Therapy: Does it Therapy: Does it Work?Work?

Last LectureLast Lecture

5/03/045/03/04

Trustworthy Testimonials?Trustworthy Testimonials?

““My therapist works wonders”My therapist works wonders”

““I work wonders”I work wonders”

Consumer Reports: 22,000Consumer Reports: 22,000 Rate laundry detergents; Breakfast Rate laundry detergents; Breakfast

cereals; home appliances, cereals; home appliances, automobiles… automobiles…

ANDAND ““If at any time over the past 3 years, If at any time over the past 3 years,

you experienced stress of other you experienced stress of other emotional problems for which you emotional problems for which you sought help…”sought help…”

How much did it help? How much did it help? Were you satisfied?Were you satisfied?

What percentage of What percentage of patients?patients?

Indicated Indicated treatment made treatment made things: things: A lot worseA lot worse Somewhat worseSomewhat worse No differentNo different Somewhat betterSomewhat better A lot betterA lot better

Indicated they Indicated they were:were: Not satisfied at allNot satisfied at all Fairly satisfiedFairly satisfied Highly satisfiedHighly satisfied

2,900 (40%) sought help from psychologist, 2,900 (40%) sought help from psychologist, psychiatrist, social worker, or marriage psychiatrist, social worker, or marriage counselorcounselor

Most people…Most people…

Indicated Indicated treatment made treatment made things things

Somewhat betterSomewhat better A lot betterA lot better

Indicated they Indicated they werewere

Fairly satisfiedFairly satisfied Highly satisfiedHighly satisfied

86%

89%

So long…So long…

Hello PsychotherapyHello Psychotherapy Psychoanalytic Therapy Behavioral Therapy Cognitive Therapy Humanistic Group

Biological Therapies Drugs, ECT, Psychosurgery

Behavioral Therapy: Behavioral Therapy: tell me tell me what you want to change…what you want to change…

Behavior = problem, not result Behaviors are learned

Therefore, can be unlearned

Classical Conditioning Techniques Flooding, Systematic Desensitization, Aversion Therapy

Operant-Conditioning Techniques Reward and Punishment, Token Economy, Biofeedback,

Social Skills Training

FloodingFlooding

Patient saturated with fear-provoking stimulus until anxiety is extinguished

After repeatedly presenting bell without food… Stopped salivating

Repeatedly expose phobic to fearful situation w/out negative consequences…

Systematic Desensitization

Treat anxiety disorders by pairing gradual exposure to anxiety-provoking situation with relaxation

Condition to respond to fear w/ calm, not anxiety

1. Relaxation Training2. Anxiety hierarchy3. Gradual exposure

1.1. Sit back comfortably, loosen Sit back comfortably, loosen clothing, take shoes off, take a clothing, take shoes off, take a deep breath, let muscles get deep breath, let muscles get loose and heavyloose and heavy

2.2. Wrinkle forehead, tighter, tighter, Wrinkle forehead, tighter, tighter, tighter, clinch jaw, purse lips…tighter, clinch jaw, purse lips…

3.3. Stop tensing and Relax. Picture Stop tensing and Relax. Picture smooth forehead, open mouth, smooth forehead, open mouth, loosen lipsloosen lips

Now that you can relax on cueNow that you can relax on cue

You see a newspaper ad for discount You see a newspaper ad for discount airfares (0)airfares (0)

You look out window as plane leaves You look out window as plane leaves ground (100)ground (100)

Close your eyes and Close your eyes and imagine…imagine…

Start with mildest fear-provoking situationStart with mildest fear-provoking situation If you keep your cool, progressIf you keep your cool, progress If anxious, stop and relaxIf anxious, stop and relax

Can be imaginal or in vivo…Can be imaginal or in vivo…

Phobias, Phobias, OCDOCD, bulimia, etc., bulimia, etc.

