psychological disorders were caused by angry gods or spirits. Celsus believed mental illness to be a form of madness to be treated with entertaining stories, diversion and persuasion therapy. Claudius Galen stated that Psychic functions of the brain were considered by Galen to be the foremost cause of mental illness. Treatment consisted of confrontation, humor and exercise. Galen maintained Hippocrates beliefs in the four humours as the cause of mental disturbance. However, Galen also suggested that a failure to control ones passions (i.e., anger) might cause a kind of madness.

II. THE MIDDLE AGES

During the Middle Ages, almost no new scientific advances in the understanding of mental illness were made. Individuals with psychological disorders were blamed for their illness because of moral weakness or for participating in forbidden practices with the devil, sorcerers, or other demons. These views resulted in a large stigma for having a mental illness. Treatment of mentally ill people sometimes consisted of torturous exorcism procedures. This was to combat Satan and eject him from the possessed persons body. Prayers, Curses, obscene epithets, sprinkling of holy water, as well as such drastic and painful therapy as Flogging (whipping/beating severely), starving, immersion in hot water were used to drive out the devil. The humane treatments that Hippocrates had advocated centuries earlier were challenged severely. The Middle Ages were bleak for the mentally ill. Belief in the supernatural became so prevalent and intense that it frequently affected the whole population. Although religious thinking resulted in a strong belief in spiritual possession and brutal treatments for the mentally ill, Christian views also called for charity. Monasteries or poorhouses, which had been built to house people who could not pay their expenses, were built all over Europe and allowed the mentally ill shelter. Early in the conception of the monasteries, patients were treated with concern. These poorhouses later became known as asylums with the most famous beingthe Hospital of St. Mary of Bethlehem in London. The hospital was originally created in 1247 for poor people, and by 1403 began to house people called lunatics. In the next few centuries, the inhumane and chaotic housing of the psychologically disturbed came to be known as bedlam, a shortened name for Bethlehem Hospital. The hospital quickly became overcrowded and the residents more uncontrollable and the hospital employed chains and punishment to control patients. Similar conditions were found at other asylums as they became overcrowded.

Beginning of the Renaissance

Witchhunts began at the beginning of the Renaissance and were at their height in the 14thand 15 centuries in both colonial America and Europe. Most psychiatric historians believe that many psychologically ill were called witches. Torture was used to obtain confessions from suspected witches, and many victimsmost of them with mental disorder. Thousands of innocent men, women, and even children were beheaded, burned alive, or mutilated. The witchcraft trials of 1692 in Salem, Massachusetts, were notorious. Several hundred people were accused and thousand people were executed as witches, many were imprisoned and tortured. It has been estimated that some 20,000 people (mainly women) were killed as witches in Scoland alone and that more than 100,000 throughout Europe from the middle of the 15th century to the end of the 17th century. A rebirth of rational and scientific inquiry during the renaissance led to great advances in science and humanism, a philosophical movement that emphasizes the human welfare, the worth and the uniqueness of the individual. Until this time, most asylums were at best custodial centers in which people who were mentally disturbed were chained, caged, starved, whipped, and even exhibited to the public for a small fee, much like in a zoo. But the new way of thinking held that if people were mentally ill and not possessed, then they should be treated as though they were sick. A number of new methods for treating mentally ill people reflected this humanistic spirit. In 1563, Johann Weyer, a German physician, published a revolutionary book called The Deception of Demons that challenged the foundations of ideas about witchcraft. Weyer asserted that many who were tortured and executed as witches were mentally disturbed, not possessed by demons. His book proved to be a forerunner of the humanitarian perspective on mental illness.

