Exam RG 17 Treatment

BEHAVIOR THERAPY In the behavioral perspective a maladjusted person (unless suffering from brain pathology) is seen as differing from others only in a) having failed to acquire competencies needed for coping with the problems of living b) having learned faulty reactions or coping patterns that are being maintained by some of kind of reinforcement or c) both. The key techniques of this perspective are as follows:  Extinction. Because learned patterns tend to weaken and disappear over time if they are not reinforced, often the simplest way to eliminate a maladaptive pattern is to remove the reinforcement for it. Two techniques that rely on the principle of extinction are implosive therapy and flooding. Both focus on extinguishing the conditioned fear and accompanying avoidance behavior. They can thus be used to treat anxiety disorders. For example, flooding involves inducing a client to undergo repeated exposures to his or her real life anxiety arousing situations. The client must stay in the situation long enough for the anxiety to abate.  Systematic Desensitization. This technique is aimed at teaching a person to relax or behave in some other way that is inconsistent with anxiety while in the presence of the anxiety inducing stimulus. It may therefore be considered a type of counter-conditioning procedure. The term systematic refers to the carefully graduated manner in which the person is exposed to the feared stimulus. The stimuli may either be real or imaginal.  Aversion Therapy. This involves the modifying of undesirable behavior by the old fashioned method of punishment. Punishment may either involve the removal of desired reinforcers or the use of aversive stimuli (typically electric shock though drugs can be used). Aversion is primarily a way of stopping maladaptive responses for a brief period of time and then encouraging more adaptive alternative behaviors.  Modeling Modeling involves the learning of skills through imitating another person. For example, modeling may be used to promote the learning of simple skills such as self-feeding in a profoundly retarded child or more complex ones such as learning complex social skills.  Systematic use of reinforcement. Systematic programs involving the use of reinforcement to elicit and maintain effective behavior have achieved notable success in institutional settings. Response shaping, token economies and behavioral contracting are among the most widely used techniques  Response shaping: this involves establishing by gradual approximation a response that is not initially in an individual's response repertoire.  Token economies: here appropriate behaviors are reinforced with tangible reinforcers in the form of tokens that can later be exchanged for desired objects or privileges. The token economy resembles the outside world where an individual is paid for his or her work in tokens. In such a situation tokens can reduce the delay that often occurs between appropriate performance and reinforcement. Behavioral contracting: In this situation the therapist specifies a client's obligations to change in a contract that is jointly signed. A common example of contracting is in behavioral couples therapy where the principles governing the exchange of reinforcements between distressed parties is formally negotiated and put in writing. COGNITIVE-BEHAVIORAL THERAPIES Two main themes seem to dominate this approach. First that cognitive processes influence affect, motivation and behavior. Second, that cognitive and behavior change techniques should be used in a pragmatic (hypothesis testing) manner. All proponents of this approach believe that if critical cognitive components can be changed then behaviors and maladaptive emotions will change. The following are therapeutic variations on this theme.  Rational-Emotive Therapy. Developed by Albert Ellis the task of this therapy is to restructure an individual's belief system and self-evaluation especially with respect to the irrational "shoulds" "musts" or "oughts" that are preventing a more positive sense of self worth. Ellis also believed that several key irrational beliefs, need to be changed, such as, "One should be loved by everyone for everything one does." and " It is horrible when things are not the way we would like them to be." Several methods are used to dispute these beliefs including rational disputation. Stress Innoculation Therapy. This typically focuses on altering the self-statements an individual routinely makes in stress producing situations. Here the approach is to restructure these statements so as to improve functioning under stressful conditions. Beck's Cognitive-Behavior Therapy. This therapy was originally developed for the treatment of depression but has since become effective for a wide range of disorders. The essential assumption underlying this therapy is that pathological behaviors result from the client's illogical thinking about themselves, the world they live in, and the future. In the initial phases clients are taught the connection between their patterns of thinking and their emotional response. They are taught to identify their automatic thoughts and to keep records of their thought content and emotional responses. By learning about the logical errors in their thinking they learn to challenge the validity of these automatic thoughts. Unlike other therapies beliefs and Page 1 Tripken erroneous thoughts are challenged through unbiased experiments. Together a therapist and client identify the client's beliefs and expectations and formulate a hypothesis to be tested. BIOLOGICAL TREATMENTS The purpose of this exercise is to teach the concepts of biological interventions as they are commonly used in the treatment of psychiatric patients. In the first part of the exercise these concepts are defined with examples and non-examples being provided as exemplars. In the second part of the exercise a number of examples are provided which are either examples or non-examples of the concepts. Feedback will be provided on each example.  