MAJOR CONCEPTS: UNIT 4 EXAM Chapter 12 Treatment (If its in BOLD TYPE, then KNOW IT) NOTE: Compare

and contrast means to define and explain similarities and differences between terms/concepts Chapter 12 1. As discussed in class, up to 25% of the population meets criteria for a mental disorder and requires treatment at any given time. Consider personal costs and social and financial costs that motivate individuals for treatment. Also consider the reasons that 70% of these individuals cannot or will not seek treatment for their disorder(s) 2. Compare and contrast insight-oriented therapy, cognitive-behavior therapy, and biologically-based treatments for mental disorders. Consider examples of each. . Insight-oriented therapy is built on one of two major theories of the causes of disorders- psychoanalytic or humanistic theories- and focuses on promoting selfunderstanding. Cognitive-behavior therapy utilizes techniques developed from behaviorism and cognitive theory to address symptoms directly. Biologically-based treatments focus on understanding and addressing the brains role in disorders. Finally, we will discuss treatment research and treatment effectiveness Insight-oriented therapy and Cognitive-Behavior therapy patient or client interacts with a trained and licensed therapist (psychologist, psychiatrist, counselor, social worker); more work on the part of the client, but relatively few negative side effects. Biologically-based treatments disorder is treated with drugs, surgery, or other procedures using medical technology; relatively new (since 1950s), little work for the client (swallow a pill or just show up to an office), potential for negative side effects is high and can be lethal 3. Define and describe psychoanalysis/psychodynamic therapy. Who founded this therapy? What is the goal of this therapy? How does it work? Psychoanalysis is the original insight-oriented therapy. Developed by Sigmund Freud, psychoanalysis is a type of therapy directly connected to Freuds theory of personality, which holds that peoples psychological difficulties are caused by unconscious conflicts among the three psychic structures of the mind: the id, ego, and superego. Even though the textbook differentiates between psychoanalysis and the newer psychodynamic therapy, that distinction will not be made here or required for the exam. These two terms can be considered interchangeable

The goal of psychoanalysis is to help patients understand the unconscious

motivations that lead them to behave in specific ways- MAKE THE UNCONSCIOUS CONSCIOUS. Only after true understanding (insight) is attained can patients choose more adaptive, satisfying, and productive behaviors. 4. Describe free association and dream analysis. What is interpretation? Compare and contrast resistance and transference in psychoanalysis. Consider examples of each of these techniques. Freud originally used hypnosis with his patients to get at unconscious issues but found it unreliable. Over time, Freud developed the method of free association, in which the patient says whatever comes into his or her mind, without censorship or filtering. The resulting train of thought reveals the issues that concern the patient and the patients ways of dealing with them. Another important feature of psychoanalysis is the use of dream analysis, in which the therapist examines the content of dreams to gain access to the unconscious. Rather than taking a dream at face value (the manifest content), the psychoanalyst would seek out its hidden meaning (the latent content) to examine its importance for the client. Freud felt that dreams were the royal road to the unconscious. Due to unreliability in

interpretation, this technique is rarely used today. 5. Describe some of the problems with psychoanalysis as discussed in class.

6. Define and describe the humanistic technique of client-centered therapy. Who founded this therapy? What is the goal of this therapy? How does it work? Describe incongruence. Carl Rogers, who developed a therapeutic approach that came to be called client-centered therapy, which focuses on peoples potential for growth and the importance of an empathic therapist. Incongruence is a mismatch between the real self (who you actually are) and the ideal self (who you would like to be). Client-centered therapy helps to reduce this incongruence so that the client feels better. Therapy is nondirective - therapist tends NOT to provide advice or suggestions, but instead paraphrases the clients words. 7. Compare and contrast the following techniques of client-centered therapy: empathy and unconditional positive regard. Consider examples of each. Unconditional positive regard - providing a nonjudgmental, warm, and accepting environment in which the client can feel safe expressing his or her thoughts and feelings. The therapist must provide unconditional positive regard by conveying positive feelings for the client regardless of the clients thoughts, feelings, or actions. The therapist does this by continually showing the client that he or she is inherently worthy as a human being. 8. Define and describe cognitive-behavior therapy. Consider how it was developed out of behavior therapy and cognitive therapy techniques. Cognitive-behavior therapy (CBT) seeks both to change problematic behaviors and irrational thoughts and to provide new, more adaptive behaviors and beliefs to replace the maladaptive ones. This therapeutic approach combines techniques developed separately from behaviorism and cognitive theories. 9. Define and describe behavior therapy. How does this therapy work? What issues does this therapy target? What learning principles is it based upon? Describe the ABCs of behavior therapy. Behavior therapy is based on well-researched learning principles focused on changing observable, measurable behavior. It appeals to psychologists because of its emphasis on quantifiable results. Antecedents (stimuli that trigger unwanted behaviors), the problematic behavior itself, and its consequences (what is reinforcing the behavior). The therapist takes an active, directive role in treatment. 10.Describe the following behavior therapy techniques based on classical conditioning and consider examples: exposure (be familiar with the three types plus the concept of response prevention), stimulus control, systematic desensitization (be familiar with progressive muscle relaxation). Exposure is a behavioral technique that rests on the principle of habituation, whereby through repeated encounters with a stimulus, the person becomes less responsive to that stimulus. Works exceptionally well for phobias. Patients are asked to expose themselves to feared stimuli in a planned and usually gradual way. People can be exposed to the feared stimulus in three ways 1) Imaginal exposure involves imagining the feared stimulus. 2) In vivo exposure involves exposing themselves to the actual stimulus. 3) Virtual reality exposure involves using virtual reality techniques to expose themselves to the stimulus.

