Chapter 13, Therapy Summary
1. Throughout history, the prevailing views of the causes of psychological disorders have influenced the treatments that have been offered. Some peoples believed that individuals could be “possessed” by evil spirits, so they used treatments such as exorcism. The ancient Greeks sought out natural causes and treatments.
2. Belief in demon possession was common during the sixteenth and seventeenth centuries. Some accused witches may have suffered from psychological disorders. Asylums and hospitals did not always provide a humane refuge for afflicted people.
3. Philippe Pinel and Benjamin Rush advocated moral therapy. Pinel removed the chains from mental patients; Rush advocated kind treatment of individuals with psychological disorders.
4. Dorothea Dix spearheaded a movement that led to state-operated custodial institutions. However, as state mental hospitals grew larger, their effectiveness declined.
5. The community mental health movement recommended community-based treatment and emphasized prevention. Use of psychotropic drugs coupled with growing awareness of the ineffectiveness of large institutions led to a policy of deinstitutionalization—release of patients from mental hospitals.
6. Many individuals who seek mental health treatment do not have a psychological disorder. About 30 percent of individuals with a psychological disorder seek treatment. Individuals with somatization disorder, schizophrenia, bipolar disorder, or panic disorder are more likely to seek treatment than individuals with substance-use disorders.
7. There are two categories of treatments of psychological disorders: biomedical and psychological therapies. Among the licensed practitioners who provide therapy for psychological disorders are clinical psychologists and psychiatrists.
8. Psychotherapy involves a special relationship between a distressed person and a therapist in which the therapist helps the client make changes in his or her thinking, feeling, and behavior.
9. Psychoanalytic therapy aims to help the patient develop insight into unconscious feelings and conflicts by using the techniques of free association, dream interpretation, and interpretation of resistance and transference.
10. Humanistic therapies emphasize the ability of each individual to solve his or her own problems. Client-centered therapy seeks to develop an accepting environment for the client. The therapist displays unconditional positive regard, empathy, and genuineness and does not direct or control the sessions. Gestalt therapy helps clients develop self-acceptance, but Gestalt therapists are more directive than client-centered therapists.
11. Cognitive therapies are designed to change the way the client thinks. Albert Ellis, the founder of rational-emotive therapy (RET), assumes that people are disturbed by the way they interpret events. Therefore, the role of the therapist is to challenge the client’s irrational beliefs. Aaron Beck’s cognitive therapy has been applied to depression with promising results.
12. Stress inoculation training helps clients deal with stressful situations by teaching them to examine their beliefs and develop self-talk to reduce the impact of stressful events.
13. Behavior therapists view maladaptive behaviors as learned and rely on the principles of classical and operant conditioning and modeling to teach the client new behaviors.
14. Systematic desensitization is an effective treatment for phobias in which clients are taught relaxation techniques and then asked to imagine or approach feared situations gradually. Modeling is also an effective treatment for phobias. Aversion therapy is used to reduce undesirable behaviors by pairing them with an aversive (unpleasant) stimulus.
15. Extinction is an operant conditioning technique used to reduce the occurrence of maladaptive behaviors. Reinforcers are withheld after the maladaptive behavior has occurred.
16. Ethical and legal concerns restrict the use of punishment to cases in which a maladaptive behavior is highly resistant to other forms of therapy.
17. Token economies are used to provide secondary reinforcement of desired behaviors. The tokens can be exchanged for primary reinforcers.
18. Lack of assertiveness is sometimes associated with anxiety and depression.
Assertiveness training combines a number of behavioral techniques to teach clients to stand up for their rights and express their feelings appropriately.
19. Group therapy is based on the assumptions that behavior does not occur in a vacuum and that behaviors learned in group settings are more likely to generalize to everyday situations. Marital therapy and family therapy are two forms of group therapy.
20. A significant number of people find support and comfort in self-help groups.
21. After Eysenck concluded that psychotherapy clients are just as likely to improve without it, psychotherapists sought to provide better information about the success of therapy.
22. Meta-analysis allows researchers to combine the results of a number of studies. Using this technique, researchers have found that therapy does lead to greater improvement than no treatment and that differences among the various forms of therapy are not great.
23. The search for the keys to successful therapy has led researchers to focus on factors such as the therapist’s ability to communicate empathy that can lead to improvement in distressed individuals who seek their help.
24. Therapists are becoming increasingly aware of the influence of ethnic and cultural factors on psychotherapy. Members of many ethnic groups drop out early from psychotherapy, in part because there is a dearth of therapists who share the language with the clients as well as a failure to provide forms of therapy that are appropriate.
25. The decision to enter psychotherapy should involve asking questions about the degree of distress one is experiencing; one’s ability to cope with that distress; and the effect of the symptoms on oneself, one’s family, and one’s work. Current forms of psychotherapy are offered in fewer sessions than in the past. Many symptoms, especially distress symptoms, respond rather quickly to treatment. There is also a growing recognition that there are limits to what aspects of our behavior can be changed.
26. The major category of antianxiety drugs, the benzodiazepines, includes the widely known and prescribed Valium, Librium, and Xanax. These drugs affect the ability of the inhibitory neurotransmitter GABA to bind to receptor sites in the brain.
27. Three categories of drugs are used to treat depression: tricyclic antidepressants, MAO inhibitors, and selective serotonin reuptake inhibitors. Tricyclic antidepressants prevent reuptake of norepinephrine and serotonin. MAO inhibitors prevent an enzyme from breaking down norepinephrine and serotonin, thereby increasing the levels of these neurotransmitters present at synapses. Drugs such as Prozac reduce the reuptake of serotonin, thus making more of this neurotransmitter available in the synapses. Lithium is an effective treatment for mania.
28. Antipsychotic drugs work by occupying dopamine receptor sites in the brain.
These drugs are more effective at reducing the positive symptoms of schizophrenia than the negative symptoms. The use of antipsychotic drugs can lead to tardive dyskinesia, a serious adverse reaction involving involuntary motor movements.
29. There are some significant ethnic differences in responses to some drugs used to treat psychological disorders. The Food and Drug Administration has issued new guidelines for the study of possible sex differences in responses to drugs.
30. Electroconvulsive therapy (ECT) is an effective therapy for major depression. Modified procedures for administering ECT, such as unilateral placement of electrodes and use of muscle relaxants, have reduced the severity of side effects. The most prominent side effect is memory disturbance immediately following ECT administration.
31. In 1935, Egas Moniz devised the first psychosurgery, the prefrontal lobotomy. Walter Freeman introduced the procedure to the United States. The few psychosurgical operations done today involve alteration of much smaller areas of brain tissue.