Electroconvulsive therapy (ECT)--this method is typically known as ECT and is frequently used to alleviate depressive episodes. There are 2 types of ECT--bilateral and unilateral. The procedure involves electric current of approximately 150 volts being passed from one side of a patient's head to the other for about 1.5 seconds. The patient immediately loses consciousness and undergoes marked muscle contractions. These are ameliorated by the use of muscle relaxant pre-medications. Upon wakening, the patient usually has amnesia for the brief period before the shock. Recently a new procedure called unilateral ECT was introduced. This essentially involves the flow of current through only one hemisphere, usually the non-dominant one. Although some critics suggest significant impairments can result from ECT, recent evidence tends to dispute this. While ECT has been found to be effective with some depressions and acute mania, it is not particularly effective in dysthymic disorders.  Antipsychotic Drugs--as a group are sometimes called major tranquilizers, though their effect is much more than sedating. Their unique quality is the alleviation of psychotic symptoms such as delusions and hallucinations. In contrast, the anti-anxiety drugs (minor tranquilizers) are effective in reducing tension but not psychotic symptoms. The earliest antipsychotic was a member of the phenothiazine family called Chlorpromazine. Since then other derivative compounds such as Stelazine, Mellaril, and Prolixin have been introduced as well as non phenothiazine antipsychotic drugs such as Haldol. All of these drugs appear to block the dopamine receptors of the brain. These drugs have varying degrees of troublesome side effects, such as dryness of the mouth and throat, muscular stiffness, jaundice and a Parkinson-like syndrome involving tremors of the extremities and immobility of the facial muscles. For some patients, a troublesome side effect of long-term use is the development of a motor control dysfunction known as tardive dyskinesia. Recently, another compound that differs from the phenothiazines, clozapine (a dibenzodiazepine) has produced very promising results.  Antidepressant Drugs--have been available for the last 40 years. They include monoamine oxidase (MAO) inhibitors. A second group of antidepressants more widely used are the tricyclics, which inhibit the reuptake of serotonin and norepinephine once they have been released into the synapse. The tricyclics are most frequently used. The most common tricyclics are Tofranil, Elavil, and Aventyl. A 'second' generation antidepressant are the serotonin selective reuptake inhibitors such as Prozac. Another group, the triazolopyridines, such as Desyrel, are technically not tricyclics at all but tetracyclics. Most antidepressants, with the exception of MAO inhibitors, are not toxic and do not require dietary restriction. Other than the treatment of depression, many of these drugs are effective in the treatment of generalized anxiety, panic disorders, obsessive compulsive symptoms and social phobias.  Antianxiety Drugs--originally the barbiturates were used as antianxiety agents but they fell out of favor because of high addictive potential and a low margin of dosage safety. Excessive doses are lethal especially when combined with alcohol since each drug potentiates the other. More recently, another class of antianxiety drug has been developed. These drugs, the benzodiazepines have been shown to selectively diminish generalized anxiety and yet leave adaptive behaviors intact. However, such drugs as Librium, Valium, Dalmane and especially Xanax, still have some addictive potential and can prompt lethargy and drowsiness. These drugs appear to work through their effects on GABA, a neurotransmitter now thought to be functionally deficient in people with generalized anxiety. These drugs appear to increase GABA. Abnormal Behavior • Definition: Behavior that is judged to be atypical, disturbing, maladaptive and unjustifiable. Perspectives: Biological (medical model): Abnormal behavior has a biochemical or physiological basis. • Diathesis-stress model: people biologically or genetically predisposed to a disorder can develop that disorder when exposed to stress. Page 2 t Tripken • Psychoanalytic Model: Abnormal behavior is a result of unconscious conflicts. • Behavioral Model: Abnormal behavior is a result of faulty learning. • Cognitive Model: Abnormal behavior is a result or irrational or maladaptive ways of thinking. Classifying Psychological Disorders : Neurotic vs. Psychotic Disorders / DSM-IV: The American Psychological Association’s (APA) Diagnostic & Statistical Manual of Mental Disorders DSM-IV: Diagnostic and Statistical Manual of Mental Disorders: 4th Edition The DSM-IV is a multiaxial system that allows assessment on several axes, each of which refers to a different domain of information that may help the clinician plan treatment and predict outcome. There are five axes included in the DSM-IV multiaxial classification: AXIS I: Clinical Disorders. Axis I is for reporting all the various disorders or conditions except for Personality Disorders and Mental Retardation. For Example: Mood Disorders, Eating Disorders, Anxiety Disorders, etc. AXIS II: Personality Disorders and Mental Retardation. Listing these disorders on a separate axis ensures that consideration will be given to the possible presence of Personality Disorders and Mental Retardation that might otherwise be overlooked when attention is directed to the usually more florid Axis I disorders. AXIS III: General Medical Conditions. Axis III is for reporting medical conditions that are potentially relevant to the understanding and management of the individual’s mental disorder. AXIS IV: Psychosocial and Environmental Problems. Axis IV is for reporting psychosocial or environmental problems that may affect the diagnosis, treatment, and prognosis of mental disorders (Axis I and Axis II). For example: educational problems, housing problems, problems with access to health care services, problems with (or lack of) primary support group, legal problems, etc. Axis V: Global Assessment of Functioning. Axis V is for reporting the clinician’s judgment of the individual’s overall level of functioning using the Global Assessment of Functioning (GAF) scale. Clinicians rate the patient on a scale of 1 to 100 with 1 = “persistent danger of severely hurting self or others OR occasionally fails to maintain minimal personal hygiene OR gross impairment in communication” and 100 = “superior functioning in a wide