The 17th Century

The unique and exotic techniques of Friedrich Anton Mesmer, an Austrian physician who practiced in Paris, presented an early challenge to the biological viewpoint. Mesmer developed developed highly controversial treatment called mesmerism and that was the forerunner of the modern practice of hypnotism. Mesmer performed his most miraculous cures in treatment of hysteriathe appearance of symptoms such as blindness, loss of bodily feeling and paralysis with no organic basis. His techniques for curing this illness involved inducing a sleeplike state, during which his patients became highly susceptible to suggestion. During this state, their symptoms often disappeared. In France, Philippe Pinel, a physician was put in charge of La Bicetre, a hospital for insane people in Paris. He instituted the moral treatment movement, a shift more humane treatment of people who are mentally ill. This involved treating patients with kindness and sensitivity. Pinel ordered that patients chains be removed, replaced dungeons, and encourage exercise. This humane treatment seemed to foster recovery and improve behavior. Pinel also instituted similar reforms at la Salpetriere a large mental hospital for women in Paris. Pinel is considered historically to be a primary figure in the movement for humanitarianism. In England, William Tuke, a prominent Quaker tea merchant, established the York Retreat House in rural England for the moral treatment of mental patients. The retreat enabled people with mental illness to rest peacefully, talk about their problems, and work.In the United States, Benjamin Rush widely acclaimed as the father of U.S. Psychiatry. He introduced more humane treatment policies into mental hospitals. He put into action plans for better ventilation, separation from violent and non-violent patients, and arranged recreation and exercise programs for the sick. Yet Rush was not affected by the established practices and belief of his times: His theories were influenced by astrology, and his remedies including bloodletting and purgatives.

III. THE 18TH AND 19TH CENTURY

Early 1800s: Rotation Therapy - The Swing

During the early 1800s, a technique called Rotation Therapy or The Swing was invented by Erasmus Darwin who was Charles Darwins grandfather. There were two methods through which this treatment is administered:

1. An ordinary chair, suspended from the ceiling, with ropes attached to the legs. The ropes were used to spin the chair until it was set in motion.

2. A pole fixed from the floor to the ceiling by iron rods. It had a horizontal arm attached, which was used to hang a chair or bed and to spin the patient.

Darwin believed that spinning a person around not only induced slumber, but also laughter and that this combination was a great way to resolve mental illness. Both methods had the same results: the spinning motion was continued until the patient promised to obey the doctors and get better. The doctors would then release them and allow them to sleep. But in the end, when the nausea and shock had worn off, the patients were still mentally ill, leading to another session on the swing and thus only repeating the process. There were eminent side effects to the treatment such as:

Anxiety and Fear Nausea and Vomiting Bowel movement Paleness Vertigo

But despite these, multiple institutions still administered this treatment and even gained recognition by Benjamin Rush, Father of Modern Psychiatry, who stated that spinning reduced brain congestion and was thus therapeutic.

1800-1850: Moral Therapy

It was also termed as Moral Therapy or Moral Treatment. One of its first pioneers was William Tuke who established the York Retreat asylum in 1796. The asylum admitted 30 mentally ill patients who lived as part of a small community in a large country house. The treatment also was supported by Philippe Pinel (Father of American Psychiatry) who initiated the Humanistic Approach in curing the mentally ill individuals in 1792. Moral therapy was based on the patients cure and rehabilitation back into society. This enabled many patients to spend only short periods of time in institutions. In 1792, Benjamin Rush initiated the widespread use of moral treatment in the United States. He was hired as a physician at the Pennsylvania Hospital for which he campaigned to the state to build a separate mental ward. It was here where he began the basic practice of moral treatment. In his book the Medical Inquiries and Observations upon the Diseases of the Mind, he stated his belief that most forms of mental illness were a direct cause of disruptions of the blood circulation, or by sensory overload. Therefore, he used methods of treatment that supposedly improved circulation to the brain such as a centrifugal spinning board, and the tranquilizer chair. The chair was designed as a sensory deprivation tool, where the patient was restrained and a sensory deprivation head enclosure was set in place.It was around 1841 when Moral Treatment really became prominent in America through the work of Dorothea Dix. She advocated a humanitarian movement in treating mentally ill patients through the use of a wide-ranging method of treatment that focused on a patients social, individual, and occupational needs. Through this, she successfully raised millions of dollars which she used to build 32 state hospitals with humane conditions. However, as state hospitals grew severely crowded and understaffed, focus on the practice of moral treatment was lost and asylums went back to warehousing those deemed insane. This led to the Decline of Moral Treatment in the 1830s.

