Introductory Psychology CJLong

TREATMENT of ABNORMAL BEHAVIOR

General Overview Questions

When would traditional talk therapy be most appropriate and when would chemotherapy be most beneficial in treating abnormal behavior?

    What evidence is there for early therapy?

    Recorded history reveals that abnormal behavior was thought to be caused by evil spirits. Trephining (making a hole in the skull) was performed in an attempt to let the evil spirit out. Apparently the belief was rather widespread as there have been a number of skulls discovered revealing this process. It is interesting to note that a number of these individuals survived.

    In the 4th century B.C. Hippocrates prescribed rest, exercise, bland diet and abstinence from sex and alcohol to relieve depression.

    Later treatments turned to exorcism a religious rite that involved prayer, starvation and beatings to cast out evil spirits.

    During the Renaissance asylums were built to house the mentally ill. Patients in these asylums were often chained to the walls.. Pinel, like Hippocrates, pushed for unchaining them and treating them by talking and giving advice.

    While not aimed at letting out evil spirits, many procedures were designed to quiet the patient. From the appearance of the apparatus at the right it may be that they were more disoriented than relaxed.

    As late as the 19th century in the US many mentally ill were housed in prisons and Dorothea Dix campaigned to provide adequate mental health hospitals.

    Hospitals were developed and by 1955 more than 1/2 million were hospitalized.

    In the 1960's others campaigned to get the patients back in society and the deinstitutionlization movement was started. Unfortunately, many were turned out into the streets and approximately 20% of prisons are mental patients.

    With the advent of managed care little resources are available for treatment of the mentally ill.
    From trephining & exorcism to deinstitutionalization & managed care! How far have we really come in concern, management, and treatment of the mentally disturbed?

    What is psychotherapy?

    Psychotherapy (talk therapy) involves the use of psychological techniques to treat emotional or behavioral problems. It is conducted in a nonthreatening and nonjudgmental environment. It teaches people how to deal with stress and can help them to understand how they respond to stress and how they can develop more effective responses. In the US, the primary goal of therapy is often enhancing self-esteem. The particular goals of therapy vary across cultures.

    Did you ever notice, everyone needs someone to talk to, to tell their problems, ideas, and accomplishments. But what we really need is someone to talk to who will not tell others what we say and someone who is accepting and not judgmental. How much does that describe psychotherapy?

    What is the research evidence regarding the effectiveness of psychotherapy?

    Psychotherapy research demonstrates that psychotherapy is effective. It works most rapidly with patients suffering from anxiety and depression. In fact, research shows that almost all legitimate therapies are effective.

    Psychotherapy may focus on individuals, groups, families or communities.

    There are about 200 different approaches to therapy today. Some of the more common approaches are:

    However, the eclectic approach is common. This approach results from the combination of aspects of several therapies into one.

    The other question you might have is, "is it cost effective?" Is it worth the time and money?

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    What are the unique features of psychoanalysis and psychodynamic therapies?

    Psychoanalysis and Psychodynamic Therapies stress the importance of the unconscious mind, extensive interpretation by the therapist, and the role of early childhood development in understanding problems in adjustment. This approach was developed by Freud and his therapy is an Insight Therapy.

    Freud originally used hypnosis but gave it up as not effective. His approach to psychotherapy uses free association, dream analysis, & transference.

    1. Free Association - Report whatever comes to mind (allows unconscious to express self).
    2. Dream Analysis - describe dreams in detail - insight into unconscious.
    3. Interpretation - involved in both - therapist provides context and meaning to idea or feeling.
    4. Resistance - Unwillingness to cooperate by which patient signals a reluctance to provide information.
    5. Transference -therapist becomes the object of a patients emotional attitudes about an important person in the patients life.

    Psychoanalysis is lengthy therapy aimed at uncovering and resolving conflicts and unconscious impulses. Its primary goals are to discover relationships between unconscious motivations and behavior.

    What are the criticism of psychoanalysis?

    Critics contend that psychoanalysis is unscientific, imprecise and subjective, however, this criticism might be leveled at most approaches to psychotherapy.

    Many find Freud's sexist concepts unacceptable, certainly by todays standards.

    Research suggests that psychoanalysis is neither more or less effective than other therapies.

    The primary disadvantage of psychoanalysis is that the person must be able to meet 1 hr. daily for 5 years. That tends to restrict it to the wealthy with considerable free time.
    Unconscious factors would appear to be an important source of anxiety and developing insight sounds important but one hour per day for 5 years as $200 to $500 per hour would appear to limit to the very rich who have very flexible work hours. Certainly not the preferred approach for the college crowd.
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    What are the unique features of person-centered therapy?