range of activities, life’s problems never seem to get out of hand, is sought out by others because of his or her many positive qualities. No symptoms”. Anxiety Disorders: Generalized Anxiety Disorder: continual tenseness & nervousness. Panic Disorder: intense fear or terror that seems to come “out of the blue”. Obsessive-Compulsive Disorder : person is compelled to think disturbing thoughts (obsessions) and perform senseless rituals (compulsions) Post-Traumatic Stress Disorder: anxiety & nightmares result from some disturbing incident from the past. Phobic Disorder: irrational fear & avoidance of a specific object or situation. • Social Phobia (ex: public speaking) • Simple Phobia (snakes, heights, etc.) • Agoraphobia: fear of leaving home or being in open spaces. Explaining Anxiety Disorders Behavioral (learning) Model: • classical conditioning • operant conditioning (reinforcement) • generalization • observational learning (Bandura) Biological Model • evolution Page 3 t Tripken • genetics • physiology Psychoanalytic/Freud- anxiety is a result of repressed impulses that begin to come into consciousness. Somatoform Disorders • Somatization Disorder: vague, recurring physical symptoms for which no medical cause can be found. • Conversion Disorder: specific and dramatic physical disability for which no medical cause can be found (e.g., blindness, and paralysis). • Hypochondriasis: small & insignificant symptoms are interpreted as signs of serious illness. Dissociative Disorders: Disorders in which some aspect of the personality seems separated or fragmented from the rest. • Dissociative Amnesia: selective memory loss often brought about by severe stress. • Dissociative Fugue : amnesia accompanied by flight from one’s home and identity. • Dissociative Identity Disorder (multiple personality disorder): more than one personality seems to be present in a single individual. Major Depressive Disorder: two or more weeks during which a person is over- whelmed by feelings of sadness, apathy, worthlessness and guilt. Mania: state in which a person is overly excited, hyperactive, and optimistic. Bipolar Disorder : the person alternates between periods of depression & mania. Explaining Affective Disorders Biological Model: • Genetics—runs in families, higher concordance rate in identical than fraternal twins. • Biochemical----serotonin & norepinephrine levels in the brain are low during periods of depression & high during periods of mania. Behavioral Model: • operant conditioning—reinforcement • learned helplessness (Seligman) Cognitive Model: • negative & irrational attributions—explain bad events in terms that are stable, global, and internal (Beck) Depression’s vicious cycle: stress--> negative explanations-->depressed mood-->cognitive & behavioral changes->stress Personality Disorders - A person exhibits inflexible & maladaptive ways of thinking and behaving that impair social functioning. • Schizoid: withdrawn, lacks feelings for others. • Paranoid: inappropriately suspicious and mistrustful of others. • Narcissistic: exaggerated sense of self- importance & need for constant attention. Antisocial : violent, criminal, or unethical behavior due to lack of conscious. Borderline: instability in mood, self-image, & personal relationships. Self-mutilation, impulsiveness, sexual promiscuity, substance abuse, “splitting”, & suicidal threats Page 4 t Tripken t Schizophrenic Disorders - Disturbances in thought, communication, emotions, & perceptions. May include: • Hallucinations: false sensory perceptions • Delusions: false beliefs about reality (Delusions of persecution…thoughts that someone is out to get them!) Positive Symptoms: incoherent speech, hallucinations, delusions, “strange” behavior Negative Symptoms: motionlessness, stupor, lack of emotion (flat affect) Schizophrenic Subtypes Disorganized: bizarre speech & behavior— Flat or inappropriate affect. Catatonic: disturbed motor behavior— immobility or excessive movement. Mimicking of others’ speech & movements or “waxy flexibility”. Paranoid: excessive suspiciousness & complex, bizarre delusions. Undifferentiated: symptoms from more than one of the above categories. Development of Schizophrenia Acute (reactive): Sudden onset—best prognosis. Chronic (process): Slower development over a long period of time—worse prognosis Explaining Schizophrenia Brain anatomy: large ventricles & shrinkage of cerebral tissue • Genetics: more common in people with a close relative who has the disorder (e.g., 50% concordance in identical twins, 16% in fraternal twins.) • Prenatal virus: (still under study) • Biochemical: too many dopamine receptors in the brain. Types of Treatment There are many different types of treatment for psychological disorders, all of which fit into three broad types: 1. insight therapies 2. behavior therapies 3. and biomedical therapies. Insight therapies -Examples – psychoanalysis, cognitive and humanistic NOT behavioral!!! • Treatments involving complex conversations between therapists and clients. • The treatments aim to help clients understand the nature of their problems and the meaning of their behavior, thoughts, and feelings. • Insight therapies involve complex conversations between therapists and clients. • The aim is to help clients understand the nature of their problems and the meaning of their behaviors, thoughts, and feelings. • Insight therapists may use a variety of approaches, including psychodynamic, cognitive, or humanistic. Psychotherapy(in general): The treatment of behavioral and emotional disorders using psychological techniques I. Psychoanalysis (Freud)/insight Goal: Bring repressed motives, desires, impulses, & conflicts into consciousness so that the person can deal with them. Method: free association interpretations by the therapist Associated Terms: resistance Page 5 Tripken transference (positive & negative) catharsis II. Humanistic Therapies/insight Designed to help clients attain self-fulfillment by boosting self-awareness & self-acceptance. Person-Centered Therapy (Carl Rogers): A non-directive form of therapy that calls for the therapist to exhibit acceptance and empathy for the client in order for the client to become fully-functioning. Method: active listening unconditional positive regard Gestalt Therapy (Fritz Perls): Form of therapy