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PSY240H1 Lecture Notes - Group Psychotherapy, Systematic Desensitization, Biofeedback

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CH. 3,5: Treatment of Abnormality and Research Methods
SEPT 29, 09
Biological approaches to treatment
-Drug therapies
- E.g. Antipsychotic, antidepressant, anti-anxiety, mood stabilizer (like lithium therapy, used for
bipolar disorder, anti-convulsive drugs)
drugs depend on gender, age, tolerance of side effects, mechanism of action
thought of as the main treatment for psychological disorders (more so than psychotherapy)
Alternatives to medicine (AKA, a last resort)
- Electroconvulsive Therapy (ECT)
- Pass electrical current through the head which triggers seizures
- Still used quite frequently, even though we don’t know exactly how it works (made safer by
shortening the duration of the current, lowering the intensity, lessening the number of sessions
per patient, and muscle relaxants used now)
- Used to be used for schizophrenia, but now limited to people with mood disorders (like
depression and bipolar disorder)
Can have impact on severely suicidal people, whose medication takes awhile to start working
Can affect cognitive function, but the effects usually fade away after a few days
- Remove part of the brain thought to be implicated in the disorder
- Irreversible, since it’s removing a part of the brain
- Experimentally used for Parkinson’s disease, epilepsy, and extreme OCD
not as widespread, but some surgeries involve implanting something to stimulate parts of the
-Repetitive Transcranial Stimulation
- Uses powerful magnets to stimulate targeted areas of the brain
more recent development
thought to result in long term increase in neurotransmitters in the synapses
since it’s recent, don’t know how it works
may work for extreme OCD
less side effects, pain, downtime, etc
A lot of variation across individual treatment
What is psychotherapy?
-Psychological approach to treatment
-Different modalities
- Individual, group, family, couple
- Advantages and disadvantages of individual vs. group
Advantages of individual: get more individual time, more personalized, better for private people
perceived shameful situations

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Disadvantages of individual:
Adv. Of group: sharing and learning about other experiences and coping skills, cost effective,
strengthen social skills
-Different models
- Psychodynamics, interpersonal, behavioural, cognitive, humanistic, existential
Therapeutic Relationship
-Genuineness (be honest in feedback, no matter how good/bad)
-Unconditional positive regard (ex: no scolding for not taking advice)
-Development of trust (based on real information and maintaining confidentiality)
-Foster expectancy of hope and change
-Collaboration (mutually coming up with what to do)
Goals of Most Psychotherapies
-Fostering insight, awareness, and self-understanding (help person become more aware of sources
of distress; connections between thoughts, feelings, behaviours; unconscious sources of conflict,
repressed impulses, etc)
-Reducing emotional distress (feel comfortable and calm)
-Encouraging catharsis – acknowledgement and release of affect (saying things that can’t be said
anywhere else)
-Providing new information (like psycho-education)
-Assigning outside therapy tasks (person goes to session regularly and does/practice ‘homework’ in
between sessions this is where change takes place)
-Development of hope and positive expectations
Psychodynamic Therapy based on Freud’s theory
meant for anxiety/mood symptoms, not schizophrenia
-Goal is to gain insight into one’s inner life (patterns, tendencies, actions, motivations, unconscious
impulses, etc)
-Examines early relationships (like past conflicts/trauma unconscious conflict)
controversial use of hypnosis (hypnotized patients often ‘make up’ memories)
-Transference – patient displaces affect and feeling about others onto the therapist (like therapist
reminds patient of their abusive father)
-Counter transference – Therapists emotional responses to patient (like patient reminds therapist
of someone else)
-Psychoanalysis – special[ized] type of psychodynamic therapy using free association and
examination of dreams and fantasies (takes a lot of motivation, time, money, etc.)
-Brief Psychodynamic Therapy – It has the same principles, but focuses on thee specific problem
to be solved; not the general problem of how to increase functioning.
-Interpersonal therapy – An effective treatment for depression by focusing on past relationships;
grief; role transition [ending a relationship, changing jobs, etc]; conflict; & social skills deficits
Not much strong empirical support

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Behaviour Therapy
Focus is NOT on mental events, past experiences rather, it looks at the present moment and what
maintains that certain behaviour
- Abnormal behaviour develops in the same way as normal behaviour
- Same principles of classical and operant conditioning
-Avoids discussion of mental events and focuses on identifiable stimuli and responses
-Therapy is present focused on the factors maintaining the behaviour
-Behaviour modification
- The application of operant learning principles to bring about a specific behavioural change
Behaviour Therapy Techniques
-Token economy
-Relaxation training (using things like abdominal breathing, meditation, ritualization, progressive
muscle relaxation… good for anxiety/phobia disorders)
-Assertiveness training (like helping person to make assertive requests, being able to say no, being
able to delegate tasks… for perfectionists, anxiety disorders, social phobia)
-Social skills training (make eye contact, paying compliments, etc specific to social phobia
groups and sometimes depressed people)
-Exposure therapy (want to expose person to whatever stimuli that causes anxiety… shows person
that nothing horrible happens when they stay in that stimulus)
- in vivo (gradually comes in physical contact with stimulus most effective), flooding (expose
client with intense level of stimulus right awayif it works, it helps the client get over phobia
right away), implosive/imaginal (recreate situation in imaginationmaybe doing it in person is too
intense/too impractical [like an earthquake phobia])
-Systematic desensitization (combines implosive with relaxation training)
-Modeling (client watches someone else interact with phobic object before doing it on their own)
-Biofeedback (helps deal with physical symptoms; brings them down to manageable level)
Cognitive Therapy
-Based on theories of Beck and Ellis
-Influences behaviour and emotions by modifying cognitions (cognitions = how people see
themselves and the world)
-Attempts to help clients change misconceptions about the self, others, and world (cognitive
Most often combined with cognitive behavioural therapy
Key Aspects of Cognitive Therapy
-Presentation of therapy rationale to patient
-Short term intervention
-Focus on “here and now not focused on changing behaviour
-Patient therapist collaboration
-Open-ended, Socratic questions (never confront client with problem; make client arrive at their
own conclusion)
- Maintain daily records of mood, behaviour, and dysfunctional thoughts
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