    Humanistic Therapies or Client or Person-Centered Therapy as developed by Carl Rogers and focuses on the person. Rogers thought that we learn by reinforcement for achievements and tend to see ourselves and others in this manner.

    Rogers viewed problems in adjustment as a result in a discrepancy between the ideal and the real self.

    He trained them to see the world from their own perspective and to improve self-regard using the following techniques:

    1. Non-directive therapy (Client Centered) - The client determines direction of therapy.
    2. Therapist accepts persons feelings and behavior and does not judge or try to dominate therapy.
    3. Therapist helps client organize thoughts by reflecting back the persons feelings.
    4. Therapist must be warn, accepting person who exhibits empathetic understanding and unconditional positive regard.

    Criticisms of the person-centered approach relate to the fact that it deals with hard to define concepts and thus results are hard to measure.

    This approach emphasizes training, developing a more realistic self-concept, was developed in a college counseling center which all sounds good but if it is non-directive, what does the therapist do?

    What are the similarities and differences between person-centered therapy and gestalt therapy?

    Gestalt Therapy is a humanistic therapy developed by Fritz Perls in which the therapist questions and challenges clients to help them become more aware of their feelings and face their problems. This approach assumes that people are responsible for their own lives. The focus is on the here and now and on the fact that people must be aware of their current feelings and situations.

    The goals of Gestalt therapy are:

    1. Help clients become aware of their current feelings and old conflicts.
    2. Help enable them to resolve future conflicts.
    3. Doesn't try to cure.
    4. Helps client become complete
    5. Perls viewed incomplete gestalts as unresolved conflicts and unfinished business
    6. Gestalt therapy helps expand conscious awareness.

    The techniques are to ask the client to concentrate on current feelings about difficult past experiences. The therapist may get client to change speech (e.g. speak more assertively) and hypnosis may be used.

    In some cases they may get to behave in a manner opposite feelings (considered experiential therapy).

    Criticisms of Gestalt Therapy are that it focus too much on individuals happiness and growth at the expense of other goals, focuses too much on feelings and not enough on thought and decision making, and may not effective with more disturbed individuals.
    The emphasis on becoming aware of feelings and conflicts appears to be the most important aspect of the Gestalt approach. Is that not the major problem? It is so easy to see problems in others but not ourself. Role playing could really be an eye opener. Imagine having a married couple play the role that they perceive of the other.
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    What are the techniques used by behavior therapy and for whom is it most effective?

    Behavior Therapy applies learning principles to behavior (behavior modification) It focuses on changing behavior not on unconscious factors or thoughts. That is, it does not focus on origins of behavior only seeks to modify it. First unlearn undesired behavior then learn more acceptable or effective ones. Behavior therapist argue that once a behavior is changed it may be easier to manage attitudes and conflicts.

    Behavior Therapy differs from psychodynamic & humanistic therapies in at least three basic ways. First, the other two use concepts almost impossible to define and measure. Second, they don't think others will produce the same results. Finally, behavior therapist feel that we need to avoid labeling person as abnormal, rather, they think in terms of the fact that the person has learned inappropriate responses.

    Behavior therapists use Operant conditioning, Counterconditioning, & Modeling.

    Their approach involves three general procedures: (1) Identifying the problem behavior and its frequency, (2) Treating the behavior, and (3) Assessing whether there is a lasting change.

    Standard Operant Conditioning principles are employed

    1. Presents some reinforcer to reinforce desired behavior.
    2. Most effective with children & psychiatric patients (token economy)
    3. Use extinction to eliminate undesired behavior.
    4. Punishment may be used when another behavior is reinforced.
    5. Time-Out - (physical removal from sources of reinforcement) is effective.
    Gestalt mentioned learning but behavior therapy really places an emphasis on it. You can see that they apply basic learning principles. This would appear to be the preferred method for children or people who do not relate verbally very well.

    What are the similarities and differences between systematic desensitization and aversive counterconditioning?

    Counterconditioning refers to reconditioning by teaching new response to familiar situation. There are two basic approaches to counterconditioning Systematic Desensitization and Aversive Counterconditioning.

    Aversive Counterconditioning involves associating an aversive stimulus with the undesired behavior. The best example of this is the use of Anabuse with alcoholics.

    Biofeedback is similar to relaxation training. In that case physiological responses such as heart rate or muscle tension is monitored and displayed so that the person can monitor such information. Individuals then learn to relax by reducing muscle tension or heart rate.

