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three essential features of all therapies
- A sufferer who seeks help
- A trained, socially accepted healer
- A series of contacts with the goal of changing attitudes, emotional states, or behaviours
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psychotherapies
use words and acts to overcome psychological difficulties
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who seeks therapy
- About 20 million North Americans per year 
- More than 3/4 of them seek help with
- More than 3/4 of them seek help with anxiety or depression anxiety or depression
- People with “problems in living
- About 2/3 of clients are women, 1/3 are men
- White individuals more likely to seek treatment than members of other ethnic groups 
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Stigma
- There has been a significant reduction in the stigma associated with mental illness
- perceptions of stigma continue to play a role in people's decisions about whether or not to acknowledge their mental issues and whether or not to seek treatment
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Canadian mental health act
outlines patients rights and conditions for involuntary admittance
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Where is treatment conducted
- Most people are treated as outpatients
- Negative effects of long-term hospitalization
- Reduction in psychiatric beds in Canada since 1964; brief stay in hospital
- 1/3 of Canadians released from hospital following treatment for mental illness are readmitted to hospital within a year
- Canadians with severe psychological disorders often face a cycle of hospital discharges and re-admissions and are often homeless
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Treatment Models
- Medical-biological: Focus on genetics, neurology
- Psychodynamic: Focus on unresolved conflicts
- Humanistic: Focus on fulfilling missing needs
- Behavioral: Focus on changing behavior through rewards and punishment
- Cognitive: Focus on helping people change their ways of thinking and developing coping strategies
- Sociocultural: Focus on cultural and social variables
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Biomedical therapies
- psychopharmacology
- electroconvulsive therapy
- trans-cranial magnetic stimulation
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Psychotropic drugs
- drugs that act primarily on the brain
- Antianxiety drugs
- Antidepressants
- Antibipolar drugs (mood stabilizers)
- Antipsychotics
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Anti-anxiety drugs
- Benzodiazepines: increase efficiency of GABA to bind to receptors
- Buspirone: stabilize serotonine levels
- Beta blockers: compete with norepinephrine at receptor sites on heart and other muscles 
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antidepressants
- Monoamine Oxidase Inhibitors (MAOI’s): inhibit metabolization of serotonin and norepinephrine
- (Tri)Cyclic antidepressants: inhibit reuptake of serotonin and norepinephrine
- Selective Serotonin Reuptake Inhibitors (SSRI’s): selectively inhibit reuptake of serotonin
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mood stabilizers (anti-bipolar drugs)
- Lithium: decreases noradrenaline, increases serotonin
- Anticonvulsive drugs: increase levels of GABA, inhibit norepinephrine reuptake
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antipsychotics
- Conventional antipsychotics: block postsynaptic dopamine receptors
- Serotonin-dopamine antagonists: block activity of serotonin and/or dopamine , clozapin 
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Psychopharmacology: schizophrenia
- Antipsychotic medications: Target positive symptoms, Tardive dyskinesia
- Atypical antipsychotics: Newer, Target positive and negative symptoms  
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electroconvulsive therapy
- used to treat depression by sending an electrical current through the brain, producing a brain seizure
- Reduces depression in 70% of patients
- Causes short-term memory problems
- Developed in the 1930s
- More traumatic than newer treatments
- Used when medication and therapy is ineffective
- Depression
- Fell out of favor because: Abuse - “One Flew Over the Cuckoo’s Nest” (movie) - Memory loss
- Regaining popularity
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vagus nerve stimulation
- electrical signals sent to the brain through the (left) vagus nerve
- Used to treat depression
- Significant improvement in 65% of patients
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transcranial magnetic stimulation
- an electromagnetic coil placed on or above a person’s head sends a current into the prefrontal cortex
- Used to treat severe depression
- Improvement in 65% of patients
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psychosurgery
- brain surgery to alleviate abnormal functioning
- Trephination: among oldest forms of surgery; holes cut in skull to treat illness
- Lobotomy: surgical practice of cutting the connections between the frontal lobe and the lower centres of the brain
- Deep brain stimulation: implanted electrodes deliver low doses of electricity, used to treat depression
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assessing the biological approaches
- Strengths: Biological treatments often bring relief when other approaches have failed - Research offers promising options
- Criticisms: Undesirable side effects - Does not consider interaction between biological and non-biological factors such as environment and experience
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Insight-oriented Therapy: Psychoanalysis
- Developed by Sigmund Freud
- First use of a “talking cure”
- Identify unconscious motivations
- Free association
- Dream analysis
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Psychodynamic therapies: how we develop
- Focus on past emotional trauma - Used by about 15% of contemporary clinical psychologists
- Several types: Psychoanalysis: Short-term psychodynamic therapy: patients choose a single problem to work on (dynamic focus)
- Relational psychoanalytic therapy: therapists are active participants in the therapy and they should share their views with the patient, disclose things about themselves, and establish equal relations with clients
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Psychodynamic Therapy
- Similar to psychoanalytic therapy
- Less frequent sessions
- Less emphasis on sexual and aggressive drives Techniques: - Interpretation - Resistance - Transference
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psychodynamic techniques
- Free association: discussions initiated by client with therapist probing to uncover relevant unconscious events
- Therapist interpretation:
- - Resistance: block in free associations or change in subject
- May expose underlying conflicts or pain
- Transference: shift feelings for figures from childhood to therapist
- May act and feel as they did with parents or siblings
- Dream interpretation: manifest content and latent content
- Catharsis: reliving of past repressed feelings to resolve conflicts
- Must be accompanied by intellectual insight
- Working through: repeatedly examine an issue to improve clarity
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assessing psychodynamic approaches
- Strengths: First practitioners to demonstrate the value of systematically applying both theory and techniques to treatment