where the therapist emphasizes the wholeness of the personality and attempts to reawaken people's emotions in the here-and-now. Methods: Take responsibility for feelings by saying "I choose" rather than, "I have to" or "I want" rather than "I need". Always speak in the first person III. Behavioral Therapies Behavioral Approaches Whereas insight therapies focus on addressing the problems that underlie symptoms, behavior therapists focus on addressing symptoms, which they believe are the real problem. Behavior therapies use learning principles to modify maladaptive behaviors. Many therapists combine behavior therapy and cognitive therapy into an approach known as cognitive-behavior therapy. Behavior therapies are based on two assumptions: • Behavior is learned. • Behavior can be changed by applying the principles of classical conditioning, operant conditioning, and observational learning. • Therapies that use operant or classical conditioning principles to change behavior. Classical conditioning: Counterconditioning: aims to condition new behaviors in response to stimuli that once elicited unwanted behaviors. Aversive conditioning: aims to associate an unpleasant state with an unwanted behavior (often used to treat addictions) Systematic Desensitization: associate a relaxed, pleasant state with gradually increasing anxiety-provoking stimuli (excellent for treating phobias) Operant Conditioning Techniques: Behavior modification: aims to use positive & negative reinforcement to change behavior. Behavioral contracting Token economies (both are used in classrooms & hospitals) IV. Cognitive Therapy/insight Therapy aimed at changing a person's irrational thoughts and perceptions in order to achieve a change in behavior Rational Emotive Therapy (Albert Ellis): Confrontational therapy where the therapist actively challenges the client's selfdefeating beliefs and cognitions. Beck's Cognitive Therapy for Depression: Less confrontational that RET, but same idea. the aim is to change the maladaptive beliefs of depressed patients by gently helping them see how irrational their cognitions truly are. V. Group and Family Therapies Family therapy Marital therapy Support groups Self-help groups Page 6 t Tripken Effectiveness of Psychotherapy 75% of clients feel satisfied with the outcome of their therapy Statistical research (using meta-analysis) suggest that approximately 2/3 of patients significantly improve with therapy. Other studies show that the average treated person is better off than 80% of untreated individuals. Remember: regression to the mean and placebo of treatment Biomedical Therapies Antianxiety Drugs Antianxiety drugs include a class of drugs called benzodiazepines, or tranquilizers. Two commonly used benzodiazepines are known by the brand names Valium and Xanax. Effects: Benzodiazepines reduce the activity of the central nervous system by increasing the activity of GABA, the main inhibitory neurotransmitter in the brain. Benzodiazepines take effect almost immediately after they are administered, but their effects last just a few hours. Psychiatrists prescribe these drugs for panic disorder and anxiety. • Side effects: Side effects may include drowsiness, light-headedness, dry mouth, depression, nausea and vomiting, constipation, insomnia, confusion, diarrhea, palpitations, nasal congestion, and blurred vision. Benzodiazepines can also cause drug dependence. Tolerance can occur if a person takes these drugs for a long time, and withdrawal symptoms often appear when the drug use is discontinued. Antidepressant Drugs Antidepressants usually take a few weeks to have an effect. There are three classes of antidepressants: monoamine oxidase inhibitors, tricyclics, and selective serotonin reuptake inhibitors. • Monoamine oxidase inhibitors (MAOIs): Include phenelzine (Nardil). • Tricyclics: Include amitriptyline (Elavil). Tricyclics generally have fewer side effects than the MAOIs. • Selective serotonin reuptake inhibitors (SSRIs): The newest class of antidepressants, including paroxetine (Paxil), fluoxetine (Prozac), and sertraline (Zoloft). Antidepressants are typically prescribed for depression, anxiety, phobias and obsessive-compulsive disorder. • Effects: MAOIs and tricyclics increase the level of the neurotransmitters norepinephrine and serotonin in the brain. SSRIs increase the level of serotonin. • Side effects: Although antidepressants are not addictive, they often have side effects such as headache, dry mouth, constipation, nausea, weight gain, and feelings of restlessness. Of the three classes of antidepressants, MAOIs generally have the most side effects. People who take MAOIs also have to restrict their diet, because MAOIs interact negatively with foods that contain the amino acid tyramine, such as beer and some cheeses and meats. SSRIs have fewer side effects than the other two classes of antidepressants. However, SSRIs can cause sexual dysfunction, and if they are discontinued abruptly, withdrawal symptoms occur. Antipsychotic Drugs Antipsychotic drugs are used to treat schizophrenia and other psychotic disorders. They include chlorpromazine (Thorazine), thioridazine (Mellaril), and haloperidol (Haldol). Antipsychotic drugs usually begin to take effect a few days after they are administer ed. • Effects: Antipsychotic drugs, or neuroleptics, reduce sensitivity to irrelevant stimuli by limiting the activity of the neurotransmitter dopamine. Many antipsychotic drugs are most useful for treating positive symptoms of schizophrenia, such as hallucinations and delusions. However, a new class of antipsychotic drugs, called atypical antipsychotic drugs, also help treat the negative symptoms of schizophrenia. They reduce the activity of both dopamine and serotonin. Atypical antipsychotic drugs include clozapine (Clozaril), olanzapine (Zyprexa), and quetiapine (Seroquel). Atypical antipsychotic drugs can sometimes be effective for schizophrenia patients who have not responded to the older antipsychotic drugs. • Side effects: Side effects include drowsiness, constipation, dry mouth, tremors, muscle rigidity, and coordination problems. These side effects often make people stop taking the medications, which frequently results in a relapse of schizophrenia. A more serious side effect is tardive dyskinesia, a usually