    Finally, modeling is another approach with behavior therapy. The assumptions is that people with inappropriate behavior may have inappropriate models. Both children and adults learn by watching others.
    Systematic desensitization has found broad acceptance in management of specific anxities. Also relaxation training has been used in more general situations. Can you think of applications of this?
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    How does cognitive therapy differ from other therapies?

    Cognitive Therapy is based upon the notion that what we think influences how we behave. Faulty behavior is thought to be the direct result of faulty thinking. This approach is based on three basic propositions (1) Cognitive activity affects behavior, (2) Cognitive activity can be monitored and (3) Behavior changes can be effective if cognitive changes are made. An example would be a person is depressed because everyone doesn't like them. Thinking that everyone should like you is faulty thinking.

    Notice cognitive therapy focuses on current thoughts.

    Cognitive therapists use cognitive restructuring which involves modifying faulty thoughts which influence behavior.

    Rational-Emotive Therapy is a cognitive therapy approach that was developed by Albert Ellis. He believed that faulty thoughts can be replaced with rational ones and thus eliminate undesired behavior.

    Bechs cognitive therapy approach involved 4 stages

    1. become aware of thoughts
    2. recognize thoughts are faulty
    3. substitute accurate thoughts
    4. receive feedback as to whether changes are correct.

    Meichenbaums Approach is based on the idea that what people say to themselves influences their behavior. Thus to modify their behavior they need to modify their self-instructions.

    Consider the student who says they can not learn a foreign language. They keep telling themselves this and it becomes true. The reason it does is due to the fact that they come to believe this false thought. If you believe that you can not do something you will not try. If you tell yourself you can do it enough you will come to believe it and you will then put out the effort to succeed.

    Try to think of ways that you give yourself negative thoughts which lead to behaviors that you would like to change. The problem is that our habits are very hard to change but they can all be changed. Sometimes we need help with our thoughts by using large signs or other reminders.

    What are the advantages of group therapy?

    Group Therapy offers the advantage that the therapist can see more people and the resulting cost per person is much less. Another advantage is that the participants in the group receive mutual reinforcement and support.

    The procedures employed are to have individuals explain their problems and have others relate similar experiences.

    Nontraditional group therapy might involve psychodrama where individuals act out roles or encounter groups which are organized for specific types of people.

    Family therapy is another group therapy procedure and focuses on relationships. This therapy attempts to change family system by restructuring family interactions. Consider marital counseling. Two individuals are not listening to one another. The therapist instructs them to play the others role. Thus, the wife acts out her view of the husband and the discussion can then focus on her perception of his behavior.

    There is comfort in knowing others have similar problems. Also, others are in a good position to point out solutions that might be tried. In other cases such as family problems, the problems most often involve group interactions, perceptions, etc. The only way to deal with the problem is to deal with the group.

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    What are two of the biologically based therapies currently in use today?

    Electroconvulsive Shock Therapy (ECT) has long been used in the treatment of depression.

    Electrical current is passed through electrodes on the head producing a seizure. Apparently it is the resulting seizure that results in reduced memory and, in some cases, reduced depression. One of the side effects is more widespread memory deficits when some have reported impair their ability to work.

    Psychosurgery is another procedure that has been used. In the early days a prefrontal lobotomy was the procedure used on mental patients.

    As can be seen in the picture to the right a knife was inserted, usually through the thin bone behind the eye and moves so as to sever the fibers between the limbic system (emotion) and the frontal lobes (thinking). This procedure was poorly controlled, used rather indiscriminately, and is no longer in use.

    Cingulotomy is a neurosurgical procedure that is still in use in extreme cases. Small holes are drilled in the skull and electrodes are placed in the cingulate cortex and a small lesion is made. This procedure, although radical, has been demonstrated to significantly reduce anxiety without degrading cognitive functioning.

    What are the advantages and disadvantages of chemotherapy?

    Chemotherapy became the major focus with regard to treatment of emotional disorders in the 1950's. While there appear to be drugs to treat all sorts of conditions, chemotherapy has become the primary treatment strategy for schizophrenia, bipolar disorders, and major depression. If offers the advantage of a relatively quick fix. However, its major limitation relates to the fact that it doesn't deal with underlying problem only the resulting behavior.

    Some of the major categories of drugs are:

    Almost all pharmacological agents effect changes in behavior by effecting the chemical activity as the junction between neurons (the synapse).

    ECT and cingulotomies are rather radical procedures which are only used in the most severe cases but chemotherapy appears to be used for everyone. Why is that and what are the advantages and disadvantages? One approach is quicker but only deals with the symptoms of the problem. The others involve talk and/or training. It would appear that no one approach is best for all problems. If it was there would be only one approach used. The strategy in understanding this is to look again at what each do or emphasize and see how which approach is best for which problem.

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