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Treatment of Abnormality and Research Methods.docx

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PSY 325
Lili Ma

Treatment of Abnormality and Research Methods Biological Approaches  Drug therapies  develop drugs that would reverse the bodily processes known to cause the disorder  after discovery of chlorpromazine  Antipsychotic  Reduce symptoms of psychosis (loss of reality testing, hallucinations, delusions)  Saved people locked away in psychiatrist hospitals  Clozaril, Chlorpromazine, haloperidol  Visual disturbances , involuntary movements of the face  Antidepressant  Reduce symptoms of depression (sadness, loss of appetite, sleep disturbances)  Hydrazine  used for fuel V-2 rocket during WWII (Germany)  Inhibit enzymes in the brain  reuptake neurotransmitters, serotonin and dopamine  Prozac  selective serotonin reuptake inhibitors  40 million take ^  Nausea, diariah headache, failure to achieve an orgasm, insomnia  Increased suicidality in children and adolescents  Parnate, Amitriptyline  Antianxiety  Reduce symptoms of anxiety (far, worry, tension)  Barbiturates  suppressed the central nervous system  Highly addictive in use 6 weeks +profuse sweating, heart rate, irritability  Toxic interactions with alcohol and other drugs  Valium , pentobarbital  Mood stabilizer  Use lithium  metallic element present in water, animals and plant tissue  Anticonvulsants and calcium channel blockers  Severe side effects Electroconvulsive Therapy (ECT)  Pass electrical current through the head which triggers seizures  Originally treatment for schizophrenia in early 20 century  Results found  effective for depression instead  Patients are anaesthetized and give muscle relaxers not to be conscious while seizures occur  70-150 volts passed through  6-12 sessions  Significant permanent cognitive damage  People who do not respond to medication  ECT effective for them Psychosurgery  Remove part of the brain thought to be implicated in the disorder  Procedure  prefrontal lobotomy  Very rarely used  Severe side effects  Do not know exactly which part of brain causes disorder Repetitive Transcranial Stimulation  Uses powerful magnets to stimulate targeted areas of the brain  Daily for a week for depression  experience relief from symptoms  Long term changes in neurotransmission / Only headache as side effect What is Psychotherapy?  Psychological approach to treatment  Different modalities  Individual, group, family, couple  Advantages and disadvantages of individual vs. group  Different models  Psychodynamic, interpersonal, behavioural, cognitive, humanistic, existential Therapeutic Relationship  Empathy  Genuineness  Unconditional positive regard  Respect  Development of trust  Foster expectancy of hope and change  Collaboration Goals of most Psychotherapy’s  Fostering insight, awareness, and self-understanding  Reducing emotional distress  Encouraging catharsis—acknowledgement and release of affect  Providing new information  Assigning outside therapy tasks  Development of hope and positive expectations Psychodynamic Therapy 1. Sigmund Freud’s ideas brought us the first psychotherapy. His techniques are used by almost no one today. Some of his ideas still exist in the psychodynamic therapies. 2. A quick review of psychoanalysis… 1. We are constantly in a struggle with ourselves. Our struggles hearken back to a childhood struggle with our parents. 2. We do things as “grown ups” because we have repressed memories and desires and our unconscious drives us to do them. 3. Psychoanalytic therapy tries to dig down into a person’s unconscious (the part of the iceberg below the water) and root out the causes of the struggles. Then the struggles can be relieved. 1. Freud first tried to dig into the unconscious with hypnosis, then trashed the idea. 2. He next turned to free association where people speak freely and quickly. The idea is that they’ll speak their unconscious and a psychoanalyst will be able to decipher it. 1. If a person stops speaking freely, the analyst sees it as resistance – the person is suppressing something they don’t want to surface. 3. Freud turned to dream analysis and what he called the “latent content” – the hidden but symbolic meaning of things in dreams. 1. Patients may feel strong emotions and transfer those onto the analyst. 