Lecture 11 - Therapy PDF

Therapy 6.53 2 Lecture Objectives Ancient Methods Psychological Therapies/ Psychotherapies Biomedical Therapies Hospitalization 3 3 Objectives...

Therapy 6.53 2 Lecture Objectives Ancient Methods Psychological Therapies/ Psychotherapies Biomedical Therapies Hospitalization 3 3 Objectives Ancient Methods Explain the approaches used in the following psychological therapies: Psychodynamic/psychoanalytic Humanistic - client centered Cognitive Behavioural Body based Mindfulness Group and Family 4 4 1  Objectives Explain the following biomedical therapies: ❖ Drug therapies ❖ Brain stimulation ❖ Psychosurgery Hospitalization 5 5 Ancient Methods 6 6 Trepanning: boring, chipping, or bashing holes Ancient into a patient’s head Methods - Unlikely the patient would survive Europe Phillippe Pinel French physician 7 7 2  Psychological Therapies/ Psychotherapies 8 8 Psychotherapies – Directive vs Nondirective Directive vs nondirective therapies Directive therapy therapist actively gives interpretations of client’s statements May suggest certain behaviour or actions; Nondirective therapy Therapist: remains relatively neutral does not interpret or give advice 9 9 Psychotherapies - Psychoanalysis Psychoanalysis Uncovering the unconscious Dream Analysis Analyzing Resistance Analyzing Transference: Transferring feelings to a therapist that match those the patient had for important people in his/her past Free association: Patient encouraged to talk about anything that came to mind without fear of negative evaluations 10 10 3  Psychotherapies – Psychodynamic Psychodynamic therapy: Newer and more general term for therapies based on psychoanalysis, Emphasis on transference, Shorter treatment times, More direct therapeutic approach 11 11 Psychotherapy – Client centered Client-Centered/Person Centered Therapy (Carl Rogers) Techniques Nondirective Active listening Four Elements: reflection: therapist restates what the client says rather than interpreting statements unconditional positive regard refers to the warmth, respect, and accepting atmosphere created by the therapist for the client empathy: the ability of the therapist to understand the feelings of the client authenticity: the genuine, open, and honest response of the therapist to the client 12 12 Psychotherapies - Behavioural Behaviour Therapies Directive Classical conditioning techniques Nocturnal bed wetting Sleeping on liquid sensitive pad connected to an alarm. Aversive conditioning Aims to create an aversion to something person should avoid Unwanted behaviour associated with unpleasant feeling Antabuse/disulfiram 13 13 4  Psychotherapies - Behavioural Exposure Therapies Exposing people to what they normally avoid. With repeated exposure they become less afraid Virtual Reality Exposure Uses computer-generated, 3D “world” Presents computerized fear stimuli to patients in a controlled fashion Systematic Desensitization (Wolpe) Combined with progressive relaxation Could use virtual reality 14 14 Psychotherapies – Behavioural Operant conditioning - ABA Operant conditioning techniques Behaviour Modification & Applied Behaviour Analysis (ABA) Removing an undesirable response and substituting a desirable one Antecedent – initial situation leading to the behaviour Behaviour – action Consequence – reinforcer associated with the behaviour Extinction: Removal of a reinforcer to reduce the frequency of a behaviour time-out 15 15 Psychotherapies Behavioural Operant conditioning Behaviour modification Token economies Tokens accumulated then exchanged for rewards Contingency Contract: Formal, written agreement between the therapist & client (or teacher and student) Goals for behavioural change, reinforcements, and penalties are clearly stated 16 16 5  Psychotherapies - Behavioural Participant Modelling: learning through the observation & imitation of others model demonstrates the desired behaviour in a step-by-step process Client is encouraged to imitate the model 17 17 Psychotherapies - Cognitive Therapies COGNITIVE THERAPIES Rational-Emotive Behaviour therapy (REBT ) (Albert Ellis) Cognitive-behavioural therapy Clients are directly challenged in their irrational beliefs and helped to restructure their thinking into more rational belief statements Beck’s Cognitive Therapy: Cognitive distortions CBT has seemed successful in treating depression, stress disorders, and anxiety. CBT