KEY: notes, definitions, examples, theories
Chapter 15: Therapy
15.1: How Do Psychologists Provide Therapy?
- Many people with disorders do not receive care
- Psychotherapies: psych treatments designed to improve symptoms of psychological disorder
through conversation between therapist and patient.
↳ Also includes medications
1. Biological approaches: based on biological knowledge of psychological disorders
↳ The rise of medication for depression and anxiety arose quickly in the pharmaceutical
field.
↳ Medications are very successful for select psychological disorders
2. Psychological approaches: non-medication based treatments
↳ Hypnosis: hypnosis was found to be very effective with treatment as it allowed people to
speak freely
- Behaviorist perspective: focused on observable behaviour approached treatment using ideas of
classical conditioning, operant conditioning and observational learning.
- Humanistic therapies: therapy approach proposed by humanistic psychologists.
↳ Did not agree with psychodynamic thinking and practise of psychoanalysis
↳ Counselling was created by Carl Rogers
- Counselling: focus on personal strengths and development
- Evidence Based Practising (EBP): combines research evidence clinical expertise and individual
values to provide the best outcome for a person
↳ Encourages full and open communication between patient and treatment provider
↳ Combines 5 steps: construct an answerable question, conduct search for current scientific
answer, evaluate relevant literature, integrate with data regarding cases values and
circumstances, evaluate performance based on outcomes
- Clinical assessment: understanding the problems presented by the person for treatment choices.
↳ Done by interviews, observations and standardized tests
- Counselling and psychotherapy is done by general medical practitioners, psychiatrists,
psychologists, social workers, nurses and religious leaders.
↳ Psychotherapist: provides psychotherapy
↳ Psychiatrists: specializes in psychiatry, can use medical procedures like prescribing
medication to treat disorders.
↳ Psychologists: focus on the assessment, diagnosis and treatment of disorders and
counselling.
↳ There are also options without licensing like life coaches.
- Psychotherapy: individual therapy involving face-to-face, hour long meetings between therapist
and patient.
↳ Frequent meetings over years
↳ Brief therapy: psychotherapy provided over a short time frame, usually between three to
five sessions.
○ Focus on solution building rather than problem solving
○ Group therapy: psychotherapy conducted on a group of people rather than
individual
- People with psychotic, suicidal, or antisocial tendencies are usually
excluded from groups until they progress
- Benefit from reduced feelings of isolation, offered hope, commonness
○ Family therapy: family participates in therapy individually and with family
members, when a child or teen is experiencing problems from family.
○ Couples therapy: family therapy that focuses on relationships
15.2: Historical Approaches to Psychotherapy
- Psychoanalysis: developed by Freud, practised by those who believe in the psychodynamic
theories.
↳ Used by psychoanalyst
↳ It's used less because there is not much evidence for its efficacy
↳ Paved the way for contemporary treatments
↳ Emphasized the theory of personality (ID, EGO, SUPEREGO, and unconscious mind)
↳ Psychoanalysts are in charge of the session, but don’t expect anything more than
information about symptoms.
↳ Example of insight therapy: improves symptoms of PD by building people’s
understanding of their situation.
↳ Cure is uncovering the unconscious contributions to the patient’s problems, and once the
source is understood, the situation should improve.
↳ Used free association: patient is encouraged to say whatever is on the mind without
censoring the content (causing “Freudian Slips”)
↳ Used dream analysis: encouraged to awaken after a dream and jot notes down that are
later reviewed by the therapist, decoding the symbolic meanings of the dream
↳ Transference: patient uses an earlier relationship as a prototype for a current relationship.
○ Eg. If the patient begins yelling at the therapist, the therapist might infer that the
patient reacted similarly to parents and others in authority under similar
circumstances in the past.
↳ Resistance: patient is getting closer to insight but resists efforts to uncover the insight.
○ Resist by changing subject, disagrees with analyst, or misses an appointment.
↳ Modern psychoanalysts focus less on past now
- Person-Centred Therapy: developed by Carl Rogers, helps clients achieve congruence or
alignment of the real and ideal selves.
↳ Discrepancies between ideal and real selves can lead to PD
↳ Empathy therapists: attempt to see the world through the eyes of a client, as opposed to
imposing their own worldviews, the client feels understood.
↳ Unconditional Self Regard: contributes to safety of therapy setting (to denote the idea that
we only have value when our behaviour is pleasing to an authority figure), help with
earlier damaging experiences
↳ Reflection techniques: therapists restating some of the clients comments in a way that it
conveys understanding, contributes to empathy and feeling understood.
