Three types of biological treatment
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Strengths of psychodynamic-first to recognize strength of psychological theories and treatment -saw abnormal functioning as rooted in the same process as normal functioning -first to apply theory and techniques systematically to treatment-monumental impact on the fieldWeaknesses of psychodynamicunsupported ideas (difficult to research) --non-observable --inaccessible to human subject (unconscious)Believe that actions are determined largely by our experiences in lifeBehavioral (and psychodynamic)concentrates wholly on behaviors and environmental factorsbehavioral modelbases explanations and treatment on principles of learningbehavioral modelbegan in laboratories where conditioning studies were conductedbehavioraldifferent forms of conditioningoperant conditioning modeling classical conditioninghow modeling explains abnormal functioningindividuals can learn responses by observing and repeating behaviorhow classical conditioning explains abnormal functioninglearned by temporal association (when two events repeatedly occur close together in time they become fused in a person's mind and before long, the person responds in the same way to both eventstherapy that aims to identify the behaviors that are causing the problems and replace them with more appropriate onesbehavioraltherapist is seen as a teacher rather than a healerbehavioralexample of classical conditioning treatment and why it is usedsystematic desensitization for phobia (changes abnormal reactions to particular stimuli)steps of systematic desensitization for a phobialearn relaxation skills, construct a fear hierarchy, confront feared situationsstrengths of behavioral modelpowerful force in the field can be tested in the laboratory significant research support for behavioral therapiessees abnormal functioning as a result of faulty assumptions and attitudes and illogical thinking processes (overgeneralization)cognitive therapistsbelieve people can overcome their problems by developing new ways of thinkingcognitive therapistMain model for cognitive therapyBeck's Cognitive TherapyGoal of Beck's Cognitive Therapyhelp clients recognize and restructure their thinking --therapists guide clients to challenge their dysfunctional thoughts, try out new interpretations, and apply new ways of thinking to their daily livesWidely used in treating depressionBeck's Cognitive TherapyIs clinically useful and effectiveCognitive Modeltherapies are effective in treating several disordersCognitive ModelSome changes may not be possible to achieve (however, a new wave of therapies has emerged, including acceptance and commitment therapy and mindfulness-based techniques)Cognitive Modelbelieve in the basic need for unconditional positive regardRogers' Humanistic Theory and Therapywhat happens when unconditional positive regard is received/not receivedreceived- leads to unconditional self-regard not received- leads to conditions of worthconditions of worth meansincapable of self-actualization because of distortion- do not know what they really need, etc.Rogers' "client-centered" therapytherapist creates a supportive climate with: unconditional positive regard accurate empathy genuineness (little research support but positive impact on clinical practice)-Added greatly to the clinical understanding of treatment and abnormality ---increased awareness of clinical and social rolesSociocultural Models (clinically successful when others have failed)What some biopsychosocial theorists favordiathesis-stress approachdiathesispredisposition (bio, psycho, or social)integrative therapists are often calledeclecticeclectictaking the strengths from each model and using them in combinationused to determine how and why a person has symptoms, is behaving abnormally or suffering and how that person may be helped (also may be used to evaluate treatment process)clinical assessmentto be useful, standardized assessment tools must bestandardized (admin, scoring, and interpretation) have clear reliability and validitiyclinicians ask open-ended questionsunstructured interviewclinicians ask prepared questions, often from a published interview schedulestructured interviewmay include a mental status examstructured interviewlimitations to clinical interviewmay lack validity or accuracy interviewers may be biased or may make mistakes in judgment interviews, particularly unstructured ones, may lack validitytypes of clinical testsprojective tests personality inventories responsive inventories psychophysiological tests neurological and neuropsychological tests intelligence testsRequire that clients interpret vague and ambiguous stimuli or follow open-ended instruction (mainly used by psychodynamic practitioners)Projective TestsMost popular projective testsRorschach Test Thematic Apperception Test Sentence Completion Tests DrawingsStrengths/weaknesses of projective testsprovide supplementary info rarely demonstrate reliability or validity may be biased against minority ethnic groupsdesigned to measure broad personality characteristics, focus on behaviors, beliefs, and feelings, and usually are based on self-reported responsesPersonality