Deck 16: B: Psychological and Biological Treatments

Question 1

Describe both systematic desensitisation and flooding,including how these are different with respect to a patient's anxiety hierarchy.

Answer 1

Answers will vary but should contain the following information for full credit.
--Systematic desensitization is an excellent example of how behaviour therapists apply learning principles to treatment.Psychiatrist Joseph Wolpe developed systematic desensitisation (SD)in 1958 to help patients manage phobias (see Chapter 2).Systematic desensitization gradually exposes patients to anxiety-producing situations through the use of imagined scenes.Systematic desensitization is based on the principle of reciprocal inhibition,which says that patients can't experience two conflicting responses simultaneously.We can't be anxious and relaxed at the same time because relaxation inhibits anxiety.Wolpe described his technique as a form of classical conditioning and called it counterconditioning.By pairing an incompatible relaxation response with anxiety,we condition a new and more adaptive response to anxiety-arousing stimuli.A therapist begins systematic desensitisation by teaching the patient how to relax.She might imagine pleasant scenes,focus on breathing and maintaining a slow breathing rate,and alternately tense and relax her muscles (Bernstein,Borkovec,& Hazlett-Stevens,2000;Jacobson,1938).Next,the therapist helps the patient to construct an anxiety hierarchy-a "ladder" of situations or scenes that climb from least to most anxiety provoking.The therapy proceeds in a stepwise manner.The therapist asks the patient to relax and imagine the first scene,and moves to the next,more anxiety-producing scene only after the patient reports feeling relaxed while imagining the first scene.
--Flooding therapies provide a vivid contrast to systematic desensitization.Flooding therapists jump right to the top of the anxiety hierarchy and expose patients to images of the stimuli they fear the most for prolonged periods,often for an hour or even several hours.Flooding therapies are based on the idea that fears are maintained by avoidance.For example,because height phobics continually avoid high places,they never learn that the disastrous consequences they envision won't occur.Ironically,their avoidance only reinforces their fears by means of negative reinforcement (see Chapter 6).The flooding therapist provokes anxiety repeatedly in the absence of actual negative consequences,so that extinction of the fear can proceed.A crucial component of flooding is response prevention,in which therapists prevent patients from performing their typical avoidance behaviours (Spiegler,1983).A therapist may treat a person with a hand-washing compulsion by exposing her to dirt and preventing her from washing her hands.

Question 2

There are many therapies that exist that are endorsed by some therapists,celebrities,and patients,but may be ineffective (e.g. ,dolphin therapy,laughter therapy,SPARX,direct analysis).What are the five reasons that can help us to understand why these therapies sometimes gain a dedicated public following?

Answer 2

Answers will vary but should contain the following information for full credit.
(1)Spontaneous remission.The patient's recovery may have nothing at all to do with the treatment.All of us have our "ups and downs." Similarly,many psychological problems are self-limiting or cyclical and improve without any intervention.A breakup with our latest crush may depress us for a while,but most of us will improve even without professional help.This phenomenon is known as spontaneous remission.Even with forms of cancer that are nearly always lethal,tumours occasionally disappear without further treatment,although such events are rare (Silverman,1987).Spontaneous remission is surprisingly common in psychotherapy.Only if people who are treated improve at a rate that exceeds that of untreated people,or those on a wait list,can we rule out the effects of spontaneous remission.
(2)The placebo effect.The pesky placebo effect (see Chapters 2 and 12)can lead to significant symptom relief.By instilling hope and the conviction that we can rise to life's challenges,virtually any credible treatment can be helpful in alleviating our demoralisation.
(3)Self-serving biases.Even when they don't improve,patients who are strongly invested in psychotherapy and have shelled out a lot of money in the pursuit of well-being can convince themselves they've been helped.Because it would be too troubling to admit to oneself (or others)that it's all been a waste of time,energy,and effort,there's often a strong psychological pull to find value in a treatment (Axsom & Cooper,1985).Patients may also overestimate their apparent successes while ignoring,downplaying,or explaining away their failures as a means of maintaining their self-esteem (Beyerstein & Hadaway,1991).
(4)Regression to the mean.It's a statistical fact of life that extreme scores tend to become less extreme on retesting,a phenomenon known as regression to the mean.If you receive a zero on your first psychology exam,there's a silver lining to this grey cloud: You'll almost surely do better on your second exam! Conversely,if you receive a 100 on your first exam,odds are also high you won't do as well the second time around.Scores on measures of psychopathology are no different.If a patient comes into treatment extremely depressed,the chances are high she'll be less depressed in a few weeks.Regression to the mean can fool therapists and their patients into believing that a useless treatment is effective.It's an especially tricky problem in evaluating whether psychotherapy is effective,because most patients enter psychotherapy when their symptoms are most extreme.
(5)Retrospective rewriting of the past.In some cases,we may believe we've improved even when we haven't because we misremember our initial (pre-treatment)level of adjustment as worse than it was.We expect to change after treatment,and may adjust our memories to fit this expectation.

Question 3

Identify and discuss the similarities and differences between the Alcoholics Anonymous (AA)and controlled drinking approaches to treating alcoholism.

Answer 3

Answers will vary but need to contain the following points to earn full credit.
--Both approaches involve others the individual can meet with who are working to help the individual.The mentor in AA is available when the individual finds him- or herself tempted to use alcohol,for example.The mentor in the controlled drinking approach focuses on helping to reinforce the patient's progress and deal with relapse when the person begins drinking.
--Both encourage the individual to avoid situations and people that would tempt them to drink.
--The approaches have very different goals.The AA approach focuses on total abstinence and providing a support system to reinforce sobriety via social support of individuals who understand the various temptations.The controlled drinking approach argues that controlled drinking can be learned and that teaching the individual how to deal with a lapse/relapse is as important,if not more important,than focusing on controlling the drinking.
--The approaches differ in how acceptable the use of controlled drinking is.AA assumes that a single drink will reveal that an individual cannot control his or her drinking behaviour.The controlled drinking approach believes that drinking behaviour is learned like all other forms of behaviour.
--Both approaches focus on the importance of control.In AA this control is internalised via external entities (higher power,social support,etc. )while in the controlled drinking approach,people focus on their own internal ability to engage in moderate,controlled drinking behaviour that is under their own control.

Question 4

Discuss how the critical thinker would use what he or she knows to help distinguish between effective and ineffective therapies so that he or she is not fooled into using an ineffective therapy.

Question 5

Compare and contrast the following forms of psychotherapy: psychoanalysis,humanistic,and behavioural.

Question 6

Discuss three major areas of concern about the effectiveness of drug treatments.

Question 7

Describe the approach to therapy that Albert Ellis used,including his A-B-C-D-Es of therapy.

Question 8

Devon is entering psychotherapy and is anxious about the experience.One particular worry he has is that he might end up with a therapist who uses ineffective techniques.How would you advise him on what to look for during his first few sessions?

Question 9

What is person-centred therapy? What three conditions must be satisfied by the therapist to ensure a positive outcome?

Question 10

The goal of psychoanalytic therapy is to make the unconscious conscious.What are the six primary approaches used to accomplish this goal?