Early 1900s: Hydrotherapy

Formerly called hydropathy, hydrotherapy was revived by Dominican monk Sebastian Kneipp through his book My Water Cure published in 1889. It was inspired by old German spa therapies and was deemed effective for mental disorders such as anxiety, insomnia, depression and aggression. Hot or warm water was used to calm and relax patients, whilst cold water was used on hyperactive patients as it slowed the blood flow to the brain and decreased activity. Hydrotherapy consisted of a bath tub covered by a thick canvas to maintain the temperature of the water. This canvas had room for the head to stick out from, plus patients could be allowed their arms outside it at meal times. Some say that hydropathy is a misleading name for the treatment for the procedure is the same for all forms of hydrotherapy. The only variation is with the medium which is water (hot or cold). Thermotherapeutics or thermotherapy is said to be more appropriate.

Late 1800s to early 1900s: Psychoanalysis

From 1838 to 1939, Sigmund Freud established the Psychoanalytic Theory which holds that the human mind was structured in three divisions:

1. Id unconscious; pleasure principle2. Ego mediator; functions consciously and unconsciously; reality principle3. Superego moral arm of the personality

Freud believed that the unconscious was the seat of psychopathology as it contained unacceptable desires and painful memories that had been repressed by the two higher functions.Anxiety arose as conflict occurs between the three parts of the human mind. This result to mental illness but if the person will be able to reveal and address the content of their unconscious, their mental ailments would be cured.Resulting treatments created by Freud became known as psychoanalysis or talking cures examples of which are:

Hypnosis a revised form of mesmerism Free association patient is instructed to relax and share whatever thoughts come to mind. Freudian slips believed to reveal an individuals beliefs, habits and even slips of the tongue Dream Analysis patients are asked to record the contents of their dreams and the psychoanalyst interprets

1934: Chemically Induced Seizures

Ladislaus von Meduna, a Hungarian pathologist, discovered that there was a distinct correlation between epileptics and schizophrenics. He found that schizophrenia was quite rare in patients suffering from epilepsy and derived the hypothesis that it was seizures which prevented the mental disorder. This was further supported by the notion that epileptic patients often felt a sense of euphoria after a seizure, indicating the same affect would be felt by a schizophrenic after a seizure.This lead to his method of giving patients an array of seizure-inducing drugs but Metrazol became his drug of choice. Critics say that this method left a trail of patients with broken bones and distorted memories.

1935: Lobotomy (Leucotomy)

This was first performed by Portuguese neurologist Egas Moniz who believed that patients with obsessive behavioral traits were suffering from fixed circuits in the brain. He believed that severing the connecting fibers of the neurons activity would eliminate the vast proportion of mental disorders, and conducted a procedure involved:

1. drilling two holes in the patients skull (top or side)2. a sharp tool known as leucotome would be forced through the holes and into the brain;3. it would be swept from left to right to ensure that connections between the frontal lobe and the rest of the brain were severed

American neurologist Walter Freeman made lobotomy a mainstream form of treatment in America by 1936 after an encounter with Moniz. He made a simplified version of the lobotomy called transorbital lobotomy which involved lifting the upper eyelid and placing a leucotome against the top corner of the eye socket. Using a mallet, the leucotome was then hammered in through the bone and into the brain. It is moved around inside the skull, ensuring the brain tissue was cut. During the 1940s, lobotomy became one of the most popular forms of mental health treatment in the UK and was even regarded as the miracle cure to insanity. One of the most celebrated lobotomists in the world was Sir Wylie McKissock who reportedly performed over 3, 000 lobotomies during his career. In the late 1950s, lobotomy began to lose popularity due to increase in adverse side effects such as incontinence, epilepsy, loss of motor function, cognitive function, emotion and personality, tact and discipline, lack of empathy, and possible death.

1935: Electroconvulsive Therapy (ECT)

Ugo Cerletti and Lucio Bini administered the first shock therapy using electricity to a schizophrenic patient and received successful results. The purpose of the ECT was to induce a clonic seizure in a patient, allowing them to lose consciousness and convulse for 15 seconds. The theory was that this jumpstarts the brain and helps boost neurotransmission, whilst alleviating most mental illness, especially schizophrenia.