 Exposure with response prevention is a planned programmatic procedure that exposes the client to the anxiety-provoking object but prevents (has the client abstain from making) the usual maladaptive response. Exposure with response prevention has been found to be as effective as medication for obsessive-compulsive disorder (OCD), and the behavioral treatment can have longer-lasting benefits. However, not all people who have OCD are willing to use this behavioral technique. This technique is also used in treating bulimia nervosa. Stimulus control involves controlling the exposure to a stimulus that elicits a conditioned response, so as to decrease or increase the frequency of the response. For example, if an alcoholic primarily drinks at bars, then limit or eliminate occasions of going to bars. Systematic desensitization teaches people to be relaxed in the presence of a feared object or situation. This technique was developed for treating phobias. It grew out of the idea that someone cannot be fearful and relaxed at the same time. It uses progressive muscle relaxation, a technique whereby the person alternates tensing and relaxing muscles sequentially from one end of the body to the other. This type of relaxation can also be used by itself to induce relaxation. When using systematic desensitization to overcome a phobia, the therapist and client begin by constructing a hierarchy of real or imagined activities related to the feared object or situation. The hierarchy begins with the least fearful activity and progresses to the most fearful. Over the course of a number of sessions, the client works on becoming relaxed when imagining increasingly anxietyprovoking activities. This technique is frequently combined with in-vivo exposure at the later stages. Highly effective for phobias and PTSD symptoms. 11.Describe the following behavior therapy techniques based on operant conditioning as discussed in class and consider examples: behavior modification, token economies, skills training, aversion therapy, extinction, self-monitoring techniques. Secondary reinforcersthose that are learned and dont inherently satisfy a biological needare used in treatment programs with psychiatric patients, mentally retarded children and adults, behaviorally disordered children, and prisoners. Token economies are treatment programs that use secondary reinforcers to change behavior. Patients and residents must earn tokens by behaving appropriately. These tokens can then be traded for small items such as candy at a token store or for privileges. Skills training - designed to improve interpersonal or basic technical skills. Emphasizes modeling, behavioral rehearsal, and shaping. Used often and effectively with severe mental illness (basic work skills), children/teenagers with behavior problems/developmental delays, and also in couples/family treatment. Skills such as these can last a lifetime because the reinforcements used by the therapist are later replaced by the rewards of successful skilled behavior. Aversion therapy - using positive punishment to reduce the frequency of an undesirable behavior (Antabuse for alcoholism, aversion therapy for child molesters). Treatment effects dont last long (a few months). Extinction (eliminating a behavior by not reinforcing it) is another important tool of the behavioral therapist. Operant conditioning principles also led to the development of self-monitoring techniques, such as keeping a daily log of a problematic behavior. These techniques can help identify the behaviors antecedents and consequences. 12.Define and describe cognitive therapy. What two individuals are most associated with this

