1. Evaluating Psychotherapies
1.1. Studies and testimonials show clients are generally satisfied with their experiences with mental health professionals
1.1.1. Limitations to testimonials
1.1.1.1. People often enter therapy in crisis
1.1.1.2. Clients may need to believe therapy was worth the effort
1.1.1.3. Clients generally speak kindly of their therapists
1.1.1.4. Biased recall/Confirmation bias
1.1.1.5. Placebo effect: belief that treatment will work
1.2. Clinicians may believe their clients left successfully
1.3. Limitations
1.3.1. People tend to seek out different clinicians when problem reoccurs
1.3.2. Placebo effect
1.3.3. Regression toward the mean: unusual events/emotions to return to their average state
1.4. Hans Eysenck (1952) - Study showed that ⅔ receiving psychotherapy for nonpsychotic disorders improved significantly but also showed that those without treatment also improved
1.5. Randomized clinical studies: randomly assign people to therapy or no therapy and then assessed by those that don’t know who received treatment and who didn’t
1.6. Meta-analysis: statistical procedure that combines the conclusions of many studies
1.7. Statistical summaries don’t show one type of therapy being more effective than others except
1.7.1. Some therapies can be harmful
1.7.2. Some therapies have little to no scientific support
1.8. Some therapies are more effective for certain disorders
1.8.1. Behavioral conditioning for phobias, compulsions, etc.
1.8.2. Therapy is more effective when problem is clear cut like phobias or panic that have specific causes of the problem versus depression and anxiety
1.9. Evidence-based clinical decision making: ideal clinical decision making for therapy for a patient should be based off of
1.9.1. patient’s values, characteristics, preferences, circumstances
1.9.2. clinical expertise of therapist
1.9.3. best available research and evidence
1.10. Eye Movement Desensitization & Reprocessing
1.10.1. magine traumatic scenes as therapist triggered eye movement
1.10.2. Limitations
1.10.2.1. EMDR worked even without eye movement
1.10.2.2. Led many to believe it’s exposure therapy of repeatedly associating traumatic experiences to a safe environment
1.10.2.3. Placebo effect
1.11. Light Exposure Therapy: Expose people with seasonal patterns of depression to light
1.11.1. Studies have shown exposure to morning bright light does decrease seasonal depression symptoms
1.11.2. Just as effective as taking antidepressants or undergoing cognitive behavioral therapy
1.11.3. Brain scans show light therapy sparks activity in brain that influences body’s arousal and hormones
1.12. Studies show little correlation between therapists’ training & experience with client’s outcome
1.13. 3 benefits of psychotherapies
1.13.1. Hope for demoralized people - therapy itself offers hope, creating a placebo effect
1.13.2. New perspective - People may approach life with a new attitude after therapy
1.13.3. Empathetic, trusting, caring relationship
1.13.3.1. Therapeutic alliance: bond of trust and mutual understanding between client and therapist to overcome the client’s problem is key aspect of effective therapy and not the therapist’s training and experience
1.14. Differences in culture, gender, or value such as religion affect therapy
1.14.1. Studies show that
1.14.1.1. People tend to continue and have successful therapy sessions when values are shared
1.14.1.2. American Psychological Association now provides training in cultural sensitivity and actively recruit members of underrepresented cultural groups
1.15. Resilience: personal strength that helps most people cope with stress and recover from adversity/trauma
1.16. Preventive mental health: seeks to prevent psychological casualties by identifying and alleviating the conditions that cause them
1.16.1. working to prevent things like poverty, racism, unemployment, etc. helps to decrease depression, anxiety, etc
1.17. Instead of saving people one by one that keep drowning in a river, go upstream and figure out the source and prevent people from falling into the stream
1.18. Psychotherapies and biomedical therapies aim to locate the cause of psychological disorders within the person
1.18.1. They have fallen into the stream already while the preventive mental health approach catches them before they fall in
2. Biomedical Therapies
2.1. Biomedical therapy: prescribed medications by a psychiatrist (medical doctors) or procedures that act directly on the person’s physiology
2.1.1. Drug therapy: most common form of biomedical therapy used
2.1.2. Psychopharmacology: study of the effects of drugs on mind and behavior
2.1.3. Evaluating effectiveness of drugs
2.1.3.1. Study effect of normal recovery in untreated people
2.1.3.2. Study placebo effect
2.1.3.3. Usually studied using double-blind procedures
2.2. Antipsychotic drugs: drugs used to treat schizophrenia and other forms of severe thought disorder
2.2.1. Accidental discovery of drugs used for other medical purposes calmed people down