1950s: Pharmaceutical Drugs

The introduction of anti-psychotic drugs such as chlorpromazine (thorazine) helped in eliminating the need for drastic treatments such as the lobotomy and ECT. Thorazine was first created as a cure for malaria but later on, it was discovered that it had sedative side effects that reduced aggressive behavior, anxiety, hallucinations, and the desire to self-mutilate or harm other.

IV. MODERN TRENDS IN PSYCHOLOGICAL TREATMENT

Methodsofpsychologicaltreatmenthavebeenvariedthroughoutthehistoryand haveevolved with the passage of time. As psychology moved from the science of speculation, perceived by great philosophers such as Socrates, to the scientific study of human behavior, methods of treating psychological diseases also have been adapted with the changing outlook. Different schools of psychology focused on different aspects of psychological problems and all developed their own techniques and methods to get rid of these problemsNowadays, accordingto the universallyaccepted standards, wecanroughly dividementaldiseasesinto two broadcategories: Less severeones: Neurosis (characterized by anxiety,depression, or other feelings of unhappiness or distress that are out of proportion to the circumstances of a personslife); More severeones: Psychosis (a medical condition that happens in the brain, in which there has been some loss of contact with reality. Example: Schizophrenia, delusions of grandeur).Itwouldbe interesting tonotethat overtheworld,thereare twomanualsavailablefor classificationof diseases, namely: a) International ClassificationofDiseases (ICD) b) DiagnosticandStatisticalManual (DSM). The formerhasbeendeveloped by theWorldHealthOrganizationwhilethelatterhasbeendeveloped by the AmericanPsychiatristAssociation.Psychologistsfromallovertheworldgottogether to developthese manuals. Theselistalltheknown mentaldiseasesup todate. Moving towardsthe treatment ofmentaldiseases,dependinguponthenatureofdisease andthe extent of severity, twocategoriesoftreatments haveemerged: 1) Psychological approachesormethodsof treatment and 2) Biological approaches or methods of treatmentThePsychologicalmethodoftreatmentis an approach in whichthepatientisnottreatedwithmedicines .Instead, thepatientin this approach is treated with the help of psychological treatment, which means that the psychologists try to find the root cause of the disease and then try totreatthepatientbyjustlisteningand talkingabout the problem or disease. In other words, thepsychologistfocuseson discovering therootcause of theproblemthatthepatient facesandtriesto eliminate theproblemthroughjusttalkingto the patient, makinghimchangehisattitude etc.In thistechnique,nomedicineis given to the patient. It involves methods such as psychotherapy. Methods such as group therapy, family therapy, etc. are also part of this mode of treatment. Psychologicalapproachmaybedividedinto: 1. Psychodynamicmethodologies, 2. Behavioral methodologies, 3. Cognitivemethodologies and 4. Humanistic methodologies.

Psychodynamic Methodologies

These are basedupontheassumption thatpsychologicalproblems and diseases arecausedbyunconscious impulsesandunresolvedpastconflicts. SoPsychodynamic Psychotherapists trytodiscoverthose unconsciousmotivationsand helpthepatientresolvehis past conflicts.Sometimespatientdoesn't know the actual cause of his disease and thus gets mentally disturbed, but sometimes thepatientknows thathe orshehadsome unresolvedpastconflicts orsome badmemories which arenowdisturbinghim.So thePsychodynamicpsychotherapistshavetofindthereasonif thepatient don't knowor isunabletorelate hispastwithhis presentproblem. Viewpointsofsomefamouspsychologists areimportantto be noted in this regards. These include Freuds, Adlers, Jungs or Horneys viewpoints.SigmundFreudgavetheconceptofunconscious andmotivations. Freud used Hypnosis to help clients recover lost memories and associated emotions while pressing on their foreheads. Hypnosisis a state of consciousness involving focused attention and reduced peripheral awareness characterized by an enhanced capacity for response tosuggestion. During hypnosis a person is said to have heightened focus and concentration with the ability to concentrate intensely on a specific thought ormemory, whileblockingout sources of distraction. Hypnotized subjects are said to show an increased response to suggestions.Hypnosis is usually induced by a procedure known as ahypnotic induction involving a series of preliminary instructions andsuggestions. The use of hypnotism fortherapeuticpurposes is referred to as "hypnotherapy", while its use as a form of entertainment for an audience is known as "stage hypnosis. Psychodynamicmethodologieshaveevolved over time with the contributions of many great psychologists. The psychodynamic perspective was originated with the work ofSigmund Freud. This view of psychology and human behavior emphasizes the role of theunconscious mind,early childhoodexperiences, and interpersonal relationships to explain human behavior and to treat people suffering from mental illnesses

