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Lecture 9

Lecture 9 - Psychological Therapies.doc

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ANTH 212
Kevin Hamilton

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Psychological Therapies Topics: • Biomedical Therapies: • Drugs • ECT • Psychosurgery • Psychological Therapies: • Psychotherapy • Behavioural Therapy • Cognitive Therapy • Humanistic and Existential • Group Therapy • Effectiveness of Psychotherapies • Prevention of mental illness 1 Biomedical Therapies: Drugs, ECT, Psychosurgery • Psychopharmacology (1950s) revolutionized treatment of severely disordered people • Liberated hundreds of thousands from confinement (now 20% fewer in mental hospitals) Drugs: • Antipsychotic • Antianxiety (lowers central nervous system activity) • Antidepressant (boosts central nervous system activity) • Antipsychotic: Chlorpromazine (first generation) (sold as Thorazine) • helps people who are experiencing the positive symptoms (e.g. paranoia and visual/auditory/tactile hallucinations) • dampens responsiveness to irrelevant stimuli • side effects – tardive dyskinesia (facial and body twitch) Clozapine (second generation) (sold as Clozaril) 2 • helps reanimate schizophrenia patients who have negative symptoms (e.g. apathy and social withdrawal) • blocks dopamine and serotonin activity • effective and now less expensive (patent expired 1994) Other second-generation antipsychotics: Risperdal, Zyprexa • side effects – increase risk of obesity and diabetes • otherwise not much more effective than first generation (but they do not cause tardive dyskinesia) Antianxiety Drugs: Valium and Librium • CNS depressants • reduce tension and anxiety without causing excessive fatigue or performance effects (if used at an adequate dose) • prescribed even for minor emotional stresses Other Antianxiety drugs: Xanax, Ativan Note: several antidepressant drugs used to treat anxiety conditions such as OCD 3 Antidepressant Drugs: • lift people up, typically by increasing the availability of the neurotransmitters norepinephrine and serotonin fluoxetine (Prozac) • blocks the reabsorption and removal of serotonin from the synapse • a selective serotonin reuptake inhibitor (SSRI) • effect similar to that of cocaine • Recent research suggests that fluoxetine may be a placebo Other SSRI’s: Zoloft, Paxil Dual–action antidepressants: work by blocking the reabsorption and breakdown of both norepinephrine and serotonin • many side effects of oral ingestion (e.g. weight gain, hypertension, dizzy spells) • side effects may be avoided by transderm application (patch) lithium salt • often an effective mood stabilizer for those suffering bipolar disorder • inexpensive but has a lot of side effects 4 Depakote • used for epilepsy (caused by rapid and synchronous firing of neurons in the brain that used to be controlled by severing the corpus callosum, preventing the inter- hemispheric transmission of epileptiform discharges) and mania *$19.5 billion in antidepressant sales worldwide in 2002 Electroconvulsive Therapy (ECT), or Shock Treatment: • Used with severely depressed patients • brief electric current is sent through the brain of an anesthetized patient • credited with saving many severely depressed individuals from suicide • no one knows for sure how it works – may stimulate release of norepinephrine (elevates mood and arousal) or may help to calm overactive neural centres (reset principle) Psychosurgery: • removes or destroys brain tissue in an effort to change behavior lobotomy 5 • once used to calm uncontrollably emotional or violent patients • the creator of the procedure, Moniz, won the Nobel Prize in the 1940s • nerves cut that connect the frontal lobes to the emotion-controlling centers (limbic system) of the inner brain • now a rare procedure • other psychosurgery is used only in extreme cases (e.g. split brain sugery) 6 Psychological Therapies: • Major psychotherapies derive from personality theory: • Psychoanalytic • Humanistic and Existential • Behavioral • Cognitive • Half of all therapists use a blend of therapeutic approaches (eclectic), such as biomedical Psychoanalysis (Freud) Assumption: • people are affected by repressed childhood memories (conflicts and impulses) • people are cured when the energy accumulating from id-ego-superego conflicts is released Goal: • help people gain insight into the unconscious origins of their disorders • to work through the accompanying feelings Techniques: • hypnosis (ineffective) • free association 7 • interpretation of dreams • examination of resistances • transference of long-repressed feelings from patient to therapist Criticisms: • difficult to refute explanations for behaviour • psychoanalysis is criticized for its after-the- fact interpretations • time-consuming • costly • recent challenges about the accuracy of repressed memories, on which much of psychoanalysis is built Humanistic Therapy Assumptions: • Behavioural problems represent the history of ones’ beliefs and actions • People need to be responsible to themselves, learn to take control, and learn how to make choices Goals: • focus on clients' current conscious feelings • teach individuals to take responsibility for their own growth 8 Techniques: Person-centered Therapy (Carl Rogers): • therapist engages in active listening and expresses genuineness, acceptance, and empathy • increases the client’s self-understanding and self-acceptance Gestalt Therapy (Fritz Perls): • a combination of • psychoanalytic emphasis(bringing unconscious feelings and conflicts into awareness); and • humanistic emphasis (getting in touch with oneself and assuming personal responsibility in the present) • aim is to make people whole by breaking through defenses and helping them to sense and express moment-to-moment feelings Behavioural Therapy
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