4. A weakness of psychoanalysis is that it’s so subjective – it’s one analyst's opinion and it can’t be objectively proven. Goal is insight into one’s inner life  Help clients gain insight into unconscious motives and conflicts, thought analysis of free associations, resistances, dreams and transferences  Examines early relationships with parents  Some therapists use hypnosis to uncover repressed material  3-4 sessions a week over many years Interpersonal psychotherapy is a 12-16 session treatment that has been successful with treating depression. o It tries to dig up the cause of their depression. But the real goal is to cut back the symptoms of depression. o Whereas a psychodynamic therapist focuses on finding the root cause of the problem, the interpersonal psychotherapist tries to do this too, but really wants a more real result. Often the real result is improving relationships with others Working through – going over painful memories to weave them as self-definition to accept them Catharsis – the expression of emotions connected to memories and conflicts, central to healing process Transference – Patient displaces affect and feeling about others onto the therapist Counter transference – Therapists’ emotional responses to patient client reacts to the therapist as if an important part of early development Behaviour Therapy  Abnormal behaviour develops in the same way as normal behaviour  Same principles of classical and operant conditioning  Behaviorists disagree that resolving unconscious conflicts or getting to know yourself will solve your mental issues. Behaviorists say you’ve learned these things through rewards and punishments. But, just as you’ve learned them, you can unlearn them too. 1. Behaviorism got its start with Ivan Pavlov and his dogs. 1. In behaviorism, a person (or dog), is conditioned to associated two things together. 2. Bed-wetting was classically conditioned with being awakened by an alarm. This stopped the bed-wetting. 2. Counterconditioning is where we “unlearn” something by conditioning or pairing a trigger stimulus with a new response. 1. For example, suppose a person has acrophobia—fear of heights Behaviour modification  The application of operant learning principles to bring about a specific behavioural change Behaviour Therapy Techniques  Token Economy  Rewards might be food or “token economy”. This is receiving tokens which can be spent for things like candy, TV time, etc. It’s like earning points in a video game which can be used for various things.  Critics say behavior modification means the behaviors are done just to get silly things like plastic tokens. Behaviorists say they slowly take a person off the tokens, and ask, “Their behavior is better, so where’s the harm?”  Relaxation Training – helps the individual voluntarily control psychological manifestations of anxiety  Assertiveness Training -  Social Skills Training – help people with communications  Exposure therapy exposes people to what they try to avoid. It tries to associate the bad thing (heights) with a good thing (like eating). Slowly, the person is moved closer to the ledge or higher up. Eventually, the height is associated with the eating.  Systematic desensitization says you can’t be worried and relaxed at the same time. So, while relaxed, you “face your fears” in small baby steps and work up to the “big fear.” 1. The therapist trains you to use “progressive relaxation” to keep calm when you feel the first hints of anxiety. 2. The trick here is to take it very slowly, in baby steps  Modeling – models desired behaviours so that client can learn through observation  Biofeedback Cognitive therapy  Based on theories of Beck and Ellis  Influences behaviour and emotions by modifying cognitions  Attempts to help clients change misconceptions about the self, others, and world (cognitive restructuring)  First goal is to assist clients in identifying their irrational and maladaptive thoughts. Key aspects of cognitive therapy  Presentation of therapy rationale to patient  Short-term intervention  Focus on the “here and now”  Patient-therapist collaboration  Open-ended, Socratic questions  Homework  Maintain daily records of mood, behavior, and dysfunctional thoughts  Carry out informal experiments to test thoughts, beliefs, and assumptions Techniques  Exposure therapy  In vivo, flooding, implosive  Systematic desensitization  Modeling  Cognitive restructuring  Identifying and challenging negative automatic thoughts and core beliefs Humanistic/Existential therapy 1. Humanists believe that people are good-at-heart and try to help people grow to reach their full potential. 1. The humanist approach and psychoanalysis are called insight therapies because they both have the person look inside to figure things out. 2. Humanist therapies differ from psychoanalysis in that humanism (1) focuses on the present instead of the past, (2) the conscious instead of the unconscious, (3) holds a person accountable for his actions instead of the unconscious, and (4) it promotes growth rather than a cure. 3. Carl Rogers innovated client-centered therapy where the patient speaks and, through self-awareness, moves himself toward his own conclusion. It's "self-help". The therapist listens without judgment and with as little input as possible. 