inventoriesMost widely used personality inventoryMinnesota Multiphasic Personality Inventory (MMPI)Strengths/weaknesses of personality inventorieseasier, cheaper, and faster to administer objectively scored and standardized appear to have greater validity than projective tests (but cannot be considered highly validAKA Responsive Inventoriesself-report questionnairesstrengths/weaknesses of responsive inventorieshave strong face validity not all have been subjected to careful standardization, reliability, and/or validity procedures (Beck Depression Inventory and a few others are exceptions)measure physiological response as an indication of psychological problems (includes heart rate, blood pressure, body temp, galvanic skin response, and muscle contractionPsychophysiological testsdirectly assess brain function by assessing brain structure and activityNeurological testsExamples of Neurological TestsEEG PET scans CAT scans MRI fMRIindirectly assess brain function by assessing cognitive, perceptual, and motor functioningNeuropsychological testsmost widely used neuropsychological testBender Visual-Motor Gestalt TestDesigned to indirectly measure intellectual ability (series of test for nonverbal and verbal skills; general score is an IQ...mental age to chronological age)Intelligence testsWeaknesses of intelligence testsperformance can be influenced by nonintelligence factors (motivation, anxiety, test-taking experience) tests may contain cultural bias in language or tasksclinical observationsnaturalistic and analog observationsthese observations occur in everyday environmentsnaturalistic observationsmost focus on parent-child, sibling-child, or teacher-child interactions and observations are generally made by "participant observers" and reported to cliniciannaturalistic observationsif naturalistic observations are impractical, ___________ are used and conducted in artificial settingsanalog observationsstrengths/weakness of naturalistic and analog observationsreliability is a concern validity is a concern (overload, observer-drift, and observer bias) client reactivity may limit validity observations may lack cross-situational validitydiagnosisa determination that a person's psychological problem constitutes a particular disorderDSM-5 requires clinicians to provide 2 types of infoCategorical information Dimensional informationCategorical informationthe name of the category (disorder) indicated by the client's symptomsDimensional informationa rating of how severe a client's symptoms are and how dysfunctional the client is across various dimensions of personality (SEVERITY)DSM-5: effective classification system?predictive validity is of the most use clinicallyuniformity myththerapy-outcome studies lump all therapies together to consider their general effectivenessmovement that looks at commonalities among therapies of clinician orientationrapprochementobsessionspersistent thoughts, ideas, impulses, or images that seem to invade a person's consciousnesscompulsionsrepetitive and rigid behaviors or mental acts that people feel they must perform to prevent or reduce anxietysuffer from OCD in a year and in lifetime1 and 2%; 3%OCD prevalenceequally common in men and women and among different racial and ethnic groups begins by young adulthood and persists for many years, although symptoms may fluctuate over time estimated that more than 40% of those with OCD seek treatmentfeatures of obsessionsthoughts become intrusive and foreign contamination, orderlinessfeatures of compulsions"voluntary" behaviors or mental acts feel mandatory/unstoppable most recognize behaviors are unreasonable, but something terrible might happen if they don't perform compulsive acts performing behaviors reduces anxiety behaviors become ritualsBehavioral Perspective/therapy for OCDERP- exposure and response preventionclients are repeatedly exposed to anxiety-provoking stimuli and are told to resist performing the compulsions (group or individual and homework is important)ERPcognitive perspective/therapy for OCDTo avoid such negative outcome, they attempt to neutralize their thoughts with actions or other thoughts Cognitive-Behavioral Therapy (CBT)Ways to neutralize thoughts with OCDseeking reassurance thinking "good" thoughts washing checkingtreatment typically includes psychoeducation as well as exposure and response prevention exercisesCBTBiological perspective/therapy for OCDFamilies and PANDAS Abnormal serotonin activitycan reduce OCD symptoms according to biological perspectiveserotonin-based antidepressantsserotonin-based antidepressantsClomipramine (Anafranil) Fluoxetine (Prozax) Fluvoxamine (Luvox)improvement of OCD from serotonin-based antidepressants50-80%; relapse occurs if meds are stopped research suggests the combo therapy is best (CBT+medication)OCD is no longer classified as part of theanxiety disorders groupa state of immediate alarm in response to a known threat to one's well-beingfearstate of alarm in response to a vague sense of being in dangeranxietyphysiological features of anxiety and fearincrease in respiration, perspiration, muscle tension, etcmost common mental disorder in the USanxiety disordersAnxiety disorder facts1/5 of adult pop in US have