has been criticized for focusing on the symptoms and not the causes of disordered behaviour 18 18 Psychotherapies - Mindfulness Mindfulness Based Psychotherapies “Mindfulness is awareness that arises through paying attention, on purpose, in the present moment, non-judgementally,” Jon Kabat-Zinn. “It’s about knowing what is on your mind.” Involves Breathing practices embracing sensations as they arise in the body in order to ground ourselves in the here and now Non-judgmental acceptance 20 20 6  Psychotherapies - Mindfulness Mindfulness Based Psychotherapies Mindfulness Based Stress Reduction (MBSR) - Jon Kabat-Zinn Dialectical Behaviour Therapy (DBT) - Marsha Lineham Mindfulness Based Cognitive therapy (MBCT) Zindel Segal, J. Mark Williams & John Teasdale Acceptance and Commitment Therapy (ACT) Stephen Hayes, Kelly G. Wilson, and Kirk Strosahl 21 21 Psychotherapies - EMDR EMDR (Eye-Movement Desensitization and Reprocessing) Non-traditional Aim: Alleviate distress associated with traumatic memories (Shapiro, F. 1989) How it works: Client attends to emotionally disturbing material in brief sequential doses Simultaneously focusing on an external stimulus. Usually therapist directed lateral eye movements, but other stimuli including hand-tapping and audio stimulation are often used (Shapiro, 1991). 22 22 Body Based Therapies – Somatic Experiencing Somatic Experiencing – Peter Levine Focus Physiological responses that occur when someone experiences or remembers an overwhelming or traumatic event. NOT the thoughts or emotions connected to it. 23 23 7  Psychotherapies – Family therapy Family Counselling/Family Therapy a form of group therapy in which family members meet together with a counsellor or therapist to resolve problems that affect the entire family 24 24 Psychotherapies –Self Help/Support Groups Self-help Groups/Support Groups People who have similar problems and who meet together without a therapist or counsellor for the purpose of discussion, problem solving, and social and emotional support 25 25 Psychotherapies - Group Group therapy Psychodrama -Jacob Moreno Clients act out personal conflicts and feelings with others who play supporting roles Specific issue groups Long term or short-term groups 26 26 8  Psychotherapies – Cybertherapy Cybertherapy: Psychotherapy that is offered on the internet Advantages - anonymity, and therapy for people who cannot otherwise get to a therapist 27 27 Biomedical Therapies 28 28 Biomedical therapies - Psychopharmacology Psychopharmacology Antipsychotic drugs Antianxiety drugs Antimanic drugs/mood stabilizers Antidepressant drugs 29 29 9  Medical Therapies: Pharmacotherapy Some Limitations Side Effects 15% of those taking major tranquilizers for extended time periods will develop a neurological disorder that causes rhythmic facial and mouth movements Complications 2/100 patients taking Clozaril (clozapine) may suffer from a potentially fatal white blood cell disease 30 30 Biomedical Therapies - ECT Electroconvulsive therapy (ECT): Severe depression Electrodes placed on either one or both sides of a person’s head Electric current strong enough to cause a seizure or convulsion is passed through the electrodes 31 31 Biomedical therapies – rTMS & tDCS Emerging techniques: repetitive Transcranial Magnetic Stimulation (rTMS) Magnetic pulses applied to the cortex Transcranial Direct Current Stimulation (tDCS) scalp electrodes used to pass very low amplitude direct currents to the brain 32 32 10  Biomedical therapies - psychosurgery Psychosurgery: Bilateral Anterior Cingulotomy: Electrode wire is inserted into the anterior cingulated gyrus area of the brain, guided by magnetic resonance imaging machine Destroys that area of brain tissue with an electric current 33 33 Hospitalization 34 34 Hospitalization Mental Hospitalization person placed in a protected, therapeutic environment staffed by mental health professionals Used as last resort after all other options exhausted Partial Hospitalization 35 35 11  Hospitalization – Halfway Houses Halfway Houses/Group Homes Short-term group living facilities for individuals making the transition from an institution (mental hospital, prison, etc.) to independent living Offer many health services like prevention, education, therapy, and crisis intervention Crisis Intervention Skilled management of a psychological emergency 36 36 End of Lecture 37 37 12