- First to suggest the potential of psychological instead of biological treatment
- Their ideas have served as a starting point for many other psychological treatments
- Criticisms: Effectiveness not supported by research
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Humanistic Therapy
- Carly Rogers
- Client-centered therapy: reflection, empathy, unconditional positive regard, self-actualization
- incongruence: real self, ideal self
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Behaviour Therapy
- A type of therapy based on learning principles, focusing on changing observable, measurable behaviors
- The ABC’s: Antecedents, Behaviour, Consequences
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Behaviourist views of abnormal behaviour
- Learned in the same way adaptive behaviours are learned
- Classical conditioning
- Operant conditioning
- Modelling
- Goal is to discover specific problem-causing behaviours and replace them with healthy behaviours
- Behavioural therapy is often effective with phobias and anxiety issues
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Behaviour Therapy: techniques based on classical conditioning
- Exposure: Imaginable exposure, Virtual reality exposure
- Stimulus control
- Systematic desensitization: Progressive muscle relaxation
- Systematic desensitization: effective in treating phobias, PTSD, asthma attacks
- Aversion therapy: increase anxiety response to harmful stimuli desired by the client 
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Behaviour Therapy: Techniques based on operant conditioing
- Behavior modification
- Primary and secondary reinforcers
- Token economies
- Self-monitoring techniques
- Observational learning
- Consistently provide rewards for desirable behaviour and withhold rewards for undesirable behaviour
- Successful in hospitalized psychotic patients
- Works best in institutions and schools
- Token economy: desirable behaviours are reinforced with tokens that can be exchanged for rewards
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assessing the behavioural approaches
- Strengths: Widely studied in research and strongly supported
- Effective for numerous problems, including specific fears, social deficits, and intellectual disabilities
- Criticisms: Changes sometimes require later therapies to sustain
- Not effective with disorders in which distress is non-specific, such as generalized anxiety disorder
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Cognitive views of abnormal behaviour
- Disorders are caused or worsened by maladaptive thinking
- Three kinds: Ellis’s rational-emotive behavioural therapy, Beck’s cognitive therapy, Second-wave cognitive-behavioural therapies
- Ellis was more about talking people out of their stupid chit
- Beck was a learn by doing type of guy
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cognitive thearpy
- A type of therapy that focuses on thoughts rather than feelings or behaviors
- Cognitive distortions
- Psycho-education
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Cognitive Therapy Techniques: Beck's Cognitive therapy
- Cognitive restructuring
- Daily record of dysfunctional beliefs
- Identify automatic thoughts
- Identify rational responses
- Widely used for depression
- Therapists help clients identify negative thoughts and perceptions and guide them to apply alternative ways of thinking
- About as effective as drug therapy for depression (2/3 improve)
- Also used for panic disorder and social anxiety disorder
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Cognitive Therapies: Ellis's rational-emotive therapy
- Goal is to identify irrational assumptions that lead to disordered emotional and behavioural responses
- Point out irrational assumptions
- Model the use of alternative assumptions
- Uses cognitive restructuring
- Effective for anxiety and assertiveness problems
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Second-wave cognitive-behavioural therapies
- recognize problematic thoughts as just thoughts
- clients accept thoughts rather than try to eliminate them
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Assessing cognitive-behavioural therapies
- Strengths: Well supported by research
- Good at treating depression, social anxiety disorder, generalized anxiety disorder, panic disorder, sexual dysfunctions, and other disorders
- Criticisms: Role of cognition unclear (cause or effect?)
- Unclear whether cognitive features, behavioural features, or combination are effective
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Humanisitc and existential Therapies
- Humanists: we are all born with the tools to fulfill our potential
- Existentialists: accept responsibility for our lives and choices
- Emphasize present events, focus on helping clients see themselves accurately and acceptingly
- Gestalt therapy: guide clients toward self- acceptance by challenging and frustrating them
- Skillful frustration, role playing, rules 
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Roger's client-centred therapy: Humanisitic
- goal is to create an environment in which clients can see themselves honestly with acceptance
- Client-centred therapy: supportive environment for clients to feel accepted and to accept self
- Unconditional positive regard: total acceptance of client
- Accurate empathy: skillful listening
- Genuineness: sincere communication
- Reflection
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Assessing Humanistic and Existential Therapies
- Strengths: Appealing to clinicians
- Emphasize positive human qualities
- Criticisms: Difficult to research, and little research has been done
- Partially supported by research
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formats of therapy
- Individual therapy: one on one with therapist and client
- Group therapy: therapist meets with several clients with similar problems simultaneously
- Self-help groups: people with similar problems meet for support without guidance from clinician
- Assessing group therapy: Varies and is therefore difficult to assess
- Helps many
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Family therapy
- whole family meets with therapist, who considers family interactions
- Family systems theory: each family has own rules, structure, and communication patterns that shape behaviour
- For one person to change, the family system may need to change
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Couple Therapy
- two people in a relationship meet together with therapist to consider relationship structure and communication
- Marital therapy
- 38% of Canadian marriages do not survive past the 13th anniversary and 25% of all treated couples eventually divorce
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are particular therapies effective for particular problems
- Behavioural: phobias
- Cognitive-behavioural: social anxiety disorder, generalized anxiety disorder, panic disorder, and depression
- Drug: schizophrenia and bipolar
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Is therapy effective across race and gender
- Members of ethnic minority groups worldwide seek therapies less and benefit less from them than do majority-group members
- Culture-sensitive therapies take into account cultural values and stresses specific to the group
- Gender-sensitive or feminist therapies acknowledge stressors girls and women face
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