permanent neurological condition characterized by involuntary movements. To avoid tardive dyskinesia, the dosage of antipsychotics has to be carefully monitored. The atypical antipsychotics have fewer side effects than the older antipsychotic drugs Page 7 t Tripken and are less likely to cause tardive dyskinesia. In addition, relapse rates are lower if people continue to take the drug. However, the relapse rate is higher with these drugs if people discontinue the drug. Lithium One drug used in the treatment of bipolar disorders is lithium. Effects: Lithium prevents mood swings in people with bipolar disorders. Researchers have suggested that lithium may affect the action of norepinephrine or glutamate. Side effects: Lithium can cause tremors or long-term kidney damage in some people. Doctors must carefully monitor the level of lithium in a patient’s blood. A level that is too low is ineffective, and a level that is too high can be toxic. Discontinuing lithium treatment abruptly can increase the risk of relapse. Recently developed alternatives to lithium include the drugs carbamazepine (Tegretol) and divalproex (Depakote). Criticisms of Drug Therapies Drug therapies are effective for many people with psychological disorders, especially for those who suffer from severe disorders that cannot be treated in other ways. However, drug therapies have been criticized for several reasons: • Tartive dysconesia • Their effects are superficial and last only as long as the drug is being administered. • Side effects can often be more severe and troubling than the disorder for which the drug was given. This can cause patients to discontinue the drugs and experience relapses. • Patients often respond well to new drugs when they are first released into the market because of the enthusiasm and high expectations surrounding the drug. But such placebo effects tend to wane over time. • The therapeutic window for drugs, or the amount of the drug that is required for an effect without toxicity, varies according to factors such as gender, age, and ethnicity. This makes it difficult for physicians to determine the right dose of a drug. • New drugs, even those approved for long-term use, are often tested on only a few hundred people for a few weeks or months. This means that the risks of taking drugs long-term are unknown. • Some critics point out that because of pressure from managed care companies, physicians may overprescribe drugs rather than recommend psychotherapy. • Drugs are tested only on certain populations, for certain conditions. Physicians, however, sometimes prescribe a drug for conditions and populations that were not included in the testing. • Researchers who study the effectiveness of medications may be biased because they often have financial ties to pharmaceutical companies. • Freely prescribing drugs for psychological disorders gives the impression that such disorders can be treated only biochemically. However, the biological abnormalities present in such disorders can often be treated by changing thoughts and behavior. Electroconvulsive Therapy Electroconvulsive therapy (ECT) is used mainly for the treatment of severe depression. Electrodes are placed on the patient’s head, over the temporal lobes of the brain. Anesthetics and muscle relaxants help minimize discomfort to the patient. Then an electric current is delivered for about one second. The patient has a convulsive seizure and becomes unconscious, awakening after about an hour. The typical number of ECT sessions varies from six to twenty, and they are usually done while a patient is hospitalized. ECT is a controversial procedure. Research suggests that there are short-term side effects of ECT, such as attention deficits and memory loss. Critics of ECT believe that it is often used inappropriately and that it can result in permanent cognitive problems. Proponents of ECT, however, believe that it does not cause long-term cognitive problems, loss of memory, or brain damage. They believe that it is highly effective and that it is underused because of negative public ideas surrounding it. Psychosurgery Psychosurgery is brain surgery to treat a psychological disorder. The best-known form of psychosurgery is the prefrontal lobotomy. A lobotomy is a surgical procedure that severs nerve tracts in the frontal lobe. Surgeons performed lobotomies in the 1940s and 1950s to treat highly emotional and violent behavior. The surgery often resulted in severe deficits, including apathy, lethargy, and social withdrawal. Page 8 t Tripken Lobotomies are now rarely performed, but some neurosurgeons perform cingulotomies, which involve destruction of part of the frontal lobes. These surgeries are usually performed on patients who have severe depressive or anxiety disorders and who do not respond to other treatments. The effectiveness of these surgeries is unclear. Transcranial Magnetic Stimulation Transcranial magnetic stimulation (TMS) is a recently developed, noninvasive procedure. It involves stimulating the brain by means of a magnetic coil held to a person’s skull near the left prefrontal cortex. It is used to treat severe depression. Drug Therapies: Antipsychotic drugs: used to treat schizophrenic and other psychotic disorders. These drugs block dopamine receptors in the brain (e.g., thorazine, stelazine, clozaril). Side effects: heavy sedation, tardive dyskinesia. Anti-anxiety drugs: (e.g., Valium, Librium, Xanax) Effectively reduce anxiety and fears but are highly addictive. Antidepressant drugs: (e.g., Prozac, Zoloft, Paxil) These drugs block re-uptake of serotonin. This increases the availability of serotonin in the brain. Other antidepressants block reuptake of serotonin and norepinephrine. They, however, cause more side effects (dry mouth, dizzy spells). Lithium: Drug specifically used to treat the mood swings seen in bipolar disorder. Electroconvulsive Therapy (ECT): Used to treat SEVERE depression. An electrical current is passed through the brain of an anesthetized patient. Side effects: memory loss Psychosurgery: Removal or destruction of brain tissue in order to change behavior. Lobotomy: Rare procedure once used to calm violent or uncontrollable patients. • Tissue in the prefrontal lobes are destroyed. MISC. Institutionalization: Pros: Patients can be monitored carefully