15.10 CHAPTER REVIEW

KEY POINTS

• Psychological disorders can be treated with psychotherapy or biomedical therapy. Psychotherapy is based on the assumption that psychological factors play an important role in psychological disorders and symptoms. The biomedical therapies are based on the assumption that biological factors play an important role in psychological disorders and symptoms.

• Psychoanalysis is a form of therapy developed by Sigmund Freud and is based on his theory of personality. The goal of psychoanalysis is to unearth repressed conflicts and resolve them in therapy.

• Psychoanalytic techniques and processes include free association, resistance, dream interpretation, interpretation, and transference. Traditional psychoanalysis involves an intense, long-term relationship between the patient and the psychoanalyst.

• Short-term dynamic therapies are based on psychoanalytic ideas but are more problem-focused and of shorter duration than traditional psychoanalysis. Therapists play a more directive role than traditional psychoanalysts, but they still use psychoanalytic techniques to help the patient resolve unconscious conflicts. Interpersonal therapy (IPT) is based on the premise that interpersonal problems are the cause of psychological disorders.

• Client-centered therapy was developed by Carl Rogers. Important aspects of client-centered therapy include a client who directs the focus of therapy sessions and a therapist who is genuine, demonstrates unconditional positive regard, and communicates empathic understanding. According to Rogers, clients change and grow when their self-concept becomes healthier as a result of these therapeutic conditions.

• Motivational interviewing is more directive than traditional client-centered therapy, and is designed to strengthen the client’s self motivation to change.

• Behavior therapy assumes that maladaptive behaviors are learned and uses learning principles to directly change problem behaviors.

• Mary Cover Jones was the first behavior therapist, using the procedure of counterconditioning to extinguish phobic behavior in a child.

• Classical conditioning principles are involved in the use of systematic desensitization to treat phobias and aversive conditioning to treat harmful behaviors such as smoking and alcohol addiction.

• Operant conditioning techniques include using positive reinforcement for desired behaviors and extinction for undesired behaviors. The token economy represents the application of operant conditioning to modify the behavior of groups of people who live in a hospital or other institution. Contingency management interventions are one application of the token economy, typically used in outpatient treatment. Virtual reality therapy is a computer-assisted form of systematic desensitization therapy, which has been effective in the treatment of phobias, posttraumatic stress disorder, social phobia, and panic disorder.

• The cognitive therapies are based on the assumption that psychological problems are caused by maladaptive patterns of thinking. Treatment focuses on changing unhealthy thinking patterns to healthier ones.

• Rational-emotive behavior therapy (REBT) was developed by Albert Ellis. REBT focuses on changing the irrational thinking that is assumed to be the cause of emotional distress and psychological problems. Therapy involves identifying and challenging core irrational beliefs.

• Cognitive therapy (CT) was developed by Aaron T. Beck. CT is based on the assumption that psychological problems are caused by unrealistic and distorted thinking. Therapy involves teaching the client to recognize negative automatic thoughts and cognitive biases, and to empirically test the reality of the upsetting automatic thoughts.

• Cognitive-behavioral therapy (CBT) is based on the assumption that thoughts, moods, and behaviors are functionally interrelated. CBT combines cognitive and behavioral techniques in an integrated but flexible treatment plan. A new approach in CBT is the use of mindfulness techniques and the development of mindfulness-based therapies.

• Group therapy involves one or more therapists working with several people simultaneously. Group therapy has these advantages: It is cost-effective; therapists can observe clients interacting with other group members; clients benefit from the support, encouragement, and practical suggestions provided by other group members; and people can try out new behaviors in a safe, supportive environment.

• Family therapy focuses on the family rather than on the individual and is based on the assumption that the family is an interdependent system. Marital or couple therapy focuses on improving communication, problem-solving skills, and intimacy between members of a couple.

• Meta-analysis has been used to combine the findings of many different studies on the effectiveness of psychotherapy. In general, psychotherapy has been shown to be significantly more effective than no treatment.

• Among the standard psychotherapies, no particular form of therapy is superior to the others. However, particular forms of therapy are more effective than others for treating some specific problems.

• Factors identified as crucial to therapy’s effectiveness include the quality of the therapeutic relationship; the therapist’s characteristics; the therapist’s sensitivity to cultural differences; the client’s characteristics; and supportive, stable external circumstances.

• One of the most common psychotherapy orientations today is eclecticism, an approach that integrates the techniques of more than one form of psychotherapy, tailored to the individual client’s needs.

• The most common biomedical therapy is psychotropic medications.

• Antipsychotic medications include reserpine and chlorpromazine, which alter dopamine levels throughout the brain. Although these drugs reduce positive symptoms of schizophrenia, they have little effect on negative symptoms. Serious side effects can include the development of tardive dyskinesia after long-term use.

• The newer, second-generation atypical antipsychotic medications affect both serotonin and dopamine levels in the brain. The atypical antipsychotics have fewer side effects, and they more effectively treat the positive and negative symptoms of schizophrenia.

• Antianxiety medications include the benzodiazepines, such as diazepam (Valium). The benzodiazepines are effective in the treatment of anxiety but are potentially addictive and have many side effects. Buspirone (Buspar) is an antianxiety medication that has a low risk of abuse but takes a few weeks to become effective. MDMA is another drug that is sometimes used to enhance the effect of psychotherapy for anxiety.

• Lithium effectively treats bipolar disorder by regulating glutamate levels in the brain. Depakote, an anticonvulsant, is also used to treat bipolar disorder.

• Antidepressant medications include the tricyclics, the MAO inhibitors, and the second-generation antidepressants. New antidepressants, including the selective serotonin reuptake inhibitors (SSRIs), the dual-action antidepressants, and the dual-reuptake inhibitors, tend to produce fewer side effects than the firstand second-generation anti-depressants. Ketamine is a new experimental treatment for severe depression in emergency room settings.

• Electroconvulsive therapy (ECT), which involves delivering a brief electric shock to the brain, is sometimes used in treating severe cases of major depressive disorder. The therapeutic effects of ECT tend to be short-lived, lasting no more than a few months. Partly because it is controversial, ECT is used far less frequently than antidepressant medication in the treatment of major depressive disorder. Transcranial direct current stimulation, transcranial magnetic stimulation, vagus nerve stimulation, and deep brain stimulation are new, experimental brain stimulation treatments that show promise in treating major depressive disorder and other mental disorders.

KEY TERMS

KEY PEOPLE