↳ Clarification: allows therapists to point out important insights that clients might have
reached.
↳ All techniques include communication strategies.
↳ Therapy is called counselling.
↳ Techniques by Rogers are better suited for serious disorders like schizophrenia
15.3: Contemporary Approaches to Psychotherapy
- Behavioral therapies: applications of classical and operant conditioning principles to treat PD
symptoms and adjust problems.
↳ Have helped ASD, schizophrenia, etc
↳ Applied behavioural analysis:focuses on what can be observed and makes few
assumptions of the unconscious mind.
○ Used to reduce unwanted habits
○ Eg. token economy: reward token for rewards to increase desirable behaviours
across various settings.
- Cognitive Therapies: the way we think about our circumstances is essential to our health and
adjustment.
↳ Situations do not cause abnormal behaviour, but situations might.
↳ Help people change negative habits
↳ Cognitive restructuring: technique used in cognitive therapies where new rational beliefs
replace earlier, irrational beliefs held by clients.
↳ Rational emotive behavioral therapy: therapist is more critical of client’s thinking.
↳ Cognitive behavioural therapy: combination of cognitive restructuring with behavioural
treatments that have been shown to be effective in reducing symptoms of many
psychological disorders.
○ Help clients initiate behavioural changes
○ Encourage client to use self0reward for more positive, rational patterns of
thought
○ Has lots of success, specifically in MDD treatment
○ Requires less than 16 sessions
- Biopsychosocial Approaches: combines elements of therapies designed to address biological,
psychological, and social underpinnings of an individual case.
↳ Focuses on what works for an individual client without adopting a single treatment
method
15.4: What are Biological Therapies?
1. Medication: most commonly used therapy
↳ 75% of people preferred psychological treatment to medication, mostly in younger
patients and in women
↳ Dramatically shaped outcomes of many patients
2. Electroconvulsive therapy: treatment where seizures are induced in an anesthetized patient, used
primarily in treatment of mood disorders that have not responded to medication or other
treatments.
↳ Seizures are induced by electricity applied through electrodes on the head.
↳ Believed to increase responsiveness to dopamine and norepinephrine, and stimulates
neural growth.
↳ First used on patients with schizophrenia, later used on MDD and bipolar disorder
↳ Considered safe under general anesthesia
↳ ⅓ of patients experience persistent memory loss following the procedure, affecting
autobiographical memory (impaired for at least 6 months after treatment was done)
3. Psychosurgery: attempt to improve symptoms of PD through operation on the brain.
↳ Evidence of ancient use is drilling holes in skull
↳ Frequent type of psychosurgery: changing behaviour with frontal lobotomy.
○ Frontal lobe participates in high order cognitive functioning in the human brain,
damage to it causes negative judgment, personality, initiative, social behaviour
and sense of self.
○ Replaced by use of medications in the 1960s.
○ Now, radiation and precise lesions are used to treat few people with MDD or
OCD.
4. Brain stimulation: electrical stimulation applied through surgically implanted electrodes used to
treat some anxiety and mood disorders.
↳ Has more advantages than psychosurgery like the effects are reversible unlike
psychosurgery.
↳ Deep brain stimulation was successful in Parkinson's disease, and now used in
depression.
↳ Mini Electrodes are surgically inserted into specific parts of the brain, and the patient
controls application of current.
↳ Helped people with depression who had this done to their nucleus accumbens, increasing
mood and engaging in pleasurable activities.
↳ Repeated transcranial magnetic stimulation (rTMS) is an alternative to stimulate the brain
without surgery, used in MDD.
↳ It has a negative effect on OCD.
5. Neurofeedback: type of biofeedback used to treat ADHD and seizures by teaching patients to
keep measures of brain activity within a certain range.
↳ By learning to relax rather than tense, people can reduce their BP in biofeedback.
↳ Neurofeedback concentrates on brain activity through EEG or fMRI.
↳ Seen to help ADHD, ASD, OCD, GAD and MDD.
15.5: How are Specific Disorders Treated?
- Neurodevelopmental Disorders: conditions that affect brain development and nervous system.
- Autism Spectrum Disorder: no meds have proved effective, two antipsychotic meds have
been helpful in reducing aggression, tantrums and self injury (but have weight gain,
diabetes, motor dysfunction and immune system problems).
○ Applied behavior analysis is used to build on operant conditioning.
- Attention Deficit Hyperactivity Disorder: treated with meds alone or with behaviour
therapy.