Behavioral Methodologies

Thisapproach stems from the behavioral school of psychology. It is based upon Pavlovian concept of conditioning. In this regard, Systematic Desensitization is amethoddeveloped byJosephWolpewhichisusedto treat some mental disorders.Thismethodinvolvesexposureofcertain elementsto theindividualwhich maybe causing fearetc.Forexample, gradualexposureofsnaketoremovesfearofsnakes. Behavioral psychology is a perspective that focuses on learned behaviors.Behaviorism differed from many other perspectives because instead of emphasizing internal states, it focused solely on observable behaviors.Another method is through Aversion therapy which is a form ofpsychologicaltreatment in which the patient is exposed to astimuluswhile simultaneously being subjected to some form of discomfort. Thisconditioningis intended to cause the patient to associate thestimuluswith unpleasant sensations in order to stop the specific behavior. Aversion therapies can take many forms, for example: placing unpleasant-tasting substances on thefingernailsto discouragenail-chewing; pairing the use of anemeticwith the experience ofalcohol; or pairing behavior withelectric shocksof various intensities.

Cognitive Methodologies

During the 1960s, a new perspective known ascognitive psychologybegan to take hold. This area of psychology focuses on mental processes such as memory, thinking, problem solving, language and decision-making. Influenced by psychologists such asJean Piaget andAlbert Bandura, this perspective has grown tremendously in recent decades. Cognitive psychologists often utilize an information-processing model, comparing the human mind to a computer, to conceptualize how information is acquired, processed, stored, and utilized.Under in thiscategoryof treatment ofmildmental diseasesis what istermedas Cognitive therapy.Cognitive therapy is based upon the assumption thatmental problemsarecausedby faulty thinking.Thetherapistcorrectsthisfaultythinking,relievingthesymptomsof the patient.The patient in thiskindofthinkingassumes thathe isnotgood, or he cannot dosomethinggood,feelsunconfident and feels thathe/sheisnotbeingtakingcaredof.It is apsychotherapeuticapproach that addresses dysfunctional emotions, maladaptive behaviors andcognitiveprocesses and contents through a number ofgoal-oriented, explicit systematic procedures. The name refers tobehavior therapy,cognitive therapy, andtherapybased upon a combination of basic behavioralandcognitiveprinciples and research. Most therapists working with patients dealing withanxietyand depressionuse a blend of cognitive andbehavioral therapy. This technique acknowledges that there may be behaviors that cannot be controlled through rational thought. CBT is "problem focused" (undertaken for specific problems) and "action oriented" (therapist tries to assist the client in selecting specific strategies to help address those problems).It is based on a theory of personality that maintains that people respond to life events through combination of cognitive, affective, motivational and behavioral responses. These responses are based on human evolution and individual learning history. The cognitive system deals with the way individuals perceive interpret and assign meaning to events. It interacts with the other affective, motivational, and physiological systems to process information from the physical and social environments and to respond accordingly. Sometimes responses are maladaptive because of misinterpretations, or dysfunctional, idiosyncratic interpretations of situations.It aims to adjust information processing and initiate positive change in all systems by acting through the cognitive system. In a collaborative process, the therapist and patient examine the patients beliefs about him or herself, other people, and the world. Rational emotive behavior therapy(REBT), previously calledrational therapyandrational emotive therapy, is a theory of personality and a method of psychotherapy developed in the 1950s by clinical psychologist Albert Ellis, holds that when a highly charged emotional consequence (C) follows a significant activating event (A), event A may seem to but actually does not cause C. Instead, emotional consequences are largely created by B- the individuals belief system. When an undesirable emotional consequence occurs, such as severe anxiety, this usually involves the persons irrational beliefs, and when these beliefs are effectively disputed (at point D), by challenging them rationally and behaviorally, the disturbed consequences are reduced. From this inception, REBT has viewed cognition