and closely. Patients are less likely to be a danger to themselves and others. Cons: the "self-fulfilling prophecy" may come into play. People continue to act and feel "sick" because they believe they are sick. Staff members can interpret "normal" behavior as "abnormal" (Rosenhan"s study). Also, the staff members (at many institutions) are overworked and underpaid. Deinstitutionalization: The release of patients from hospitals (often in large numbers) due to political pressures. Pros: Patients are given a chance to live a "normal" life away from unwanted confinement. Cons: Due to lack of federal and state funding, many patients are unsupervised. They may stop taking their medication, have no social support, and may become a danger to themselves or others. Page 9 t Tripken Name: __________________________ Date: _____________ t ___ 1. An eclectic psychotherapist is one who: A) takes a nondirective approach in helping clients solve their problems. B) views psychological disorders as usually stemming from one cause, such as a biological abnormality. C) uses one particular technique, such as psychoanalysis or counterconditioning, in treating disorders. D) uses a variety of techniques, depending on the client and the problem. ___ 2. Of the following therapists, who would be most likely to interpret a person's psychological problems in terms of repressed impulses? A) a behavior therapist B) a cognitive therapist C) a humanistic therapist D) a psychoanalyst ___ 3. The technique in which a person is asked to report everything that comes to his or her mind is called ________; it is favored by ________ therapists. A) active listening; cognitive C) free association; psychoanalytic B) spontaneous remission; humanistic D) systematic desensitization; behavior ___ 4. During a session with his psychoanalyst, Jamal hesitates while describing a highly embarrassing thought. In the psychoanalytic framework, this is an example of: A) transference. B) insight. C) mental repression. D) resistance. ___ 5. During psychoanalysis, Jane has developed strong feelings of hatred for her therapist. The analyst interprets Jane's behavior in terms of a ________ of her feelings toward her father. A) projection B) resistance C) regression D) transference ___ 6. Which type(s) of psychotherapy would be most likely to use the interpretation of dreams as a technique for bringing unconscious feelings into awareness? A) psychoanalysis B) psychodynamic therapy C) cognitive therapy D) both a. and b. ___ 7. Which of the following is not a common criticism of psychoanalysis? A) It emphasizes the existence of repressed memories. B) It provides interpretations that are hard to disprove. C) It is generally a very expensive process. D) It gives therapists too much control over patients. ___ 8. Unlike traditional psychoanalytic therapy, interpersonal psychotherapy: A) helps people gain insight into the roots of their problems. B) offers interpretations of patients' feelings. C) focuses on current relationships. D) does all of the above. ___ 9. Of the following categories of psychotherapy, which is known for its nondirective nature? A) psychoanalysis B) humanistic therapy C) behavior therapy D) cognitive therapy ___ 10. Given that Jim's therapist attempts to help him by offering genuineness, acceptance, and empathy, she is probably practicing: A) psychoanalysis. B) behavior therapy. C) cognitive therapy. D) client-centered therapy. ___ 11. Carl Rogers was a ________ therapist who was the creator of ________. A) behavior; systematic desensitization B) psychoanalytic; insight therapy C) humanistic; client-centered therapy D) cognitive; cognitive therapy for depression ___ 12. Which type of psychotherapy emphasizes the individual's inherent potential for self-fulfillment? A) behavior therapy B) psychoanalysis C) humanistic therapy D) biomedical therapy ___ 13. The technique in which a therapist echoes and restates what a person says in a nondirective manner is called: A) active listening. B) free association. C) systematic desensitization. D) meta-analysis. ___ 14. Which type of psychotherapy focuses on changing unwanted behaviors rather than on discovering their underlying causes? A) behavior therapy B) cognitive therapy C) humanistic therapy D) psychoanalysis ___ 15. Leota is startled when her therapist says that she needs to focus on eliminating her problem behavior rather than gaining insight into its underlying cause. Most likely, Leota has consulted a ________ therapist. A) behavior B) humanistic C) cognitive D) psychoanalytic Page 10 Tripken ___ 16. The techniques of counterconditioning are based on principles of: A) observational learning. B) classical conditioning. C) operant conditioning. D) behavior modification. ___ 17. The technique of systematic desensitization is based on the premise that maladaptive symptoms are: A) a reflection of irrational thinking. C) expressions of unfulfilled wishes. B) conditioned responses. D) all of the above. ___ 18. In order to help him overcome his fear of flying, Duane's therapist has him construct a hierarchy of anxiety-triggering stimuli and then learn to associate each with a state of deep relaxation. Duane's therapist is using the technique called: A) systematic desensitization. B) aversive conditioning. C) shaping. D) free association. ___ 19. In which of the following does the client learn to associate a relaxed state with a hierarchy of anxiety-arousing situations? A) cognitive therapy B) aversive conditioning C) counterconditioning D) systematic desensitization ___ 20. To help Sam quit smoking, his therapist blew a blast of smoke into Sam's face each time Sam inhaled. Which technique is the therapist using? A) exposure therapy B) behavior modification C) systematic desensitization D) aversive conditioning ___ 21. Using techniques of classical conditioning to develop an association between unwanted behavior and an unpleasant experience is known as: A) aversive conditioning. B) systematic desensitization. C) transference. D) electroconvulsive therapy. ___ 22. One reason that aversive conditioning may only be temporarily effective is that: A) for ethical reasons, therapists cannot use sufficiently intense unconditioned stimuli to sustain classical conditioning. B) patients are often unable to become sufficiently relaxed