○ Common meds: methylphenidate, dextroamphetamine and combination of
amphetamine salts, increase dopamine and norepinephrine.
○ Behavioral parent training builds parental skills for ADHD children by using
operant conditioning.
- Conduct Disorder: rarely treated with meds, treated with CBT, family therapy, behaviour training
of parents, therapeutic alliance, group therapy.
- Schizophrenia: medications (phenothiazines reduce psychosis), psychological treatments like
staying home and getting opportunities to do meaningful work.
- Bipolar Disorder: mainly meds (lithium carbonate prevents mania recurrences, and preventive of
suicidal behaviours, increases grey matter and neural growth, antioxidant properties),
antipsychosis (not as effective), changing diet with more omega-3 intake, psychotherapy alone
doesn’t work but is combined with meds.
- Major Depressive Disorder: medication (antidepressants/SSRIs, increase serotonin and neuron
numbers in hippocampus), psychotherapy like therapy, CBT, group therapy, mindfulness-based
cognitive therapy, aerobic exercise.
- Anxiety Disorders: medication (barbiturates, benzodiazepines), CBT and behavioural techniques,
exposure therapy for phobias.
- Obsessive Compulsive Disorder: antidepressant medication and/or CBT, train a person to
anticipate a compulsive behaviour and apply the competing learned behaviour.
- Body Dysmorphic Disorder: CBT, cognitive restructuring, psychotherapy.
- Post Traumatic Stress Disorder: exposure therapy with/without SSRI meds, and additional
treatment for full recovery in those who develop a substance use disorder.
- Dissociative Identity Disorder: hypnosis is commonly used, psychotherapy, maybe use
antidepressants.
- Somatic Symptom Disorders: biological and psychological treatments are used, meds like
antidepressants and increased physical activity, CBT, maybe psychotherapy.
- Antisocial Personality Disorder: meds, tranquilizing drugs
- Narcissistic Personality Disorder: CBT, psychotherapy
- Borderline Personality Disorder: meds like antidepressants, antipsychotic meds, mood stabilizers,
anti anxiety meds, hospitalization for safety, CBT.
Lecture Notes:
- Types of clinician focused on mental health treatment in Canada
↳ Psychiatrist: treat more severe patients, are medical doctors (have an MD)
○ Can diagnose, prescribe and sometimes practise psychotherapy (therapy/talking)
↳ Psychologist: see complex cases (lots of comorbidities, or resistant to treatment
disorders)
○ Can diagnose and practise psychotherapy
↳ Clinical Counsellor: focus on less complex cases
○ Can practise psychotherapy
↳ Social Worker: have an MSW degree, less complex cases
○ Can practise psychotherapy
- Diagnosis via psychological and biological treatment
↳ Psychological: often talk therapy and other forms
↳ Biological: often medications
- Why get treatment?
↳ Mental illness can cost us personally and socially
○ Unable to carry our daily activities
↳ May cause a financial cost (we lose billions of dollars/year due to people’s mental illness
impacting work)
↳ Impairments are just as severe as physical illness
- Access to treatment: only 40% of affected people get treatment (only ⅓ feeling satisfied with
treatment)
↳ Higher income countries have a higher % of people in treatment for mental illnesses
↳ Why would people fail to get treatment?: fear of stigma/lack of desire to share (signalling
weakness), not accessible, costly, cultural variation, fear that treatment is not effective for
you.
- Psychotherapy: types of psychological treatment
↳ Techniques in psychotherapy are called orientations
↳ Therapy practised in Canada: cognitive behavioural, interpersonal, psychodynamic,
humanistic/existential, family systems, other.
- Psychoanalysis comes from the roots of Freud's psychodynamic theory
↳ Psychodynamic therapy gives insight into internal conflicts (insight is the goal)
↳ Ineffectively repressing urges causes fixations and use of defense mechanisms, creating
conflict between parts of dynamic subconscious
↳ Interpersonal psychotherapy: updated Freud's methods with focus on attachment (begins
in infancy), grief, role disputes (conflicts in a relationship), role transitions (change in life
status) and interpersonal deficits (lack to start/maintain relationships).
○ “Offshoot” of psychodynamic therapy, more present focused with some
exceptions.