and emotion integratively, with thought, feeling, desires, and action interacting with each other. It is therefore a comprehensive cognitive affective behavioral theory and practice of psychotherapy. REBT considered the importance of both mind and body or of thinking, feeling, wanting, and of behavior. It is a holistic approach. It has stressed that personality change can occur in both directions: therapists can talk with people and attempt to change their minds so that they will behave differently, or they can help clients change their behaviors and thus modify their thinking. Another approach is Mindfulness Based approaches; these are designed to deliberately focus ones attention on the present experience in a way that is non-judgmental. Mindfulness has its roots in Eastern techniques, in particular Buddhist meditation. Mindfulness Based/Contemplative Based Approaches were developed byZindel Segal,Jon Kabat-Zinn,Mark WilliamsandJohn Teasdale. The practice requires that one intentionally directs focus away from states of mind that would otherwise occupy them, such as frightening or worrisome thoughts, and instead observe and accept the present situation and all it has to offer, regardless of whether that is good or bad. Mindfulness approaches include mindfulness based cognitive therapy, (MBCT), mindfulness-based stress reductions (MBSR), acceptance and commitment therapy (ACT) and Dialectical Behavior Therapy (DBT). Mindfulness based approaches and contemplative approaches are becoming widely accepted methods for relieving symptoms related to many psychological issues and can be applied across many different population segments. Mindfulness is practiced individually or in group setting. Compared to other behavioral and cognitive behavioral approaches, mindfulness and acceptance based approaches are still new.Mindfulness-based cognitive therapy(MBCT) is apsychological therapydesigned to aid in preventing therelapseof depression, specifically in individuals withMajor depressive disorder(MDD).It uses traditionalCognitive behavioral therapy(CBT) methods and adds in newer psychological strategies such asmindfulnessandmindfulness meditation. Cognitive methods can include educating the participant aboutdepressionMindfulness-based stress reduction(MBSR) is amindfulness-based program designed initially to assist people with pain and a range of conditions and life issues that were difficult to treat in a hospital setting developed byJon Kabat-Zinnat the University of MassachusettsMedical Center, which uses a combination ofmindfulnessmeditation, bodyawareness, andyoga tohelppeople becomemoremindful Dialectical behavior therapy(DBT) it was developed by psychologist Marsha Linehan (1993). It combines traditional cognitive behavioral techniques with mindfulness based strategies for acceptance and tolerating distress. It was first developed to treat borderline personality disorder, although it is now used for a wide range of other problems, including eating disorders, substance abuse disorders, and trauma based problems. It is a therapy designed to help people change patterns of behavior that are not effective, such as self-harm, suicidal thinking and substance abuse. This approach works towards helping people increase their emotional and cognitive regulation by learning about the triggers that lead to reactive states and helping to assess which coping skills to apply in the sequence of events, thoughts, feelings and behaviors that lead to the undesired behavior.Acceptance and commitment therapyorACT(typically pronounced as the word "act") is a form ofclinical behavior analysis (CBA)used in psychotherapy. It is anempirically-basedpsychologicalinterventionthat usesacceptanceandmindfulness strategiesmixed in different ways withcommitmentand behavior-change strategies, to increasepsychologicalflexibility. It is a form of psychotherapy developed by Stephen Hayes and colleagues (2012). ACT includes two main components. The first component involves fostering acceptance fostering acceptance. Rather than trying to control or avoid unwanted thoughts, feelings and other private events, ACT teaches clients to notice, accept, and even embrace private events. Clients are encouraged to distance themselves from their thoughts and take the perspective of an observer. The second component of ACT involves encouraging clients to become more aware of their values and to take action so that their behaviors match their values, bringing more vitality and meaning into the clients life and ultimately increasing flexibility in the clients behavioral repertoire.

