5 Steps to a 5 AP Psychology, 2010-2011 Edition (66 page)

Cognitive therapists, sometimes called cognitive-behavioral therapists, think that abnormal behavior is the result of faulty thought patterns. Many psychologists consider cognitive therapy to be an insight therapy. Cognitive-behavior therapy helps clients change both the way they think and the way they behave. Through
cognitive restructuring
, or turning the faulty, disordered thoughts into more realistic thoughts, the client may change abnormal behavior.

Albert Ellis developed
Rational Emotive Therapy
(RET), which is also called
rational emotive behavior therapy (REBT)
, based on the idea that anxiety, guilt, depression, and other psychological problems result from self-defeating thoughts. The therapist has the client confront irrational thoughts by discussing his/her
a
ctions, his/her
b
eliefs about those actions, and finally the
c
onsequences of those beliefs. The actions, beliefs, and consequences he called the ABCs of treatment. For instance, a young man is feeling guilty about not having helped his mother more before she died. Ellis might have confronted this guilty belief with a statement like “And you were the only person in the entire universe who could have helped her, right?” While defending these beliefs, the client may see how absurd they truly are. Ellis believed that much of this thinking involves the tyranny of the “shoulds,” what we believe we must do, rather than what is actually realistic or necessary.

Cognitive Triad Therapy

Aaron Beck also developed a cognitive therapy to alleviate faulty and negative thoughts. His
cognitive triad
looks at what a person thinks about his/her Self, his/her World, and his/her
Future. Depressed individuals tend to have negative perceptions in all three areas. As noted by Martin Seligman, depressed individuals tend to think they caused the negative events, the negative events will affect everything they do, and the negative events will last forever. Such thoughts and beliefs lead to low self-esteem, depression, and anxiety. The goal of therapy is to help them change these irrationally negative beliefs into more positive and realistic views. Failures are attributed to things outside their control and successes are seen as personal accomplishments. Beck suggests specific tactics, including evaluating the evidence the client has for and against automatic thoughts, reattributing the blame to situational factors rather than the client’s incompetence, and discussing alternative solutions to the problem. For example, instead of blaming yourself for being stupid when the entire class does poorly on a math exam, you might substitute the thought that you didn’t have an adequate opportunity to study, and the test may not have been valid.

Cognitive therapies have been demonstrated to be effective in treating depression, eating disorders, chronic pain, marital discord, and anxiety disorders (generalized anxiety disorder, panic disorder, agoraphobia, and social phobia).

Biological psychologists believe that abnormal behavior results from neurochemical imbalances, abnormalities in brain structures, or possibly some genetic predisposition. Treatments, therefore, include
psychopharmacotherapy
(the use of psychotropic drugs to treat mental disorders), electroconvulsive therapy, and psychosurgery. Medical doctors, psychiatric nurse practitioners, and a limited number of clinical psychologists can prescribe psychoactive drugs. Four major classifications of psychotropic drugs are
anxiolytics
(antianxiety medications),
antidepressants
,
stimulants
, and
neuroleptics
(antipsychotics).

Anxiolytics, also called tranquilizers and antianxiety drugs, include quick-acting benzodiazepines such as the widely prescribed drugs Valium (diazepam), Librium (chlordiazepoxide), and Xanax (alprazolam); and slow-acting BuSpar (buspirone). Benzodiazepines increase availability of the inhibitory neurotransmitter GABA to the limbic system and reticular activating system where arousal is too high, reducing the anxiety felt by the patient. Other therapies such as visualization, relaxation, and time management can be used in conjunction with drugs so that the drugs may be tapered off over time, because patients can develop unpleasant side effects and build up a
tolerance
to these compounds. Anxiolytics are helpful in the treatment of post-traumatic stress disorder, panic disorder, agoraphobia, and generalized anxiety disorder.

Antidepressant medications elevate mood by making monoamine neurotransmitters including serotonin, norepinephrine, and/or dopamine more available at the synapse to stimulate postsynaptic neurons. Types of antidepressants include monoamine oxidase inhibitors (MAOIs), which inhibit the effects of chemicals that break down norepinephrine and serotonin; tricyclics, which inhibit reuptake of serotonin; selective serotonin reuptake inhibitors (SSRIs), which inhibit reuptake only of serotonin; and atypical antidepressants (sometimes called non-SSRIs), some of which may inhibit reuptake of serotonin, norepinephrine, and dopamine, or a combination of two of them. Commonly advertised SSRls include
paroxetine
(Paxil),
fluoxetine
(Prozac),
sertraline
(Zoloft), citalopram (Celexa,
Lexapro), and fluvoxamine (Luvox). Non-SRRIs include bupropion (Wellbutrin) and velafaxine HCL (Effexor XR). They have all been found effective for treating depression, and some have also been found effective for treating anxiety disorders, such as obsessive-compulsive disorder, panic disorder, and post-traumatic stress disorder (PTSD). For treatment of bipolar disorder, lithium has been widely used to stabilize mood, alone or with antidepressants. Anti-seizure medicines used to treat epilepsy, such as valproic acid (Depakene), divalproex (Depakote), and Topiramate (Topamax) have also been used.

Stimulants

Stimulants
are psychoactive drugs, such as Ritalin (methylphenidate) and Dexedrine (dextroamphetamine), that activate motivational centers and reduce activity in inhibitory centers of the central nervous system by increasing activity of serotonin, dopamine, and norepinephrine neurotransmitter systems. They are used to treat people with narcolepsy and people with attention-deficit hyperactivity disorder.