therapy? What is this therapy designed to target? Cognitive therapy is designed to help clients think realistically and rationally in order to reinterpret events that otherwise would lead to distressing thoughts, feelings, and/or behaviors. It highlights the importance of the way people perceive and think about events. THEORIES OF COGNITIVE THERAPY Two particularly important contributors to cognitive therapy were Albert Ellis and Aaron Beck. 13.Compare and contrast Ellis rational-emotive behavior therapy and Becks cognitive therapy. Describe cognitive distortions. In the 1950s, Albert Ellis, a clinical psychologist, developed a treatment called rational-emotive behavior therapy (REBT). REBT emphasizes rational, logical thinking and assumes that distressing feelings or symptoms are caused by faulty or illogical thoughts. People may develop illogical or irrational thoughts as a result of their experiences and never assess whether these thoughts are valid. Psychiatrist Aaron Beck developed a form of (Becks) cognitive therapy that rests on the premise that irrational thoughts are the root cause of psychological problems. Recognition of irrationality and adoption of more realistic, rational thoughts cause psychological problems to improve. Irrational thoughts that arise from systematic biases in the way a person thinks about events and people (including oneself) are considered cognitive distortions, which are learned and maintained through reinforcement. There are many recognized and researched cognitive distortions, such as dichotomous (or black-and-white) thinking, which allows for nothing in between the extremes. For example, a person is considered either perfect or a piece of garbage. 14.Describe the following cognitive therapy techniques and consider examples: cognitive restructuring, psychoeducation. Becks cognitive therapy utilizes cognitive restructuring, a process of helping clients to view their situation in a new light, by teaching them to shift their thinking from automatic, distorted, negative thoughts to more realistic ones. 15.Consider the unique features of cognitive-behavior therapy compared to other treatments as discussed in class. Problem focused - CBT is undertaken for specific problems and has been applied to a wide range of disorders. Action oriented - CBT tries to solve these problems by encouraging the client to act (outside of sessions). Practice in the form of homework assignments is common. Structured - CBT sessions typically begin with setting an agenda for the meeting and a review of homework from the previous week. Then focus is on learning and practice of new skills. Frequently homework is assigned for the next week. Transparent nothing is withheld from the client. Clients have a very good understanding of the treatment and techniques, unlike psychodynamic or humanistic techniques. Flexible can be catered to the unique needs of the client. Treatment is short term (10-20 sessions); can be used on individuals, couples, families, or groups; frequency of sessions can be altered. 16.What general approaches are used in biologically-based treatments of disorders? Physical and pharmacological interventions targeting the brain have been used throughout recorded history, but have only been scientifically tested and developed for the specific use on psychological disorders over the last 60-80 years. The treatments include drugs, surgery, and other means of physical brain intervention.

 These treatments have broad effects and should not be thought of as magic bullets targeting only the symptoms displayed by an individual or a specific disorder. 17.What is psychopharmacology? Compare and contrast antipsychotic, antidepressant, and antianxiety medications as discussed in class. What is each class of drugs designed to target? How quickly does each drug class take effect? What are advantages and disadvantages (e.g., side effects) of each drug class? The use of medication to treat psychological disorders and problems is known as psychopharmacology 18.Describe the side effect of tardive dyskinesia and explain how atypical antipsychotics have addressed this problem. Long-term use of these medications can cause tardive dyskinesia, an irreversible neurological and movement disorder in which the affected person experiences involuntary smacking of the lips, facial grimaces, and other side effects (involuntary movements of the extremities). Atypical (2nd generation) antipsychotics (e.g., Clozaril, Risperidal, and Zyprexa) were introduced in 1990s and add the effects of reducing negative symptoms (apathy, lack of interest, and social withdrawal) without the high risk of severe side effects such as tardive dyskinesia (also still work well on positive symptoms). There is an increased risk of blood sugar disorders (diabetes). 19.Consider the drawbacks of monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs). Monoamine oxidase inhibitors (MAOIs) were the first antidepressant medications discovered. MAOIs require users not to eat foods containing tyramine (e.g., cheese and wine) because of potentially fatal changes in blood pressure. They are also difficult to tolerate. They are particularly effective in treating atypical depression involving increased appetite and hypersomnia but less effective in alleviating typical symptoms of depression. More effective pharmacological treatment for depression emerged in the 1950s with the discovery of tricyclic antidepressants (TCAs). For decades, TCAs were the only effective antidepressant medications readily available. Common side effects of TCAs include constipation, dry mouth, blurred vision, and low blood pressure. TCAs affect serotonin levels. They take weeks to work. 20.In what class of drugs are SSRIs (selective serotonin reuptake inhibitors)? How do these drugs work and how commonly are they used? In the 1980s, selective serotonin reuptake inhibitors (SSRIs) (e.g., Prozac, Zoloft, Paxil, Celexa) were developed for the treatment of depression. SSRIs block the reuptake of serotonin in the brain; fewest and most mild side effects of all psychopharmacotherapeutic drugs; possible to take for long term (lifetime); among the most commonly prescribed drugs on the planet. Like TCAs, they can take weeks to work. One common side effect of SSRIs is decreased sexual interest. Researchers found that SSRI use among children and adolescents was associated with an increased risk of suicide. Researchers continue to discover drugs that can alleviate symptoms of depression without producing as many side effects and work via other biological mechanisms so that patients who do not respond to existing antidepressants can obtain relief. The newer antidepressants called serotonin/norepinephrine reuptake inhibitors (SNRIs) affect both the serotonin and norepinephrine systems. Little is known yet about this newest class. 21.Describe mood stabilizers and discuss how they are used for treatment. What class of drugs are viable alternatives to mood stabilizers for those who cannot tolerate their side