Therapeutic Applications of Mindfulness based approaches to Psychological Disorders

Stress Disorders- Mindfulness based therapies can ameliorate multiple anxiety disorders such as generalized, social, panic, phobia and ptsd. Meta analyses show large effect sizes compared to CBT and that multicomponent mindfulness-based therapies- such as MBSR, MBCT, and ACT are more effective than mindfulness alone, it reduces anxiety in special occasions. Depression- one of the most painful psychological disorders. Often chronic and relapsing, and exacts an enormous worldwide toll. Unfortunaltely, antidepressants help only 2/3 of patients, fortunately, MBCT as well as therapeutic lifestyle changes (TLC) such as yoga and exercise and diet (esp.fish and oil supplements) can be helpful (Wals, 2011)Contemplative therapies can help treat some diseases and reduce anxiety and distress accompanies many diseases. Research suggests that many stress related psychosomatic disorders benefit from meditation.CARDIOVASCULAR SYSTEM- it reduces both high blood pressure and cholesterol levels. But the effects dissipate if practice is discontinued. (Anderson, Liu & Kryscio, 2008)HORMONAL AND IMMUNE EFFECTS- Meditation can enhance immune function in both healthy people and cancer patients. Example, meditators have an enhanced response to influenza immunizationFURTHER ADJUVANT TREATMENTSMeditation enhances the conventional treatment of many other psychological disorders, including asthma, psoriasis, prostate cancer, and chronic pain disorders. Meditation, yoga, tai chai can reduce secondary distress in a wide array of illnesses including cancer, fibromyalgia, rheumatoid arthritis, and gastrointestinal disorders. (Wang, et. al 2010) Contemplative practices were originally intended to enhance psychological and spiritual well being.

Humanistic Approach

CarlRogerswasoneofitspractitioners. Humanistic therapists view themselves more as guides than therapists. Theassumptionisthatapersonhasthepotential togetwellbuthejustneedsthewayto beshowntomentalhealth.ClientCenteredtherapy isonesuch method ofhumanisticmethodof treatment. It is also called Person-centered therapy, a form oftalk-psychotherapydeveloped by psychologistCarl Rogersin the 1940s and 1950s. The goal of PCT is to provide clients with an opportunity to develop a sense of self where they can realize how their attitudes, feelings and behavior are beingnegatively affected. Treatmentoflesssevereforms ofmentaldiseasesmayalsobe done ingroups.Wherethisapproachis adopted,it iscalledGrouptherapy. Group psychotherapyorgroup therapyis a form ofpsychotherapyin which one or more therapists treat a small group of clients together as a group. The term can legitimately refer to any form of psychotherapy when delivered in a group format, includingCognitive behavioural therapyorInterpersonal therapy, but it is usually applied to psychodynamic group therapy where the group context andgroup processis explicitly utilized as a mechanism of change by developing, exploring and examining interpersonal relationships withinItmaytaketheformof agroupof peopletakingpartin adrama,as in psychodrama,atechniquedeveloped byJ.L.Moreno (1920) , in which groups were used as both cast and audience for the exploration of individual problems by reenactment under the direction of the leader. Grouptherapy is aformofpsychotherapyinwhichthe therapisthasregularmeetingswithasmallgroupof individuals.Thepurposeofgrouptherapy is to assisteachoftheseindividualinhisorheremotional development and assist him to solve his or her personal problem.Peoplemaychoosegrouptherapyfor severalreasonswhichincludereasonssuchasgrouptherapy being cheaperthanindividualtherapiessince the thecostisdividedamonggroupmembers.Anotherreasonmaybethatgrouptherapyallowsinteraction with otherpeoplegivingmoreinsightsintohowpeoplesolvetheirproblemseffectivelyandachanceto learnfromthese.Inaddition,itwasrevealedthatCognitivetherapyhadasuccessrateof 95%:Behavioral therapyhadasuccessrateof 85%followedbyPsychodynamicmethodshaving asuccess rateof 80%andsoon.Biological Mode of Treatment/Approach