Antipsychotics

The last class of drugs,
neuroleptics
, are powerful medicines that lessen agitated behavior, reduce tension, decrease hallucinations and delusions, improve social behavior, and produce better sleep behavior, especially in schizophrenic patients. An excess of dopamine is thought to be the cause of the schizophrenic symptoms; neuroleptics block dopamine receptors. Neuroleptics include Thorazine (chlorpromazine), Haldol, and Clozaril. Unfortunately, these drugs can have serious side effects, including
tardive dyskinesia
, or problems with walking, drooling, and involuntary muscle spasms, which result from the blocking of dopamine at other sites. These problems cause some patients to abandon the medication after hospitalization, which results in a return of psychotic symptoms.

Other Biological Treatments

Some patients do not respond well to antidepressant drugs or psychotherapy.
Electroconvulsive shock treatment
(ECT) is used as a last resort to treat severely depressed patients. ECT is administered humanely, with the patient under anesthetic and given a muscle relaxant to prevent injury from convulsions. Then the patient receives a momentary electric shock. Typically, the procedure is repeated about six times over 2 weeks. Just how the procedure works is still unknown, but many depressed, suicidal patients are restored to healthy functioning. The patient usually experiences some (often temporary) memory loss immediately following the procedure, but no apparent brain damage. A promising new painless treatment for severe depression is
repetitive transcranial magnetic stimulation (rTMS)
in which repeated pulses surge through a magnetic coil positioned above the right eyebrow of the patient. The treatment is administered daily for a few weeks. The treatment may work by stimulating the depressed patient’s left frontal lobe.

Psychosurgery
, or the removal of brain tissue, can also be used to treat certain organic problems that lead to abnormal behavior. Psychosurgery is a treatment of last resort because its effects are irreversible. From about 1935 to 1955, the
prefrontal lobotomy
, which cut the main neural tracts connecting lower brain regions to the frontal lobes, was performed on thousands of schizophrenic patients, especially violent ones, to reduce the intensity of their emotional responses. Unfortunately, following the lobotomies, many patients were left as emotional zombies, with extensive brain damage. Today psychosurgery is very limited. One successful procedure used for severe epilepsy is the corpus callosum transection, or split brain surgery, in which only the corpus callosum between the left and right cerebral hemispheres is cut.

So far we have discussed therapies that are largely individual—in other words, one-on-one. Another way that psychological services can be delivered is in groups.

The same types of therapies used in individual counseling can be used with a group of patients. Typically, group therapy is more helpful than individual counseling in enabling the client to discover that others have similar problems. Individuals receive information about their problems from either the therapist or other group members. Financially, group therapy is also cheaper for clients who might otherwise not be able to afford individual counseling. Less verbal clients and those more resistant in individual settings may find it easier to open up about their problems in a group setting. Clients get helpful feedback from peers that may allow them to gain better insight into their own particular situations.

This is especially true in family and marital counseling sessions. Trained professionals can direct spouses and family members to openly discuss their individual perspectives on the same issue. In the neutral setting of the therapist’s office, individuals can come to better understand others’ feelings and beliefs and how their behavior affects others. The therapy can serve as a training ground to practice better communication skills and bring about improved relationships.

Self-help groups are yet another way that individuals who share the same problem may get assistance. One of the best-known examples is Alcoholics Anonymous. Recovering alcoholics get peer support and have an outlet to share their individual experiences. It should be noted, however, that trained psychotherapists do not conduct these sessions. The responsibility for leading the group is up to the group members themselves. Meetings can be attended anywhere in the United States. New members can receive a sponsor, someone who has been in recovery for a longer period of time, to call in emergency situations. A spiritual aspect underlies Alcohol Anonymous’s Twelve-Step Program as well.

With deinstitutionalization came the problem of how to help patients released from mental hospitals and an ever-growing number of other people in need of aid in local communities. The vast increase in the homeless population, many of whom have symptoms of schizophrenia, has posed a problem that has not been solved. Yet these problems have led to the rise of a relatively new subfield of psychology, community psychology. Community psychologists aim to promote psychosocial change to prevent psychological disorders as well as to treat people with psychopathologies in their local communities.

As part of the community mental health movement of the 1960s, local clinics cropped up. With continued funding problems, these local clinics try to provide both treatment and preventive services. One of their major goals is to treat people with psychological problems to prevent them from getting worse and help them recover. They address unemployment, poverty, overcrowding, and other stressful social problems that can affect mental health. Other initiatives include prenatal and follow-up well-baby care, dissemination of information on sexually transmitted diseases, suicide prevention programs, child abuse prevention,
and training of paraprofessionals to help community members cope with emergency situations. They hold free screenings for depression and anxiety, sponsor suicide hotlines, and provide outreach programs for at-risk children and teens.

Directions:
For each question, choose the letter of the choice that best completes the statement or answers the question.

1.
Jenna is telling her therapist about the dream she had last night and her therapist begins to interpret it for her. Which approach to psychotherapy does Jenna’s therapist probably represent?

(A) group

(B) behavioral

(C) Gestalt

(D) cognitive

(E) biomedical

2.
In contrast to a clinical psychologist, a psychiatrist is more likely to

(A) engage in an eclectic approach

(B) use a biomedical treatment

(C) recognize the importance of group therapy with patients having the same disorder

(D) treat clients in community mental health centers exclusively

(E) see patients with less serious mental health problems

3.
Which of the following disorders is most likely to be treated with electroconvulsive therapy as a last resort?

(A) schizophrenia

(B) obsessive-compulsive disorder

(C) dissociative identity disorder

(D) major depression