for conditioning to take place. C) patients know that outside the therapist's office they can engage in the undesirable behavior without fear of aversive consequences. D) most conditioned responses are elicited by many nonspecific stimuli and it is impossible to countercondition them all. ___ 23. A patient in a hospital receives poker chips for making her bed, being punctual at meal times, and maintaining her physical appearance. The poker chips can be exchanged for privileges, such as television viewing, snacks, and magazines. This is an example of the: A) psychodynamic therapy technique called systematic desensitization. B) behavior therapy technique called token economy. C) cognitive therapy technique called token economy. D) humanistic therapy technique called systematic desensitization. ___ 24. Principles of operant conditioning underlie which of the following techniques? A) counterconditioning B) systematic desensitization C) stress inoculation training D) the token economy ___ 25. The operant conditioning technique in which desired behaviors are rewarded with points or poker chips that can later be exchanged for various rewards is called: A) counterconditioning. B) systematic desensitization. C) a token economy. D) exposure therapy. ___ 26. Which of the following is not a common criticism of behavior therapy? A) Clients may not develop intrinsic motivation for their new behaviors. B) Behavior control is unethical. C) Outside the therapeutic setting, the new behavior may disappear. D) All of the above are criticisms of behavior therapy. ___ 27. After Darnel dropped a pass in an important football game, he became depressed and vowed to quit the team because of his athletic incompetence. The campus psychologist challenged his illogical reasoning and pointed out that Darnel's “incompetence” had earned him an athletic scholarship. The psychologist's response was most typical of a ________ therapist. A) behavior B) psychoanalytic C) client-centered D) cognitive ___ 28. Which type of therapy focuses on eliminating irrational thinking? A) EMDR B) client-centered therapy C) cognitive therapy D) behavior therapy ___ 29. Which form of therapy is most likely to be successful in treating depression? A) behavior therapy B) psychoanalysis C) cognitive therapy D) humanistic therapy Page 11 t Tripken ___ 30. One variety of ________ therapy is based on the finding that depressed people often attribute their failures to ________. A) humanistic; themselves C) cognitive; external circumstances B) behavior; external circumstances D) cognitive; themselves ___ 31. Ben is a cognitive-behavior therapist. Compared to Rachel, who is a behavior therapist, Ben is more likely to: A) base his therapy on principles of operant conditioning. B) base his therapy on principles of classical conditioning. C) address clients' attitudes as well as behaviors. D) focus on clients' unconscious urges. ___ 32. Cognitive-behavior therapy aims to: A) alter the way people act. B) make people more aware of their irrational negative thinking. C) alter the way people think and act. D) countercondition anxiety-provoking stimuli. ___ 33. Which of the following types of therapy does not belong with the others? A) cognitive therapy B) family therapy C) self-help group D) support group ___ 34. Family therapy differs from other forms of psychotherapy because it focuses on: A) using a variety of treatment techniques. C) the present instead of the past. B) conscious rather than unconscious processes. D) how family tensions may cause individual problems. ___ 35. Before 1950, the main mental health providers were: A) psychologists. B) paraprofessionals. C) psychiatrists. D) the clergy. ___ 36. The effectiveness of psychotherapy has been assessed both through clients' perspectives and through controlled research studies. What have such assessments found? A) Clients' perceptions and controlled studies alike strongly affirm the effectiveness of psychotherapy. B) Whereas clients' perceptions strongly affirm the effectiveness of psychotherapy, studies point to more modest results. C) Whereas studies strongly affirm the effectiveness of psychotherapy, many clients feel dissatisfied with their progress. D) Clients' perceptions and controlled studies alike paint a very mixed picture of the effectiveness of psychotherapy. ___ 37. Which of the following best describes the results of the 30-year follow-up study of 500 Massachusetts boys who had been considered predelinquents? A) Predelinquent boys who received counseling had fewer problems as adults than untreated predelinquent boys. B) Predelinquent boys who did not receive counseling had slightly fewer problems as adults than boys who received counseling. C) Predelinquent boys who underwent behavior therapy had fewer problems as adults than boys who underwent psychoanalysis. D) Predelinquent boys who underwent psychoanalysis had fewer problems as adults than boys who underwent behavior therapy. ___ 38. The following are some of the conclusions drawn in the text regarding the effectiveness of psychotherapy. For which of these conclusions did the Massachusetts study of predelinquent boys provide evidence? A) Clients' perceptions of the effectiveness of therapy usually are very accurate. B) Clients' perceptions of the effectiveness of therapy differ somewhat from the objective findings. C) Individuals who receive treatment do somewhat better than individuals who do not. D) Overall, no one type of therapy is a “winner,” but certain therapies are more suited to certain problems. ___ 39. (Thinking Critically) A person can derive benefits from psychotherapy simply by believing in it. This illustrates the importance of: A) spontaneous remission. B) the placebo effect. C) the transference effect. D) interpretation. ___ 40. Nick survived a car accident in which another passenger died. Feeling anxious and guilty, he sought treatment from an alternative therapist, who used eye movement desensitization and reprocessing to help Nick return to his normally upbeat, optimistic frame of mind. After several months of treatment Nick began feeling better. Although Nick is convinced that the alternative therapy was responsible for his improvement, it is also possible that it was the result of: A) regression toward the mean. B) a placebo