effects? Mood stabilizers medications used to suppress swings between mania and depression of bipolar disorder (Lithium and Valproate). Side effects can be intense, so close monitoring is required. Lithium requires monitoring because of potential damage to kidneys and thyroid (its basically a poison), so Valproate is more commonly prescribed. 22.Discuss the main drawbacks of the benzodiazepines. Benzodiazepines type of tranquilizer that is most commonly used antianxiety (e.g., Valium, Ativan, and Xanax). Significant potential for overuse (abuse), tolerance (need for higher doses to achieve the same effects with long-term use), and eventual dependence- can be like an alcohol or heroin addiction (drug of choice for middle-aged women, particularly housewives). Dangerous and potentially lethal when combined with alcohol.

A person using these drugs can develop tolerance and dependence and can experience withdrawal reactions. Withdrawal risks include shakiness, insomnia, agitation, and anxiety. For these reasons, drugs of this class are often prescribed only for short periods of time. Need to reduce use gradually to come off medication when used longterm. Side effects include drowsiness, poor coordination (be careful driving), impaired memory. 23.Medications by far are the most common type of therapy for mental illness. Discuss advantages and disadvantages of medications in general as discussed in class. 24.Compare and contrast electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS). What disorder are they currently and most frequently used to treat as discussed in class? What disorder was ECT previously used to treat, INEFFECTIVELY, several decades ago as discussed in class? Electroconvulsive Therapy (ECT) is essentially a controlled brain seizure. The treatment that involves inducing a mild seizure by delivering an electrical shock to the brain. Can be effective to treat severe depression that is nonresponsive to other forms of therapy. Originally used from the 1930s-1970s to treat schizophrenia, but the procedure has shown no efficacy for this illness. Originally quite violent, frightening, and painful. Now used with anesthetic and muscle relaxants so that cortical seizures are mild. Since the 1980s, the use of ECT for depression has increased. Side effects include impaired shortterm memory. TRANSCRANIAL MAGNETIC STIMULATION Transcranial Magnetic Stimulation (TMS) - a treatment that involves placing a powerful pulsed magnet (electromagnetic coil) over a persons scalp, which alters neuronal activity in the brain. Useful in treating severe depression unresponsive to medication. Does not require anesthesia and no side effects as compared to ECT. TMS has also been administered to people with bipolar disorder, schizophrenia, and PTSD. 25.Briefly describe psychosurgery and phototherapy as discussed in class. What disorders do these treatments target? Consider the controversial early history of psychosurgery via lobotomy. Psychosurgery - the surgical destruction of specific brain areas. Very rare, but useful as a treatment for severe obsessive-compulsive disorder (OCD). This treatment has a controversial history starting with lobotomy, which was used for agitated or violent patients (not any real diagnostic indications). It involved severing brain connections with an instrument inserted through eye sockets or holes drilled in skull... a lot like trepanning practices of ancient times and about as accurate in its aim. Lobotomy was successful at

times (inventor won Nobel Prize) but also produced extreme lethargy or impulsivity and other severe side effects. Lobotomy was abandoned after medication was introduced. Todays psychosurgeries are much more precise and involve considerably fewer side effects. Phototherapy - a therapy that involves repeated exposure to bright light. Used to treat seasonal patterns of depression [e.g., seasonal affective disorder (SAD)] 26.Describe eclectic therapy as discussed in class and consider examples. Describe therapy protocols and consider reasons for their use in treatment. In the last quarter century, many therapists have moved away from identifying their work as exclusively employing one theoretical orientation. Between 68 and 98 percent of all mental health professionals identify themselves as eclectic in orientation. Eclectic therapy involves drawing on techniques from different forms of therapy, depending on the client and the problem. Rather than sticking to one theoretical perspective, therapy is fitted to the client and his/her specific set of problems. 27.Compare and contrast outcome studies and process studies of psychological treatment as discussed in class. Outcome studies - designed to evaluate whether a particular treatment works, often in relation to some other treatment or a control condition. Process studies - designed to answer questions regarding why a treatment works or under what circumstances a treatment works. Process studies also can examine whether some parts of the treatment are particularly helpful, whereas others are irrelevant to the treatments success. Process studies can refine therapies and target their influence to make them more effective. 28.Be familiar with how ethnic diversity may affect treatment considerations. 29.Compare and contrast the therapeutic relationship to other professional relationships and/or friendships. What can you expect in the therapeutic relationship? Consider factors that are important in finding a therapist and fitting therapy to the problem. SEE ONLINE HANDOUTS.