- Person-centered therapy: assumes that individuals want to grow and get better, but is prevented
from a perceived lack of acceptance
↳ So the therapist expresses genuine and warm reactions to make them feel accepted
↳ Therapist focuses on congruence (warm words, warm body language, etc), empathy and
unconditional positive regard
- Cognitive and behavioral therapy
↳ Most commonly used in Canada because there is lots of evidence of its effectiveness
↳ The most effective type of therapy (mainly for depression and MDD) according to DSM
↳ Relies of behaviorism (study of observable, measurable variables)
↳ Focuses on changing behaviour (action) or cognition (thoughts) to combat mental illness
↳ CBT= cognitive therapy + behavioural therapy
○ Behavioural therapy centers around conditioning to change behaviour
● Operant conditioning: involves adding incentives for positive behaviour
or taking away incentives for negative behaviour
- One method is the token economy (reward vouchers for positive
behaviour)
● Classical conditioning: combining stimuli together
- One method is exposure therapy (combining something
distressing with safety, leading to decrease in the scary thing)
○ Cognitive therapy worked to change unhealthy thoughts leading to mental illness
● Teach clients to question their beliefs, assumptions and predictions that
lead to negative emotions
● Replace irrational negative thoughts with positive and rational ones
○ Cognitive-behavioural therapy: most common treatment for depression and
anxiety, and PTSD, now used for many more illnesses.
● Problem focused, specific, action oriented, transparent (so you
understand why the therapist is doing what they are doing, leading to
client being more likely to carry out the therapy)
● Uses an ABC model: Activating event (can’t change it, the trigger point),
Beliefs (evaluating if beliefs because of the event are rational or
irrational, can change), and Consequences (can’t change,what is the
result of the belief she has?)
- Negative event (A) → rational belief (B) → healthy negative
emotion (C)
- Negative event (A) → irrational belief (B) → unhealthy
negative emotion (C)
- Biological treatment: medications, electroconvulsive therapy/shock therapy, transcranial magnetic
stimulation, psychosurgery
↳ Pharmacological treatment/meds: began with an accident, often used in combination with
psychological treatments
1. Typical Antipsychotic Medications: when developing an allergy medication
(phenothiazine, an antihistamine), started to be used as a sedative for surgical
patients because of its calming effects by blocking dopamine receptors, which
then later started to be used as antipsychotic
● Phenothiazine: block dopamine receptors
● An example of phenothiazine is chlorpromazine
● Changed the way that schizophrenic patients were treated.
● Have significant side effects, sleep disturbance, appetite change, slow
movement, nausea, etc.
2. Anti-anxiety medications: benzodiazepines increase GABA (neurotransmitter)
activity thereby reducing anxiety
● Problems: drowsiness, difficulty making memories, drug tolerance (take
more and more for it to work), withdrawal symptoms (more heightened
anxiety than before), highly addictive, poor coordination
3. Antidepressant medication: discovered accidentally
● Monoamine oxidase inhibitors: used to treat TB, but found to elevate
patient moods.
- Prevent the breakdown of serotonin and dopamine, so theres
more transmitters in brain, thereby reducing depression
symptoms and increasing mood
- Problems: dizziness, loss of sexual interest, etc
● Reuptake Inhibitors: prevent neurotransmitters from being taken back
up leaving more neurotransmitters in the synaptic space to be used by
postsynaptic neuron (so recycling doesn’t occur) thereby increasing
levels of neurotransmitter and decreasing depressive mood
- Eg. SSRI: focus only on serotonin (most common type of
antidepressant)
- Eg. tricyclic antidepressants: focus on serotonin and
norepinephrine
- Elevate mood, increase motivation, and may have some
anti-anxiety effects, not for bipolar (bc SSRIs can make bipolar
worse)
- Problems: difficulty concentration, sexual side effects, weight
gain, emotional numbness, withdrawal symptoms like brain zaps
or mood imbalance,
↳ Electroconvulsive Therapy (ECT): can be painful, indices controlled seizures, is effective
and safe in modern times
○ Not permanent
○ Increases neuroplasticity in the brain
○ Meant for people who haven’t had success with medications or other treatment
↳ Transcranial magnetic stimulation (TMS): produces longer lasting changes to brain
chemistry
○ Can be more targeted
○ Meant for people who haven’t had success with medications or other treatment
↳ Deep brain stimulation (DBS): electrodes are embedded into the brain, to make repetitive
brain stimulations.
○ Increase neuroplasticity and allow pathways to be formed or changed.
○ Meant for people who haven’t had success with medications or other treatment
↳ Natural/alternative solutions: specific to anxiety and depression
○ Changes to lifestyle (meditation, exercise, diet)
○ Often looked at first