effect. C) merely seeking treatment from any practitioner who provided an empathic, trusting environment. D) all of the above. Page 12 t Tripken ___ 41. Which of the following is not necessarily an advantage of group therapies over individual therapies? A) They tend to take less time for the therapist. B) They tend to cost less money for the client. C) They are more effective. D) They allow the client to test new behaviors in a social context. ___ 42. A relative wants to know which type of therapy works best. You should tell your relative that: A) psychotherapy does not work. B) behavior therapy is the most effective. C) cognitive therapy is the most effective. D) no one type of therapy is consistently the most successful. ___ 43. The results of meta-analysis of the effectiveness of different psychotherapies reveals that: A) no single type of therapy is consistently superior. B) behavior therapies are most effective in treating specific problems, such as phobias. C) cognitive therapies are most effective in treating depressed emotions. D) all of the above are true. ___ 44. Light-exposure therapy has proven useful as a form of treatment for people suffering from: A) bulimia. B) seasonal affective disorder. C) schizophrenia. D) dissociative identity disorder. ___ 45. A close friend who for years has suffered from wintertime depression is seeking your advice regarding the effectiveness of light-exposure therapy. What should you tell your friend? A) “Don't waste your time and money. It doesn't work.” B) “A more effective treatment for seasonal affective disorder is eye movement desensitization and reprocessing.” C) “You'd be better off with a prescription for lithium.” D) “It might be worth a try. There is some evidence that morning light exposure produces relief.” ___ 46. Among the common ingredients of the psychotherapies is: A) the offer of a therapeutic relationship. B) the expectation among clients that the therapy will prove helpful. C) the chance to develop a fresh perspective on oneself and the world. D) all of the above. ___ 47. A meta-analysis of research studies comparing the effectiveness of professional therapists with paraprofessionals found that: A) the professionals were much more effective than the paraprofessionals. B) the paraprofessionals were much more effective than the professionals. C) except in treating depression, the paraprofessionals were about as effective as the professionals. D) the paraprofessionals were about as effective as the professionals. ___ 48. Seth enters therapy to talk about some issues that have been upsetting him. The therapist prescribes some medication to help him. The therapist is most likely a: A) psychologist. B) psychiatrist. C) psychiatric social worker. D) clinical social worker. ___ 49. Which biomedical therapy is most likely to be practiced today? A) psychosurgery B) electroconvulsive therapy C) drug therapy D) counterconditioning ___ 50. In an experiment testing the effects of a new antipsychotic drug, neither Dr. Cunningham nor her patients know whether the patients are in the experimental or the control group. This is an example of the ________ technique. A) meta-analysis B) within-subjects C) double-blind D) single-blind ___ 51. Linda's doctor prescribes medication that blocks the activity of dopamine in her nervous system. Evidently, Linda is being treated with an ________ drug. A) antipsychotic B) antianxiety C) antidepressant D) anticonvulsive ___ 52. The antipsychotic drugs appear to produce their effects by blocking the receptor sites for: A) dopamine. B) epinephrine. C) norepinephrine. D) serotonin. Page 13 t Tripken ___ 53. The types of drugs criticized for reducing symptoms without resolving underlying problems are the: A) antianxiety drugs. B) antipsychotic drugs. C) antidepressant drugs. D) amphetamines. ___ 54. Abraham's doctor prescribes medication that increases the availability of norepinephrine or serotonin in his nervous system. Evidently, Abraham is being treated with an ________ drug. A) antipsychotic B) antianxiety C) antidepressant D) anticonvulsive ___ 55. Antidepressant drugs are believed to work by affecting serotonin or: A) dopamine. B) lithium. C) norepinephrine. D) acetylcholine. ___ 56. Electroconvulsive therapy is most useful in the treatment of: A) schizophrenia. B) depression. C) personality disorders. D) anxiety disorders. ___ 57. A psychiatrist has diagnosed a patient as having bipolar disorder. It is likely that she will prescribe: A) an antipsychotic drug. C) an antianxiety drug. B) lithium. D) a drug that blocks receptor sites for serotonin. ___ 58. Which of the following is the drug most commonly used to treat bipolar disorder? A) Ativan B) chlorpromazine C) Xanax D) lithium ___ 59. Although Moniz won the Nobel prize for developing the lobotomy procedure, the technique is not widely used today because: A) it produces a lethargic, immature personality. C) calming drugs became available in the 1950s. B) it is irreversible. D) of all of the above reasons. ___ 60. In concluding her talk entitled “Psychosurgery Today,” Ashley states that: A) “Psychosurgery is still widely used throughout the world.” B) “Electroconvulsive therapy is the only remaining psychosurgical technique that is widely practiced.” C) “With advances in psychopharmacology, psychosurgery has largely been abandoned.” D) “Although lobotomies remain popular, other psychosurgical techniques have been abandoned.” ___ 61. Psychologists who advocate a ________ approach to mental health contend that many psychological disorders could be prevented by changing the disturbed individual's ________. A) biomedical; diet B) family; behavior C) humanistic; feelings D) preventive; environment ___ 62. A psychotherapist who believes that the best way to treat psychological disorders is to prevent them from developing would be most likely to view disordered behavior as: A) maladaptive thoughts and actions. B) expressions of unconscious conflicts. C) conditioned responses. D) an understandable response to stressful social conditions. Page 14 t Tripken t Answer Key 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56. D D C D D D D C B D C C A A A B B A D D A C B D C D D C C D C C A D C B B B B D C D D B D D D B C C A A A C C B Page 15 Tripken 57. 58. 59. 60. 61. 62. t B D D C D D Page 16