2.2.2. Similar to dopamine and blocks activity by occupying its receptor sites
2.2.3. Powerful side effects: sluggishness, tremors, twitches, tardive dyskinesia
2.2.4. Successful treatments involve a combination of life skills programs and use of antipsychotic drugs
2.3. Antianxiety drugs: drugs used to control anxiety and agitation
2.3.1. Xanax, Ativan depress central nervous system activity
2.3.2. Usually combined with psychological therapy
2.3.3. D-cycloserine + behavioral treatment helps the extinction of learned fears
2.4. Antidepressant drugs: drugs used to treat depression, anxiety disorders, OCD, PTSD
2.4.1. Increases availability of norepinephrine or serotonin to elevate arousal and mood
2.4.2. Takes time to go for psychological effect
2.4.3. SSRIs - selective serotonin reuptake inhibitors
2.5. Antidepressant drugs
2.6. Mood stabilizing medications
2.6.1. Treats mood disorders like bipolar disorder
2.6.2. Lithium
2.6.2.1. Helps prevent or decrease effect of manic episodes, lifts depression, protects patients from significant cognitive decline, lower suicide rates
2.6.2.2. Depakote
2.6.2.2.1. Drug used to treat epilepsy found to also control manic episodes
2.7. Electroconvulsive therapy (ECT): biomedical therapy for severely depressed patients, brief electric current is sent through the brain
2.7.1. In the past, patients were awake, strapped down receiving 100 volts of shock
2.7.2. Today, patients are anesthetized and given less electricity
2.7.3. Studies show ECT is effective in treating depression
2.7.4. Side effects: memory loss, seizures
2.8. Alternative neurostimulation therapies - gentler alternatives to jumpstart neural circuits in the depressed brain
2.8.1. Magnetic stimulation
2.8.1.1. Repetitive transcranial magnetic stimulation (rTMS) the application of repeated pulses of magnetic energy to the brain; used to stimulate or suppress brain activity
2.9. Alternative neurostimulation therapies
2.9.1. Deep brain stimulation
2.9.1.1. Helen Mayberg focused on neural hub bridges thinking frontal lobe with limbic system that is overactive when sad
2.9.1.2. Deep brain stimulation worked to excite neurons that inhibit negative emotion-feeding activity in this area of the brain
2.9.1.3. Future research is necessary to understand this treatment
2.10. Psychosurgery: surgery that removes or destroys brain tissue in an effort to change behavior
2.10.1. Drastic and least used biomedical approach
2.11. Lobotomy: psychosurgical procedure once used to calm uncontrollably emotional or violent patients. Cut the nerves connecting the frontal lobes to the emotion controlling centers of the inner brain
2.11.1. Intention was to disconnect emotion from thought
2.11.2. Decreased person’s misery/tension but produced lethargic, immature, infantile people
2.11.3. Method was abandoned after medication became available
2.11.4. Rare occasions lobotomy is used today
2.12. Aerobic exercise - 30 mins a day, 3x a week
2.13. Adequate sleep - 7-8 hours of sleep
2.14. Light exposure - 30 minutes each morning with a light box
2.15. Social connection - less alone time and at least 2 meaningful social engagements weekly
2.16. Anti rumination - identifying and redirecting negative thoughts
2.17. Nutritional supplements - daily fish oil supplement with omega 3 fatty acids
3. Treatments
3.1. Treating Psychological Disorders - Philippe Pinel & Dorothea Dix helped to reform mental hospitals for more humane treatment
3.2. Psychotherapy: treatment involving psychological techniques; interactions between therapist and someone seeking to overcome psychological difficulties or achieve personal growth
3.3. Biomedical therapy: prescribed medications or procedures that act directly on the person’s physiology
3.4. Eclectic Approach: approach to psychotherapy that depends on the client’s problems, using various forms and combining techniques for therapy
3.5. Psychoanalysis: Freud’s therapy - free association, resistances, dreams, transferences - as interpreted by therapist to provide patient with self insight
3.5.1. Not popularly used today
3.5.2. Not supported by scientific research and unclear
3.5.3. Analyst’s interpretation cannot be proven or disproven
3.6. Goals of Psychoanalysis
3.6.1. Bring patient’s repressed thoughts or feelings into conscious awareness
3.6.2. Release the conflict between id-ego-superego
3.6.3. Give insight into the origins of patient’s disorder
3.7. Psychoanalysis
3.7.1. Techniques of Psychoanalysis
3.7.2. Free Association: Saying aloud whatever comes to mind and pausing/omitting embarrassing items or inability to remember to an analyst
3.7.2.1. These pauses/omittance/lack in memory is what the analysis would call resistance: blocking from consciousness of anxiety-laden material
3.7.2.2. Interpretation: analyst’s supposed dream meanings, resistances, and other significant behaviors and events in order to promote insight of patient
3.7.2.3. Transference: patient’s transfer to the analyst of emotions linked with other relationships
3.8. Psychodynamic Therapy: derives from psychoanalysis