1. Rogers encouraged therapists to show genuineness, acceptance, and empathy. In other words, be real, don’t judge, and feel their pain. 2. Rogers thought this encouraged the patients to “open up” and seek to grow and move on. 3. Rogers spoke of active listening where the listener echoes what’s heard, restates it, then seeks clarification. 4. Rogers #1 thing was that a therapist use unconditional positive regard – that they listen without judging. The hints to listening… 1. Paraphrase what you hear. 2. Seek clarification to see if you got it right. 3. Reflect the feelings that you’re hearing/sensing.  Existential therapy  Emphasis on people’s needs to confront questions about meaning and direction of their lives  Group therapy  Group therapy provides a number of factors that contribute to psychological and behavioural change  E.g., cognitive-behavioural group therapy, process groups Family and marital therapy  Group therapy is the most common type of therapy—it saves therapist time and patient money.  It shows patients that they are not alone and that others share their problems.  Family therapy is a type of group therapy. It stresses the importance of being an individual and a member of a family.  Family therapy sees a person not solely as an individual but as a component. It’s like a spark plug as a part of an engine—both individual yet part of the whole.  Usually, family-therapy seeks to help a relationship issue.   Does Psychotherapy work?  Eysenck’s study ­ no   Smith & Glass Meta­analysis ­ yes   NIMH collaborative study ­ yes   The Consumer Reports Study ­ yes   Empirically Supported Therapies – yes  A list of therapies that are superior to placebo or another form of therapy Issues in psychotherapy  Specifying the problem  Patient characteristics  Specifying the treatment  Specific and nonspecific elements of therapy  Treatment manuals  Therapist training and fidelity  Research design issues (e.g., single case and RCTS)  Internal validity issues (e.g. measurement of outcome, sample size, blindness)  External validity issues (e.g., setting, flexibility of treatments) Concerns about reliance on ESTs  ESTs are limited by the methodology of psychotherapy research (e.g. RCT)  Some therapies are easier to test (e.g. CBT)  Some problems are more difficult to treat and therefore have fewer ESTs   Just because a therapy is not listed as an EST does not mean it could not be  Treatment research might not generalize to clinical settings  ESTs are too restrictive in general clinical practice  There is a need for dissemination research  Third party payers might misuse lists of ESTs Hospitalization   Reasons for hospitalization  Behaviour poses threat to self or others  Behaviour intolerable to community  Outpatient treatment failed  Treatment requires controlled setting  Withdrawal from drugs or alcohol  Physical illness complicated by mental disorder requiring continuous care  Legislation exists to hospitalize patients against their will if required for safety Types of hospitalization   Inpatient hospitalization  May or may not have passes to leave hospital  Partial hospitalization  When complete hospitalization not required  Day, evening, or weekend care  Day hospitalization  For patients who can live at home but need structure and social interaction Research Methods The Scientific Method 1) Specify the topic as clearly and precisely as possible. 2) Review the relevant literature. 3) Define the variables: Independent variables are conditions or factors that are being studied or  manipulated Dependent variables are what you observe as outcomes 1) Develop a specific hypothesis or hypotheses.  2) Select a research strategy­­how will the hypothesis be tested? 3) Conduct the study. 4) Analyze the results, using descriptive and/or inferential statistics.  The former  describe the sample (e.g. means, s.d.) and the latter provide probabilistic  judgments. 5) Report the findings.  Case Study  Detailed clinical description of a single subject   Provides important ideas or hypotheses regarding a specific disorder or theory  May be useful for rare disorders, such as DID (multiple personality disorder) Correlational Research  Examines the relationships between variables without manipulating any of the  variables  Provides useful preliminary information, but are limited in that they cannot  determine causal relationships  Research Designs  Cross­sectional ­ assessment is conducted at one point in time   Longitudinal ­ assessment is conducted at several points in time with the same  group of individuals   Follow­up ­ assessment is conducted at several points in time with the same  group of individuals, usually to examine the impact of an intervention  Epidemiological Rese
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