Aversion Therapy Technique to react with aversion to

harmful substances Calm doesn’t apply to smoking, drinking,

overeating and other destructive habits Goal: e.g. get drinkers to feel sick to

stomach at sight, smell, and taste of liquor

Cognitive Therapy Distorted thoughts produce maladaptive

behavior (depression, anxiety, emotional/ mood disorders) Open your minds, think about old problems in

new ways, challenge assumptions… Rational-Emotive Behavior Therapy Beck’s Cognitive Therapy

Therapist = partner, friend, teacher Sessions focused on concrete problems

Rational Emotive Therapy Rational Emotive Therapy (RET)(RET)

Distress caused by Distress caused by rigid, maladaptive ways ppl construe ways ppl construe events, not upsetting events per events, not upsetting events per se…se…

Irrational beliefs:Irrational beliefs: I have to be perfect at everything I doI have to be perfect at everything I do Everyone must like meEveryone must like me

Ellis’ A-B-C Theory of Emotional Distress

AActivating Event - ctivating Event - BBeliefs – eliefs – CConsequencesonsequences“ “ My approach to psychotherapy is to zero in as quickly as My approach to psychotherapy is to zero in as quickly as

possible on the client’s basic philosophy of life; get him to possible on the client’s basic philosophy of life; get him to see exactly what this is and how it’s self-defeating; and to see exactly what this is and how it’s self-defeating; and to persuade him to work his ass off, cognitively, emotionally, persuade him to work his ass off, cognitively, emotionally, and behaviorally, to profoundly change it”and behaviorally, to profoundly change it”

Where is it written that life’s Where is it written that life’s supposed to be fair?supposed to be fair?

Not easy to rid ppl of lifelong Not easy to rid ppl of lifelong assumptionsassumptions Blunt, confrontational techniquesBlunt, confrontational techniques

E.g. shy woman in subwayE.g. shy woman in subway Step out of characterStep out of character PsychoeducationPsychoeducation

““Not just to FEEL better, but to get better”Not just to FEEL better, but to get better”

SHAPE UP ALREADY!SHAPE UP ALREADY!

Get real, get smart, get Get real, get smart, get going!going!

Beck: It’s my fault, I can’t do Beck: It’s my fault, I can’t do anything right, It’s the story of anything right, It’s the story of my life…my life…

Same idea, gentler, more collaborative Same idea, gentler, more collaborative approachapproach Restructure interpretations by questioningRestructure interpretations by questioning ““Is there another way to look at the sitch.?”Is there another way to look at the sitch.?” ““What’s the worst thing that could happen?”What’s the worst thing that could happen?”

Distress in therapyDistress in therapy Keep diary: situation, felt, thinking, rational?Keep diary: situation, felt, thinking, rational? Bibliotherapy: You feel the way you thinkBibliotherapy: You feel the way you think

The Bottom Line: Does The Bottom Line: Does PsychotherapyPsychotherapy

Work? Work?

Based on the results of 475 studies (Smith et al., 1980), the Based on the results of 475 studies (Smith et al., 1980), the average psychotherapy client shows more improvement than average psychotherapy client shows more improvement than 80% of those in the no-treatment control group.80% of those in the no-treatment control group.

BUT:BUT:

UnUntreated ppl improvetreated ppl improve Ppl who receive therapy are somewhat Ppl who receive therapy are somewhat

more likely to improve regardless of more likely to improve regardless of kindkind

All approaches are equally effectiveAll approaches are equally effective For some disorders, certain types of For some disorders, certain types of

therapy tend to be more successful.therapy tend to be more successful. Placebo treatments also improvePlacebo treatments also improve

What are the Active What are the Active Ingredients?Ingredients?

Common, nonspecific factors apparent in all Common, nonspecific factors apparent in all types of psychotherapy:types of psychotherapy:

Supportive RelationshipSupportive Relationship

A Ray of HopeA Ray of Hope

Opportunity to Open UpOpportunity to Open Up

On opening up… On opening up… Preventative Preventative

medicine?medicine?