one 1/3 develop one at some point during life 1/5 of those seek treatmentMost individuals with an anxiety disorderalso suffer from a second disorderSociocultural Perspective on GADMost likely to develop in people faced with social conditions that truly are dangerousone of the most powerful forms of societal stress ispovertyPsychodynamic response for GADonly of modest help to persons with GAD Short-term psychodynamic therapy may be the exceptionHumanistic Perspective on GADCarl Rogers -Lack of unconditional positive regard in childhood leads to conditions of worth (harsh self-standards)Cognitive Perspective on GADinitially thought GAD was caused by maladaptive assumptions (about dangerousness)...research backed ALBERT ELLIS AARON BECKAlbert Ellis on GAD(Rational Emotive Therapy) basic irrational assumptions are a dire necessity for an adult human being to be loved or approved of and it is catastrophic when things don't go the way he/she wants to (constant assumptions lead to GAD)Aaron Beck on GADthose with GAD constantly hold silent assumptions that imply imminent danger (unsafe unless proven otherwise, always best to assume worse mindset)Newer cognitive explanations on GADMetacognitive theory Intolerance of Certainty theory Avoidance theorydeveloped by Wells, suggests that most problematic assumptions in GAD are the individual's worry about worrying (meta-worry)Metacognitive theoryCertain individuals consider it unacceptable that negative events MAY occur, even if the event is very small; they worry to correct itIntolerance of Certainty theoryBorkovec; worrying holds a positive function for those with GAD by reducing unusually high levels of bodily arousalAvoidance theoryTwo kinds of cognitive approaches with GAD(Ellis and Beck): changing maladaptive assumptions helping clients understand the special role that worrying plays, and changing their views and reactions to itHow common fears differ from phobiasphobias -are more intense and persistent fear -greater desire to avoid feared object or situation -distress that interferes with funcitoningFor phobias, evidence supports which explanationsbehavioralHow phobias are developed according to behavioral approachthrough conditioning through modeling maintained through avoidancewhat causes specific phobias according to the behavioral-evolutionary explanation"preparedness" because humans are theoretically more prepared to acquire phobias than others models explain why some phobias are more common than othersmost widely used treatment for specific phobiasbehavioral techniquesexposure treatments (specific phobias)desensitization, flooding, and modelingDeveloped by Joseph Wolpesystematic desensitizationteaches relaxation skills creates fear hierarchy pair relaxation with feared objects or situations (relaxation is thought to substitute for fear responseSystematic desensitizationtypes of Systematic desensitizationin vivo desensitization (live) covert desensitization (imaginal)Forced non-gradual exposurefloodingtherapist confronts the feared object while the fearful person observesmodelingkey to success in treatment for specific phobiasACTUAL CONTACT with feared object or situation (virtual reality has become popular)afraid of being in situations where escape might be difficult should they experience panic or become incapacitatedagoraphobiasudden explosions of fearpanic attacksagoraphobia can cause __________ which creates a second diagnosis of __________panic attacks, panic disordermost common/effective treatment for agoraphobiabehavioral therapy with an exposure approachsevere, persistent, and irrational fear of social or performance situations in which scrutiny by others and embarrassment may occursocial anxiety disordersocial anxiety disorder was previously referred to associal phobiaoften kept a secretsocial anxiety disordernarrow form of social anxiety disordertalking, performing, eating, or writing in publicbroad form of social anxiety disordergeneral fear of functioning poorly in front of otherstwo components addressed in social anxiety disorder treatment-address fears behaviorally with exposure -social skills and assertiveness training have proved helpfulMedication and social fearsoften reduce (particularly antidepressant medications)extreme anxiety reaction can result when a real threat emergespanicperiodic, short bouts of panic that occur suddenly, reach a peak within ten minutes, and gradually passpanic attackspanic attack sufferers often fearthey will die, go crazy, or lose controlAttacks feature at least four of these symptomspalpitations of the heart tingling in hands and feet shortness of breath sweating hot and cold flashes trembling chest pain choking sensation faintness diziness feel of unrealityConsistency of an assessment measureReliabilityYields the same results every time it is given to the same peopleTest-retest reliabilityDifferent judges independently agree on how to score and interpret a particular toolInterrater reliabilityAccuracy of a tool's resultsValidityTool must sample representatively from the construct it is intended to assessContent validityTools result agree with independent measures assessing similar characteristics or behaviorConcurrent validity