In the biological approach, the patient is treated not only by listening and discussing the problem butalso through medicines.Thepsychiatrist advises/recommendssomemedicines.Usually thepsychiatristadvises medicines whichhelpthepatienttorelaxhimself. Inotherwords, biologicalapproachfocuses notonlyon solving the patient'sproblemthroughtalkinganddiscussing;italsoinvolvesuseofmedicinefor the treatment ofmentaldiseases.Thefirstmajormodeof treatment in biological approach is Drug therapy. Thisiscontrolofmental disordersthroughdrugs. Somesuchdrugsinclude: Anti-psychoticdrugs, drugswhichareusedforseverecasesofpsychosis, including delusions, hallucinations or disordered thought, including major tranquilizers such as Risperda, Olanzapine (Zyprexa), which helps people with severe or psychotic depression, which often is accompanied by a break with reality, hallucinations, or delusions and Aripiprazole (Abilify) which can be taken as a pill or as a shot; Anti-depressantdrugs, such as Zoloft and Lexapro, Prozac, Paxil (paroxetine), Cymbalta, and Luvox. These drugsareusedtorelaxthe patient and elevate mood and combats depression; and Anti-anxietydrugs, drugs whichareusedtohelpanxiety such as Benzodiazepines, (Valium), Anti Beta blockers , Tricyclic Antidepressants, Monoamine Oxidase Inhibitors, Serotonin Norepinephrine Re-uptake Inhibitors,Mild Tranquilizer and Anticonvulsants.AnothermethodapartfromprescribingdrugsiscalledElectroconvulsivetherapyorECTin short. It is formerly known aselectro shock therapyand often referred to asshock treatment, a standardpsychiatrictreatment in whichseizuresare electrically induced in patients to provide relief from psychiatric illnesses. ECT is usually used as a last line of intervention formajor depressive disorder, schizophrenia,maniaandcatatonia. A usual course of ECT involves multiple administrations, typically given two or three times per week until the patient is no longer suffering symptoms. In this method,mildshocksaregiven to theheadof thepatienttohelphimridhismentaldisease.Usually ashock of 70 to150voltsisadministeredto theheadof aseverelysickpatient.Scientistsandpsychiatristsarestill unabletounderstandthe phenomenonbehindthesuccessofECT. Thethirdmethod in thiscategoryisPsycho-surgery. Thismethod involvessurgicallyremovingapartof the brain.Thismethod is veryrarelyusedtodayandonlyas alastresort.Transcranial magnetic stimulation- A magnetic field passes unimpeded and uncharged through the skull, creating an electrical spark only when it bumps against neural tissues. Scalp discomfort, pain at the site and temporary headache are minimal in comparison with ECT. It is a noninvasive method to causedepolarizationorhyperpolarizationin theneuronsof thebrain. TMS useselectromagnetic inductionto induce weakelectric currentsusing a rapidly changingmagnetic field; this can cause activity in specific orgeneral partsof thebrainwith little discomfort, allowing for study of the brain's functioning and interconnections. According to the United StatesNational Institute of Mental Health, TMS "uses a magnet instead of an electrical current to activate the brain. An electromagnetic coil is held against the forehead and short electromagnetic pulses are administered through the coil. The magnetic pulse easily passes through theskull, and causes small electrical currents that stimulate nerve cells in the targeted brain region. Because this type of pulse generally does not reach further than two inches into the brain, scientists can select which parts of the brain will be affected and which will not be. Themagnetic fieldis about the same strength as that of a magnetic resonance imaging (MRI) scan." It has been tested as a treatment tool for variousneurologicalandpsychiatricdisorders includingmigraine,stroke,Parkinson's disease,dystonia,tinnitusanddepression.

SOURCES:

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Merluzzi, A. (2014). Breaking Bad Habits. APS Observer. 27, 1 Greeson, Jeffrey M.; Webber, Daniel M.; Smoski, Moria J.; Brantley, Jeffrey G.; Ekblad, Andrew G.; Suarez, Edward C.; Wolever, Ruth Quillian (2011)."Changes in spirituality partly explain health-related quality of life outcomes after Mindfulness-Based Stress Reduction".Journal of Behavioral Medicine34(6)

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