Writing Paradigm: Writing Paradigm: OverviewOverview

For the next four days, I would like for you to write your very deepest thoughts and feelings about the most traumatic experience of your life. In your writing, I’d like you to really let go and explore your very deepest emotions and thoughts. You might tie your topic to your relationships with others, including parents, lovers, friends, or relatives. You may also want to link your experience to your past, your present, or your future, or to who you have been, who you would like to be, or who you are now. You may write about the same general issues or experiences on all days of writing, or on different traumas each day. All of your writing will be completely confidential.

Monthly Health Center Monthly Health Center Visits:Visits:((Across four studies)Across four studies)

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0.10

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0.25

0.30

3 mo prior to writing 3 mo after writing

Experimental

Controls

Samples of ParticipantsSamples of ParticipantsSamples of ParticipantsSamples of Participants

Students (undergraduates, medical Students (undergraduates, medical students, adolescents)students, adolescents)

Maximum security prisonersMaximum security prisoners Unemployed engineersUnemployed engineers Holocaust survivorsHolocaust survivors University staff membersUniversity staff members Chronic pain, arthritis, and asthma Chronic pain, arthritis, and asthma

patientspatients Recently bereaved adultsRecently bereaved adults PTSD samplesPTSD samples

Objective Health Objective Health Improvements following Improvements following writingwriting

Reduced physician visits for illnessReduced physician visits for illness Fewer absentee days among university staffFewer absentee days among university staff Reduced medication use among pain Reduced medication use among pain

patientspatients Reduced alcohol consumption (older, non-Reduced alcohol consumption (older, non-

college samples only)college samples only) Reduced blood pressure, skin conductance, Reduced blood pressure, skin conductance,

muscle tensionmuscle tension Long-term physiological markers (e.g. Long-term physiological markers (e.g. NK cell NK cell

activity, CD-4 (t-lymphocyte) levels)activity, CD-4 (t-lymphocyte) levels)

Emotional Expression: Emotional Expression: NO WORDS?NO WORDS?

Dance study (Krantz, Dance study (Krantz, 1993)1993)

Conditions:Conditions: Dance onlyDance only Dance + writeDance + write ExerciseExercise

Changes in HandwritingChanges in Handwriting

Linguistic Inquiry and Linguistic Inquiry and Word CountWord Count

LIWCLIWCA computer-based text analysis program

LIWC DimensionsLIWC Dimensions

I. Standard linguistic dimensionsI. Standard linguistic dimensionsWord count, pronouns, articles, prepositionsWord count, pronouns, articles, prepositions

II. Psychological processesII. Psychological processesEmotionsEmotions Sensory ProcessesSensory Processes

Cognitive processesCognitive processes Social ProcessesSocial Processes

III. RelativityIII. RelativityTime, space, motionTime, space, motion

IV. Personal concernsIV. Personal concernsOccupationOccupation ReligionReligion

LeisureLeisure Physical states (illness, sex, Physical states (illness, sex, sleeping)sleeping)

MoneyMoney

Language Dimensions Language Dimensions Predicting HealthPredicting HealthLanguage Dimensions Language Dimensions Predicting HealthPredicting Health

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100

Day 1 Day 2 Day 3 Day 4

Rel

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PositiveEmotion

NegativeEmotion

CognitiveWords

To HealthTo Health

Personal upheavals cause havoc by:Personal upheavals cause havoc by: disrupting normal cognitive activity disrupting normal cognitive activity undermining social interactions and relationshipsundermining social interactions and relationships

Writing about an upheaval:Writing about an upheaval: reduces the need to inhibit thoughts, emotions, reduces the need to inhibit thoughts, emotions,

behaviorsbehaviors brings about cognitive resolution, freeing up brings about cognitive resolution, freeing up

working memoryworking memory allows for more open social relationshipsallows for more open social relationships

The EndThe End