Cognitive Therapy and Behavioral Techniques

Treatment of Psychological Disorders

• The Helping Relationship: Aims to change maladaptive thoughts, feelings, and behaviors. Resources include psychologists, psychiatrists, social workers, marriage/family counselors, pastoral counselors, and abuse counselors. The therapeutic process involves a relationship between the client and therapist, alongside selected techniques.

Psychodynamic Therapies

• Psychoanalysis: Rooted in Freudian principles, focusing on achieving insight (conscious awareness of underlying problems). It aims to adjust learned childhood behaviors.
• Free Association: Uncensored conversation where clients verbalize thoughts, feelings, and images spontaneously.
• Dream Interpretation: Therapists help clients understand the symbolic meaning of their dreams.
• Resistance: Defensive actions that hinder therapeutic progress, indicating anxiety-arousing material is being approached.
• Transference: Clients reacting irrationally to therapists as if they were important figures from their past, bringing repressed feelings and maladaptive behaviors to the surface. Can be positive (affection, dependency) or negative (anger, hatred).
• Interpretation: Therapist's insights and statements aim to provide clients with understanding of their behavior. It's a time-consuming process.

Brief Psychodynamic Therapies:

• More focused and economical, utilizing psychoanalytic concepts actively.
• Interpersonal therapy that focuses on current relationships.

Humanistic Psychotherapies

• Focus: Conscious control of behaviors, personal responsibility, and seeing disordered behavior as distorted perceptions, lack of self-awareness, and a negative self-image.
• Client-Centered Therapy (Carl Rogers): Emphasizes a supportive therapeutic environment with unconditional positive regard (acceptance without judgment), empathy (seeing the world from the client's perspective), and genuineness (consistency between therapist's feelings and actions).
• Gestalt Therapy (Fritz Perls): Aims to bring feelings, wishes, and thoughts into awareness, often involving group settings and more active/dramatic approaches.

Cognitive Therapies

• Focus: Examining the role of irrational, self-defeating thought patterns. Therapists help clients identify and alter these cognitions.
• Rational Emotive Therapy (RET, Albert Ellis): Aligns a client's activating event with their conscious belief system, which creates consequences on their emotions and behaviors. It involves challenging maladaptive emotions and behaviors.
• Beck's Cognitive Therapy: Focuses on irrational beliefs (like feelings of unlovableness, worthlessness) that underlie depressing responses. It aims to highlight errors in thinking and help clients reprogram automatic thoughts. Research shows changes in brain function after Cognitive Behavior Therapy (CBT) for depression, impacting the limbic system and cortex.

Behavioral Therapies

• Focus: Maladaptive behaviors are the problem, learned through classical and operant conditioning, and modeling. They can be unlearned.
• Exposure: Treats phobias by exposing clients to feared stimuli (CS) without unwanted consequences (UCS). Response prevention avoids avoiding behaviors.
• Flooding: Direct exposure to a feared stimulus without gradual steps. Implosion involves imagining these situations.
• Systematic Desensitization: Learned treatment for anxiety, eliminating anxieties through counterconditioning.
• In-Vivo Desensitization: Controlled exposure to real-life situations.
• Aversion Therapy: Conditioning an aversion to a stimulus (e.g., alcohol) by pairing it with an unpleasant one.
• Operant Conditioning (Behavior Modification): Using positive reinforcement, extinction, negative reinforcement, or punishment to increase or decrease behaviors. It is effective with children and people with disabilities.
• Token Economies: Reinforcing desired behaviors with tokens exchangeable for tangible rewards. Criticisms focus on its effectiveness in inducing lasting change for patients.

"Third-Wave" Cognitive-Behavioral Therapies

• Mindfulness-Based Approaches: Acceptance, commitment (focus includes mindfulness), and dialectical behavior therapy (DBT) are key components. DBT addresses borderline personality disorder, incorporating elements from multiple therapy styles. Acceptance and Commitment Therapy (ACT) utilizes mindfulness as a way to exert more control over thoughts and feelings.

Cultural and Gender Issues in Psychotherapy

• Cultural Factors: Cultural norms influence treatment utilization. Western assumptions (individual-focused, personal responsibility, emotional expression) may not be universal. Cultural competence is crucial for a therapist.
• Gender Issues: Therapy should address societal pressures and oppressive circumstances, particularly for women, while remaining gender-sensitive.

Evaluating Psychotherapies

• Difficulties: Measuring effectiveness involves many uncontrollable variables, therapist-client interactions, and outcome measurement.
• Research Methods: Randomized clinical trials (RCTs) are crucial for evaluating treatment effectiveness. Meta-analysis combines findings from multiple studies.
• Dodo Bird Verdict: Similar efficacy has been found across various therapy types.
• Importance of Client Variables: Openness to therapy, nature of the problem, and self-relatedness.
• Therapist Variables: Empathy, acceptance, genuineness contribute to the therapeutic relationship.
• Techniques: Selecting and applying appropriate techniques, understanding the dose-response effect (treatment amount to outcome).

Biological Approaches to Treatment

• Psychopharmacology: Studies the effects of drugs on cognition, emotion, and behavior. Drug therapies are widespread, focusing on anti-anxiety, antidepressant, and antipsychotic medications.
• Drug Therapies: Anti-anxiety drugs (reduce anxiety), antidepressant drugs (increase serotonin and norepinephrine activity), and antipsychotic drugs (reduce dopamine activity) are examples. There are side effects.
• Electroconvulsive Therapy (ECT): Induces seizures through electrical stimulation, useful for severe depression but with relapse potential and possible memory loss/brain damage risks. Current techniques have limitations, but scans often show no permanent damage.
• Psychosurgery: (least common): destroys brain parts (e.g., lobotomies, cingulotomies).

Psychological Disorders & Society

• Deinstitutionalization: Movement to community-based treatment, though sometimes challenging due to insufficient community mental health support.
• Preventive Mental Health: Focuses on situational factors and personal resources to prevent psychological disorders.

Applications

• When to Seek Therapy: Experiencing severe emotional distress, difficulty managing life transitions, worsening/resurfacing past problems, difficult emotional responses to trauma.
• Where to Seek Therapy: School counseling centers, community agencies, hospitals, or private practice.
• Important Considerations When Seeking Therapy: Therapist characteristics, shared values, ease with methods, and agreed treatment goals.