3.8.1. Focus on themes in relationships, childhood experiences, etc. to understand current symptoms
3.8.2. Meet 1-2x a week for a few weeks to a few months, face to face with a therapist
3.8.3. Patients explore and gain perspective into thoughts and feelings
3.8.4. Restore awareness of their own wishes and feelings and awareness
3.8.5. Interpersonal psychotherapy: help people gain insight into their roots of difficulties and focusing on present relationships and situations
3.9. Insight therapy: Humanistic & Psychodynamic therapy are both forms of insight therapy in that it aims to improve psychological functioning by increasing a person's awareness of underlying motives and defenses
3.10. Humanistic therapy
3.10.1. Aims to boost people’s self fulfilment
3.10.2. Promoting growth and not curing of illness
3.10.3. Take immediate responsibility for one’s feelings and actions
3.10.4. Conscious thoughts are more important than unconscious
3.10.5. Present and future more important than the past
3.10.6. Client centered therapy: Carl Roger’s technique using active listening, genuine, accepting empathic environment during therapy to facilitate clients’ growth
3.10.6.1. Non-directive therapy: therapist listens without judgement or interpreting
3.11. Humanistic therapy
3.11.1. Active listening: Empathic listening where listener echoes, restates, clarifies
3.11.2. Unconditional positive regard: caring, accepting, nonjudgmental attitude that Rogers believed would help clients develop self awareness and self acceptance
3.11.3. Many of Carl Rogers’ ideas and methods are used today in schools, colleges, clinics during counseling sessions
3.12. Behavioral Therapy: do not believe in healing power of self awareness and believe in that maladaptive symptoms are learned behaviors that can be replaced by constructive behaviors
3.12.1. Classical Conditioning Techniques
3.12.1.1. Counterconditioning: uses classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors
3.12.1.2. Exposure Therapies: treat anxieties by exposing people to the things they fear and avoid through real or simulated situations
3.12.1.3. Systematic desensitization: associates a pleasant relaxed state with gradually increasing anxiety-triggering stimuli
3.12.1.4. Virtual reality exposure therapy: progressively exposes people to electronic simulations of their greatest fears
3.13. Behavioral Therapy - Classical Conditioning
3.13.1. Aversive Conditioning: associates an unpleasant state with an unwanted behavior
3.13.1.1. Opposite of systematic desensitization because person is seeking to avoid something
3.13.1.2. Limitations: Aversive conditioning may work short term but needs to be combined with other forms of treatment to have long term effects
3.14. Behavioral Therapy - Operant Conditioning
3.14.1. Behavior modification: reinforcing desired behaviors and withholding reinforcement for undesired behaviors
3.14.1.1. Token economy: desired behaviors are rewarded with “tokens” which then can be exchanged for rewards such as candy, TV time, excursions, etc.
3.14.1.2. Studies have shown behavior modification has worked greatly with children with autism spectrum disorder
3.15. Cognitive Therapies: teaches people new, adaptive ways of thinking; based on assumption that the way we think is influencing the way we feel
3.16. Rational-Emotive Behavior Therapy: Albert Ellis created a confrontational therapy that vigorously challenges people’s illogical, self defeating attitudes and assumptions to enable healthier behaviors
3.17. Cognitive Therapies
3.18. Aaron Beck’s Therapy for Depression: Gentler approach of confronting negative beliefs as compared to Albert Ellis
3.18.1. Seek to reverse catastrophizing beliefs about themselves
3.18.2. Gentle questioning seeks to reveal irrational thinking
3.18.3. Gentle questioning seeks to reveal irrational thinking
3.18.4. Getting people to change what they say to themselves to change the way they think
3.19. Stress Inoculation Training: teaching people to restructure their thinking in stressful situations
3.20. Cognitive-Behavioral Therapy: popular integrative therapy that combines cognitive therapy with behavior therapy
3.20.1. Make people aware of their irrational negative thinking
3.20.2. Practice more positive approach to everyday settings
3.20.3. Address behavior first and then cognitive change
3.20.4. Focus on maintaining and preventing relapses
3.21. Group Therapy: therapy conducted with groups, allowing therapeutic benefits from group interaction
3.22. Family Therapy: views an individual’s unwanted behaviors as influenced by, or directed at, other family members and changing their relationships and interactions
3.23. Self-Help Groups
3.23.1. Fosters community, fellowship, and growth
3.23.2. People feel more connectedness rather than individual therapy
3.23.3. Alcoholics anonymous, Eating disorder support groups, Cancer patient support groups, etc
3.23.4. Meet regularly and discuss problems, solutions, or just listen to one another